A woman in her later 50s with a 44DD cup who has problems with neck pain, shoulder pain, grooving and irritation of her shoulders from the bra straps, and back pain. She is a ½ ppd smoker. Smoking and a history of smoking dramatically increases the risk of healing complications It damages the tiny blood vessels that supply the skin and can lead to larger amounts of tissue dying at the time of surgery. She was very symptomatic and wished to proceed with surgery if it was possible and an acceptable risk. I had her stop smoking for 2 months before surgery with the nicotine patch. We then proceeded with a “free nipple graft” technique. With a typical breast reduction in someone who has never smoked and doesn’t have diabetes or other reason for vascular compromise, we will try and maintain the blood supply to the nipple either from above “superior pedicle technique” from above and the side “superior-medial technique” or from below “inferior pedicle technique”. In the case of someone with a significant smoking history the small blood vessels in the tissue connecting the nipple, the “pedicle” have been damaged enough that the tissue is likely to die. In that case, a free nipple graft is done, where the nipple is removed completely and replaced like a skin graft. Because it is thicker, it will become scabby and blister and generally not look very attractive in the first 6-8 weeks. But then it generally heals and allows us to proceed in someone with a smoking history and with fewer potential complications
Cosmetic & Plastic Surgery Specialist
"I treat my patients like I would treat
- Jonathan D. Hall, MD, FACSmembers of my own family."
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