Naturally high nipple placement, should I consider a lift with explantation? (Photos)

47 yrs old and plan to explant my 11 year old Mentor saline implants, 350cc, periareolar incision, under the muscle. Prior to BA I was 34B, now 34D. No problems other than some lateral tenderness but they feel heavy and seem to be sitting pretty low. Considering the fact my nipples sit so high, I'm concerned they'll be very droopy on the bottom. Should I consider a lift, and what kind? Would an internal lift work? What about the muscle, I lift weights, is it going to need repair?

Doctor Answers 9

Here is my plan for you...

My advice is since they are saline, have them deflated in clinic.  I do this all the time for my patients.  You can numb up the skin and insert a needle attached to a suction canister and remove the saline from the implant.  This allows your breast to start the process of skin retraction and can better estimate what your shape and size will be once you remove the implants.  This lets us know if you might need a breast lift to help your shape and breast appearance.  It is really a valuable tool that I use.  Allow 6 weeks-3 months after deflation before you have your formal surgery done. Hope this helps!-JGH

Charlotte Plastic Surgeon
4.9 out of 5 stars 36 reviews

You’ll likely need a lift when removing implants.

Thank you for your questions. Your concerns about the appearance of your breasts after explantation are legitimate. With the removal of your implants, you’re losing a lot of breast volume which will likely lead to a saggy appearance. The breast skin has been stretched for 11 years to accommodate your implants, so you should expect to need a breast lift as part of your explantation. What kind of life you’ll need is best determined after a consultation and physical exam. As to your question regarding the chest muscle, this is also something that can’t be determined from photos and may not even be determined until your plastic surgeon is performing your procedure and is able to assess the state of your chest muscles. 

Lee B. Daniel, MD
Eugene Plastic Surgeon
4.7 out of 5 stars 16 reviews

Find the right surgeon to decide if you need a lift or not?

Far more important than the technique is the skill and experience of your plastic surgeon. Choose your surgeon rather than the technique and let them explain why one technique may be better than another. 
See the below link on some suggestions on finding the most qualified Plastic Surgeon for a  Breast Augmentation .

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 154 reviews

Naturally high nipple placement, should I consider a lift with explantation?

Hello dear, thanks for your question and provided information as well.. The breasts may lose their elasticity and firmness which can be caused by different factors such as pregnancy, massive weight loss, lactation and aging. To reaffirm the breasts and restore the natural look your surgeon can perform a mastopexy or breast lift. A breast lift restores a firmer, perkier, and more aesthetically pleasing shape to sagging breasts. This not only can improve a patient’s appearance by restoring her youthful, feminine proportions, but  also help bras and swimsuits fit more comfortably and attractively. By removing excess, stretched out skin, reshaping the breast tissue, and raising the nipple & areola into a more forward position, a cosmetic surgeon can create a more youthful breast contour. Stretched, large areolae can also be reduced during breast lift surgery, creating an overall better proportioned, natural looking breast, Actually the perkiness on a person or another, depends on patients skin and breast tissue… Breast augmentation surgery increases or restores breast size using silicone gel implants, saline implants or in some cases, fat transfer. One of the most popular and frequently performed aesthetic surgery procedures, breast augmentation has a long and successful track record in satisfying women who wish to enhance, regain or restore balance to their figures. At the first 3 to 5 months, it is too soon to determine how your results are going to be, per now, they look very nice and beautiful, you can have one bigger than the other, feel swollen and also have bruises and open wounds, it is normal and that can happen for the first 3 to 4 months until your implants have settle in. I recommend you to wait and keep using your post surgical bra, that will help you with the shape and support…

Tania Medina de Garcia, MD
Dominican Republic Plastic Surgeon
4.5 out of 5 stars 397 reviews


Explantation will leave you more saggy. You might need lift as well, but that can be done as a secondary procedure after you settle.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Breast explant expectations

Hello!It's so hard to know how things will look once the implants are out. The implants are sitting low and it's possible that once they are removed the nipples will be better centered on the breast. I would recommend you undergo explant and see how things look without implants, and return for fine-tuning after you know what your breasts look like without the implants in place. You will not look identical to how you looked prior to implant placement. I don't recommend internal plication or muscle repair. You will be fine without these. Best of luck!

Michele A. Shermak, MD
Baltimore Plastic Surgeon
4.8 out of 5 stars 50 reviews

Internal repair and lift with new implants

It looks like some internal capsular repair with shortening of the nipple to fold distance with excision of a crescent of skin along the fold will be a reasonable approach. If you remove the implants you will be small and need a full lift. Knowing what final cup size you want helps determine a plan as well. Good luck and please see a board certified plastic surgeon.

Gregory T. Lynam, MD
Richmond Plastic Surgeon
4.9 out of 5 stars 59 reviews

A breast lift is often needed after explantation.

If you have definitely decided to remove the implants you will probably need some type of breast lift with removal of extra skin so that your breasts will have a normal shape and to avoid drooping of the breast. It seems that with time and gravity you have had the lower part of the breast stretch out. This could be corrected with keeping the implants in place by removing a strip of skin from the lower part of the breast.Muscle function should be intact and should stay intact after the surgery. Even if the implants are under the muscle the muscle itself will probably not be disturbed.Good luck.

Rodney A. Green, MD
Cleveland Plastic Surgeon
4.8 out of 5 stars 24 reviews

Usually it is best to replace old implants and perform a simultaneous vertical lift.

I would recommend that you reconsider your decision not to have implants. You just won't look good, even with a lift. There is no such thing as an "internal lift" despite what you might have read. In your situation, replacing your implants with a smaller size in a higher pocket with a simultaneous vertical breast lift, taking care not to elevate the nipples at all but simply to tighten your lower poles, would give you the best result. You can see some examples on my website in the Ideal Breast section. No nothing needs to be done to the muscle. The best, and most effective, kind of breast lift is the vertical lift (don't have a donut lift or an anchor-scar lift). Nipple overelevation is common so be sure your surgeon keeps the nipple from being too high. Look at before and after photos.

Eric Swanson, MD
Kansas City Plastic Surgeon
4.7 out of 5 stars 56 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.