The art of Mastopexy: Nipple Placement

Human Proportion and Plastic Surgery: Nipple Location

When it comes to re-shaping the breast, i.e. through breast lift (Mastopexy), breast reduction (reduction mammoplasty), or breast reconstruction, the surgeon needs to have an artistic eye for human proportion in order to maintain the truest human form as the process and skill of the surgeon is comparable to that of a sculptor. This is especially important when it comes to post-surgery nipple placement. The female breast should be viewed as the combination of a dome and a cone, with the nipple being at the apex. Although there is no perfect position to assign to every breast and nipple due to the variety in shape and size, adhering to the principles of human proportion will ensure that the surgeon can locate the appropriate nipple position. It is essential to get the placement correct during the first procedure because failure to do so will give an abnormal or even deformed appearance to the breast. If the nipple is place in an incorrect position, it can be difficult, if not impossible, to correct.

The first step in perfecting the placement of the nipple is recognizing that the breasts do not normally point straight forward. They diverge from the midline plane of the body (see image), so that when one breast is seen in outline or silhouette, the other breast is seen in the full round. The second step is making sure that the nipple is located in the mid-axial plane of the breast, balancing between the center (medial) and the side plane (lateral).  Once the central line is drawn, a line from the naval to the acromion (outer high-point of shoulder) will pass through the projected placement of the nipple. If a measurement is made between the suprasternal notch (at the base of the neck) to the tip of the xiphoid bone (end of the sternum) and this distance is moved down to the umbilicus (naval). While the patient is standing, the upper measurement will be at the horizontal level at the preferred nipple location. This, in combination with the other measurements, will provide the ideal nipple placement. To confirm the location, the distance from the supra sternal notch to the nipple papilla (equal on both sides) should equal the inter-nipple papilla distance, making an equilateral triangle.

The human body and its proportions are well known to an artist who draws, paints, or sculpts the human figure. The surgeons at Fairbanks Plastic Surgery are also artists in the same capacity and it is evident through their work and experience. Proper nipple positioning in plastic surgery operations regarding the breast is not a complex subject; however, it does require that the surgeon have extensive knowledge of human body proportions and that they are able to apply that knowledge to their practice and ultimately, to the benefit of their patients.

At a major national meeting, a surgeon was presenting his self-proclaimed successful breast operation cases, completely disregarding the obviously misplaced nipples.  Dr. Fairbanks rose to address the issue by drawing attention to the nipple displacement and asked if it was a drawback of the particular procedure that the surgeon was promoting. The speaker, after a significant amount of time talking around the question at hand, declared it to be a non-issue. After the meeting, a female journalist from London approached Dr. Fairbanks and said, “Thank you for making the point you did. We women don’t think it’s a “non-issue!”