How Soon After Anchor Lift Surgery Are You in the Clear From Necrosis?

Question

I am wondering how quickly necrosis generally shows up after an anchor breast lift? When can I feel safe? Also, I had nipple sensation right out of surgery. Does that mean I have dogged that bullet and it is hear to stay? Thank you!

Vishnu Rumalla, MD · Answer

If you are concerned about the nipple, necrosis usually occurs quickly within hours to days.  Skin at the t-junction can breakdown from necrosis or tension within the first ten days to two weeks.

Richard H. Tholen, MD, FACS · Answer

First of all, if sensation is intact after surgery it remains intact long term. You may even go through hypersensitivity as everything heals, but your nerves must be intact to provide any sensation. If intact after surgery, they remain so.

	If the nerve or nerves (one or both sides) are bruised, stretched, or partially injured, you could have numbness initially but recover sensation once the nerve(s) heal. The longer nipple sensation is absent, the more likely it is permanent. So, you HAVE dodged that particular bullet! Permanent numbness occurs in about 15% of patients who undergo breast lift procedures, and in 5-10% of women who have implants only.

	As far as necrosis (dead skin or nipple from inadequate circulation) goes, if the tissues are alive after surgery, the only way they die is in response to decreased circulation, which CAN occur if you have post-op  bleeding, infection, or even excessive swelling that constricts blood flow in the skin flaps before they have fully healed.

	The easiest way to cause necrosis, however, even after surgery, is to resume smoking, use of ANY nicotine product (gum, patch, spray, inhaler, etc.), OR exposure to second-hand smoke. Nicotine is such a potent vasoconstrictor that you could have adequate circulation after surgery, get a false sense of security, and CAUSE dead tissue by resuming smoking.

	YES, even ONE!

	Perhaps I'm wrong, but your signature "CantWait77" seems to indicate you may be craving tobacco. Until you have healed completely and have your surgeon's clearance, smoking is the easiest way to cause yourself problems you really don't want. Trust me on this, I have had a patient or two that have done this and then when the skin is dead and we're doing dressing changes and talking about skin grafts, they invariably say "If you had only told me it would be this BAD, I wouldn't have started smoking again!"

	Sure, I really believe that.

	It WILL be THAT BAD!!! But I keep trying to tell this to patients. Here you go again. Good luck and best wishes!

David Bogue, MD · Answer

Necrosis is due to a lack of blood supply in the breast tissue. This is typically obvious in the first hours to days following surgery. Fat necrosis usually is discovered in the weeks to months following surgery as a firm mass within the breast. If you have sensation in the nipple following surgery, it is highly unlikely that you will lose that sensation.

Steven Wallach, MD · Answer

What type of necrosis? Skin or fat? Usually skin issues occur in the early post-op period( 1st week or so). Fat necrosis may show up as a firm area of the breast and may not drain for several weeks to months if at all.

Neal Goldberg, MD · Answer

You will not lose further sensation.  Fat necrosis can present up to six months post op.  For an anchor style lift it is rare.

Tal T. Roudner, MD, FACS · Answer

Although nipple necrosis or lose after breast lift is a rare complication due to compromised blood flow to the nipple and areolar complex it is a devastating complication that needs to be avoided with proper surgical technique. The signs of pending necrosis maybe seen in surgery or soon after in the first 12 to 24 hours. If the nipples are viable after the first 24 to 48 hours you should be safe. Regarding nipple sensation lose which is around 5% to 10% if your sensation is normal or you have sensation after surgery you should have a promising outcome!

	 

	Good luck

David A. Lickstein, MD · Answer

Typically, sensation that is present immediately following surgery will not be lost. Skin discoloration and "bruising" is a sign of tissue injury, and if seen in the first few days after surgery could lead to necrosis, although most will heal.

Tom J. Pousti, MD · Answer

Thank you for the question.

	Generally, if there is going to be a problem with blood flow to tissue and resulting &ldquo;necrosis&rdquo; your surgeon will be able to detect this within the first week after surgery. Often, there will be signs of ischemia and/or venous congestion within the first few days after surgery.

	Within the first few weeks after surgery patients after breast lift and surgery may experience problems with incision line/wound healing.  This may or may not be related to blood flow issues.

	If you had sensation immediately after surgery,  it is extremely likely that you will continue to have sensation; in other words, the nerve supply to the nipple/areola remains intact.

	I hope this helps.

Abraham Marcadis, MD (retired) · Answer

Generally necrosis will occur within 1-2 weeks. Nipple sensation at this early stage is definitely a positive sign. Good luck. Sounds as if you are doing great.

Lawrence Foster, MD (retired) · Answer

You're in the clear after 1 wk.  Total cost is $5560 at my practice.

	Dr Foster

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