Background: Breast implants are placed in a wide variety of breast shapes. While they will always increase breast size that does not mean an improved breast shape will always result. A key feature of the perception of breast shape is the location of the nipple-areolar complex. It is always most aesthetically pleasing when it is centered on the breast mound. However, there are some breast augmentation patients whose preoperative mound has sagging and a lower than desired nipple-areolar position.
When sagging breast exists, particularly if it is significant, a breast lift is going to be needed with implant placement. There is the perception that implants will lift up a sagging breast but this effect is a relatively minor one. In fact, implants in a sagging breast will usually make it look worse as the increased upper pole fullness drives the nipple-areolar position even lower. But many women who have mild to moderate sagging do not want the scars of a breast lift when undergoing augmentation.
The nipple lift, also known as a superior crescent mastopexy (SCM), is not a form of a breast lift. It has no ability to lift up the breast mound, it only changes the position of the upper margin of the areola. But in minor amounts of breast sagging, it can help ‘hedge the bet’ against a worsened nipple-areolar position after implant placement.
Case Study: This 44 year-old female wanted implants to fill out her deflated breast mounds after having had children. Earlier in life she had larger D breasts as judged by the width of her breast base mound and the amount of breast skin present. Her nipple-areolar complexes were on the lower half of the deflated breast mound and just at the level of the underlying inframammary folds. She did not have enough sagging to justify any form of a breast lift but there was concern what would happen when implants were placed.
Under general anesthesia, 550cc gummy bear silicone implants were placed in the submuscular position through a lower breast fold incision. At the same time a nipple lift was performed, removing a 15mm segment of skin at the very center of the crescent-shaped excision. This lifted the upper areolar position and increased the diameter of the nipple-areolar complexes as well.
She had the typical breast augmentation recovery which was short as she was placed on early physical therapy. (rapid recovery breast augmentation program). All sutures for the nipple lift closure were placed under the skin so no removal was necessary. Her incisions healed uneventfully and she had implant settling and the final breast shape by one month after surgery.
The nipple lift produces a mild elevation which, in and of itself, has little value in breast shaping. But when done in conjunction with implants, it has value in correcting nipple-areolar asymmetry and in creating a more central nipple position in mild amounts of breast sagging.
Case Highlights:
1) Breast implants have a very minimal lifting effect as judged by the nipple-areolar complex.
2) When the nipple-areolar complex is on the lower meridian of the breast, implants can create a lower looking nipple-areolar position with the increased upper pole fullness.
3) A nipple lift creates a small amount of upward nipple positioning and size increase that may be beneficial in certain breast augmentation patients that have mild preoperative sagging.
Dr. Barry Eppley
Indianapolis, Indiana