I'm 25, exercise daily, eat health, never drink or smoke. Areola necrosis after crescent breast lift. (Photos)

Question

I had 275cc silicone breast augmentation through an inframamary incision and crescent breast lift to correct tuberous breasts. I experienced skin necrosis on my right areola. I was thinking of a donut lift after healing to decrease the huge areolas. Does the fact that I had skin necrosis once mean that I will have again? Can it be the doctor 's fault? Thank you in advance.

Gary Lawton, MD, FACS · Answer

A lift with an implant is controversial for two reasons.  First, when you perform a lift you are making everything tight and closing the wounds under tension.  It you add the expansive forces of the implant at the same time, you are fighting against yourself.  There are forces on the wound which try to make them separate, which results in wider, thicker, more irregular scars.  In the worst case, the wounds will open.  So compromises are usually made in the operating room by the surgeon because they cannot close the lift wounds over the appropriate sized implant.  Either less of a lift is performed so that the skin is not as tight and therefore there is less tension on the closure.  Or a smaller implant than would be appropriate is used so as to decrease the expansive forces.  Either way, you are compromising the aesthetic outcome.  Often the outcome is so compromised that a second revision surgery is required.  If however, you plan to have the lift first and then the augmentation after everything has healed, then you have two operation that are planned, both with much lower risk than the combined mastopexy/augmenation.  The outcomes of the two meticulously planned operations are much better and a more aesthetically pleasing, and a safer outcome is achieved.

The second reason the combination of mastopexy and augmentation is controversial is because of the risk of nipple necrosis (death of the nipple).  By making the skin tight for the lift, you are putting external pressure on the veins that supply the nipple.  By putting an expansive force on the undersurface of the breast with an implant, you are putting pressure on the thin walled veins that supply the nipple.  If the pressure by squeezing the veins between the implant and the skin is greater than the venous pressure in the veins, the flow will stop.  If the venous outflow stops, the arterial inflow is stopped.  If the arterial inflow is stopped, there is no oxygen for the healing wounds and the tissue dies.

Placing the implant on top of the muscle in combination with a lift puts the blood supply to the nipple at a much higher risk because in addition to the issue of pressure on the veins, you have to divide the blood vessels that are traveling from the pectoralis muscle directly into the breast (and to the nipple) in order to place the implant between the breast tissue and the muscle. This adds a third element of risk to an already risky operation.  Mastopexy/augmenation with sub glandular implant placement is by far the riskiest way to address your anatomic question.

Jed H. Horowitz, MD, FACS · Answer

The patient will go home in a bra or with only light dressings over the incision lines. Sutures are dissolvable but an ending knot, if present is removed within 1-2 weeks. Initial discomfort is easily controlled with oral medication. Light activities may be started in 7-10 days.Over time, gravity will continue to have an effect and the breast skin will tend to stretch. The degree of #stretching and #sagging varies between women: generally, women with smaller breasts experience less recurring sagging. If sagging does occur, further excision of the skin on an outpatient basis can be used to correct the problem. Heavy and large breasts may lead to recurrent sagging and may require the removal of a small amount of breast tissue to achieve an optimal shape and size. One key to a satisfying result is realistic expectations.All surgical procedures carry some degree of risk Any breast operation can result in changes in sensation. This happens less with lifts than reductions but is still possible Occasionally, minor complications occur and do not affect the surgical outcome. Major complications associated with this procedure are rare. The suitability of the breast lift procedure and specific risks may be determined during your consultation. #Hypertrophic or #keloid scars can be a problem. The worst are usually under the breast with an #AnchorLift or inverted “T”. These can be treated like all thickened scars with re-excision, laser, kenalog/5-FU injections, creams, silicone strips and other methods to reduce and improve healing.The best thing to do if there are concerns or questions about your feelings since the procedure would be a follow-up with your surgeon to have the area examined and make sure that healing is progressing well. While there are a number of risks at potential, as well as swelling, bruising and pain that can last for several months, it is best to remain in close contact with your surgeon throughout the healing process. Good luck.

Dallas Buchanan, MD · Answer

Thank you for your pictures and questions. Sorry to hear you are having problems. Skin necrosis is a known complication of this type of surgery. Although you are correct in that this type of complication is increased in those who smoke or have other medical problems, it can also happen in those that have no risk factors. So I would not try to jump to the conclusion that this is the surgeon's fault.I would follow your surgeon's instructions regarding ongoing wound care and let the area heal. Once it is healed and the scar has completely settled (often one year from the time of surgery), you can consider scar revisions or additional procedures to reach your ideal goals.The only other thing you can do is make sure you are seeing a qualified surgeon. Make sure your surgeon is board certified by the American Board of Plastic Surgery and has experience with procedures such as these. If you did not choose a board certified surgeon for your first surgery, then I would consider at least a consultation with one before having another procedure.Best of luck!

Curtis Wong, MD · Answer

come with minimal to no risks but if you operate enough, every surgeon will have his/her share of such events.  With an inframammary approach, there should be no risk to your implant so heal and then critique your results and let your surgeon offer you options from which you can choose to help you get the best outcome possible.

Gary L. Ross, MBChB, FRCS · Answer

Areola necrosis can happen in the best of hands and you need to wait at least 6-12 months before considering a scar revision. you may find that this heals well with minimal scarring and you may not need further surgery. you need to stay in contact with your PS while things are healing.

I'm 25, exercise daily, eat health, never drink or smoke. Areola necrosis after crescent breast lift. (Photos)

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I'm 25, exercise daily, eat health, never drink or smoke. Areola necrosis after crescent breast lift. (Photos)

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