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Archive for the ‘nipple lift’ Category

The Role of the Nipple Lift in Breast Augmentation

Monday, July 4th, 2016


Some women that undergo breast augmentation surgery have various breast asymmetries. These could be differences in the mound size, level of the inframammary fold and the size and shape of the nipple-areolar complex. Because it is the most visible part of the female breast, the size and location of the nipple on the breast mound often plays a major role in how a breast augmentation result is perceived from a symmetry standpoint.

Differences in the horizontal position of the nipple need to be recognized before surgery. As implant enlargement will almost always make a horizontal nipple asymmetry worse. If not recognized before surgery patients may perceive that it was the fault of the surgeon or the implant surgery in general. When pointed out before surgery this gives the surgeon and the patient the opportunity to review management options.

Breast Augmentation with right nipple lift results oblique view Dr Barry Eppley IndianapolisBreast augmentation with right nipple liftresults front view Dr Barry Eppley IndianapolisThe only surgical management option is a superior crescent mastopexy (SCM) or, more accurately, termed a superior nipple lift. (SNL) Not a true breast lift, it is where the superior border of the areola is moved upward through a skin excision shaped like a crescent. The areolar margin can be moved upward from 10 to 12mms in most cases. This is usually enough to either make the upper margins of the areolas even or at least much closer.

It is important to realize that a nipple and a breast mound that is significantly lower than the other side may require a different management strategy. When the horizontal nipple distance is greater than 15mm,  a vertical breast lift would be more effective.

A superior nipple lift does so at the expense of small line scar at the areolar-skin margin. This scar will be red for a few months but usually fades to be inconspicous with more healing time.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Breast Implant Surgery with IMF Lowering

Sunday, March 6th, 2016


Breast Sagging classification Dr Barry Eppley IndianapolisBackground: It is well known in breast implant surgery that the final shape of the breasts afterwards is highly influenced by what they looked like before. Besides asymmetry, the most common adverse breast shape problem seen in breast augmentation patients is sagging or ptosis. Such breast mound sagging can occur in many degrees of which most will require some type of breast lift technique to adequately address at the time of implant placement.

The most challenging breast sagging problem in breast implant surgery, in my experience and opinion, is the woman with a more mild or first degree breast ptosis. The amount of sagging they have is not quite enough to justify a breast lift. But there is enough sagging that the implants will likely drive down the nipple on the breast mound in a more downward direction or force most of the breast mound on the bottom side of the implant. This is a particular risk when the patients desires larger breast implant sizes.

In mild cases of breast sagging there are several strategies to help the breast mound and nipple get centered over the implants. The most common approach is to lower the inframammary folds (IMF) to center the implants over the low hanging nipple. An accompanying technique is a superior crescent mastopexy or an upper nipple lift. This simple technique helps move the nipple up on the breast mound up to 1 cm superiorly

Case Study: This 34 year-old female wanted breast implant surgery but had some moderate breast sagging after multiple pregnancies. She did not appear to have enough sagging to warrant a breast lift and did want such scars anyway. She also wanted larger breast implants.

Breast Implant Surgery with IMF lowering results front view Dr Barry Eppley IndianapolisUnder general anesthesia, 650cc silicone breast implants were placed in a partial submuscular plane through inframammary incisions. The original inframammary fold (IMF) creases were still evident above the new fold levels. The original inframammary fold creases were released right under the skin and rigotomies were also done using an 18 gauge needle. Superior nipple lifts were also done.

Breast Implant Surgery with IMF lowering result oblique view Dr Barry Eppley IndianapolisBreast Implant Surgery with IMF lowering results side view Dr Barry Eppley IndianapolisHer postoperative results show a centric nipple position on the enlarged breast mounds. Her nipple lift scars are barely noticeable at this early healing period. The original inframammary fold (IMF) creases are still present. Whether they will ever completely go away and round out remains to be determined.

Management of the persistent fold crease in breast implant surgery when the inframammary folds (IMF) are lowered can be done through several strategies. One technique is further rigotomies of the crease line with underlying fat grafting. Another technique is to reposition the implants up higher and re-establish the original inframammary fold levels.


