Nipple Blood Supply Problems After a Reduction or Lift: What Helps

Let's talk about trouble with perfusion, or blood supply, to your nipple after surgery. This came from someone going through it right now, and I'm so sorry it's happening. It's really scary.

I can't tell any one person what's going on with them. But I can tell you what we watch for, what we can do about it, and what to ask your surgeon.

After a breast reduction or a breast lift, we are always concerned with the amount of blood supply, or food, that is getting to the nipple and the areola.

The reason is simple: we make cuts during surgery that decrease the amount of food that gets there. And we want to make sure everything stays happy and healthy. (Some patients start at higher risk than others, which is part of what we plan around.)

One of the most common solutions we use when perfusion to the nipple and areola is not great is to remove the stitches.

We will actually go in and remove all of the stitches around the areola, which allows the area to have space to expand and breathe, so to speak.

In a lot of patients, this improves the blood supply, and the nipple and areola can be saved with no issue.

Here's the important limit:

• If swelling is putting pressure on the tiny blood vessels going up to that area, taking the stitches out and letting the area expand fixes that problem.
• If the problem is that the perfusion is just not good at baseline, and it has nothing to do with swelling, then this solution won't work.

We can send you for hyperbaric oxygen therapy. It can reduce swelling, and it also supercharges the blood that gets to the area with oxygen.

That's a great option for patients who have a struggling nipple after a breast reduction.

There are also two medications, both topical creams, that we can use to increase perfusion in the area. One is called nitropaste and one is called DMSO, and all surgeons have their favorites.

Placing one on the area can enlarge the blood vessels under the skin and help extra blood flow get there.

These are the same tools we reach for when skin is struggling after a tummy tuck. They are your surgeon's call, not something to try on your own.

I don't know what happened in your surgery, and I don't know exactly what you look like right now. So it's important to talk to your surgeon, and these are the questions I'd ask:

1. What do you think is going on?
2. Am I a candidate for hyperbaric oxygen or the topical medications?
3. What do you think the chances are that this is going to be okay?

I will tell you this, though:

So don't always lose hope right away. Give it some time. It can be many weeks until the area heals and we figure out exactly what is going to be salvageable.

That waiting period has its own logic, including why a dark or scabbed areola is usually left alone instead of being cut away early.

Talk it out with your surgeon. We don't want you spinning in the wind, nervous at home.

This is exactly what post-op follow-up is for, and managing a complication is your surgeon's job, not something you should be carrying alone.

• After a reduction or lift, the blood supply to the nipple and areola is what we watch most closely, because the surgery itself reduces it
• Removing the stitches around the areola often helps, but only when swelling is the cause
• Hyperbaric oxygen and topical nitropaste or DMSO are other ways to improve blood flow
• Ask your surgeon what they think is happening, whether you're a candidate for those treatments, and what the chances are
• A struggling nipple often looks terrible and still makes it, and it can take many weeks to know