Over the muscle 600cc - need breast lift and Implant change in 2 procedures

The risk of nipple necrosis is always present with your proposed procedures. Many factors come in to play to determine how high this risk is. If two surgeons have already told you that a single procedure is not safe, then it would be wise to follow their recommendations. It is not worth losing your nipples simply to avoid the extra exposure to anesthesia.

Thank you for your question. A large portion of my practice is dedicated to breast revision. I often reposition of implants in the subpectoral location, mastopexy-breast lift and removal of breast tissue one stage. Over the years, I have developed a technique known as " reductive augmentation ". You might be an excellent candidate for this. Best wishes to you.

When a large implant is use over the muscle, most of the blood supply going from the muscle to the overlying skin is interrupted. The blood supply going to the nipple is now mostly coming from the surrounding skin. To do a breast lift, one needs to cut around the areola. If this cut is deep below the dermis and the skin has to be mobilized substantially, the blood supply to the areola and nipple will be compromised. The tension on the skin resulting from the lift will also contribute to less blood getting to the nipple. Many factors can influence the decision about doing this procedure in one or two stages. These are situations where I may consider doing the procedure in one stage. 1) If the lift is minimal and the areola doesn’t have to be moved a long distance, the dermal connection from the surrounding skin to the nipple could be mostly preserved. 2) If no capsulectomy is necessary the capsul would allow some additional blood supply to the breasts tissue and the nipple. 3) If the patient accepts a smaller implant to reduce tension in the skin closure. I hope this is helpful. Please let me know if you liked this answer and if there is any other questions.

Dear Phenomenal111817,
I understand your concern. It is best however that you consult with a board certified plastic surgeon to determine whether you can have several aesthetic surgeries in one session, as this would depend on various factors including but not limited to your general health condition, the type of anesthesia that will be used, and the type of surgeries that will be performed among others.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

The more conservative and safe thing to do would be to remove the implants and capsules if needed at one surgery and perform the lift and implant replacement at a later surgery. This may not be necessary as the majority of the revision procedures I perform are single stage procedures. There are some rare circumstances where it is feasible to stage the procedure. It really depends on the patient and the situation.

Hope that helps.

If two surgeons who have examined you recommended the procedure in two steps, then this is the safest way. The 625 cc implant is a very large and heavy implant that has thinned and stretched your own tissue. In doing the lift, the skin is cut around the nipple area so it can be raised. Many times with large implants, the main blood flow to your nipple is now through the skin since the breast tissue is thinned. If the skin is cut around your nipples, your nipples could die. Your surgeons are trying to prevent this. Do go down in size or a lift will not hold.

I do agree with the 2 doctors that you saw in that the safest way for this procedure would be to do it in stages. Nipple necrosis is a very real and serious complication. Better to do it in 2 stages and lower the risks.

Post some photos. We do lifts with implants in the same procedure just about every operative day including revision cases like yours. We use Galaflex mesh in every case for support whether over or under the muscle.

You failed to post photos??? So impossible to see what those 2 in person surgeons saw… please post photos so we can offer advice.