Scheduled for a lift with implant this week & want to back out of lift, would my surgeon do this if I asked?

Question

I am scheduled on Thursday for a mastopexy and implant. I'm becoming increasingly terrified of the potential of necrosis of the nipple. I know it's small chance but ive seen enough people on here that have experienced it and it terrifies me. I have minor ptosis (grade 1)... would my surgeon perform the implants without a lift if I asked? Do you think he would see me to discuss this week though my surgery is Friday?

Daniel Barrett, MD · Answer

Dear Creative764023,
you need to discuss this with your plastic surgeon prior to surgery. Determining whether you need simply a breast augmentation versus a breast lift 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 a breast augmentation depending on the size of the implant the patient wants. I often still using implant when I perform a breast lift because it provides more upper breast fullness after the lift. 
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Ted Eisenberg, DO, FACOS, FAACS · Answer

You should also ask your surgeon what his experience is with nipple necrosis, if any. In my experience, with hundreds and hundreds of this surgery, I have never seen this complication. Good luck. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Sean Fisher, MD · Answer

Most surgeons are very open to discussing operative plans with their patients. Reputable surgeons are not in the habit of forcing any surgery on a patient and if you voice these concerns, it is very likely he or she will take the time to discuss with you. That being said, if the recommendation was for a lift with an augmentation this was likely due to a combination of personal goals and anatomy. Assuming no prior breast surgery/prior lift etc- a single stage augmentatin-mastopexy is a safe operation if an appropriate implant is selected. While a breast augmentation alone may result in a sub-optimal result, aesthetically speaking, it doesn't mean that your surgeon will push you to have both operations performed. You could always consider proceeding with the breast augmentation alone, and if you are unhappy with the results a lift could be considered at a later date. 
Sean Fisher Aesthetic Plastic SurgeonSeattle, WA

Camille Cash, MD · Answer

The time to discuss your desire to change your surgical plan is now, not at the time of surgery.  There is much preparation that goes into your surgery.  Your surgeon needs to be aware of your concerns, discuss options with you, and then make adjustments as needed.

Connie Hiers, MD, FACS · Answer

Call his office and discuss this. Yes, you can have just the augmentation, but you will still have some sagging. You might be a candidate for minimally invasive radiofrequency skin tightening like BodyTite or Renuvion.

Mats Hagstrom, MD (license on probation) · Answer

There are a number of variables to take in the consideration for this combined procedure.
There are certain variables that can increase or decrease the risk of serious complications.
Some plastic surgeons choose to do these as separate procedures to decrease the risk of tissue necrosis.
 The complication when it happens, can be pretty devastating.
General variables that lean towards safety include healthy patients who are young and are not obese.
Any history of nicotine use seriously increases the chance of complications and active cigarette abuse is the absolute worst culprit. Most plastic surgeons will place the implant below the pectoralis muscle.
This is considered much safer than above the muscle when a lift is done in conjunction.
You should confirm this.
the amount of lift needed also adds risk.
A small lift is very safe in comparison to someone whose breast sit down by the bellybutton. 
The last variable is the size of implants used.
Especially implants with a wide diameter .
It’s generally not a good idea to change things last minute.
If you’re having concerns about your procedure, then first ask yourself if this is just general anxiety and talk to your surgeon regarding the overall risk and especially the risk variables.
If you are a young, healthy non-smoker, who has grade one droopiness with modest size implants placed below the picture, Allis muscle, the chance of you having devastating tissue necrosis is highly unlikely.
On the other hand, if you have more than a couple of the above risk factors, especially if you’re an active cigarette user, then choosing to do this as a split procedure may be wise.
My best guess is the great majority of these procedures are done as combined procedures.
It’s also probably true that most people who have significant medical complications. Don’t talk about it or post about it on the Internet so these complications do happen, but there is a strong correlation, between risk factors and having the complication.
Without knowing more variables, we can’t really give you any good advice.
Stress up to the day of surgery regarding decision-making isn’t going to change your outcome and it is probably uncomfortable and unproductive.
If you did a good job of choosing providers, and you feel comfortable with that provider Having a high degree of confidence then you should be all set.
A good plastic surgeon would know when to encourage patients to do split procedures.
In the end provider selection is by far the most important variable 
Best,
Mats Hagstrom, MD

Scheduled for a lift with implant this week & want to back out of lift, would my surgeon do this if I asked?

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