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nipple symmetry

Now there is a title which gets your attention.

Nipples aren’t symmetric.  Breasts aren’t symmetric.  We always aim for them to be close, but as a colleague once said “breasts are sisters, not twins.”

I got an email from a breast augmentation patient saying her nipples are asymmetric.  Most are a little.  I looked at her preop photos and hers were always asymmetric.  She was happy after her surgery at all of her visits, including a couple months out.

But she is sending me an email now, about 2 years after her surgery, saying they are asymmetric.  What changed?  Why is she now noticing there is a difference?

The most likely culprit for seeing a progressing nipple asymmetry when you have breast implants is a mild capsular contracture on one side (if it happened on both, your nipple position would likely be changing equally).  If you notice one breast is softer than the other, you might be forming a mild contracture.  When this happens, it often causes the affected breast to become a little rounder in shape, firmer, and it lifts the breast up a little.  You may notice your nipple position changes or you look like you have more cleavage in the upper breast on one side than the other.

See your surgeon when you see this.  Sometimes there are habits which may make one side age differently than the other.  Do you sleep on your tummy? Only on one side?  Do you wear good supportive bras? Did you have a child? Did you breastfeed evenly?

You can try nonsurgical ways to loosen it up.  Massage, lying on a stack of books, vitamin E, singulair have all been described.  I haven’t seen tremendous success with these, but it is worth a shot.  We don’t do closed capsulotomies like they did in the old days (turns out you could rupture the implant when you were trying to break open the capsule).  So it frequently ends up being a surgery. (ug.)

When to operate? Hmmm. Tough question.  If it bothers  you.  If it is a grade III or IV capsule.  If it is painful.  If it is visible in clothing.  The bad part is we still don’t really know what causes capsular contracture.  Bleeding, fluid, infection, gel implants, in front of the muscle placement- all are associated.  But then there is dumb (bad) luck.  To fix it you can open up the capsule, cut out the capsule, or create a neopocket.  The issue is there is no guarantee it won’t recur.

So. See your surgeon.  And think- how much does it bother you? are you willing to do the time/expense/recovery of another surgery? how will you feel if it recurs?   There is no rush.  Remember your nipples were likely never exactly symmetric.

Breasts are like sisters, not twins.  (But is nice if the sisters look like they are from the same family.)

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Please keep in mind: subjects covered in this blog and certain tips and advice are not substitutes for professional medical advice. This blog is for general informational purposes only. If you are considering plastic surgery, reconstructive surgery, or cosmetic enhancement, you should always consult with a board-certified plastic surgeon and/or your general practitioner in-person for professional medical advice.

If you think you may have a medical emergency, call your doctor or (in the United States) 911 immediately. Always seek the advice of your doctor before starting or changing treatment.

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Lauren Greenberg M.D.

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