1. Asymmetry – Some breast asymmetry naturally occurs in most women. Differences in terms of breast and nipple shape, size, or symmetry may also occur after surgery. Additional surgery may be necessary to revise asymmetry after a reduction mammaplasty. Additional surgery may not completely correct asymmetry.
2. Change in Nipple and Skin Sensation – You may experience a diminished sensitivity, total loss of sensitivity, or hypersensitivity of the nipples and the skin of your breast. With some techniques, and after several months, many patients regain normal sensation. Nipple graft techniques remove the nipple and replace it as a skin graft. With this technique, sensation will be lost, as well as the possibility of breastfeeding. Changes in sensation may affect sexual response or the ability to breastfeed a baby.
3. Breastfeeding – Breast milk is the best food for babies. If a woman has undergone a breast reduction using a nipple graft technique (nipple removed and replaced as a graft), it is unlikely that she will be able to breastfeed. Pedicle and liposuction techniques may be able to spare the breast ducts and it may be possible to breastfeed after such breast reductions. It is unknown whether you will be able to produce sufficient milk to nurse a baby, even with use of these techniques.
4. Unsatisfactory Results – Although good results are expected, there is no guarantee or warranty, expressed or implied, as to the results that may be obtained. You may be disappointed with the results of reduction mammaplasty surgery. Asymmetry in nipple location, unanticipated breast shape and size, loss of function, wound disruption, poor healing, and loss of sensation may occur after surgery. Healing may result in a lost nipple requiring further surgery and reconstruction. There is no way to predict the final breast size (bra cup size) after surgery. It is possible that the breast may be smaller, but the bra cup size may not change. Unsatisfactory surgical scar location or visible deformities at the ends of the incisions (dog ears) may occur. Liposuction may be necessary to thin breast tissue that is outside of the normal surgical location for reduction mammaplasty. It may be necessary to perform additional surgery to attempt to improve your results. Some techniques remove the ability to breastfeed. Unsatisfactory results may NOT improve with each additional treatment.
5. Breast Disease – Breast disease and breast cancer can occur independently of reduction mammaplasty surgery. Individuals with a personal history or family history of breast cancer may be at a higher risk of developing breast cancer than a woman with no family history of this disease. It is recommended that all women perform periodic self-examination of their breasts, undergo routine mammography according to Cancer Research UK guidelines, and seek professional care should a breast lump be detected. In the event that suspicious tissue is identified prior to or during breast surgery, additional tests and therapy with corresponding expenses may be warranted.
6. Wound Healing Issues – Even in excellent surgical candidates, the surgical incisions may not heal appropriately, leading to poor scarring, asymmetry, unsatisfactory results, and/or the need for further surgery. The skin, the nipple, or the fat inside the breast may die (skin, nipple, and/or fat necrosis). This may leave an unsatisfactory result and may require further surgery. If fat inside the breast dies (fat necrosis), this may leave a hard lump in the breast. You and your Consultant may opt to remove this hard lump. Additional surgery may not restore the breast to "normal."
7. Nipple and Areola Necrosis – While very rare, it is possible for the areola (area around the nipple) and nipple to have poor blood flow after surgery that may result in the death of the tissue. This will result in a wound and delayed healing. The nipple and areola may be reconstructed if necessary. Nipple graft techniques, in which the nipple is completely detached and repositioned as a skin graft, carry a higher risk of partial or total graft failure compared to pedicle techniques, where the nipple remains attached to underlying tissue with an intact blood supply.
8. Long Term Results – It is not possible to predict how pregnancy, weight change, and aging will affect the results of a breast reduction. If you are considering significant weight reduction or pregnancy in the near future, breast reduction surgery may be postponed to avoid possible undesirable effects and late unsatisfactory results.
General Risks of Surgery
9. Healing Issues – Certain medical conditions, dietary supplements, and medications may delay and interfere with healing. Patients with massive weight loss may have a healing delay that could result in the incisions coming apart, infection, and tissue changes requiring additional medical care, surgery, and prolonged hospitalisations. Patients with diabetes or those taking medications such as steroids on an extended basis may have prolonged healing issues. Smoking will cause a delay in the healing process, often resulting in the need for additional surgery.
10. Skin Laxity – Patients with significant skin laxity will continue to have the same lax skin after surgery. The quality or elasticity of skin will not change, and recurrence of skin looseness will occur at some time in the future, more quickly for some than for others. There are nerve endings that may be affected by healing scars from procedures. While there may not be a major nerve injury, small nerve endings may become too active during the healing period, producing a painful or oversensitive area due to the small sensory nerves involved with scar tissue. Often, massage and early non-surgical interventions resolve this. It is important to discuss postsurgical pain with your Consultant.
11. Bleeding – It is possible, though unusual, to experience bleeding during or after surgery. If postoperative bleeding occurs, it may require emergency treatment to drain accumulated blood (haematoma). Blood transfusion is rarely required. Increased activity too soon after surgery can increase the risk of bleeding. It is important to follow all postoperative instructions and avoid strenuous activity for the advised period. I have stopped taking aspirin, anti-inflammatory medications, and any herbal or dietary supplements that may increase the risk of bleeding, as advised by my Consultant.
