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Breast Reduction - Potential Risks & Complications

What Are the Risks and Complications of Reduction Mammoplasty?

As with any major surgery, your risks are higher if you have diabetes, poor circulation, heart, lung or liver disease, if you are a smoker or have a family history of blood clots. Your cosmetic surgeon will want to assure that any medical conditions have been treated, and optimized, before you can consider having a Breast Reduction.

Infection
The risk of wound infection is less than two percent. Most patients receive intravenous antibiotics during surgery and antibiotic medication after surgery, which minimizes this risk. Sometimes accumulated of blood (hematoma or seroma) can become infected, requiring drainage and further coarse of antibiotics. In extremely rare instances, life-threatening infections, including toxic shock syndrome have been noted after breast surgery. Individuals with an active infection in their body or weakened immune system should not undergo breast surgery.

Bleeding
While this is unusual, it is possible to experience a bleeding episode following surgery. If this occurs, emergency treatment to drain accumulated blood, or a blood transfusion, may be required. You can reduce this risk by not taking any aspirin or anti-inflammatory medications for ten days before or after surgery. Non-prescription "herbs" and dietary supplements can also increase the risk of bleeding. The risk of major bleeding, or blood collection, is only about three percent. Most women lose about two test tubes of blood during surgery. Any blood clots that form must be removed in a later surgical procedure.

Hematoma & Seroma
Sometimes blood in the depth of the breast tissue can accumulate and form a blood collection, called a Hematoma. Seroma is a fluid that arises from the breakdown of accumulated blood or Hematoma. In cases with extensive dissection and manipulation of the breast tissues, most plastic surgeons place a drain in the depth of the breasts to remove accumulated blood and fluid and thus prevent formation of a seroma. After drains are removed, this fluid may re-accumulate in the breasts, especially following trauma or vigorous exercise. Additional treatment may be necessary to drain the accumulation of fluid from the breast.

Pain
As is the case with any major surgery, a Breast Reduction involves pain. Most women say that the pain is greatest in the first 48 hours after surgery. However, this will be minimized by the prescription that your cosmetic surgeon will prescribe before you go home. In very rare cases there are some women that develop chronic or long-term pain that will require further treatment.

Scarring
All surgeries of the breast involve some scarring, which is permanent but will fade with time. People scar differently, and some women are more delicate than others. All scars appear red and lumpy at first. Also, some ethnic groups are prone to the formation of thicker scars. Your pattern of scarring in the past could be a good predictor of how you will scar following a Breast Reduction. In most women, the scars will be less noticeable within one year. In rare cases, scars may require surgical revision or treatment. Poor healing and scarring are more common in smokers.

As a rule, your cosmetic surgeon will place incisions in areas that can be covered by a bathing suit or under garments.

Change in Nipple and Skin Sensation
After breast surgery, it is normal to experience temporary numbness of the skin and the nipples. This usually resolves from six weeks to six months. During this period you may even experience a period of increased sensation or hypersensitivity that can be treated with massage. Permanent partial or complete loss of nipple and skin sensation can occur following a Breast Reduction in one or both nipples. This can depend on the extent of breast surgery. However, since the plastic surgeon doesn't detach or remove breast tissue, nipple sensation is usually preserved. In general, the incidences of partial or complete loss of nipple sensation are each about 10%.

Asymmetry
As is true in nature, no two breasts are identical. This is even more common with sagging breasts. After Breast Reduction surgery, there is a period of healing and settling of the breasts. During this period breasts with different extent of sagging and laxity will settle at different rates. Therefore, it is very common to see some differences early on during the healing period. Afterwards, there may appear some slight differences between your breasts but it should be no more pronounced than that which would happen in breasts naturally. In some cases, additional surgery may be performed to improve symmetry.

Fat Necrosis
There is a risk that small areas of fatty tissue deep within the breast might die. Sometimes, this causes hardness within that area of the breast that may be mistaken to be breast lumps. Mammogram can help differentiate between the two. In some cases, removal of fat necrosis through surgery may be necessary. Smokers have an increased risk of skin loss and wound healing.

Delayed Healing
Wound disruption or delayed wound healing is possible. Some areas of the breast skin or nipple region may not heal normally and may take longer to heal. This is especially common at the junction of the Inverted-T incision. Usually, these will heal without any sequel over several weeks.

Areas of skin or nipple tissue may die. This may require frequent dressing changes or further surgery to remove the non-healed tissue. Individuals who have decreased blood supply to breast tissue from past surgery or radiation therapy may be at increased risk for wound healing and poor surgical outcome. Smokers have a greater risk of skin loss and wound healing complications.

Sutures
Most surgical techniques use deep sutures. You may notice these sutures after your surgery. Sutures may spontaneously break through the skin, become visible or produce irritation that requires suture removal.

Nipple-Areola size and shape
Following Breast Reduction the size, shape, and position of the nipples will not be identical as it is true in normal breasts. Depending on the skin elasticity of the two breasts, one areola might stretch more than the other after a surgery.

Recurrent Ptosis
The breast skin and tissue continue to change with age, with gradual loss of its elasticity. Breasts continue to age and sag with time even after surgery. Those who have breasts with sun damaged thin skin and stretch marks, or those after weight loss, or with inherently poor elasticity are at a higher risk of developing recurrent sagging (ptosis) early on. In this group there is also a relatively high incidence of "bottoming out" of the breasts. Under this circumstance the weight of the breast tissue can stretch out the lower breast skin causing the majority of the breast tissue slides below the level of the nipple, making it appear that the nipple is sitting too high on the breast.

Skin Discoloration/Swelling
Bruising and swelling normally occurs after a Breast Reduction. The skin in or near the surgical site can appear either lighter or darker than the surrounding skin. It is very rare, however, for swelling and skin discoloration to be permanent.

Allergic Reactions
In rare cases, patients may experience allergies to tape, suture material and glues, blood products, topical preparations or injected agents. Sometimes these reactions also, rarely, include systemic reactions such as shock from drugs used during surgery and prescription medicines.

Anesthesia Reactions
All anesthesia, local or general, involves a risk of complications, injury and even death. You should interview your cosmetic surgeon thoroughly about the kind of anesthetist that he or she employs. While many surgeons use nurse anesthetists, the safest option is a physician who specializes in anesthesia. This is particularly true when the surgery is performed in a surgical facility other than a hospital. A physician anesthetist is better qualified to address any complications that may arise.

Future Pregnancy and Breast Feeding
It is possible that pregnancy will cause your breasts to enlarge and your breast skin to stretch. Therefore it can offset the Breast Reduction results.

As a general rule a Breast Reduction or any breast surgery that involves rearrangement of the breast tissue can affect a woman's ability to breast feed. Because during breast reduction the nipple is generally not detached or separated from the milk glands, there is a reasonable chance of preserving breast feeding ability.

Emotional Changes
Your cosmetic surgeon will advise you that the change may feel very dramatic to you, and you may need some time to adjust to your new look. In many cases, however, the almost immediate relief from medical problems and the emotional traumas that accompany overly large breasts is a source of happiness for patients. The level of patient satisfaction from Breast Reduction surgery is among the highest of all plastic surgery procedures.

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Dr. Sean Younai
is a Board Certified Cosmetic Plastic Surgeon, who practices in Encino, Los Angeles, Southern California.
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