Part of Nipple Missing After Augmentation

Thank you for the pictures. You are not missing the nipple, your areola is a little mishapen after augmentation and mastopexy. This is a normal result and is due to tension. Visit with your plastic surgeon and ask for a scar revision. I bet he/she can give you a more rounded areola with a small procedure under local anesthesis. In terms of the " bottoming out," perhaps the capsule can be adjusted/tightened or the breast lift can be improved.

In general, larger implants that weigh more and stretch skin bottom uot more that smaller implants.

Good Luck, Leo Lapuerta Jr MD

Triple Board Certified Plastic SUrgery

Hello,Thank you for your question and photo. Sometimes irregularities do even out as breasts heal and settle. At one year this is not likely to change on it's own. It should be relatively simple for your Plastic Surgeon to repair this and stretch out that lower portion of areola under local anaesthetic.I recommend that you discuss options with them.All the best

The asymmetry you have in your nipple/areola complex can be easily fixed under local anesthesia. The surgeon will remove a small amount of skin in the inferior portion and then stretch the areola to close it. This should correct the problem that you have. It is very hard to achieve perfect symmetry when doing an augmentation/lift even though we use cookie cutters and measure exactly. 

This is not very difficult to fix.  This happens most likely due to the way the areola is sutured during the surgery.  The upper pole stretches out and the lower half does not during the repair.   This does most often "take care of itself"  with time.  However sometimes it does not.  Ask your surgeon to perform this minor procedure to correct this issue under local anesthesia.  

Thanks for posting pictures - it is very helpful for other patients and allows us to give you more specific advice / information.  Based on the pictures, it does not look like any part of your nipple is missing.  The darker skin around your nipple is called the areola.  It looks like the incisions from the lift have misshapen the areola.  Since it is a year from surgery, you may want to consider a small revision surgery.  With the procedure, the incision around the areola can be reopened and the skin trimmed to form more of a even circle.  The areola can then be re-sutured in place.  This will likely help improve the shape of your areola.

 

Good Luck.

I do not think part of your areola is missing. When the areola was moves up to its new location the upper portion of the areola got stretched and lower portion folded over and it can be fixed easily under local anesthesia. As far as the bottoming out, it can also be fixed with a horizontal excision around the inframammary fold to decrease the distance from the areola to the fold. When this distance is long implants tend to bottom out.

You are just showing some irregularity of the areola.   The edges of the areola can be rounded out with a relatively minor revision.  Discuss this with your plastic surgeon.  

As has been alluded to previously, your nipple is fine.  The shape of your areola is not quite circular.  This can be improved with  a minor revision surgery if you desire.

Unfortunately, we cannot stop gravity, the weight of your implants have caused your skin to stretch and now your implants are sitting lower on your chest wall--they have "bottomed" out.  Everyone's skin elasticity is different,  in some women the skin is resilient and snaps back like a rubber band, and other women the skin gets stretched out and looks like a prune.  My guess is your skin is more like the prune, because you needed the lift to began with, so it is not a surprise that your skin is stretching AGAIN.  You implants still look fine and I would not recommend any revision, yet.

Good Luck,

David R Finkle, MD

This should be easy to correct and can be done in the office under local.A small segment of skin can be cut out where there is a deficiency and the nipple stretched out to expand.

From the photos, I see two issues that are apparent. The implant has bottomed out slightly and the areola is misshaped. The nipple itself is fine. When the lift was performed, an incision was made around the areola. This removes a portion of the areola and the goal is to keep the shape as circular as possible. Technical issues with closing of the incision, tension on the closure, or wound healing difficulties can all lead to an abnormally shaped areola. This is not difficult to correct in minor cases like yours. The bigger issue is the bottoming out. A large implant will cause tension on the mastopexy repair and can thin the tissues leading to rotation of the nipple upwards, and excessive fullness underneath the breast. To correct this, I prefer the use of a dermal matrix (ie Strattice) to provide an "internal bra" for the implant. All of this can be done in a single procedure. If you feel your surgeon is not being upfront with you, consult another plastic surgeon for a second opinion.