Nipple pointing downward slightly when not erect?

Question

I have good positioning of nipple on top of implant, but my nipples point downward slightly, so the PS who wishes to go through the areola, would like to repair this at the incision. While another doctor said it was impossible to fix, chuckling at my request. Not sure why he would laugh, my questioned seemed very reasonable, and the procedure seemed very do-able...to me.

Steve Laverson, MD, FACS · Answer

Nipples consists of breast ductal volume in a roughly cylindrical shape surrounded, enveloped, and contained within a surface area of skin cover.  Because of this anatomy, your intuition is correct, that the direction a nipple is "pointing" or the direction toward which your unclothed nipples naturally incline, can indeed be controlled, changed, and adjusted.  Straightforward techniques performed in the office under local anesthesia are the norm.  Although final determination can only follow consultation with examination of your exact situation and understanding your desired outcome, the surgeon who states it's impossible to fix is merely stating that he or she does not know how to fix it.  The former is much more comfortable for some professionals to offer as advice  than the latter is to acknowledge.

Urmen Desai, MD, MPH, FACS · Answer

Every surgeon is different and has different approaches to challenges.   I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS), a member of the American Society of Plastic Surgery (ASPS) and the American Society of Aesthetic Plastic Surgery (ASAPS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach TrainedDouble Board-Certified Beverly Hills Plastic Surgeon

Dallas Buchanan, MD · Answer

Thank you for your question. Without an exam, it is impossible to determine whether a procedure could fix the problem. Perhaps the surgeon was not aware of the procedure or did not think it would help. If the other surgeon is confident they can help your problem and you trust them and their credentials, then perhaps they can help you.Best of luck!

Daniel Barrett, MD · Answer

Dear IrenePS,without an examination it is impossible to tell whether something can be done to help you. If you aren't satisfied with your plastic surgeon, you can always ask for a second opinion. Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

Curtis Wong, MD · Answer

If just the nipple, a crescent excision at the upper half will make it stand upright again.  And if the areola, then an exam or photos would be needed to comment on that.

Mary Gingrass, MD · Answer

If I doctor tells you he/she is not comfortable with a procedure or that they think it will not be successful I would believe them. If you ask 10 doctors you may get 10 answers so it is wise to ask questions at the time of the consultation and physical exam.

Eric E. Wegener, MD · Answer

Thank you for your question, Irene. 
Without photographs or an examination, it is difficult to give you an informed opinion. Routinely it should not be very difficult to elevate the downward pointing nipple. They can be elevated under local anesthesia with little to no downtime. I'm not sure why anyone would "chuckle" at your request or state it is impossible.
Good luck!

Nipple pointing downward slightly when not erect?

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