12. Infection – Although uncommon, infection can occur after surgery. Should an infection occur, additional treatment including antibiotics, hospitalisation, or additional surgery may be necessary. It is important to tell your Consultant of any other infections, such as a history of Methicillin Resistant Staphylococcus Aureus (MRSA) infections, an open wound, recent upper respiratory infection/pneumonia, ingrown toenail, insect bite, tooth abscess, or urinary tract infection. Infections in other parts of the body may lead to an infection in the operated area. Postoperative infections often result in more extensive scarring and predispose to revision surgery.
13. Ileus – The return of bowel function following surgery is important. An ileus is a disruption in bowel function caused by the failure of peristalsis or the hypomobility of your bowels/gut resulting in a lack of defecation and possibly repeated vomiting. Anaesthetics and medications such as the pain medications given to you at the time of surgery can contribute to the development of an ileus in the postoperative period. An ileus can result in abdominal distention, vomiting, inability to absorb oral medications, and possibly hospitalisation. Repeated vomiting could result in aspiration pneumonia and respiratory failure. It is essential to regain regular bowel function after your surgery.
14. Scarring – All surgery results in scars. Although good wound healing is expected, scars may be wider, thicker, or more prominent than anticipated. Scar colour and texture may differ from surrounding skin, and scars may appear different on each side of the body. Hypertrophic or keloid scarring may occur, particularly in patients of Asian or Afro-Caribbean descent. Visible suture marks are possible. In some cases, further treatment such as steroid injections, silicone products, or surgical scar revision may be required. If the areola is very large or poorly defined, there is a risk that some areola will be left behind on the lower half of the lifted breast.
15. Firmness – Excessive firmness can occur after surgery due to internal scarring. The occurrence of this is not predictable. Additional treatment including surgery may be necessary.
16. Skin Sensitivity – Itching, tenderness, or exaggerated responses to hot or cold temperatures may occur after surgery. Usually this resolves during healing, but in rare situations it may be chronic.
17. Major Wound Separation – Wounds may separate after surgery. Should this occur, additional treatment, including surgery, may be necessary.
18. Sutures – Most surgical techniques use deep sutures. You may notice these sutures after your surgery. Sutures may spontaneously poke through the skin, become visible, or produce irritation that requires suture removal.
19. Damage to Deeper Structures – There is the potential for injury to deeper structures including nerves, blood vessels, lymphatics, muscles, and lungs (pneumothorax) during any surgical procedure. The potential for this to occur varies according to the type of procedure being performed. Injury to deeper structures may be temporary or permanent.
20. Fat Necrosis – Fatty tissue found deep in the skin might die. This may produce areas of firmness within the skin. Additional surgery to remove areas of fat necrosis may be necessary. There is the possibility that contour irregularities in the skin may result from fat necrosis.
21. Shock – In rare circumstances, your surgical procedure may cause severe trauma, particularly when multiple or extensive procedures are performed. Although serious complications are infrequent, infections or excessive fluid loss can lead to severe illness and even death. If surgical shock occurs, hospitalisation and additional treatment will be necessary.
22. Pain – Some degree of pain and discomfort is expected after surgery, which is usually well controlled with prescribed painkillers. In rare cases, chronic pain may develop due to nerves becoming trapped in scar tissue or tissue stretching. Small nerve endings may become overactive during healing, producing areas of tenderness or heightened sensitivity, which typically resolves with massage and time. If pain persists, I will inform my Consultant.
23. Allergic Reactions – In rare cases, local allergies to tape, suture material and glues, blood products, topical preparations, or injected agents have been reported. Serious systemic reactions including shock (anaphylaxis) may occur in response to drugs used during surgery and prescription medications. Allergic reactions may require additional treatment. It is important to notify your Consultant of any previous allergic reactions.
24. Surgical Wetting Solutions – There is the possibility that large volumes of fluid containing dilute local anaesthetic drugs and epinephrine that is injected into fatty deposits during surgery may contribute to fluid overload or a systemic reaction to these medications. Additional treatment including hospitalisation may be necessary.
25. Fat/Air Embolism – In rare cases, fat particles or air can enter the vascular system and can travel to the heart, lungs, or brain. This can result in significant complications including death.
26. Persistent Swelling (Lymphedema) – Persistent swelling can occur following surgery.
27. Unsatisfactory Result – Although good results are expected, there is no guarantee or warranty, expressed or implied, as to the results that may be obtained. The body is not symmetric and almost everyone has some degree of unevenness, which may not be recognised in advance. You may be disappointed with the results of surgery. Asymmetry, unanticipated shape and size, loss of function, wound disruption, poor healing, and loss of sensation may occur after surgery. Size may be incorrect. Unsatisfactory surgical scar location or appearance may occur. It may be necessary to perform additional surgery to improve your results. Unsatisfactory results may NOT improve with each additional treatment.
28. Interference with Sentinel Lymph Node Mapping Procedures – Breast surgery procedures that involve cutting through breast tissue, similar to a breast biopsy, can potentially interfere with diagnostic procedures to determine the lymph node drainage of the breast tissue in the staging of breast cancer.
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