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Breast augmentation is an operation that is essentially about enlarging the breast mounds. Where and how the implant is placed can affect not only the shape of the breast mounds but their symmetry to each other. The change in the breast mound, however, will not make a difference in the position of one’s nipples. This is an extremely important point for patients to realize and appreciate before undergoing the procedure.

Breast augmentation will usually make a small change in the size or diameter of the nipple. It may also affect how the nipple is viewed in the vertical dimension on the breast mound or how it sits relative to the newly enlarged and shaped breast mound.

 But enlarging the breast mound will NOT change the horizontal position of the nipples relative to each other. In other words, if you have a difference in the position of the nipples between the two breasts (by drawing a level horizontal line between the two nipples), this will not improve as a result of placing breast implants. Most often the difference in nipple position is a direct reflection of the size and shape of the breast mound. Those breasts that have more skin or loose skin may have a nipple that sits lower.

Recognizing that the nipple position is different before surgery is extremely important. Unhappiness or criticism of breast augmentation results is often from either some mound or nipple asymmetry. Recognizing that horizontal asymmetry exists before surgery gives one the opportunity to consider a nipple lift or adjustment during the breast augmentation procedure. While a nipple lift can always be done after, the patient should be given a choice as to how to manage nipple asymmetry beforehand. Pointing it out after the fact is usually viewed as the plastic surgeon’s fault more than as a result of one’s preoperative anatomy.

Nipple lifts are very simple removals of crescent-shaped pieces of skin that move the areola in the direction of the skin removal. Most commonly, this is going to be upward for a nipple that sits lower. (also known as a superior crescent mastopexy) But in my Indianapolis plastic surgery practice, I have done them for nipples that were too far to the side to move them inward (towards the sternum) as well. They result in a change of about one to two centimeters based on the tightness of one’s skin and how large of a breast augmentation has been done. They do leave a very scar but it usually is quite fine and not a concern to most patients.

Dr. Barry Eppley

Indianapolis, Indiana 

 

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