This is sort of like the arguments going around here in the US about gun control - "guns don't kill people, it's people with the guns that kill!" So it is with nipple position and anatomical implants. The implants don't change the nipple position, it's the surgeons using the implants that do! The anatomical implants have been a wonderful addition to my toolbox for breast augmentation, especially in ladies like yourself, who have very little natural breast tissue and want to retain a "natural" breast shape, and I have had NO problems with nipple position. It's all about how you plan the operation. To use anatomical implants effectively, the surgeon has to plan everything up front for the most part, and then stick to that plan. In other words, the nipple position is planned and marked preoperatively, as are the exact locations of the incision, the folds, and the implants, and once the implants are placed, because the pocket is designed to be snug and the implants are textured, there is very little change after surgery. This precision and predictability are what I believe to be the most attractive features of the shaped implants for those of us surgeons who have "gone over to the dark side" of using shaped implants. And, I can tell you that I have more consistently high satisfaction rates in my shaped implant patients statistically than I do in my round patient cohort, which is saying a lot, because even my round cohort is consistently happy.In a nutshell, and in that way of a brief explanation of how the planning goes, the proper marking of the nipple position is based upon a preoperative prediction of final nipple position after surgery. If you subscribe to the aesthetic of our Swedish colleagues, you utilize a point called the "Stockholm point," which amounts to the position of the nipples with the arms overhead; this is marked on the chest, and results in slightly higher nipple placement after surgery. If you prefer a more modest nipple elevation, you use the "Grand Rapids point," popularized by Dennis Hammond, which is about halfway between the resting nipple position (arms down) and the Stockholm point. Both are remarkably accurate, and both produce very beautiful implant placement, just slightly different aesthetics. I personally find that the Stockholm point produces consistently higher nipple placement and fuller lower breasts than the Grand Rapids point, so I use the Grand Rapids point with consistently beautiful, reliable results which are consistent with published studies on the aesthetics and desirable proportions of the female breast. I point these things out to you merely in rebuttal to what you have been told about shaped implants. I fully disagree that they "make the nipples sit too high." They will if the surgeon does it that way, though, and furthermore, I can also make nipples sit too high with round implants too.If you remain committed to the idea of shaped implants and your surgeon is not confident in using them, I suggest that you schedule some other consultations for second opinions with board certified plastic surgeons who specifically have experience with and like using shaped implants, so that you can hear about all of your options. Don't give up on an option which may well provide you with exactly the result that you want simply because one surgeon doesn't agree with it or can't make it work for himself, even if he is a great surgeon otherwise. Best of luck.
