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.

A properly performed breast reduction by a board certified plastic surgeon with many years of experience in cosmetic surgery and thousands of patients can result in a beautiful outcome with minimal discomfort.  The procedure is done in an outpatient surgery center, and the patient can return to work at one week.  Pain is minimal though pain medicine is provided.  It takes about a month before one can resume exercise.  Surgery can go wrong for many reasons.  If the surgeon is not properly qualified, one is just asking for trouble.  If the patient smokes or engages in physical activity prior to the recommended recovery, the patient can contribute to a bad outcome.  Overall, it is a safe operation with high patient satisfaction rates.

It is understandable to be concerned after seeing images of complications from breast reduction surgery, but it is important to remember that these issues are relatively rare and often preventable. During a breast reduction, the blood supply to the breast tissue (particularly around the nipple) is disrupted, leaving the area with reduced perfusion for healing.
Problems like dead tissue (necrosis) and problematic wounds can occur due to poor blood circulation, overly aggressive tissue removal, infection, or pre-existing health conditions that affect healing. Smokers, diabetics, and individuals with obesity are at a higher risk of complications. However, these issues can generally be avoided with careful planning, a skilled surgeon, and proper aftercare. A knowledgeable surgeon will take steps to ensure blood flow is preserved and will carefully plan the surgical technique to minimize risks.
While complications can happen, even with the best surgery and aftercare, they are fairly uncommon. Following post-operative care instructions, managing pre-existing conditions, and attending follow-up appointments can significantly reduce the risk. If complications do arise, they are usually treatable if detected early. One of the most common wound healing problems is at the “T-junction” where the horizontal and vertical limbs of the incisions come together near the bottom of the breast (a typical incision pattern for breast reductions), which can result in minor oozing or a small wound at that point.Ultimately, choosing an experienced surgeon, avoiding nicotine or smoking, maintaining a healthy lifestyle, and adhering to all care guidelines are the best ways to minimize risks and achieve a successful outcome. With the right preparation and care, the likelihood of major complications is minimal. Breast reduction is generally a safe procedure with a high patient satisfaction rate, but it is important to discuss benefits, risks, and potential complications with your surgeon.
Krishna Vyas, MD, PhD, MHSHarvard, Hopkins, & Mayo Clinic Trained Aesthetic Plastic SurgeonNew York, New York

Hi there and thank you for this great question. Technical issues happen during a breast reduction which causes necrosis of the tissues, but generally speaking the likelihood of this happening is very minimal.

Your concerns are understandable. Although breast reduction is routinely performed by most Plastic surgeons , it still remains extensive surgery and carries a number of risks. The most common problem being wound healing complications. These can vary from minor oozing at the "T" junction, to more extensive wound breakdowns, tissue necrosis, and even nipple loss at the extreme. Having said that, breast reduction still remains the plastic surgery procedure with the highest satisfaction rate amongst patients and surgeons. The wound problems can be due to patient factors- smoking, diabetes, connective tissue disorders etc -, and /or due to inappropriate surgical technique. Plastics surgeons are trained very hard to understand and respect the tissue blood supply, and this is a key aspect for the success of almost every plastic surgery operation. For this reason, you should never cut corners when it comes to selecting your surgeon. Look for proper qualifications, training, memberships, and make sure they have an accessible aftercare service. However, even the most qualified and experienced surgeon may have problems. The difference is that they do recognise and deal with them early. Wound problems usually heal with conservative management and rarely affect the overall result. It is extremely important however, to have a good aftercare and be able to see your surgeon or a specialist nurse for regular checks. Don't forget that disaster cases make the news very easily. Still, most of those disasters could have been avoided, had they been diagnosed and treated at an early stage.

Hi. Thanks for asking those very real and relevant questions regarding the risks of breast reduction.
Your surgeon will be able to outline to your some of the risks, both common and uncommon, pertaining to breast reduction. Having a surgeon who is board certified does not guarantee a risk free procedure. It does however, ensure that your surgeon has undergone the necessary level and quality of training to carry out the procedure safely AND to be able to manage any complications that may arise.
Wound healing problems, poor scarring, and nipple necrosis are both all un-welcomed (and uncommon) complications in breast lift/reduction surgery. They are generally related to inadequate blood supply going to the tissue, although infection can also be a factor. 
Please remember that breast reduction surgery does give a very good outcome and high satisfaction in the majority of patients. Complication risks are involved in every kind of surgery, and all measures need to be taken to minimize them.You need to be confident in understanding the procedure and in the experience and skill of your surgeon. 
All the very best.
Dr Ray Goh