What can I do to prevent nipple necrosis after surgery?

Question

I would like to have an explantation with mastopexy. I read that circulation to the nipple tissue can be impaired. Is there anything I am do preoperatively to minimize the risk?

Luis Villar, MD, FACS · Answer

There is nothing you can do to PREVENT nipple necrosis.  It is a risk of surgery.  But you can improve your chances and lower the risk.  Do not smoke. Pick a very experienced surgeon after interviewing at least three.  Avoid combining an implant insertion at the same time as a mastopexy.  These operations are the enemy of each other, stretching and shrinking.  Make sure your surgeon places drains during surgery.  Do not combine multiple lengthy surgeries.  Keep total operative time under 4 hours. These precautions will lower the risk but not eliminate it.
We have not lost a nipple in 40 years following these rules, but maybe we are just lucky?

Jose Telich, MD · Answer

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.

Jed H. Horowitz, MD, FACS · Answer

hello dctaurus80I would advice you visit or contact your plastic surgeon about this concern. #necrosis #mastopexy

Gary M. Horndeski, MD · Answer

I
do approximately 1 explantation with mastopexy per month and the technique I
use is The Bellesoma Method.  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 and the ability to breast feed are maintained, if not injured
during your previous surgery.  After
implantation, the breast below the level of the nipple is stretched thin.  Vertical scar techniques cut through this
thin tissue and damages the circulation of the nipple.  You do not want to smoke or wear a
compressive garment, which will interfere with circulation.  Best Wishes,Gary Horndeski, M.D.

Daniel Barrett, MD · Answer

Dear dctaurus80,If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.Daniel Barrett, MD

Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

James Knoetgen, III, MD · Answer

Nipple necrosis, while rare, can occur after certain surgeries, particularly breast surgeries such as breast reduction or breast lift. Here are some steps you can take to minimize the risk of nipple necrosis:
1.	Choose an Experienced Surgeon: Select a board-certified plastic surgeon with extensive experience in the specific procedure you're undergoing. A skilled surgeon can minimize the risk of complications.
2.	Quit Smoking: If you smoke, it's crucial to quit before surgery and avoid smoking during the recovery period. Smoking reduces blood flow to tissues, increasing the risk of complications such as necrosis.
3.	Follow Preoperative Instructions: Your plastic surgeon will provide specific instructions to prepare for surgery. This might include avoiding certain medications or supplements that can increase bleeding risk.
4.	Maintain a Healthy Lifestyle: Eat a balanced diet and maintain a healthy weight. Good nutrition supports proper healing and reduces the risk of complications.
5.	Avoid Excessive Pressure: After surgery, avoid putting excessive pressure on the breasts. This includes wearing tight bras or clothing that may constrict blood flow to the area.
6.	Follow Postoperative Care Instructions: Your plastic surgeon will provide detailed postoperative care instructions. Follow these carefully, including wound care protocols and attending follow-up appointments.
7.	Monitor for Signs of Complications: Keep an eye on your surgical site for any signs of infection or impaired healing, such as increased pain, redness, swelling, or drainage. Promptly report any concerns to your plastic surgeon.
8.	Stay Hydrated: Proper hydration supports overall healing and circulation. Drink plenty of water unless otherwise directed by your plastic surgeon.
9.	Limit Physical Activity: Avoid strenuous activities or heavy lifting as recommended by your plastic surgeon during the initial stages of recovery.
10.	Ask Questions: Don't hesitate to ask your plastic surgeon any questions or express any concerns you may have before or after surgery. Clear communication can help ensure that you receive the best care possible.
Remember, while these steps can help reduce the risk of complications like nipple necrosis, it's essential to follow your plastic surgeon's guidance closely throughout the entire surgical process.

Tom J. Pousti, MD · Answer

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.

Milind K. Ambe, MD · Answer

Like the other surgeon said, there isn't much you can do before surgery other than do NOT smoke and select a board certified plastic surgeon who performs a lot of breast explantations with mastopexies.  Then follow their instructions post operatively and you should be fine.  Hyperbaric oxygen treatments right before and after surgery can also help. Best of luck to you

Camille Cash, MD · Answer

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.

Melinda Haws, MD, FACS · Answer

I agree with others DO NOT SMOKE. if you smoke, quit 30 days before surgery.  If you are a diabetic, keep your blood sugars in tight control.  Pick a board certified plastic surgeon who can tell you what to expect if you get nipple necrosis. If we have been in practice long enough, all of us have seen at least a partial nipple/areola necrosis, and we fear it. Pick a board certified plastic surgeon with a special interest in breast surgery and then follow their post op instructions.

What can I do to prevent nipple necrosis after surgery?

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