What are the risks?
All surgery and anaesthesia carries some uncertainty and risk. The following list gives you information about the most common or significant problems that can occur following this type of surgery.
Pain
The pain from this operation is not usually severe. Different people require varying amounts of painkillers (analgesia). You may feel some pain for the first few days especially as you move around and cough. There may be further discomfort for a week or more. Your surgeon or anaesthetist will prescribe regular painkillers to lessen the pain. If you are in constant pain, telephone the hospital and speak to the nursing staff. In the long term your breasts should not be painful as a result of the operation, but if you suffer from breast pain before the operation it is unlikely to be cured by the surgery.
Deep vein thrombosis
This is a blood clot in the veins in the legs and is a potential complication following surgery and bed rest. People taking the oral contraceptive pill or hormone replacement therapy, and those who smoke, are at the greatest risk. Occasionally clots can break off and pass to the lungs, known as a pulmonary embolus. All patients are given compression socks to try to prevent this problem. Preoperative assessment may also result in the need for heparin injections to reduce this risk.
Blood transfusion
It is not common to require a blood transfusion after this operation, but it may occasionally be required. If you have strong views or religious beliefs about this, discuss this with your surgeon before surgery. If you ar found to have a low blood count (anaemia) after your operation, a course of iron tablets will be prescribed.
Haematoma
This is a collection of blood underneath the skin which may occur after surgery. To try to prevent this a small drainage tube may be placed in each breast to allow any blood and fluid to drain into a vacuumed bottle. Even with this care, occasionally blood collects, causing the breast to become painful and swollen. A second operation may then be necessary to remove the haematoma.
Drains
A wound drain may be inserted into each breast during the operation to allow any blood and fluid to drain away. The drainage tube is attached to a vacuumed bottle where the fluid is collected and measured. The nurses will remove the tube on the doctor’s instructions, usually after 24–48 hours, depending on the amount and colour of the fluid drained. After the drain has been removed a small amount of leakage from the wound is common. A light gauze pad can absorb this.
Infection
A wound infection can occur after any surgical procedure. If this happens it may be treated with antibiotics and, if necessary, further dressings. After an infection the scars may not be quite as neat. Any major operation with a general anaesthetic carries a small risk of a chest infection, particularly among people who smoke. This would be treated by antibiotics.
Nipples
Breast reduction surgery always involves changing the position of your nipples. This causes loss of normal sensation in the nipple and areola which can be permanent. Rarely, the nipples may become over-sensitive.
The nipple and areola, or part of them, may die due to poor blood supply. Smoking increases the risk of this by reducing the flow of blood to them. Dressings are required until new skin has formed. The nipple and areola will have a scarred appearance in the affected area. Complete loss of the nipple and areola is rare, but if it does happen it is often necessary to have a second operation, and further surgery to improve the look of the nipple and areola may be required at a later date.
Wound breakdown
Wound healing may sometimes be delayed. This may be because of poor blood supply to the area, poor nutritional status and/or infection. Occasionally the wound may break down, resulting in a longer hospital stay, wound dressings and possibly further surgery. Smoking increases the risk of this in any surgical wound. Wound breakdown can also occur at the T-junction of the anchor scar at the bottom of the breast, and at the junction of the vertical scar with the scar around the nipple and areola.
Scars
Any operation leaves a permanent scar. Infection can cause a wound to reopen, which may lead to problems with scar formation such as stretching or thickening. At first, even without any healing problem, the scars will look red, slightly lumpy and raised. Regular massage of the scar using a light, non-perfumed moisturising cream and using sun protection measures such as a factor 30 sunblock should help it to settle and fade in time. This may take up to two years. Some people develop keloid or hypertrophic scars which are raised, itchy and red. If you already have a tendency to produce scars like these then please discuss this with your surgeon. In most patients the scars soften and flatten to become less noticeable.
Breastfeeding
It is likely that you may not be able to breastfeed after this operation, so if you are keen to be do so at any time in the future after the surgery, you should consider postponing the operation until you have completed your family.
Symmetry
Although the surgeon will try hard to make your breasts equal in size and shape, there may be a small difference between the two breasts. This is quite normal, but if you have any concerns or questions please talk to your surgeon. If necessary, revision surgery can be done to improve the look of the breasts.
Occasionally there is an area of excess breast tissue on the outer part of your breast, known as a ‘dog ear’. This is completely harmless, but may be irritating as it ‘catches’ when moving your arm. Most ‘dog-ears’ settle by six months following surgery, but if these do not, then they are easily revised under local anaesthetic.
Fat necrosis
This is an uncommon, benign condition where fat cells within the breast become damaged and delay wound healing. It is usually painless and the body repairs the tissue over a period of weeks. Sometimes however the fatty tissue swells and the breast becomes red and painful. The fat cells may die and their contents form a collection of greasy fluid which may drain to the skin surface and be mistaken for pus. The remaining tissue may become hard. In severe cases the skin may die. If this occurs, you may require dressings until the area is healed. It is very rare that further surgery is required.
Psychological aspects
Most patients are pleased with the results of their surgery. Occasionally, women feel very anxious about their treatment or have difficulty coming to terms with their new look because their breasts may not be as they had imagined they would be, or as a result of a complication during surgery.
Bra
You will need to wear a good, supportive, non-wired support bra, as advised by your surgeon, for six to eight weeks. This is to help support the underlying tissue and suture lines while healing. After surgery there will be swelling and your breasts will seem high and firm which may seem unnatural to you. However, the swelling will reduce and become more comfortable and after a while the breasts will look a more natural shape.