1) Breasts that have mild to moderate degrees of sagging poses challenges in breast implant surgery.

2) Lowering of the inframammary fold (IMF) is one maneuver in breast implant surgery that can help avoid the need for a more formal breast lift.

3) Persistence of the original inframammary fold crease is one of the trade-offs, as well as the risk of bottoming out, when the inframammary fold is lowered in breast implant surgery.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Nipple Lifts with Breast Implants

Tuesday, February 9th, 2016


Background: Sagging or ptosis of the breasts is seen in s wide variety of forms, all of which can influence breast augnentation results. Severe or Grade III and IV breast ptosis is an easy breast lift decision to make as there is no other choice. Grade I breast ptosis is also an easy decision as breast implants alone will have a lifting effect on its own.

The intemediate or Grade II breast ptosis is challenging decision. A breast lift will provide the needed upward change of nipple position but will create undesired scars in so doing. Implants will avoid visible breast scars but may make the appearance of the breast worse with a lot of upper pole fullness but a nipple-areolar complex that is oriented more to the lower pole of the breast.

Case Study: This 34 year-old female presented for breast implants. She knew she had a bit of breast sagging but did not want any scars that went beyond the margin of the areolas

Breast Implants with Nipple Lift results front view Dr Barry Eppley IndianapolisUnder general anesthesia she had 400cc smooth silicone breast implants placed through small inframammary incisions using a funnel technique. At the same time nipple lifts were performed by removing a superior crescent skin at the superior aspect of the areolas of 1 cm in height at the central aspect.

Breast Implants with Nipple Lift results oblique view Dr Barry Eppley IndianapolisSmall to moderate degrees of sagging pose issues for optimal breast augmentation results. Many patients understandably think that implants will have a breast lifting effect which is only true if the nipples are right at or above the inframammary fold level. Often in more minor amounts of sagging the patient may not even recognize that they are ‘droopy’ since they may have been that way for a long time.

Breast Implants with Nipple Lift result side view Dr Barry Eppley IndianapolisThe nipple lift, formally called a superior crescent mastopexy, is not a true breast lift. It is really a nipple edge relocation procedure. While it may not centralize the nipple during the placement of breast implants, it can prevent it from having a worse and lower mound position after its enlargement.


1) Ptosis or sagging of the breasts is not usually fixed by breast implants alone.

2) Borderline breast lift patients can be treated by a superior crescent mastpexy (nipple lift) with their breast augmentation.

3) Nipple lifts offer an alternative option to the scars of a more formal breast lift albeit with a much less lifting effect.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Nipple Lift with Breast Augmentation

Tuesday, December 1st, 2015


Background: Many women who are to undergo breast augmentation surgery have asymmetric breasts. These asymmetries may be in breast mound size, breast mound shape, amounts of sagging and the nipple position. Preoperative education about how breast implants will impact these asymmetries is of critical importance as breast implants alone will not correct many breast asymmetries. In some cases they make even make them worse. This has led to the well worn phrase in breast augmentation surgery of…’they are sisters, not twins’.

Almost all differences between two breasts, however, are reflected in some degree with the position and shape of the nipple. Nipple size differences can exist but the most important and visually distracting nipple issue is that of a horizontal discrepancy. When one nipple sits lower than the other nipple based on a horizontal line drawn between the two, this is a critical preoperative diagnosis to make. It usually is the result of one breast having a little more sag than the other one and women often state this was the primary suckling breast. This diagnosis is important as the placing of breast implants will always increase any horizontal nipple discrepancy.

Managing a horizontal nipple asymmetry is almost always done through a nipple lift, also called a superior areolar mastopexy. In reality it is just a lift of the superior margin of the areola and has no breast lifting capabioity as suggested by the mastopexy name. This is a simple procedure of skin removal and areolar margin adjustment that has no detrimental effect on nipple sensation or prolongs the recovery from breast augmentation surgery.

Case Study: This 46 year-old Asian female presented for breast augmentation surgery. She has lifelong small breasts of B cup size and wanted to be a fuller C cup. On examination her right breast had more sag and an appreciable lower upper margin of the areola with a 12mms discrepancy.

