Breast Reduction

What are the risks of breast reduction surgery?

Your surgeon will discuss risks with you during your consultation, however, some of the common risks are listed below.

• Risks of anaesthetic – there are general risks of going under an anaesthetic such as a mild stress on the heart and lungs, risk of reaction to anaesthetic drugs and risk of blotting in the legs. These risks are generally low in patients who are otherwise fit and healthy.

• Bleeding (1-2%) – any bleeding is controlled during surgery however unexpected bleeding can occur in the immediate postoperative period. If this occurs it will necessitate a return to theatre to control the bleeding.

• Seroma (2%) – after any injury to the body the area swells. Part of the fluid that enters the area sends cells to the area that help the area heal. However excess fluid can create a fluid collection called a seroma, which can then create the risk of infection. Insertion of a drain during surgery can help reduce incidence of a seroma. Wearing compressive garments and reducing activity post-surgery also helps mitigate this risk.

• Infection (<1%) – this is very rare. However, you are given antibiotics during induction (when you are going to sleep), as well as a course of oral antibiotics after your surgery to keep this risk to a minimum.

• Poor Wound Healing (5%) – Occasionally absorbable sutures used under the skin can be rejected by the body forming a small pustule where the suture spits out. These issues usually resolve with removing the suture and dressings.

•  Nipple compromise – this is a rare but most significant complication in a breast reduction procedure. When the breast is reshaped the aim is to keep a block of breast tissue behind the nipple intact. This block of breast tissue contains the blood supply that keeps the nipple alive as well as the nerves that supply sensation to the nipple.

• There can be problems with the blood supply of the nipple, and if there has been previous surgery to the breast.

• Arterial problem – this is when there is a problem with the blood coming to the nipple and it therefore turns white. This may require the nipple to be removed and placed back as a nipple graft.

• Venous problem – this is where there is a problem with the blood returning to the body from the nipple. It gets to the nipple, and pools there therefore turning the nipple blue. This may require manoeuvres to reduce the tension on the nipple, and sometimes other adjunctive techniques to increase the blood draining from the nipple.

• The risk of these complications are much higher in patients who smoke or who are diabetic.

• Change in nipple sensation – a third of women preoperatively have reduced sensation to their nipples, a third have normal sensation and a third have more than normal sensation (hypersensitivity). Literature indicates that these ratios are unchanged following breast lift/reduction surgery.

• In most cases this should be transient and returns to normal, a process that takes up to 12 months.

• Change in the ability to lactate or breast feed: a third of normal women (who have not had surgery) have normal ability to breast feed, a third have reduced capacity (i.e. will need to supplement their feeds with formula to their infant), and a third have no capacity to breast feed. Literature indicates that these ratios are unchanged following breast lift/reduction surgery.

• If this is of great significance to you, you should either not have breast lift/reduction surgery or postpone it to when you have completed having your family.

• Widening of the nipple-areola complex – this can be a problem with a periareolar mastopexy. The most effective way of preventing this complication is to place a vertical scar in addition to the scar around the nipple (lollipop) which takes the tension off the nipple and areola.

• Asymmetrical scars – There can be a difference in how each breast behaves to the underlying implant, and can produce an asymmetry to the scars, albeit the aim is to get them as symmetrical as possible.

• Hypertrophic or poor scars – How one’s body behaves to scarring is individual and largely genetic. Some types of skin are more prone to hypertrophic or keloid scarring, and some individuals and families are more prone to this. We will routinely advise you on how to improve the quality of scars over time. You should also discuss any history of abnormal scarring with your doctor preoperatively.

• Asymmetrical nipple position and shape – due to scars on the breast, and native asymmetry of every woman’s breasts there can be a difference in how each breast behaves to the surgery, and this can produce an asymmetry to the nipple size and shape, albeit the aim is to get them as symmetrical as possible.

• Nipples too high or too low – in general at the end of a breast reduction procedure the aim will always be to have the nipples sit a little low. This is because as the breast settles, and scars relax the nipples will move up. The aim is to avoid the nipples looking too high as this can be an extremely difficult problem to correct. If long term nipples are too low this can be easily addressed though a crescenteric skin excision of skin just above the nipples, which can be performed under local in rooms.

• Unusual breast shape – it is common for the initial shape of the breast to be unusual as lower part of the breast gland and skin is tightened making the upper part look fuller and the lower part look tight. This settles as the scars relax and the breast settles. This can take approximately 3 to 6 months.

• Asymmetry

• Most women’s breasts are asymmetrical

• The aim during breast reduction is to get them more symmetrical – if required this may involve removing more tissue from one side than the other

• However, there can be small asymmetries in the final breast shape.