5 years after breast augmentation, one of my nipples is facing downwards. How is this possible? What can I do about it? (Photo)

Your narrative suggests that you are developing a capsular contracture. This can be confirmed by a visit to your surgeon and examination of your breasts. If present, he or she and discuss treatment options.

Hello there,
You could be developing a capsular contracture on the right side. This is when the internal scar (the capsule) around your implant becomes thickened and contracted. this puts pressure of the implant and distorts its shape.
If the right breast is harder than the left and moves less in the pocket, you likely have a contractureI would bet that the inferior part of your capsule is thick and causing the implant to sit higher that the other side.
It is possible to fix, but will require another surgery to removed the thickened part of the capsule and placement of a new implant. This has a fairly high success rate however could occur again. I would be sure to also put you on Singulair and Vitamin E after the next surgery to help reduce the risk of the contracture

An examination is needed to be certain, but you may have some capsule on the higher side and do need to lift you lower nipple area.

Quality breast augmentation outcomes are based on three variables.
When patients are unhappy with the results, the problem can usually be traced back to one or more of these three variables.
The first variable is patient candidacy.
Variables that affect patient candidacy include breast asymmetry, breast position on the chest wall, breast Divergence, breast diameter, and several others.
The second variable is the choice of implants in regards to size shape, and type.
The third variable is the surgeons ability to place the implant in the correct anatomic location.
In your case, the lack of quality outcome is based on all three.
Your natural breast sit wide on your chest wall and have small natural diameter.
Your implant selection is far bigger than your natural breast diameter.
That implant has to go somewhere.
Because your surgeon was smart enough to not violate your IMF inframammory fold. The implant has to go somewhere so it’s riding high.
still, I think your left breast is sitting a bit high, and there is potential for lowering the implant with revision surgery.
In a nutshell, your candidacy for breast augmentation, especially using large implants was not ideal.
The implant selection was not well thought through in regards to your natural breast anatomy.
The placements of implants is not ideal either.
I think you have a potential for a high-quality outcome. This would require modifying the implant pocket and downsizing your implants to something that would be more appropriate and fit your breast pocket.Recogizing your own inherent limitations for this procedure and picking implants accordingly will go a long way twords being happy with your outcome.
I agree that your current look is far from ideal.
In the end, the problem is related to all three variables. Patient candidacy, implant selection, and technical aspect of implant placement,
Addressing and acknowledging, all three variables should be the end goal.
Best,
Mats Hagstrom, MD