Nipple Lift BAM results front viewDuring her breast augmentation surgery, 300cc high profile round smooth silicone gel breast implants were placed through inframammary incisions. At the same time a superior crescent of skin was removed above the right areolar to better match the horizontal levels of the nipples.

Nipple Lift BAM results oblique viewRight Nipple Lift Scar Dr Barry Eppley IndianapolisHer postoperative results show larger breasts that appear more symmetric in both size and nipple position. Even though she was of Asian origin, her areolar scar shows on signs of hypertrophy or hyper pigmentation afterwards.

A superior nipple lift is a simple and effective method for improving breast asymmetry in some women undergoing breast augmentation surgery. The preoperative diagnosis of horizontal nipple asymmetry is critical and one that even some women are not aware that they have. Some women may defer to wait after surgery to see whether they want to do it or not. And that is easily done under local anesthesia in the office should they so decide. But bringing it to their attention before surgery and offering the nipple lift option, either during their breast augmentation surgery or after in the office, is sound pre surgical education.


1) Many women have varying degrees of breast asymmetry of which one feature is that of a horizontal nipple asymmetry.
2) A simple nipple lift can be an effective solution to a horizontal nipple asymmetry which will become magnified with the placing of breast implants.

3) A nipple lift is not a breast lift and only changes the upper location of the areolar margin.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – One-Sided Nipple Lift in Breast Augmentation

Tuesday, September 1st, 2015

Background: Differences in the size and shape of a woman’s breasts between the two sides is very common. Sometimes the breast asymmetry is very obvious and it is well recognized. Many times, however, the breast asymmetry is more subtle and the woman is not even aware of it. Women tend to pay more attention to breast mound differences than to nipple position differences.

The assessment of the horizontal nipple position in the preoperative breast augmentation consult is critical.  The position of the nipple on the breast mound draws one’s eye to it. As the breast mound increases in size with implants, almost always the differences in the horizontal nipple levels will become magnified. While a women may not have noticed that their nipples were at different levels before surgery, one can be assured that they will notice after surgery when that discrepancy becomes more noticeable.

Nipple Lifts in Breast Augmentation Dr Barry Eppley IndianapolisThe best role that the nipple lift, also known as the superior crescent mastopexy (SCM), plays is in the correction of horizontal nipple differences in breast augmentation surgery. The nipple lift is just that…it lifts the superior level of the nipple up to a centimeter. It is not a breast lift even in the most minor of ways. It can help even out minor horizontal nipple level differences.

Case Study: This 32 year old petite female wanted breast implants to improve her naturally smaller breasts. She had a slight breast asymmetry both in the mounds and in the horizontal level of her nipples. It was decided to perform a nipple lift on the lower side at the time of her breast augmentation.

Nipple Lift Breast Augmnetation results frofnt view Dr Barry Eppley IndianapolisUnder general anesthesia she had Sientra silicone gel gummy bear breast implants of 300cc size placed through inframammary incisions. The left breast had a 10mm nipple lift done through an excision of a superior crescent of skin.

Nipple Lift Breast Augmentation results oblique view Dr Barry Eppley IndianapolisNipple Lift Breast Augmentation results side view Dr Barry Eppley IndianapolisHer postoperative results showed good symmetry of her breast mounds as well as an even horizontal nipple level. The fine line superior areolar scar was still visible at 6 weeks after surgery but will go on to fade by 3 to 4 months after surgery.

The superior nipple lift is a small but valuable breast procedure that can correct one cause of breast asymmetry. If in doubt of its need before surgery it can be delayed until the breast mounds have settled and performed as an office procedure done under local anesthesia.


1) Horizontal nipple asymmetry is not uncommon in prospective breast augmentation patients.

2) Breast implants will most likely magnify a horizontal nipple asymmetry, not even it out.

3) A superior crescent nipple lift at the time of breast augmentation can ensure that the horizontal levels of the nipple improve as the mounds are made bigger.

Dr. Barry Eppley

Indianapolis, Indiana

Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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