Breast lift with implants - is it true that there is a higher risk of nipple necrosis if I go higher than 250cc? (Photo)

Question

Hello, I'm starting to get consultations for breast lifts with implants. I'm currently a deflated 32A (5'1", 110lbs) after having babies and looking to get a breast lift along with implants (ideally 350cc). One surgeon that I have talked to has said that he would not be willing to go any higher than 250cc for implant due to risk of nipple necrosis. No other surgeons have said anything about this, so would love to hear additional insight on this topic.

James M. Economides, MD, FACS · Answer

It's great that you're gathering multiple consultations to get a well-rounded perspective on your breast lift and implant procedure. The surgeon who mentioned the risk of nipple necrosis is being cautious, and it’s understandable that you want more insight since this hasn’t come up in other consultations.

Nipple Necrosis and Breast Lift with Implants:
Nipple necrosis is a rare but serious complication that can occur when the blood supply to the nipple is compromised during a breast lift (mastopexy) or augmentation. Several factors influence the risk of this complication, including:

Size of Implants: Larger implants (like 350cc) can increase the tension on the surrounding skin and tissues. When the implant is too large, the skin may be stretched too much, putting pressure on blood vessels that supply the nipple and areola. This pressure can potentially reduce blood flow, increasing the risk of necrosis.

Extent of the Lift: The more the breast tissue is manipulated during the lift, especially if there’s a significant amount of sagging or the nipple needs to be repositioned considerably, the higher the risk for complications. Adding a larger implant can further strain the tissues and compromise circulation.

Your Anatomy: Your breast size, skin quality, and the amount of stretching that occurred during pregnancy and breastfeeding all affect how your body might handle both a lift and augmentation. Given that you’re a petite woman (5'1", 110 lbs, 32A), your skin and tissues may be more sensitive to tension, especially with larger implants.

Why Your Surgeon Cautioned 250cc:
This surgeon’s concern about nipple necrosis likely stems from your anatomy and the combination of both a lift and larger implants. Surgeons sometimes recommend staying with smaller implants when there’s already significant sagging, as a more moderate size may reduce tension on the tissue and lessen the risk of complications.

Other surgeons may not have mentioned this risk if they feel comfortable handling the procedure with larger implants, but they should be considering your anatomy and tissue health during their assessment.

What You Might Do:
Ask for Clarification: During your consultations, ask each surgeon about how they assess the risk of nipple necrosis, especially with larger implants. This will help you understand whether this concern is unique to the first surgeon or if others might share similar reservations after more detailed analysis.
Consider Compromise: If you’re set on a larger size (like 350cc), you could discuss the option of starting with a slightly smaller implant, like 300cc, which may still give you the volume you’re seeking without as much strain on your tissues.
Second Opinion on Lift Technique: The type of lift (anchor, lollipop, etc.) and how much the nipple needs to be moved could also play a role. Surgeons may use different techniques, and some are more conservative when it comes to implant size for safety reasons.
Your safety and long-term results are the priority, so it’s good that the surgeon brought up potential risks. It’s worth having a detailed conversation with each surgeon about balancing your desired look with what’s safest for your anatomy.

Ellen Ozolins, MD · Answer

Thank you for your question. Nipple necrosis is a complication of breast surgery that occurs when the blood supply to the nipple-areola complex is reduced. The risk of nipple necrosis is influenced by the extent of tissue manipulation, the size of the implant, and the surgical technique used. While larger implants do not necessarily increase the risk of nipple necrosis immediately, using a large implant may raise the risk of complications, especially if there is already insufficient tissue or if the breast skin is significantly stretched. Consequently, many surgeons are cautious about using large implants compared to the existing breast tissue and skin flexibility. Placing implants below the muscle may provide more support and coverage, improve blood flow, and potentially reduce the risk of nipple necrosis. Your surgeon might have recommended a limit of 250cc based on your anatomy, skin flexibility, and other breast tissue characteristics.

Daniel Barrett, MD · Answer

Dear Inventive811321,
breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Gianfranco Frojo, MD · Answer

Each breast has a maximum implant size that it can tolerate based on the tissue measurements that your surgeon will take. In general, placing an implant higher than what the individual breast can tolerate at the time of mastopexy will increase the likelihood of having problems after surgery. This is a conversation you should have with whatever surgeon you decide to proceed with. I do not think that inserting an implant over 250 will lead to nipple necrosis. Nipple necrosis a risk independent of the implant; this is more so related to the incisions around the blood supply to the nipple areola complex.

Wayne I. Yamahata, MD · Answer

Nipple necrosis is the result of inadequate blood supply to the area. Many factors can affect the blood supply. Two of the most common are smoking and diabetes. Larger implants can place greater pressure on the tissues and thus compromise the blood flow. Surgeons cannot know exactly what volume implant would lead to necrosis, so many will recommend staying on the smaller side for safety.

Ted Eisenberg, DO, FACOS, FAACS · Answer

After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size breast implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon' s experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what is right for them. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Gary M. Horndeski, MD · Answer

The technique I recommend is The Bellesoma Method. This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained. Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Ronald J. Edelson, MD · Answer

My answer is kinda yes kinda no. Larger implants with a lift makes the procedure more difficult and risky in general. These risks are lower when using reasonable size implants. I would  not go above 375 but each surgeon figures that out for themselves based on experience.

Leopoldo Baccaro, MD · Answer

As much as the larger implant you place, the higher risk of nipple necrosis exists… I think saying “anything more than 250cc” is arbitrary.

Your droopiness is not severe. I think it’s perfectly reasonable to do an augmentation with a lift, with about a 350cc implant.

Connie Hiers, MD, FACS · Answer

There is a point when a large implant applies too much pressure on the breast tissue, especially near the relocated areola-nipple complex, and the risk of necrosis increases. Placing the implant behind the muscle helps decrease this risk, plus gives better upper breast fullness, more support to the weight of the implant and less sag, and better coverage of the implant so that the edge does not show. You are small so that the 350 cc implant may be somewhat risky. I would suggest considering only 250-300 range depending upon your measurements.  If you go with 250 cc's now, you can safely increase the size later.

Breast lift with implants - is it true that there is a higher risk of nipple necrosis if I go higher than 250cc? (Photo)

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