Will diabetes affect my surgery if I get a Breast Reduction?

Question

Hi Im a 42 yr old ,and use insulin for my diabetes. I was wondering how my diabetes will affect surgery/ results? I have 48 DD/ E breast. I have been this size since I hit puberty at age 11. I have wanted a breast reduction most of my life. I have back, neck and shoulder pain. I also have deep grooves on my shoulders and often have rashes under breast. My biggest concern is nerve damage/ sensation and scaring.

Ronald J. Edelson, MD · Answer

My only concern would be adjusting the insulin doseprior to surgery to avoid intro prestige hypoglycemia. You should discuss the issue with both your surgeon and anesthesiologist per operatively. The effect on healing and circulation to the skin and nipple will probably be negligible, although your surgeon might recommend antibiotics to reduce the risk of infection. Overall the operation can be done quite safely in your case.

Lewis Albert Andres, MD · Answer

Hello!  Thank you for your question!  There are a few medical 
comorbidities that contribute to a higher risk during any surgical 
procedure including infections, wound complications, delayed wound 
healing, bleeding, anesthetic risks, etc.  Diabetes is one that is known
 to have an increased risk for infections and wound healing issues. 
There are a number of both systemic and local host factors that can 
contribute to infections.  Whether or not diabetics are truly at greater
 risk and the magnitude of the effect of diabetes on the risk of 
infection remain controversial.  However, there is a known increased 
propensity to develop infections and delayed healing.  Some of the 
hyperglycemia-related impairments on the immune response include 
vascular insufficiency, sensory peripheral neuropathy, autonomic 
neuropathy,  and skin and mucosal colonization with pathogens such as Staphylococcus aureus and Candida species.  That
 being said, well-controlled diabetes should equate a minimal increased 
risk for the above and surgical procedures still safe and a reasonable 
decision.  You should ensure adequate glucose control always, but also 
obtain medical clearance from your primary care physician that you are 
at an acceptable risk for undergoing a surgical procedure.  Laboratory 
results such as HgbA1C is a good measure of control.  Discuss all of 
your medical comorbidities and medication with your surgeon prior and 
discuss these risks.  This procedure should still be very safe for you 
and hope for an uncomplicated course with an excellent result!  Hope 
that this helps!  Best wishes!

Gary M. Horndeski, MD · Answer

Diabetics may undergo a breast reduction without complications if their diabetes in under control.  Many diabetics have peripheral neuropathy, which decreases sensation of the areolas.  If you have areola numbness now, it is possible that you may have areola numbness afterwards from the diabetes.  With a new technique (The Ultimate Breast Reduction) often the areola sensation can improve.  Shoulder, neck and back pain can also improve with this technique by the breast weight transfer to the underlying muscle.  This technique eliminates vertical scars used in lollipo or boat anchor reductions.

	Best Wishes,

	Gary Horndeski, M.D.

Andrew T. Lyos, MD, FACS · Answer

Breast reduction can be  performed safely for women with well controlled diabetes. Your primary care physician will play a vital role in a successful outcome. Preoperative evaluation including history, physical examination and laboratory tests (including hemoglobin A1c) will help to determine if you are a candidate for the procedure. Additional cardiac testing may be required to determine if you are medically cleared for the procedure. Your primary care doctor will also participate in the management of your diabetes during and after the procedure. With optimal control of your diabetes, complications such as delayed healing, poor scarring, and infection can be minimized. 

	Breast reduction has one of the highest patient satisfaction ratings of any plastic surgery procedures. Breast reduction not only improves the way you look, but also alleviates the symptoms of large breasts, including back, neck and shoulder pain, rash, grooving of the shoulders, and reduced exercise tolerance. I would recommend a consultation with a Board Certified Plastic Surgeon. Best regards,

	Andrew Lyos, MD, FAC

Z. Paul Lorenc, MD · Answer

Proper clearance form your internist,controlled diabetes and you should be fine to undergo a breast reduction. Patients with diabetes are at a higher risk of infection and with the right antibiotics and a close watch on the recovery you should heal without complication. Nerve damage/ sensation is unlikely. There will be scars that are red at first however those scars should heal into fine white lines.

Herluf G. Lund, Jr, MD · Answer

Dear bigboobiesco,

	This is not an uncommon situation and one that can be successfully addressed by getting everyone to work together as a team.  This means getting the doctor who is managing your diabetes to evaluate and clear you for surgery.  The anesthesia team needs to be consulted and prepared to manage your diabetes' needs before, during, and after surgery.  The plastic surgeon needs to be willing to see the patient on an increased level to ensure the wounds are healing well and there is no evidence of infection.  By working together, you should be able to have a very successful surgery.  

	As an FYI, we performed this exact procedure on a IDDM patient on Friday and she is doing great.  Again, thanks to team prep and planning.  Hope this helps and best of luck with your surgery.

Steven Wallach, MD · Answer

Patients with diabetes have risks of complications. If you want to go ahead with surgery, your diabetes should be well controlled to minimize the complication rate.

Robin T.W. Yuan, MD · Answer

While diabetes, especially insulin-dependent diabetes, can generally affect healing and infection rates, when planned carefully and with the diabetes under control diabetes in of itself is not a contraindication from breast reduction. Make sure your surgeon and internist/endocrinologist communicate with each other to optimize timing and insulin dosage.

	 

	Robin T.W. Yuan, M.D.

Tom J. Pousti, MD · Answer

Thank you for the question.

Based on your description, you may be an excellent candidate for breast reduction surgery; this operation tends to be one of the most patient pleasing operations we perform. Patients are encouraged to try to have the procedure performed when they are at their long-term stable weight if possible.

Well-controlled diabetes will not  in itself  pose a contraindication to breast reduction surgery. I would suggest an evaluation and “medical clearance” from  your primary care physician.

Best wishes.

Peter E. Johnson, MD · Answer

Diabetes does increase the risk of infection with all surgical procedures, however with good control and planning, even insulin dependent diabetes will not prevent you from havng a breast reduction. Medical clearance and team approach with your primary doctor will see you through.

Will diabetes affect my surgery if I get a Breast Reduction?

Answers (17)

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