Nipple necrosis: possible causes? What percentages could be physician driven contrasting patient?

Prior to breast revision, I am researching what the surgeon has proposed?

Doctor Answers 3

Nipple necrosis: possible causes?

 Thank you for the thought-provoking question.  Although I understand your question,  I do not think that you will find specific/relevant information here;  the potential for tissue necrosis will vary greatly from one patient to another depending on many factors including past surgical history, exactly what procedure is planned, and surgeon experience/skill level.  General these types of complications occur more frequently when patients have had previous surgery and/or are undergoing extensive surgery involving significant tissue movement and/or blood supply disruption.


 Best to address this question to your plastic surgeon,  who knows the above details and will be able to provide you with more specific/relevant information.  Best wishes.  

Nipple Necrosis

I would not consider performing a cosmetic procedure with a nipple necrosis risk >1%. There are many ways to mitigate or decrease this risk:

1. performing surgery in multiple stages

2. Utilizing the delay phenomenon 

3. Tolerating a less than ideal nipple position. 

Your question is a little vague. Hope this helps to answer your question!

Nipple necrosis after breast surgery

Thank you for your question. As mentioned by the previous doctor there are many factors that can contribute to risk of nipple loss or death of the nipple ( aka nipple necrosis). Since many risk factors can not be change such as your anatomy and the procedure being done. Then  your only option is to maximize the things you can. You would want to reframe from smoking or being around anyone who smokes for two weeks prior and for a week after surgery. Also you would like to know what does your surgeon do if that occurs because expediting treatment is very important. Just so you know every surgeon who performs breast reductions or lifts has probably seen tissue ischemia ( which stands for vascular changes prior to complete necrosis or death of the tissue) but what a surgeon does when he sees this is of primary importance. If nothing is done then the incidence of necrosis will rise and they will tend to see it quite often. We perform around 300 of these procedures a year and have not had loss of a nipple is over 15 years. This is partly because we have a regimen we have implemented to reduce the risk. Every patient who undergoes a breast lift or reduction will recieve nitroglycerin paste on the nipple right after surgery. NItroglycerin paste (ntg) dilates blood vessels and helps perfusion. If we see on post operative day one even the hint of a bluish color to the nipple then we continue nitro for three days but also send the patient home on an oxygen generator to increase the oxygen concentration in the blood being delivered which also helps but we also have the patients nipple be evaluated every day. Now this is the most important point. If you have this procedure and there is evidences that there may be some pending necrosis then you should insist your surgeon send you for hyperbaric oxygen. Most don't do this and you only have a very small window of time to start this otherwise the damage is done and the nipple will not survive. Most of the time insurance will cover hyperbaric o2. There has been such a  significant reduction in us seeing this that we have ordered our own hyperbaric chamber as well. So be proactive and if there is any hint of tissue pending necrosis insist on hyperbaric treatment!!

William J. Hedden, MD
Birmingham Plastic Surgeon
4.8 out of 5 stars 285 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.