Why do some patients who have breast reduction surgery end up with dead tissue and really awful wounds?

Breast reduction surgery removes a large amount of tissue: anywhere from 1-4+ lbs of tissue per side.  When the remaining tissue does not have adequate blood flow, healing problems can occur.  These might range from a small area that is slow to heal, all the way up to losing a nipple.  The major risk factors for healing problems are:SmokingDiabetesVery large breast sizeIf you have very large breasts, your surgeon may recommend a free nipple reduction, where the nipple is taken off the breast and put back on as a skin graft.  This ensures good blood flow to the nipple in its new position.  I require my patients to quit smoking before reduction surgery to help minimize risks due to smoking.Good management of diabetes can help decrease risks as well.  This is evaluated by looking at the hemoglobin A1c level.In addition, ask your surgeon how many breast reductions he or she does a year, as well as his/her complication rate.  This should give you a better idea of your individual risk of complications after breast reduction surgery.

Every surgery has risk and potential for complications. Breast reduction is typically very well tolerated. Complications can range from small wound healing issues to bleeding and hematoma that require surgical washout, fat necrosis or nipple necrosis. The most common complication is a small wound at the T junction. This is the point at the base of the breast where the incisions come together. Typically this heals without consequence over 1-2 weeks. In general the larger the breast the more likely that there will be a complication. Smoking and diabetes are two other major risk factors. Quitting smoking and optimizing glucose control is essential to minimize complications. Seeing a board certified surgeon is essential but never guarantees that you won't have a complication. Most breast reduction patients are extremely happy with their decision to undergo surgery due to the function and aesthetic improvements. 

The process of post operative recovery in any surgical procedures including breast reduction is primarily dictated by a combination of patient factors, procedural factors and surgeon factors.

Patient factors include both loco-regional factors as well as systemic factors for consideration. For example, the magnitude of the breast reduction itself, is it a small, medium, large or massive reduction from weight point of view in terms of the weight of the breast tissue removed; is the patient otherwise healthy or are there some other medical conditions which put her at a higher risk category, such as being a smoker, diabetic, or any form of immunosuppression etc. Tissue healing can be easily compromised or prolonged with less resistance to infection if any of the mentioned conditions are associated with the patient undergoing breast reduction procedure. Obviously surgeon factors are also very important in terms of the surgeon's skills, experience and qualifications in performing the procedure with the safest, most reliable and effective aesthetic technique in restoring both the function and form of a smaller & lifted breasts that is right for the patient concerned. However, no surgeon is free from complications no matter how good & qualified the surgeon is. It's really about the surgeon's ability to minimise and manage the complications should complications occur.

In the majority of patients after a breast reduction procedure, they usually experience an instant relief from the heavy weight off their chest, shoulder and back! Provided they adhere to the specific post op recovery guidelines from their surgeons, breast reduction is usually regarded as the most satisfying procedure from both patient and surgeon's point of view.The associated recovery process can vary between patients due to factors discussed above, but overall it's a truly liberating procedure from both functional and aesthetic perspectives for many of my breast reduction patients.

Hope that helps.

Best wishes

Ellis Choy