Breast uplift & implants - what are the risks of blood circulation issues if breasts are sagging lower than recommend? (Photo)

Question

Hi I’m 34 years old looking at havjng a breast uplift with implants i have spoken to a surgeon who would do a uplify with implants for me but i have to measure 35cm or less drop from my collar bone to my nipple to reduce the risk of having my blood supply to my nipple as an issue. I am bordering just over the 35cm drop from the sag from my breasts basically what is the % chance of me getting the issue with the blood circulation if I opted to have the implants with the lift due to this? Thanks

Finny George, MD · Answer

Hi, thank you for sharing your question. While your surgeon is correct that this combined surgery has certain risks, it can be done safely without compromising the circulation to your nipples. Careful planning, proper implant selection and following postop protocols will help minimize that risk.

Jacob Carlson, MD · Answer

I would agree with your surgeon that an augmentation can be done with a breast lift, BUT in your case, I would recommend staging the lift and the augmentation into different procedures. I think you will achieve a better, more predictable aesthetic result if these are performed at different times.
The nipple-areolar complex (NAC) receives its blood supply from several different vessels, but it's main blood supply is usually from the internal mammary arteries, which start near the center of the chest. The blood flows from the center of the chest all the way down to the nipple-areolar complex. In a breast lift, that blood supply has to be preserved to maximize perfusion to the nipple-areolar complex, but obviously the whole purpose of the lift is to bring the NAC and breast tissue up. In order to lift those up, that blood supply can become twisted, placed under tension, or just simply not be adequate enough to supply the NAC.
Doing an augmentation at the same time adds another confounding factor because that increases the tension that is placed on the NAC once it is lifted and adds another step to the surgery where that blood supply might become injured.
It's difficult to quantify that risk with a percentage, because there are a lot of factors during surgery that can affect it. There are also patient factors that need to be considered (smoking history, obesity, diabetes, and prior radiation, etc.). If you proceed with a breast lift first, your surgeon can focus on achieving the lifted appearance to the breasts, minimize the risk of having any complications related to the NAC, and set you up beautifully for a second stage breast augmentation.

Donovan Rosas, MD · Answer

A lift is accomplished by isolating the nipple/areola on a pedicle which is an island/tongue of protected tissue. This "pedicle" will provide vascularity to the breast after reduction/lift.

The pedicle can be oriented in several directions depending on surgeon preference/patient anatomy. The pedicle length is typically defined by the interval between where the nipple sits (distance from sternal notch to nipple) and the planned relocation/lift (at/or above the fold). The longer the distance the greater the risk of vascular compromise.

With regards to your specific question, while it is not possible to offer a specific % risk of compromise, distances SNN distances greater than 40 cm is typically a source of concern. Anecdotally, 35 cm is not a distance that is a cause for particular concern. However, surgeon preferences will vary.

It is also important to understand, the addition of an augmentation does increase the risk of surgical complications, generally speaking. If there is concern for compromise, these procedures can be staged...beginning with a lift and following with an augmentation.

As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Waylon Zeng, MD · Answer

Hi there, thank you for the question and thank you for sharing your photo. Given your measurements and photo, implant placement at the time of a breast lift would not be a good idea. This is due to several factors:1. Nipple blood supply, high likelihood of nipple necrosis2. Issues with controlling the "pocket" to contain the implant in the right position3. Overall shape of the breast
The best and safest way to manage this would be perform a lift first, allow your body to recover, and then place the implant as a second stage.

Breast uplift & implants - what are the risks of blood circulation issues if breasts are sagging lower than recommend? (Photo)

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