What can I do to prevent nipple necrosis after surgery?

In order to lower your risk of nipple necrosis you should have a balanced diet before and after your surgery, do not smoke, and follow your surgeon's advice carefully.  One option is to stage the surgeries where you have the implants removed in one stage and the lift done after you are healed from the first stage. There is no way to prevent nipple necrosis, but with proper management you should be able to keep the risk low.

Dear dctaurus80 this is an excellent question.

Explantation with mastopexy presents a risk of nipple necrosis, particularly if the implant was situated directly behind the mammary gland or if a capsulectomy is required. While many risk factors stem from surgical techniques, there are steps you can take to mitigate these risks.

Foremost, refrain from smoking or using any nicotine-containing products, as nicotine restricts blood flow and impedes healing. Additionally, inquire about the availability of hyperbaric oxygen therapy post-surgery, as it can aid in tissue healing and reduce the risk of complications. Lastly, diligently adhere to your surgeon's postoperative care instructions, which may include wound care, medication regimens, and activity restrictions. Following these precautions can help minimize the likelihood of nipple necrosis and promote optimal healing outcomes.

Thank you for the excellent question.   Nothing will replace in-person evaluation when it comes to providing you with good advice.  In other words, whether to lift breasts at the same time as removal of breast implants or "stage" the procedures is a decision that is best individualized.   Every patient starts out with different anatomy, different goals/expectations, as well as different  preferences…
 I have found in my practice, that when breast lifting surgery is definitely going to be necessary in order to achieve an aesthetically pleasing outcome, MOST patients prefer to have the breast lifting performed at the time of breast implant removal.   Most patients simply do not wish to undergo two operations, if avoidable.
 On the other hand, there are patients who (where safety considerations such as potential for loss of blood supply to tissues…), benefit from a two-stage approach.   For example, there are patients who benefit from the following operation: removal of breast implants and capsulectomy surgery,  if indicated based on the patient's clinical situation and examination (in the first stage).  A second stage breast lift may be more accurately planned and more safely executed.
 
  
In "borderline" cases where there is doubt whether breast lifting is necessary or not, I advise patients to undergo explantation only and to give their breasts the benefit of the doubt  before deciding whether breast lifting would be beneficial.  Patience is definitely indicated after removal of breast implants; it will take many months/year for the skin to “bounce back” and for you to see the final appearance of the breasts.
 
 As you can see, there is much to consider (which is why nothing replaces individualized care,  centered on good communication and good judgment, provided by a well experienced board-certified plastic surgeon). 
My best advice: select your plastic surgeon carefully. Make sure that he/she has significant experience achieving the types of outcomes you will be pleased with. Then, communicate your goals carefully, as well. Working together you will come up with a good plan to achieve your goals.  
Best wishes.