Will going submuscular with implants improve nipple blood flow?

Question

Hello I hope you're well. I have had some consultations for a breast enlargement, and it turns out I need a lift at the same time. The surgeon will be using the lollipop incision with L 350cc R 300cc, high profile, totally smooth silicone implant, dual plane. I have just discovered the risk of nipple necrosis due to lifts+implants and I am terrified! Does the procedure I'm having carry high risks of nipple necrosis? I'm wondering if going dual plane will help? I don't know how it works but does putting the implant submuscular disturb the bloodflow/blood vessels in the breast tissue less? Or is it the lollipop scar which is the most risk for necrosis due to disturbance of the tissue in that area? What can I do during recovery to promote blood flow to the nipples? Are there any other major complications I should know about and do they have methods to prevent them? Thank you so much in advance! x (I forgot to mention, I am a full C cup currently aiming for DD with heavy breast tissue which has made them slightly sag which is why the lift is needed I think. The lollipop scar is for a slight bit of tubular breasts, my nipples go cone shaped when warm so this is to make them smaller/less puffy/make the breasts look more round)

Gary M. Horndeski, MD · Answer

Unfortunately, you have not provided photographs. However, I recommend a breast lift using the Bellesoma. This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained. Later, fat transfers or small implants can be placed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Daniel Barrett, MD · Answer

Dear turtle123451231,

I almost always place implants submuscular. It lowers the rate of capsular contracture significantly. In addition, it looks much more natural because the muscle provides covering over the implant so its not as round on the top. I've also noticed the implants drop less over time when they are protected under the muscle.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Ted Eisenberg, DO, FACOS, FAACS · Answer

Nipple blood flow; I have only gone dual plane for initial cosmetic breast augmentation and/or with a lift. In my experience, I tell my patients, "it is rare to have a permanent  decrease or loss of nipple sensitivity" and no one has lost their nipple. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Kadir Berat Oyur, MD · Answer

The concerns you are raising regarding globe prominence versus a lack of infraorbital support are very insightful, and in your case, it appears to be a combination of both rather than one isolated issue. Based on your photos and the CT scans, there is a degree of true globe prominence (morphologically known as a "negative vector" relationship), where the eye sits forward relative to the cheekbone; however, this is significantly exaggerated by the lack of structural volume in the infraorbital rim and tear trough area. If you were to pursue eyelid surgery or ptosis repair alone without addressing the foundation, you would risk further "skeletonizing" the eye or worsening the retraction, as the soft tissue still wouldn't have a stable shelf to rest upon. A more balanced, long-term approach typically involves using infraorbital implants or custom malar implants to build up that recessed bone structure first, which provides the necessary support for the lower lids and naturally creates a more recessed, harmonious, and "supported" appearance for the eyes without the high risks associated with more invasive orbital decompression.

Semih Yildiz, MD, FEPOBRAS · Answer

Nipple necrosis after a breast lift with implants is uncommon, but it is a real risk and should be discussed directly with your surgeon. In my experience, the implant pocket alone is not the main factor; blood supply depends more on the lift design, nipple position, amount of lifting needed, tissue thickness, implant size, closure tension, nicotine use, prior surgery, and medical risks such as diabetes or vascular disease.
A dual-plane pocket can help with shape and coverage, but it does not automatically protect nipple blood flow. A lollipop scar is also not the only issue; the key is preserving the nipple blood supply and avoiding excess tension. Avoid all nicotine, follow your surgeon's bra and activity instructions, and if after surgery you notice severe pain, rapidly increasing swelling, dusky or black skin, drainage, or worsening redness, contact your surgeon immediately or seek urgent care.

Will going submuscular with implants improve nipple blood flow?

Answers (5)

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