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.

Surgery can be scary!   It is important to understand the risks, and then, it's not so scary.  Breast reduction patients routinely have surgery, recover quickly and celebrate freedom! From back pain, neck pain, shoulder strap indentation, rash and headaches. They are able to exercise better, sleep better, and breathe better. In a large outcome study, 98.7% of breast reduction patients were either Very Glad, or Glad that they had surgery.  I perform about 100 breast reductions a year, and they are among my happiest patients!  Breast reduction is usually an out patient surgery which takes about two hours.  Patients take pain medicine for 1-3 days and return to a desk job in an average of one week.  Patients are cleared for full activity at two weeks.   It is a Rapid Recovery procedure! So, what can go wrong?  Thankfully, the complication is low. Complications occur more often in patients at greater risk: smokers, diabetics, patients with obesity and scarring from previous breast surgery.  Most common, a little 'scabby' healing, usually trivial, usually healed up in 2-3 weeks.  5-10% chance.  Permanent nipple numbness. 1% Scars.  Some scarring is necessary, but with good scar management, they can be minimized.  Short scar techniques like No Vertical Scar and Lollipop techniques combined with aggressive scar treatments afterward, yield very many Happy patients.  Bigger complications, like large skin loss and nipple loss, occur even less frequently, way less than 1% of the time.  Even with these rare complications, a reasonable result is usually still achieved. 

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

Thank you.
There are side effects and complications of any surgical procedures. Breast reduction is a common and safe procedure. Minor wound or delayed wound healing can occur but in the main most patients heal well and is back to their routine in about 4-6 weeks.
please check that your surgeon is a fully qualified specialist.
I hope this helps.

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. 

Healing following breast reduction surgery is usually uneventful. There are a number of steps that your doctor can take to reduce the risk of wound breakdown, however part of it is also down to how you heal. The chances of wound break down is greatly increased if you are a smoker, ex-smoker or take any form of nicotine replacement including e-cigartettes (or vaping). Even when wound break down occurs however it always heals eventually.  If necessary the scars can usually be revised to be acceptable, though this is rarely necessary. Most women end up very happy with the final outcome of their breast reduction surgery. Not only does it improve the silhouette, it can also improves symptoms such as back pain and make it easier to exercise. 

The best way to address your concerns is by seeing a board-certified plastic surgeon and having a consultation. Within the consultation, expectations on results should be discussed along with evaluating any risk factors that would effect the end result. Eighty percent of women rate cosmetic results good. Of all the procedures plastic surgeon do, breast reduction patients have the highest satisfaction rate. Best of Luck!

Like all surgery there is always the risk of complications but risks can be minimised as I will explain below. Breast reduction is an excellent operation which very reliably improves the common complaints that larger-breasted women have. These include back and neck pain, bra strap grooving and shoulder pain, heavy feeling breasts, rashes under the breast, difficulty finding clothing, discomfort when exercising and suffering from social embarrassment and unwanted attention. 
Complications such as breast tissue or nipple necrosis causing loss of skin or contour defects in the final shape of the breast are rare but are more commonly seen in smokers, uncontrolled diabetics, women with very large pendulous breasts(G or H cup) or women who are overweight. Luckily, except for having very large breasts of course, these are all things that can can changed pre surgery. In my practice I ask my patients to aim for a body mass index (BMI) of around 30 or less before proceeding with breast reduction surgery. You should be at the weight you want to be at, and can realistically maintain, prior to surgery too. If you are heavier than usual and you have a reduction and then you lose weight after the surgery you may end up too small! Believe me it really can happen! Conversely if you are thinner than normal and you put on weight after a breast reduction you may feel you are too big again.    
To work out your BMI:
Divide your weight in kilograms (kg) by your height in metres (m)Then divide the answer by your height again to get your BMI.
Other complications like seroma or fluid collection after breast reduction can be a nuisance and require aspiration of the fluid using a needle. This is also more commonly seen in large reductions or overweight women. Wounds opening up a bit underneath the breast is one of the more commonly seen complications of breast reduction but when this does occur, in the vast majority, its just a small opening along centimetre or so of the wound and this is easily treated with dressings and generally heals up within a week or two. Larger areas of wounds opening up are uncommon but may require more prolonged dressings or even sometimes a trip back to the operating theatre. 
Do your research and get advice from a trusted family doctor before choosing your surgeon. I would advise you choose a registered plastic and reconstructive surgeon. If you know your surgeon has been well trained in breast reduction techniques and s/he communicates clearly with you regarding the surgery, the expected recovery, the consequences and possible complications of breast reduction surgery then this is an excellent start. Breast reduction really can give women a new lease on life.