Downward-pointing nipples and overall poor breast form. What surgery should I be looking into?

Question

I'm 20 years old, and ever since I can remember my breasts have had extreme sag and my nipples are puffy and point downward. It has been a major hinderance to my confidence. I have always thought about surgery to fix this, but I am unsure of what surgery I would need, and I am also worried about scarring. My breast seem to be pretty dense and the skin is tight, but they point downwards severely. Any help on what surgery I should be looking into or any other advice would be greatly appreciated!

Alex Seal, MD, FRCSC · Answer

As has been mentioned, your description suggests a component of a tuberous breast.  This is more common than most patient think, and can be quite subtle for some people, or more noticeable for others.  There are several different approaches to improve the appearance of the breast depending on your goals.  Most likely these would include a mastopexy, or lift-type procedure, that would involve an incision around your nipple which would also allow for release of the tightness you are describing under the breast.  Implants can also be beneficial to help expand this area of tightness and increase the volume and appearance of the breast.I agree with the advice you have already been given, and having a consultation will help to give you more information on what you are noticing and what the recommendations would be to help improve this.  Best of luck.

Christopher J. Davidson, MD, FACS · Answer

Thank you for your question and excellent description.  I completely understand why these issues are upsetting and do appreciate that they can very well affect your self confidence.  Although it certainly sounds like you have tuberous breasts  - of course it would be most helpful to examine you in person and then discuss the different options.  Certainly an implant and a lift can improve upon the appearance of tuberous breasts.  This is a challenging operation however and it will be important to see a plastic surgeon with many years of experience.  I wish you the very best of luck!

Rodger Shortt, FRCSC · Answer

Hi there,You really do need to see a plastic surgeon with an interest in breast surgery (preferably someone that has a practise in both cosmetic and reconstructive breast surgery).  From your description it could be a simple lift (mastopexy) or a more involved procedure.  Photos would help but really nothing can replace a thorough consultation.  Anytime I do surgery on patients I talk about scars ahead of time.  I take an extra special amount of time in young people.  No matter how perfect your scars...No matter how much they fade….they will always be there.  When you are going through different stages in your life and potentially different relationships it can be something that you think a lot about.  In general, the improved appearance of a beautiful well shaped breast should offset the scars.  If it won't then the surgery is not worth it.  Talk very openly with a plastic surgeon to get there opinion.Good luck,Dr Rodger ShorttOakville Plastic Surgeon

Sultan Hassan, MD, FRCS(Plast) · Answer

hi and thank you for your question it is very difficult without a photograph to make a an appropriate comment however by the sounds of your description you are likely to have tuberous breasts for which there are common forms of treatment it would be best to arrange a consultation with an accredited plastic surgeon for appropriate advice. good luck

Jerome Edelstein, MD · Answer

From the description, you may have something called a "tuberous breast", which usually requires a combination of breast lift and implant.  Google the term and look at Images to see if this is what your breasts look like.  All the best.

Erik Miles, MD, FACS · Answer

It is very difficult to make recommendations without examining you or at least seeing some pictures. It is possible that you have a very constricted or tight lower pole of the breast which gives a downward pointing appearance to the nipples.  You might also have downward pointing breasts due to ptosis.  You describe "extreme sag" and then state that the skin is tight over dense breast tissue which is somewhat inconsistent.  My recommendation is that you have a consultation with a board certified plastic surgeon so he/she can fully assess the situation and listen to your goals. I am confident that there is something that can be done to help you feel better about your breasts. Best wishes!

Martin Jugenburg, MD · Answer

It is impossible to give you any concrete advice without pictures or seeing you, however it sounds like you need a breast lift, and possibly implants if you wish to be bigger.  Schedule a consultation with a royal college certified plastic surgeon to get a proper assessment.  Fees for something like this range from 8500 to 13500, depending on how much work is needed to give you the results you want

Jeffrey Umansky, MD · Answer

Thanks for the question. Without photos it is a little bit difficult to give you advice. What you are describing sounds like tuberous breast deformity. This can cause a lot of psychological distress for women with this deformity. I suggest you set up a consultation with a board certified Plastic Surgeon for an exam and to go over options to improve the look of your breasts. Good luck!

Jacob Freiman, MD, FACS · Answer

Downward pointing nipples means you will need a mastopexy and it is an extremely common problem. The mastopexy reshapes the breast making it perky.

Steven Wallach, MD · Answer

It is best to be evaluated in person, but it is likely you will need a lift of some sort. Best to be seen in person.  Good luck.

Downward-pointing nipples and overall poor breast form. What surgery should I be looking into?

Answers (17)

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