Investigating the Need for a Nipple Lift Alongside Breast Augmentation? (Photo)

Question

I'm a 30-year-old, 5'7", 168 lbs woman seeking breast enhancement for increased perkiness and volume at the bottom, without a significant size increase. I aim for higher nipple positioning; currently, they are 22cm from my collarbone. My surgeon suggests placing implants 5cm lower for bottom fullness. My question: Can I achieve higher nipple placement and enhanced bottom fullness as desired, without compromising the natural look I aim for? 3D rendering and inspo pics are attached.

Jeremy Bosworth, MD · Answer

With an implant only you wont get much actual nipple elevation. The implant will fill things out so you will get some what I like to call "pseudo" nipple elevation just from some fullness increase, but generally I explain it that once everything settles, you will have similar breast/ nipple position and shape to what you have now, just with more fullness and more upper pole fullness. Depending on techniques and the implant size will determine how natural it can look, but without a ton of breast tissue to cover the implant, even if placed under the muscle there can still be some degree of implant visibility.

Ted Eisenberg, DO, FACOS, FAACS · Answer

After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon's experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what is right for them. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Connie Hiers, MD, FACS · Answer

You might do well with just implants, however, measurements are needed to be certain. In your last photo, the implant was sitting too low.

Francisco Rodriguez Rosario, MD · Answer

Sí, es posible mejorar la apariencia de los pezones y los senos con cirugía plástica. Una de las opciones es la mastopexia, también conocida como levantamiento de senos. Durante este procedimiento, el cirujano plástico puede reposicionar los pezones y mejorar la forma y la firmeza de los senos. En algunos casos, también se puede realizar una cirugía de reducción o aumento de senos en combinación con la mastopexia para lograr el resultado deseado. Sin embargo, es importante consultar a un cirujano plástico calificado para determinar cuál es la mejor opción en tu caso específico y discutir los posibles riesgos y complicaciones asociados con la cirugía.

Mats Hagstrom, MD (license on probation) · Answer

To assess your candidacy for breast augmentation we need to see quality pictures.
We need to see a frontal picture to assess breast position on your chest wall, including an assessment for breast divergence, and a symmetry.
Computer generated speculative outcomes has little to do with what’s possible during surgery.
In many ways computer simulation tools are not helpful. Other than selling surgery.
The usefulness of this technology is completely dependent on how it’s used.
Without having a complete set of pictures, we can’t really make a good assessment.
I’m guessing that your breast are slightly tubular and sit wide on your chest wall and this is going to inherently limit your candidacy for a quality outcome.
As much as you may wish to be a good candidate for breast augmentation, the results are always based on your candidacy, the choice of implants and the surgeons ability to place the implant in the correct anatomic position.
 Opening up the IMF is asking for trouble.
I’m not saying it can’t be done, but it presents a slippery slope.
Breast augmentation with implants is first and foremost going to make your breast larger.
It creates projection, and this will amplify variables like breast divergence.
To get a good understanding of what your results are likely to look like I suggest searching for before, and after pictures that accurately represent what your chest looks like.
I’ve already mentioned the three variables that make up the outcome of breast augmentation surgery.
All three variables contribute, and understanding the impact of each of those variables in an important part of understanding What the procedure can and cannot accomplish.
There isn’t much patience can do regarding their own candidacy.
What patients do have control over is implant selection, and provider selection.
Guiding patient through implant section in regards to size shape and type is an important part of the equation. And some plastic surgeons do this better than others.
 The ability to place the implants in the correct atomic location is key for quality outcomes and minimizing undesirable side effects, and the need for revision surgery.
To find the right provider, I suggest patients have multiple in person, consultations with plastic surgeons in their community, who seem to have extensive experience with breast surgery.
During each consultation, ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of previous patients, who had similar breast and body characteristics to your own.
This is the best way to get a good understanding of what your outcome is likely to look like.
 This is much better than using computer simulation, which does not in fact, simulate what can be done in the operating room very well at all.
An experienced plastic surgeon should have no difficulty showing you the before, and after pictures of at least 50 previous patients.
Being shown a handful of pre-selected images, representing only the best results of a providers career may be insufficient to get a clear understanding of what average results look like in the hands of each provider, what your results are likely to look like or how many of these procedures that surgeon has actually done.
 There’s no correct number of consultations needed to find the right provider repaired.
The more consultations you schedule the more likely you are to find the better provider for your needs.
Ask each provider what most common indication for revision surgery is, what their revision rates are, and what their revision policy is.
All plastic surgeons do revisions.
Claiming to have a very low revision rate is not necessarily a sign of a quality provider.
Revisions are indicated when results can be improved by doing a second operation.
Perhaps the one thing patient should be looking out for is providers who have an unnecessary rate of implants bottoming out.
This is far more likely when the IMF is opened and violated.
If the inherent integral structure of the lower part of the breast is violated with surgery as sub, pectoral implant will continue to slide down due to contract our forces of the pectoralis muscle, and the pole of gravity.
This creates an outcome known as implants “bottom out”. 
The condition tends to get worse over time and is sometimes difficult to correct.
It can be avoided by working with surgeons who have sufficient skill and experience to place implants correctly.
It is in my opinion completely preventable.
Desiring a modest augmentation and working with conservative size implants is a wise choice.
Using excessively large implants greatly increases the risk of undesirable outcomes and need for revision surgery.
All in all it is absolutely key to understand your own candidacy for the procedure. This is going to have a major impact on what the procedure is capable of delivering.
The pictures you have shown are of individuals who have simply very different breast anatomy.
They are not good representatives of what your outcome is likely to look like.
 Don’t compare apples to oranges.
My intention is not to be disappointing, but I prefer a fairly forward, and very honest approach in the practice of plastic surgery.
Unfortunately, this field of work has plenty of disappointment on the postoperative side, so setting things straight in the beginning, tends to work out much better for both sides.
Best,
Mats Hagstrom, MD

Jared Blau, MD - Account Suspended · Answer

Thank you for the photos and inspo. The last inspo photo has a particularly high areola. To achieve this look you would need a breast lift during augmentation

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