Dr. Robert Whitfield (YouTube, Apr 4, 2024) explains how breast explant combined with mastopexy (lift) is performed and how the nipple–areolar complex (NAC) is managed. He emphasizes that in his practice the NAC is not removed and is left attached to preserve blood supply; reshaping uses vertical ("lollipop") mastopexy when significant lowering is present. He describes removal of implants and capsules (to reduce biofilm and potential malignancy spread), gives a guideline measurement for NAC position (about 17–20 cm from the sternal notch to the NAC), and outlines postoperative therapies (hyperbaric oxygen, lymphatic massage, red-light therapy, and a gluten-free/dairy-free, high-protein diet).
Questions this video answers
April 4, 2024
Approximately 17–20 centimeters (notch to nipple/areolar edge).
About one third of patients (surgeon's report).
No — in his practice the NAC is not removed; it is left attached to preserve blood supply.
Chapters
Hey, everyone, it's Dr. Whitfield. Today we're going to talk about breast lifts and how they relate to explant surgeries that we do. We get a lot of questions that ask me, do I actually take the areolar nipple complex actually off and then put it back on. So for everybody listening, I think when we do simultaneous explant lift, fat transfers, any of those combinations, we're really trying to execute a series of steps so that we get really more balance. And so those can be difficult variables because when you're trying to execute basically an explant, you're doing a reduction here instead of breast tissue, reducing the actual breast form. By removing the implant, we remove the capsular material as well. We've had a handful of patients have breast cancer, lymphoma. We have about a third of our patients have biofilm. So we want to take all the material out intact. Each time we put it all, all possible that helps protect the patients from biofilm that can be spread throughout the pocket or cancers. That's one element. Now, when we're trying to reshape the breast, it depends on how much breast tissue each patient has. When we're trying to get the areolar nipple complex positioned on the chest so that it's higher, that's done a certain way. So depending on each patient's skin, where the nipple areolar complex sits, how much sag there is, how much volume there is, how big the implant is, we have to discern what combination of procedures will help that patient. If we're taking, for instance, a patient has really low set nipple areolar complex, you want the nipple areolar complex to actually line up to where the breast fold should be. If you can't actually tell where that is because it was arbitrarily lowered during the breast augmentation procedure, you can make measurements and give an estimate, typically between 17 and 20 centimeters, depending on the patient, from the notch to the edge of the ruler complex, this will help give you a guide. If once again, you can't tell due to the distortion of the anatomy. When that's evaluated, if the nipple complex is significantly lower than that, then a vertical lip that leaves the lollipop scar is typically what we would recommend that allows you to lift the nipple are the complex. You do not, in the course of that procedure, ever remove the nipple complex itself. You simply are removing the top layer of skin around it. You're not damaging any of the tissues. You're simply going to just gently take the top layer of skin off around it. That allows you to help reposition it. Because all the repositioning for the most part, we're going to do through the lower portion and when we get a change in the position and remove that skin and then suture the tissues together, it also helps cover up the chest wall, which are many of my patients, just because they're already relatively thin and that's why they got implants in the first place. We want to make sure we do our best to cover that up. The other issue is once we get that closed and we're adding fat back, we want to fill in the upper 2/3, the cleavage area. And we don't want to really create more of a presence of tissue out into the side of the patient. So we don't want to try to create side move, if you will. Any patient's going to be complaining of how far their implant sticks out or that it's too big, it's bigger than they anticipated or discussed prior to the procedure, which is obviously disheartening to hear. So there are a lot of factors that go into doing an explant and a lift procedure at the same time. But as it pertains to the nipple ruler complex, we do not ever take that off in our practice. We always leave that attached. We want to preserve the blood supply to it. We don't want to cause damage to it. And then after surgery, of course, in our program, you come to our office and have hyperbaric oxygen treatments, you have lymphatic massage, red light therapy, and these are all ways to help to speed the process along, get you recovering faster, along with a gluten free, dairy free diet high in protein. All right, So I think that puts to rest taking the nipple off and on discussion, I have until next time.
