Why haven’t my nipples raised during (drop and fluff) and is there a way to correct nipple placement? (Photos)

Question

I’m coming up on 1 year post op in 2 weeks and my nipples are still very low and slightly pointing downwards. My doctors office said they would rise in time and then eventually started saying my nipples were low to begin with so it can be expected. Was wondering what the issue could possibly be and if there are any non-invasive ways to fix it. Thanks!

Gary M. Horndeski, MD · Answer

Your breast implants are at one level and your breast tissue is at another level. At this time, it is highly unlikely that your implants will drop anymore and gravity will prevent your nipple-areola complex for raising higher. At this time, I recommend a donut mastopexy to re-position your nipple-areola complex higher on the chest wall. Your other alternative would be lowering the inframammary fold. However, lowering the inframammary fold will allow the implant to descend and may result in bottoming out or double bubble deformity.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Joshua Cooper, MD, FACS · Answer

- It appears that your breast implants never settled into the correct position after you augmentation.  They remain too high on your chest wall. 
-Your nipples/areolae were in perfect position prior to your breast augmentation.  They were not low by any means. 
-Typically, breast implants settle into the correct position after a few months. It takes time/gravity for the implants to stretch out the skin of the lower portion of the breast.
-There are a couple possibilities in your case for the cause of your implants remaining too high. 
-The first would be that the lower pole (bottom 1/2) of the breast pocket was not made large enough to accommodate your implants at the time of augmentation. 
-The second explanation is that you had premature pocket closure during the healing process.  This means that the capsule (normal scar tissue) around the implant formed more quickly than the implants settled into position, thereby preventing the implants from dropping into the appropriate position. 
-I have had this happen to a couple patients over the years. BUT, it is usually on just one side.  The treatment is to open the incision up and cut through the scar tissue in the lower pole of the breast, thereby allowing the implant to drop into the correct position. 
- I recommend meeting with a board certified plastic surgeon (ASPS Member) to find out more. He/she will likely recommend a revisional procedure in which the implant pocket is reopened and the capsules are removed inferiorly to allow the implants to settle into place. 
-Thanks for sharing, and best of luck to you!

Michael E. Decherd, MD, FACS · Answer

So the nipples are not centered over the implants.  So you can, 1) raise the nipples, or 2) lower the implants.  Probably #2 is easier.

Good Luck!

Daniel Barrett, MD · Answer

Dear Tough6508,
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. Only after thorough examination you can get proper recommendations and advice.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Donald R. Revis Jr, MD · Answer

Good afternoon!
Your implants never dropped and fluffed properly, because your nipple position was and is totally normal. Either the muscle was not released enough, or you developed some encapsulation, or the muscle didn't relax fast enough and the bottom of the pockets closed before the implants could drop into them- whatever the reason- it is your implants that are uncommonly high, and your nipples which are normally positioned. You may be able to change this by massaging three times a day and avoiding any type of pushup bra, but often the only way to correct this is to surgically go back in and re-open the bottom of the pockets so the implants can finally drop and fluff as they are supposed to!

Connie Hiers, MD, FACS · Answer

You probably have large implants for your space and there is not much room to let them drop. Ultrasound treatments may possibly be helpful, or lower or widen the pocket some or choose a smaller implant.

Kenneth R. Francis, MD, FACS · Answer

Dear Tough6508,

It is unfortunate that your breast implants have not fully descended yet, because your result will be great when they do.  If you were my patient, and this is without the benefit of an examination and information on the implant type, I would probably recommend continued observation, use of a bra band and remaining braless to entice the implants to descend on their own.  Although we usually call for a 6 month time for implant descent, sometimes it takes longer.  Good luck!

Frederic H. Corbin, MD (license restricted) · Answer

Thank you for the question and photos and your implants are sitting higher then desired making your nipples appear low and would consequently benefit from a pocket revision.to correct the problem

Dr Corbin

Why haven’t my nipples raised during (drop and fluff) and is there a way to correct nipple placement? (Photos)

Answers (8)

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