Reduction in May 2023, my nipples have been ruined. Correction options? (photos)

Question

I had a reduction in May 2023 in which my nipples have been ruined. I would like advice on how one would correct this. My surgeon said “he has never seen this happen.” I am not confident in him attempting to correct this. I also now have “rolls” on my sides of my breasts. Would like advice on correction of this too. He states I should “just accept it as the correction would look worse.” Finally, is it normal to have sagging within a year of reduction/lift? (Pics available.)

Emre Guvercin, MD, FEBOPRAS · Answer

I’m very sorry you’re dealing with this &mdash; and to be clear, what you’re describing is not something you should be told to ‘just accept’, especially at only about 1 year post-op.Is this normal within a year of reduction/lift?No.While minor settling is normal, significant nipple distortion, early sagging, and lateral ‘rolls’ within a year usually indicate a structural problem, not normal healing.What’s likely going on anatomicallyFrom your description, there are three separate but related issues:Nipple distortionOften caused by uneven tension, poor tissue support, or scar contractureNot rare, but often under-acknowledgedSaying “I’ve never seen this” is not reassuring &mdash; it usually means the surgeon lacks revision experienceSide rolls / lateral fullnessThis happens when breast tissue is not properly re-centered on the chestThe breast spreads outward instead of being lifted inwardLiposuction alone often doesn’t fix this &mdash; it’s a shaping issueEarly saggingTypically due to:Inadequate internal supportFailure to reposition breast tissue upwardOver-reliance on skin closure instead of structural reshapingAre there real correction options?Yes &mdash; and they do not have to look worse.You sound like a classic revision Push-Up Lift candidate.What a revision Push-Up Lift can addressA properly planned revision Push-Up Lift can:Release scar contracture affecting the nipplesImprove nipple shape, symmetry, and orientationReposition your existing breast tissue upward and inwardEliminate or greatly reduce side rollsRestore upper-pole (first-pole) fullnessCorrect early sagging by shortening the lower poleImprove overall breast balance without implantsThis is not just “touch-up surgery” &mdash; it’s rebuilding the breast architecture.Should you let the same surgeon revise this?Given:Your loss of confidenceThe dismissive response (“accept it”)The statement that correction would look worse&hellip;it is very reasonable to seek a second opinion, ideally from a surgeon who:Regularly performs revision breast surgeryIs comfortable correcting nipple deformitiesUses tissue-preserving / Push-Up techniquesRevision surgery requires a different skill set than primary reduction.Important reassuranceMany patients in your situation fear:“What if revision makes things worse?”That risk is highest when:The revision is done without a clear structural planThe same technique that failed is repeatedWhen done correctly, revisions often provide the result patients expected the first time.*** Bottom lineYour outcome is not something you should just acceptNipple distortion, side rolls, and early sagging are correctableA revision Push-Up Lift is the most appropriate approachYou are justified in seeking a new surgeonBeing told “it will look worse” usually reflects lack of revision expertise, not realityYou deserve a result that feels balanced, natural, and confidence-restoring &mdash; and with the right revision strategy, that is absolutely achievable.

Ajaya Kashyap, MD · Answer

Thank you for your query. The pulling in and deformity of the nipples is because of scar tissue. The scar tissue can be released and autologous fat grafting can improve  the look of your nipples significantly. Some liposuction on the sides will help with the “side rolls”. Rather than sagging of your breasts   there is some “bottoming out” going on , the tissues moving down while the nipple-areola stay up. This can be corrected only by a revision of the procedure using  a different technique. Please discuss your concerns with your Plastic surgeon who can help you or with another Plastic surgeon who is more experienced with these procedures. All the best!

Daniel Barrett, MD · Answer

Dear lish6902,
I understand your concern. However, without a proper assessment, it would be difficult to determine what is wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Ronald J. Edelson, MD · Answer

Your areolae can be reshaped pretty easily. The main issue  is that your have too much skin and breast tissue in the lower portion of the breast. L. That is also a straightforward  correction to have done

Gary M. Horndeski, MD · Answer

It appears the nipple has contracted laterally. This may benefit from release or possibly areola revision. If you compress your breasts inferiorly, this will allow the nipples to achieve a normal position.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Karl William Schwarz, MD · Answer

I don't think your nipples are ruined--what is happening is they are being pulled towards the outside of the breast because they are attached to the underlying tissue (pedicle) and that is falling down and out and taking the nipple and areola with it. It can be fixed by redoing the reduction and sewing the pedicle to the medial aspect of the chest and reducing the size of the pedicle to get rid of the weight. Obviously this would mean another surgery but it might be worth considering or at least discussing it with your surgeon. He is the best person to do this as he did the first surgery and knows where the blood supply to the nipple and areola are so it is also the safest way to do it.

As for the roll--it was there before but not in the same configuration and that's what has changed by lifting the breast the roll has just become more prominent but it is pretty normal so I wouldn't concentrate on revising it.

As for the roll--it was there before but not in the same configuration and that's what has changed by lifting the breast the roll has just become more prominent but it is pretty normal so I wouldn't concentrate on revising it.

Camille Cash, MD · Answer

From the posted photos it appears you would benefit from a revision to the lift.  This would include correction of the nipples and a nice improvement is very possible.  If you are no longer confident in your surgeon, visit with another board certified plastic surgeon in your area for a consultation.

Connie Hiers, MD, FACS · Answer

Your nipples are not "ruined." More tissue can be removed, especially from the inferior scar to give a better size and shape and help fill in the area behind the nipples.  Liposuction on the lateral chest will help correct the rolls.

Scott C. Lindsay, DO · Answer

Thanks for your question! If you are bothered by the recurrence of droop, you could always consider another lift. That could also help with the nipple deformity by getting the nipple/areola centered on a more projecting part of the breast. Good luck!

Mats Hagstrom, MD (license on probation) · Answer

To make a quality assessment regarding a plastic surgery outcome we need to see proper before and after pictures. If you don’t have before pictures then ask your surgeon to forward the pictures they took. 
It looks like you had divergent breasts and your surgeon attempted to bring the nipple position more medically(words the midline) in doing so the nipples are being pulled laterally (towards the side) cause your outcome. 
The lateral dog ear(skin fold on the side) is common especially if the surgeon limits the length of the scar. Sagging is common after a breast reduction. The nipple position is usually improved but the breast shape is often somewhat flat. 
Best,
Mats Hagström MD

Reduction in May 2023, my nipples have been ruined. Correction options? (photos)

Answers (10)

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