Part of Nipple Missing After Augmentation

I had an augmentation and lift done at the same time just over a year ago. The results are ok except I think a bit of "bottoming out" has occurred. The worst thing is that part of the bottom half of my right nipple is missing! It was like that right after the surgery and I was in tears about it but the doctor told me to keep coming back every few months to see if it would repair itself. It still looks weird and I can't get a straight answer from him. Why did this happen?

Doctor Answers 16

Nipple loss after Breast 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

Houston Plastic Surgeon
4.2 out of 5 stars 47 reviews

Areolar symmetry after breast lift with augmentation

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.  

Bhupesh Vasisht, MD
Voorhees Plastic Surgeon
5.0 out of 5 stars 86 reviews

Smaller nipple

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.

Robert Brueck, MD
Fort Myers Plastic Surgeon
4.9 out of 5 stars 64 reviews

Areola is misshaped.

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.

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 25 reviews

Breast Lift or Reduction and Nipple Asymmetry

Hi dodgegal in Calgary, AB,

There are many reasons why there can be some deformity after a procedure such as this, including some irregular lies of the areola.  If it was visible right after the procedure then it may be just a question of the way it was inset; ie, put into its new position.  If that's the case, a relatively small procedure under local anesthesia may stretch the areola out enough to flatten it a bit.

Of course, the specifics of this would have to be discussed with surgeon.  You may need to schedule a consultation and bring along a friend for moral support.  Have a list of questions and try to get a clear answer and a plan.

I hope that this helps, and good luck,

Dr. E

Alan M. Engler, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 125 reviews

Why is the areola abnormal in shape?

The area that you are referring is called the areola. What has happened is that as a result of the wound closure and/or  subsequent healing, the proper shape was disrupted by forces resulting in the contour irregularity. There is actually no loss of the areola.

The solution is quite simple and straightforward. Using local anesthesia, this area of the areola can be stretched out to the proper shape and then inset by excising a small amount of the adjacent skin.

Steven Turkeltaub, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 30 reviews

Nipple issue

It looks like the areola is tethering up a bit, perhaps a scar revison at the base can help "stretch it out."

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

Nipple irregularity

The reason your nipples are not circular and oblong is because of assymetric tension on your nipple and areola. remember that your nipples were pulled up and inset in their current location, well the upper half of your nipple is being pulled on by the upper breast skin where as your lower nipple half is sitting on the lower breast pole with minimal tension on it and so it has bunched up as apparent by your photo. To correct this you need to revise the lower nipple area by removing breast tissue from the inferior pole. But you have to measure the lower breast pole to make sure that this maneuver will not ruin the over all ballance of your nose.

Arian Mowlavi, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 68 reviews

Nipple missing after breast lift?

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.

David Shafer, MD
New York Plastic Surgeon
4.9 out of 5 stars 77 reviews

Deformity of the areola

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.

S. Ozan Sozer, MD
El Paso Plastic Surgeon
4.9 out of 5 stars 195 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.