Breast augmentation and nipple piercing?

Question

I have one of my nipples pierced and am going in for breast augmentation next month. The first PS stated it should come out permanently due to infection risk/higher risk of CC. The second PS said it comes out for surgery but can go back in immediately after. I would like other opinions on this. I love my piercing but I definitely won't keep it if it's been proven that capsular contracture risk is higher. Thanks!

Christian Subbio, MD · Answer

There are no studies that have been conducted to test the effect of nipple piercing on augmentation.  My opinion is that this is a long-standing piercing, which is already healed over.  There is no active wound in that area.  The metal needs to be removed for the surgery, but I see no reason why a healed nipple piercing could not be replaced after surgery as it is not causing any wound in the contaminated area, and the breast implant incision, if not through the nipple, is at a distant site.Best of luck!
Dr. SubbioBoard-Certified Plastic SurgeonNewtown Square/Philadelphia, PA

Jeffrey M. Darrow, MD · Answer

There has never been a proven link between nipple piercing and breast implant infections, however, it makes sense to be as thorough as possible in minimizing any risk.  If the piercing is metal, it should be removed and replaced with a temporary plastic post to maintain the hole.  A meticulous skin prep and occlusive nipple/areolar shields during surgery will keep the pierced site excluded from the operative field.  A inframammary incision will further reduce and risk by placing the incision far away from the site.  The metal post can be replaced 3 weeks after surgery.  Best wishes.

Urmen Desai, MD, MPH, FACS · Answer

Every surgeon has different rules. I like to take them out just prior to surgery and then put them back in just before you wake up from surgery. I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS), a member of the American Society of Plastic Surgery (ASPS) and the American Society of Aesthetic Plastic Surgery (ASAPS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach Trained, Double-Board Certified Plastic Surgeon

Donovan Rosas, MD · Answer

To my knowledge there is no available data regarding contracture and piercings.The current thought is that contracture is the result of subacute infection/inflammation which could be the result of biofilm. Thus the concern surrounding a piercing is the introduction of bacteria. In an established and well healed piercing, this risk is negligible.The piercing needs to be removed for surgery (risk of burns), but permanent removal is probably unnecessary. Ultimately, as with any body piercing, there is a risk of infection. As long as you understand these real but small risks, a piercing can be replaced.As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Mark K. Markarian, MD, MSPH, FACS · Answer

Hi and thank you for your question about nipple piercings with breast implants.  This is not an uncommon question, but unfortunately, there is no evidence-based data to support decision-making one way or another.  All answers are anecdotal.  Metal piercings can cause burns due to the electrocautery used during surgery, and plastic spacers may be used to keep the pierced hole patent during the surgery and may be replaced afterwards under sterile conditions.  However, it is my practice to remove piercings altogether, as this is the safest way to reduce the risk of infection.  Even piercing or re-piercing nipples after undergoing breast augmentation may increase the risk of infection in the future... Hope this helps.  Please refer to my link below for further questions regarding Breast Augmentation.Enjoy your recovery in the Seaport area...Best,Mark Markarian, MD, MSPHHarvard-trained Aesthetic Plastic Surgeon

Joel M. Stewart, Jr., MD · Answer

I would avoid having it in before and after surgery. After some time (after the incisions have healed and the breast appearance is stable, usually 3-6 months) you can have the nipple pierced again. If you were my patient, however, I would recommend that you let me do the piercing due to potential sterility issues. Your MD probably would feel the same.
I had a patient several years ago who had the nipple of one breast pierced roughly one month following breast augmentation (no she did not ask, just did it) and she got a horrible case of mastitis and required oral antibiotics for a week.

Brian A. Pinsky, MD, FACS · Answer

There is no clear scientific evidence that nipple piercing is associated with a higher risk of infection for breast augmentation.  If the piercing has been there for some time and is well-healed, the hold has re-epithelialized.  I will remove the ring at the time of surgery and cover the nipple area with an occlusive dressing.  The piercing can then be put back in after surgery once the incisions have healed and the patient is comfortable.  Good luck!

Todd B. Koch, MD · Answer

I have been involved with several patients who had nipple piercings prior to breast augmentation.  The piercing is removed prior to surgery.  During the procedure the nipple area is covered with Tagaderm to prevent contamination.  After the procedure is completed I reinsert piercing.  I have not had any problems or complications with this approach.

Steven Wallach, MD · Answer

I prefer that it comes out for surgery, but it can go back in right after. Best of luck......................

Isaac Starker, MD · Answer

To the best of my knowledge there are no studies linking the presence of a nipple piercing to the development of capsular contracture.  It would certainly be important to remove the nipple piercing for the surgery itself, but if this is a well established piercing (as yours is), then the likelihood that it will raise the risk of bacterial contamination of the implant in the future should be extremely low.  I agree with the others who suggest that you should be able to resume wearing your nipple ring after surgery, but that it should be removed before surgery and the piercing area prepped and isolated during surgery.

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