I want to get a breast lift but I'm scared of getting nipple/areola death. How can I prevent this?

Fortunately, this complication is uncommon.  You should make sure you are not smoking or using nicotine or marijuana products prior to surgery.  If you are diabetic, your sugars should be well controlled.  If you have had prior breast surgery, you should give your surgeon the records of the prior procedure to review.  And most importantly, you should follow the surgeon's advice about post-op activity and monitoring the nipple area 100%.  If it does happen, usually rapid intervention can salvage the tissue, but it may add to your recovery time.As for being "devastated" if your nipple or breast shape isn't perfectly perfect - that's something that you will have to think over a bit more.  Realistically, no surgeon can promise you perfection.  We all try very hard to do great work.  When you work on biologic systems, and not inanimate objects, sometimes there are factors that the surgeon does not control 100%.

hello thank you for your question and provided information as well..based on your question it is difficult to evaluate your case without photos, my recommendation is a consultation in person with a certified plastic surgeon that sees you and evaluates what you need.

Nipple
or areola death is extremely rare after a breast lift procedure.  I recommend The Bellesoma Method to 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
and the ability to breast feed are maintained. 
In the 18 years of doing this, I have never had nipple or areola
death.  Best Wishes,Gary Horndeski, M.D.

Dear tatiiiii,

Determining whether you need simply a breast implant versus a breast lift or both can be somewhat complicated. It depends on a number of factors including skin laxity and current nipple position.

Generally speaking, if the nipples are lower than the inframammary line the patient will most likely need a breast lift. If the nipples are at or above the inframammary line we can generally get by with just breast augmentation depending on the size of the implant the patient wants. I often use an implant when I perform a breast lift because it provides more upper breast fullness after the lift.

These two surgeries can be done at the same time and this may be optimal as the risks can be minimized. 

My preferred lift is a lollipop lift when a periareolar won't do (ie greater than 2cm lift required). The lollipop technique was created by a Canadian plastic surgeon named Elizabeth Hall-Findley and treats the breast as a three dimensional structure instead of two dimensions (anchor - lift).

Most importantly, it does not require the horizontal component scars that the anchor-lift requires and breasts appear much more natural, lifted, and less boxy. Lastly, the lift lasts longer because the lollipop doesn't rely on the skin to hold the breast up, it is actually breast tissue that is being brought together to support the breast and hence improves longevity.

On the other hand, many women have overdevelopment of breast tissue and require reductions. Some of the questions you need to ask yourself are if you are willing to have scars from the surgery, take the risk of losing nipple sensation and other complications in addition to possible problems breast feeding if you plan to have children in the future.

It is best that you visit a board certified plastic surgeon to discuss your options further. Only after a thorough examination you will get more information and recommendations.

Daniel Barrett, MD, MHA, MS

Certified, American Board of Plastic Surgery

Member, American Society of Plastic Surgery

Member, American Society of Aesthetic Plastic Surgery

The best thing you can do is carefully pick your surgeon. Make sure you have a plastic surgeon with long and vast experience with  breast lifts. Ask about whether they have had nipple death, I have been fortunate to have not lost a nipple in any lifts or reductions in my 33 years of practice. I keep the maximum tissue attached to the nipple to help keep blood supply as well as sensation. Also look at their photos to see if you like the nipple/aerola shapes and position. You can also help by having yourself in top medical shape and especially no smoking. Good luck.

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  When good technique is used, nipple necrosis is extremely rare from this type of surgery.   Make sure you specifically look
at before and after pictures of real patients who have had this surgery
performed by your surgeon and evaluate their results.   The most
important aspect is to find a surgeon you are comfortable with. I recommend
that you seek consultation with a qualified board-certified plastic surgeon who
can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.  FACS
Harvard-trained plastic surgeon

Careful planning with your plastic surgeon will address your concerns. Smoking, lift design, technique, any medical issues are important to discuss.Properly planned breast lift on a good candidate should ensure nipple areolar integrity.

hello thank you for your question and provided information as well..based on your question it is difficult to evaluate your case without photos, my recommendation is a consultation in person with a certified plastic surgeon that sees you and evaluates what you need.

The risk of nipple areolar necrosis or death is extremely low in most cases. What impacts this is how far the nipple is moved during surgery and whether internal pressure of an implant pushes on the nipple. If you are not considering implants, that removes the most common cause of nipple necrosis. Otherwise, there is nothing a patient can do to "prevent" nipple necrosis preoperatively. As for position and scarring - this depends much more on the technique. For small movements, keeping the incision around the areola only is sufficient. However, if there is considerable sagging to the breast or the nipple needs to be moved more than 1-2 inches, a lollipop or anchor scar leads to better scars because the nipple doesn't take all the tension of the repair. Most importantly, you need to find a plastic surgeon you are comfortable with. 

Hi and thanks for your questions. After reviewing your description, it seems that you potentially would be a good candidate to have a breast lift using the Bellesoma technique.    Photos and a more complete description would be helpful in order to give you the best advice about your options.  If you would like more fullness and volume, a natural fat transfer using your own tissue can be performed after your lift.  The best way to avoid problems with the nipple-areoala is to search for and choose a surgeon who has a tremendous amount of experience with breast lifts.
Bellesoma is a new breast lift technique that seems like it would be a great fit for you.  This procedure utilizes 3-D volumetric scanning and a multi-point measuring system to design a customized, precise surgical blueprint exactly tailored to your body and the lifted, perky breasts that you desire. The Bellesoma procedure reduces the sagging of your breast, lifts your breast and reduces areola diameter, preserves the nipple sensation and ability to breast feed, and looks as full and perky as if an implant had been placed without using any implant, so no need to compromise.  One of the huge positives of this technique is that there is no vertical incision traveling down the front of your breasts.  If you would like to add more fullness and volume, a natural fat transfer using your own tissue can be performed after your lift to give you the look you're wanting.
Some of the differences between Bellesoma and the traditional breast reduction/lift techniques:
-Bellesoma creates upper pole fullness and projection that traditionally needed an implant to achieve.
-There is NO vertical scar, only well-hidden scars in the fold under the breast, and around the areola.
-The breast is dynamically supported by attaching it to the muscle, so there is no recurrence of sagging which are expected with traditional lifts or reductions.
-The entire central portion of the breast is undisturbed, so nipple sensation remains intact and is very unlikely to be compromised giving the best possible chance for future breast feeding.
-For absolute best results, patients should have a stable weight and have a BMI under 30.
The procedure is accomplished by using the skin of the lower pole of the breast (the part below the nipple that sits in the bra cup) to shape the whole breast into a perky dome, then straps are made of the extra skin, anchoring it to the underlying chest muscle so that there is virtually no chance of repeat sagging.  The skin that above your nipple and below your collar bone is utilized to cover the perky, lifted dome that has been created and then a new (usually smaller) circular opening for the areola is placed at the high point of the cone, creating your new lifted, full and shapely breast.
From your description and photo, you seem to be a very good candidate for this new technique and should really get the look that you are desiring without implants or unnecessary visible scars. I would recommend that you search for an ABPS board certified plastic surgeon who is also a member of the American Society of Plastic Surgeons and the American Society of Aesthetic Plastic Surgeons in your area or an area that you would like to travel to on holiday who offers the Bellesoma technique to discuss your breast lift and possible results.
Best wishes!Daniel Brown, MD, FACSBoard Certified, American Board of Plastic SurgeryMember, American Society of Aesthetic Plastic SurgeonsMember American Society of  Plastic SurgeonsCastle Connolly Top DocReal Self Top 500