I've just turned 40. My breasts have always had low set nipples and now since I have...


I've just turned 40. My breasts have always had low set nipples and now since I have had children, my breasts are sagging and are very soft. With the nipples set low they look really bad. I am a size 40D and I would like to refresh my breasts, make them smaller, firmer, and higher. Do I achieve this look by getting a reduction, a lift, and a repositioning of my nipples? Or, would I need a small implant to achieve this look and have more firmness?


It all depends on how much upper pole fullness remains in your breasts. If all the breast tissue has migrated down, it is difficult to almost impossible to recreate upper pole fullness without an implant. If however the breasts start higher, one can get a good result with just a reduction which includes the raising of the nipples and a breast lift.  It is not uncommon that I have to do a breast reduction and an implant at the same time which sounds strange but it is necessary to get the optimal result.


A better look would be achieved by reducing, lifting and shaping the breasts.  Generally, some one with as large breasts as yourself has a wide diameter breast, and therefore would not look good with a small implant.

Dr. Costanzo Thousand Oaks, CA. 91360


Breast augmentation will not make breasts smaller.  Implants can fill in a deflated upper pole, but then you have to like how they move with activities and sports.

If you want smaller breasts lifted to a fuller shape, then the sculpture is by definition some form of Breast Reduction Surgery.  Essentially all breast reductions involve lifting of the tissues and repositioning of the nipples. To assess the effectiveness of a technique, check how the tissues move. Here are Movies Before and After Breast Reduction and Lift Surgery.  Before considering implants, check equivalent details beyond what still photos demonstrate.

Hope this helps,

Michael Bermant, M.D. Board Certified American Board of Plastic Surgery



This is a very common situation after pregnancy, and also is seen in many patients who naturally have full and somewhat droopy breasts but who have never been pregnant.  As you obviously are aware, a number of surgical options are available.  A breast lift (mastopexy) will remove some skin and in most cases some breast tissue as well (in order to tighten and re-shape the breasts internally), so your lifted breasts will most likely seem somewhat smaller, even if you still fit a D cup bra.  A reduction can be performed if you would like to transition from a D to a smaller C-cup (or even a full B-cup) breast profile; it is essentially a breast lift plus more extensive removal of breast tissue.  Both procedures relocate the nipple/areola complex to a youthful position at the top of the breast mound.


In either case you may or may not end up with upper pole breast fullness, which is something most patients want from their breast rejuvenation surgery.  If you pinch the breast above the nipple/areola complex and  there appears to be a fair amount of breast tissue there, then you may be fine with a lift or reduction alone.  If there is not much breast tissue there, then in most cases a lift or reduction will not improve that situation in a lasting way, and you'll have to think about whether or not to have an implant placed to create that aesthetically ideal upper pole fullness.


Mastopexy (breast lift) and augmentation can frequently be performed simultaneously, but in some patients with larger breasts it is best to perform the mastopexy first and then several months later perform the augmentation.  Reduction and augmentation, as odd as it may sound, are sometimes performed simultaneously as well.  It sounds counterintuitive, but what is being accomplished (ideally, if the appropriate surgical technique is used) is removal of excess lower pole and lateral breast tissue, and simultaneous augmentation of the upper / medial aspect of the breast by means of implant placement.  It is critical in these surgeries to be very conservative with the size of the implant, as too large an implant will quickly stretch out the lower poles and produce a 'bottomed out' appearance.  Which generally results in another trip to the operating room to tighten the lower poles, usually by the removal of additional lower pole skin.


So the most important consideration in planning the surgical rejuvenation of your breasts is determining: (1) whether or not you will have upper pole breast fullness (above the nipple/areola complex, especially the upper cleavage area) with a lift or reduction alone, and (2) whether or not you are willing to consider the placement of modest-sized breast implants for the purpose of creating upper pole fullness if it is determined that there is not enough natural breast tissue to create an ideal, youthful shape without implants.  This assessment can be reliably made by a board-certified plastic surgeon who has plenty of experience with cosmetic breast surgery.  As your doctor examines you he or she will take a number of measurements, simulate a breast lift or reduction, and assess whether or not you need an implant to provide you with lasting upper pole breast fullness.


Make no mistake about it: this is a complex surgical issue, both in the planning and in the performance.  Make sure that your board-certified plastic surgeon shares your aesthetic vision for the result you have in mind, and that he or she is able to show you numerous photographic examples of the surgery you are considering.

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