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.

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.