Nipples Facing Outwards 2 Years After Silicone Implants. Will This Recur w/ Revision?

Your anatomy, your implant choice and the surgery that you had, can all affect your nipple / areola position with implants.  If you post before and after pictures, we may be able to give you more specific advice.  If it is just a matter of properly centering your implants under your nipple / areola, you can possibly have better position and symmetry.  If you have ptosis (or looseness of your breast), then you may need a mastopexy at that same time as your implant revision.  In this case, the nipple / areolar complex can be moved into better position during the surgery.

 

Good Luck.

It is difficult to answer your question without photos (both preop and postop). Was this a gradual drift outwards or they looked like now initially after surgery? As a general rule, if your nipples are far apart prior to surgery, they will tend to move even more laterally with an augmentation. If you are going to get larger implants, the nipples will tend to go even more laterally. Imagine what happens if you place two dots on a balloon and then inflate the balloon. You need to discuss this with your plastic surgeon before your planned surgery. Good luck.

Nipples can face outwards after breast augmentation if the implants are placed more towards the midline instead of being centered behind the nipple and areola. Sometimes this is done to prevent a seperated cleavage and should be communicated with the patient. A larger implant will help with the problem to a cretain extend depending on the nipple and areola position. If the patient has lateral position of the nipple and areola to start with they may face outwards but to a lesser extend.

I have reviewed the comments of my colleagues and agree with almost everything they have said.  The bottom line is, it depends on the specific factors of your case.  I will add 2 more thoughts.  I have seen lateral positioned/pointing nipples in sub glandular augmentations, that are corrected with submuscular placement.  These cases have been associated with capsular contracture and implant displacement, which may be the cause of your problem.  High profile implants, because they are narrower, may be placed more medially to give the appearance of greater cleavge  leading to a more lateral appearing nipple.  This  can  usually be corrected with wider implants.  Even if your nipples did point to the side before your 1st surgery, it should be possible to improve the position/appearance with a subsequent surgery that is tailored to fit your specific issues. Just be open minded when you are having your PS consultation.

Outward nipple position can be exaggerated after breast augmentation. This can sometimes be corrected by repositioning the implant. However, the easiest way to improve the nipple position is to remove a crescent of skin on the inside of the nipple-areola complex to "pull" the nipple more inwards. (medial crescent pexy). This leaves a small scar around the inner border of the areola which usually heals very well being in the margin of the areola. Nipple sensation should not be affected. This could easily be done at the same time as your implant exchange.

Your before surgery photos will indicate if this was already present and to what degree. If yes, then increasing your  implant size may not correct this.

A lot will depend on what you had pre-op.  If your nipples pointed outward prior to surgery then putting in an implant may accentuate this.  A wider implant may improve the appearance but  it is hard to tell without photos.  Before proceeding with surgery I would discuss this with your plastic surgeon.

This is caused by many factors. Implants can be too big or too small causing the nipple-areola complex to be not centralized on the breast mound. The implants can be inadvertantly malpositioned medially thus putting the nipple more towards the outer half on the resulting breast mound. Finally, patients can begin with nipples that are facing a certain direction and this is accentuated with implants. A careful analysis and discussion regarding natural anatomy and goals should prepare you for this possibility and for options to correct it. 

Robin T.W. Yuan, M.D.

Photos of your concerns would be helpful.  Generally, if your nipples are facing outward there must have been an increased distance between the nipples prior to surgery or the nipples had a lateral (outward) position before surgery.  If your implants have become displaced or you have developed some sagging this may also contribute to the current appearance.  I would consult with your plastic surgeon to see what options are available for correction.

It is both critical and knowable to determine whether the cause of outward pointing nipples is because of natural conditions or because of implant malposition. Properly sized, positioned, and healed breast implants should never change the axis (direction) the nipples point. A revision with an implant change will require a new assessment of proper sizing, positioning, and healing to correct the outward pointing nipples if they were due to implant malposition or to leave them the same if the problem was there before the first procedure.