Uneven Nipples After Breast Augmentation and Lift

Like most of my colleagues, I am going to ask you to relax and let things heal before rendering final judgement on your plastic surgeon's work. Your mastopexy augmentation looks very well done, by the way.'

Let's address your concerns as listed. First, uneven nipples. The irregularity around the suture line is due to the sutures, and as they dissolve and the tissues heal and the scars mature, this will settle to a degree that is quite good for most patients (everyone IS different, as are their scars). The skill of your surgeon and the fineness of the sutures and closure technique DO play a role in this. The skill of the surgeon also has a role in the roundness of the areola (how the cut is made), and whether or not the nipple remains in the center. This can easily be redone if it's "off" when healing is complete in 3-6 months, and when the scars have fully matured, softened, and faded in 6-12 (rarely longer) months.

BTW, did you or your surgeon measure your nipple position pre-operatively? I can virtually guarantee that they didn't match exactly before, so don't be too surprised that they may not match perfectly now. This is NORMAL!

Higher would seem, at least by your photos, to be unnatural. Did you mean larger, less full in the lower pole of your breasts, or did you  really want your nipple areola complexes closer to your collarbones? Measure your nipple-to-collarbone distance. Depending on your height, 19-21cm is considered near "ideal." Some of us adjust these figures a bit for individual anatomic differences, so this is not written in stone!

The bottom line here is: be patient, trust your surgeon, and listen to his/her advice. This appears to be a nicely-done operation that will likely be just fine when all is said and done. Best wishes! Dr. Tholen

Answer from Dr. Sean Hill, Board-Certified Plastic Surgeon at Lone Star Plastic Surgery – Frisco, TX:
It’s totally normal to feel concerned during this stage of healing — especially with procedures like a breast lift with implants, where the final result takes time to fully settle. The 2-week mark is still very early in the healing process, and there are a few important things to keep in mind:
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⏳ Healing Is Ongoing • Swelling, tightness, and unevenness are extremely common at 2 weeks. • Your implants are likely still sitting higher on the chest and the skin around the lift may appear tight or puckered. • Nipples often look asymmetric, stretched, or “off” during this time — this usually improves dramatically as swelling subsides and tissues soften.
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This is a good question. Usually over time after the implant settles and the scars heal you will have a better idea of the final result. Swelling will go down after the surgery and be a better picture of what to expect for the long term.

Your results look great for 2 weeks. It is not natural to have "perfectly circular" areolas, and very difficult to achieve that surgically, especially with the amount of lift and size implant that was used. Give it time and allow your tissues to adjust to the implant. Time fixes a lot!!

Dear ajonesca,I understand your concern and it is quite normal to be concerned about the outcome following a breast augmentation surgery. However, you are still in the very early stages of the healing process.Your will need to be patient at this moment and follow what your surgeon has instructed you to do post operatively.At the early stage of the healing process, the tissues around the implants are still swollen. Once the swelling subsides and the implants drop to their final position, you will be able to see the final result of your breast augmentation surgery.Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

It's too early to know at this point. It takes a good 3 months for things to settle and the swelling to resolve enough to get a real sense of what your final results will look like. If you are really concerned then book a follow up with your surgeon so they can reassure you, but based on the photos you are showing this looks like a good result for 2 weeks out. There may be a touch of asymmetry between the levels of the areolas, but that may be due to differential swelling this early on. Its best to be patient and wait for your final results before worrying whether the work done was substandard. Best of luck!  

All women have asymmetries so a small degree of difference is likely. You do have some differences between your breasts now, as you did preoperatively. At this point, 2 weeks out, I think you need to wait and see. I don't see anything that doesn't look "normal" for this point in your recovery, but waiting is the key. Good luck.

Your areolas will become more circular.  SO far you have an EXCELLENT result.  No surgery will give you perfect symmetry or perfect circular areolas, but you are well on your way to success.

It is very early to tell what your result is going to be.  I would say your early result looks very good and that you need to be patient.  You need to wait for the result usually about 3-6 months before you decide that anything further needs to be done. If at that time you have some nipple asymmetry it could be dealt with when your scars mature.
Good luck,
Dr. T

Thanks for your question.  I agree with my colleagues below.  Your results look very typical for what I would expect at two weeks after the procedure.  Breast implants add swelling to the breast, and often the two different breast implants settle at different rates which can be another factor in seeing what you are seeing. I would strongly recommend to you (as I do to all my patients) that in general, it is not good to "over analyze" small details about a surgery in the immediate period of time after the procedure. There are so many things going on with resolution of swelling and healing of incisions that affect the results.  It requires patience through this period.  In many plastic surgery procedures, sometimes you "look worse" before you look better.  I find the results you are showing are just fine, and what I would expect to see for an augmentation/lift at 2 weeks. Areolae (pigmented skin around the nipples) are never perfectly circular or symmetric. They never start out that way, nor do they end up at that way after any plastic surgery. Skin can stretch differentially on one breast to another and every patient is different. Even if the surgery is executed perfectly, which involves a perfectly circular template that all plastic surgeons use at the time of the lift, skin can heal and stretch differently even one side to another.  This is also impacted by the breast implant which adds stretch to the areola as well.  In time, my prediction is that all of your concerns will abate and you will enjoy your results.  I hope this is helpful.  Good luck!

Uneven nipples after a breast augmentation and lift can be caused by a variety of reasons. Some possibilities include an implant that has dropped too low, causing the the nipple to rise higher; differences between the two breasts in the distance between the nipple and and the breast crease; differences in healing. The exact cause needs to be carefully analyzed and corrected. Almost always, some secondary surgical treatment will improve asymmetries between the two breasts.