My nipples are pointing outwards! 9 months post op (Photo)

I had breast enlargement surgery last August, so I am almost 9 months post op. I am really concerned about how they look now! I am not sure why but one of my nipples is facing sideways and seems to be pulling that way more and more everyday. My surgeon has left and I will be seeing a different one at the end of the month... any thoughts in the meantime?

Doctor Answers 8

My nipples are pointing outwards! 9 months post op

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Sorry to hear about your concerns. It appears you implants are sitting low. Please consult with an experienced board certified plastic surgeon to discuss your concerns. In the mean time consider wearing a supportive bra.


Toronto Plastic Surgeon
4.9 out of 5 stars 521 reviews

BBA 9 months out

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Hi and thanks for posting your question and photos.

It appears that you underwent placement of VERY large breast implants for your body. The risks of having implant malposition (too low) and stretch marks increase significantly when trying to push the envelope of size in breast augmentation. Stretch marks are, unfortunately, not reversible and represent actual tearing of the strength layer of your skin (the dermis). The position of the implants are what is accentuating the appearance of your nipples and an other operation would be require to correct this-likely with the use of some sort of mesh support. You may also want to consider downsizing your implants.

You should discuss your concerns with your plastic surgeon or another Board certified plastic surgeon so that you can have an examination and detailed descriptions of your options laid out for you.

Best wishes!!

Rachel Streu, MD
Portland Plastic Surgeon
5.0 out of 5 stars 29 reviews

Nipples pointing in the wrong direction at 9 months post-op are probably going to stay that way

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Unfortunately, at this stage of the game, your capsules have probably matured, and I would not expect your breasts to change much on their own from this point onward.  It's hard to tell precisely from the one preop picture you have provided, because your arms are being held upward and outward which changes your nipple position, but it appears as though you may have started with slightly widely spaced nipples to begin with.  This is not a problem in and of itself, it just needs to be recognized by your surgeon, and its significance needs to be explained to you.

The principle at work here is that the for the most natural and aesthetically appealing breasts, the implants MUST be positioned properly.  If the implants are positioned even the slightest bit off center, especially side-to-side, this will show up in the nipple position and direction too.  From the side-to-side position, the nipples MUST be the visual center of the breast mound, and from the up-and-down position, we ideally would have about 45% of the breast volume above the nipple and 55% of the breast volume below the nipple; so just a bit more full below the nipple than above.  But, just a bit.  In your case, either the surgeon didn't appreciate this principle, or the implants migrated over time.  In either event, they are now positioned too low and too far medially, or toward the midline, and this is why they are pointing upward and outward.  They may be slightly different in their directions too because they either started that way, or the implants are slightly asymmetrical in position as well.  Thus, the correction for this problem is to reposition the implants.

When we do this, we typically perform a procedure called "capsulorrhaphy," which involves tightening of the capsule in the areas where it is too loose, or full, and this may also require "capsulotomy" on the opposite sides to allow for expansion in the opposite direction.  Thus, in your case, you will likely require an inferior, or lower, capsulorrhaphy to tighten and raise the lower capsule to the appropriate position, and this may require a release, or capsulotomy, of the capsule at the top to make room as the implant is repositioned upward.  We can't always tell if we need to release the capsule until we get in there and see how much room there really is.  Then at the same time, the capsule will have to be tightened on the inner border, or medial aspect by the sternum, too.  Depending upon the strength and quality of your capsules this may also require reinforcement with a material called acellular dermal matrix, which is a skin collagen product taken either from human donors or pigs.  I don't always feel the need to use that, but it's worth mentioning just for your information. 

In the end, you will want to be sure to consult with properly trained and experienced board certified plastic surgeons who know how to do this procedure, as it can be technically challenging sometimes.  Once you are properly evaluated, your surgeon can explain the details of exactly what will need to be done to improve the appearance of your breasts.  Good luck.

Joseph L. Grzeskiewicz, MD
San Diego Plastic Surgeon

Nipples pointing outward

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Your implants are too low and medial.  The surgery needs to be revised by raising the implants.  This could be accomplished by tacking down the lower part of the capsule or creating a new pocket altogether.  Hope this helps.

Breast augmentation - nipples pointing out and getting worse

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Thank you for asking about your breast augmentation.
  • I am sorry this has happened and agree with your concern.
  • Your photo suggests that both breasts have moved low -
  • One breast has moved far to the side and the other, to a lesser degree.
  • Some of the problem is how your nipples are positioned naturally on your breasts but the present appearance strongly suggests the need for a capsulorrhaphy (surgical revision of the pocket.
  • It is possible that a smaller implant is needed but only an exam and review of your present implant size can tell for sure.
Always see a Board Certified Plastic Surgeon.
Best wishes - Elizabeth Morgan MD PHD FACS

My nipples are pointing outwards!

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Your concerns are understandable; your breast implants seem to have shifted too far inferiorly and medially. Revisionary breast surgery, involving adjustment of the breast implant capsules (capsulorraphy)  may be necessary to improve your outcome.  It will be important that you select your plastic surgeon carefully; in my opinion, significant experience is beneficial when it comes to this type of revisionary work. You may find the attached link helpful to you as you learn more. Best wishes.

Nipple position after augmentation

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Thank you for the question and the photos.  I do see your nipple position and breast shape concerns.  Although your nipples were always more laterally (to the side) located as noted by your preoperative photo, they have gone further to the side after the breast augmentation.  This is likely the result of the implant expanding the lower and inner part of the breast primarily.  Repair of this would likely need a capsulloraphy and perhaps a different width of implant.  If you push your implant up and slightly to the side and your nipple position corrects itself, then a capsulloraphy or pocket repair will be needed.

All the best,

Dr. Remus Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 173 reviews

Nipple points outward?

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From your photographs, I do see your concern. Usually, when your preoperative appearance has an angulated outward chest wall the placement of implants can sometimes magnify this appearance. Also, in an attempt to narrow the cleavage the implants when moved inward will no longer be centered on the breast. While it is not an emergency, this can be remedied with some capsule work to move the implants outward. You might want to consider the exchange of your implants for shaped ones, specifically implants whose base width is wider than tall. For example, a Sientra anatomically shaped oval shape. These options can be discussed with the next plastic surgeon. Good luck on your revision.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 58 reviews

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