Was Told there was a Risk of Losing my Nipples if I Had Second Breast Reduction, is this Likely?

I had this surgery 30 years ago and do not have any of the medical records or even remember the surgeon's name. I am considering this surgery again and was advised at a consult that I would be at risk of losing my nipples as blood supply might be lost. I very much want to have the surgery but am concerned. I am 55 years old. Would this be dangerous to pursue? Thank you!

Doctor Answers 7

Secondary Breast Reduction Risks

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An examination by a board certified plastic surgeon experienced in secondary surgeries would be required. Often, the location and type of scarring tells the surgeon the most likely surgical approach used previously. Your position is not unique and in most cases revisional surgery is possible without complications.

Here is an overview of complications that can occur with breast revisional surgery

The specific risks and suitability of this procedure for a given individual can be determined only at the time of consultation. All surgical procedures have some degree of risk. Minor complications that do not affect the outcome occur occasionally. Major complications are rare. In general there are comlications that apply to surgery just about anywhere such as : excessive bleeding, unsightly scars, pain, fluid collection (seroma) beneath the skin, wound separation, infection,etc.

Then there are complications specific to the breast reduction such as: nipple sensation change/loss, fat necrosis (hardening of breast tissue), breast asymmetry, all of which may require revisional surgery.

Nipple loss after repeat breast reduction

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Certianly there is an increased risk of nipple necrosis after a repeat breast reduction, however there are a series of measures that can be taken to maximize the viability of the nipple during  reduction.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Nipple necrosis in repeat breast reduction

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Nipple necrosis is a recognized risk of breast reduction surgery. The risk increases in a repeat operation. It is impossible to ascertain whether nipple grafting surgery, which has its own risks, would be better for you. TThis would depend, in part on the breast size and the current nipple heights.

Repeat Breast Reduction?

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Thank you for the question.

It sounds like you have been well-informed of the potential problem with blood supply when a redo breast reduction is performed.

The concern is related to blood flow to the remaining breast tissue;  is important to perform the operation in such a fashion that the blood flow to the nipple/areola/breast tissue is not compromised.   The  part of the tissue that is left in place  after breast reduction surgery is called the “pedicle"; this segment of tissue is responsible for delivering the blood supply to the nipple/areola/ breast tissue. If the pedicle (that was used during the previous breast reduction procedure)  is cut  then the blood flow to tissues may be compromised leading to serious complications such as tissue necrosis etc.

On the positive side, his surgery was done 30 years ago;  there is a good possibility that the blood flow that had been previously divided may have reconstituted to some degree.

Nevertheless, you will have to make a informed decision weighing the pros and cons of further breast reduction surgery

Best wishes.


Secondary breast reduction, risk of nipple loss

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The situation you describe is one most plastic surgeons encounter fairly frequently.  The risk of nipple loss your plastic surgeon advised you of is real and exists with all breast reduction or lift surgery.  The risk is probably slightly higher in secondary surgery, particularly if the second surgeon doesn't know what surgical technique was used the first time round. Having said that most surgeons do secondary surgeries like this regularly, I've done many such surgeries and have not  had a patient lose the blood supply to her nipple.  Like all plastic surgery there are risks involved and your decision to proceed should always be a balance between your motivation to have the surgery and what degree of risk your surgeon tells you is involved in the surgery. Good luck with your decision.

Nicholas Carr, MD
Vancouver Plastic Surgeon

Breast reduction with free nipple grafts is a very safe option.

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1)  I think you can definitely have another breast reduction.  If the nipples don't have to be lifted very much, a conventional lift with a lollipop scar should work just fine.

2) If the nipples do have to be lifted a lot, then I would recommend a free nipple graft breast reduction.  Then the blood supply to the nipples is not an issue at all.  The only disadvantage is that you often lose erotic sensation in your nipples.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Risk Of Tissue Necrosis Is Greater With Second Reduction

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There is an increased risk of necrosis and other wound healing problems with a secondary or repeat breast reduction.  The reason is that there are two separate episodes of interference with and reduction of the blood supply.  This may be seen in nipple-areolar loss or loss in other areas.

John Whitt, MD (retired)
Louisville Plastic Surgeon

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.