What Can Be Done for Failed Breast Reduction?

Question

Had breast reduction in September. Complications, was told "fat necrosis", wound split top to bottom and has healed that way. Looks badly scarred, clefted, and is full size too small. It was too small right out of op room, so don't see that expln?. Hematoma developed. Took 3 months to heal.Told an implant and scar revision needed after healing. Won't the scar revision make it even smalller? Will I also need a tissue expander? And won't a healed hematoma show on scans as cancerlike? Past BC pt

Kenneth Hughes, MD · Answer

A revision should not be performed for at least 6 months to a year after surgery. The moment that the breast incisions heal should not be time to return to the OR. The scars will have to mature and inflammation will have to reduce. The operation could then include scar revision and implant to improve shape and volume.

David Shafer, MD, FACS · Answer

Without seeing before and after pictures or seeing you in person, it is impossible to give you specific advice.  However, it is correct that you should wait for everything to heal.  If your breasts are too small, then you may need an implant for fat grafting to help replace missing volume.

	 

	Good Luck.

Jeffrey Ditesheim, MD, FACS · Answer

A difficult situation and glad to help you if I can, it would be best to post pictures before and current to see what you are describing.

Tom J. Pousti, MD · Answer

I am sorry to hear about the significant complications you have experienced. Obviously, the situation is very frustrating for many reasons.  Although I cannot provide you with specific advice, some general thoughts may be helpful to you.

	At this point, given that your surgery was done in September, you will be best off exercising patience in waiting for as long as possible ( at least one year after surgery).  You may be surprised at how well the tissues soften and become more pliable with time.

	 In the longer term, you may benefit from additional surgery such as breast augmentation and/or scar revision surgery. These operations will be indicated when no additional “fat necrosis” is present and when the tissues have softened as much as possible.

	 Again, although it may be challenging, it will be in your best interest to remain as patient as possible.  When the time is right, you may benefit from several opinions from board-certified plastic surgeons before proceeding with further surgery.

	 Best wishes.

Steven Wallach, MD · Answer

Without pictures and an exam it is very difficult to guess what could be done for you and what specific procedure would be right.

Robert L. Kraft, MD, FACS · Answer

I am sorry to hear about your problem.  Breast reduction has one of the highest patient satisfaction rates.  Lots of issues raised here.  First is timing of any revision.  If you had a complication, you need to add 3 month to the usual one year for complete healing.  Scar revision should not change the breast size unless it involves addressing what you call the cleft.  Hematoma or scarring will not show on a mammogram as the equivalent of breast cancer; the scar tissue will be visible but a good mammographer can detect the difference.  In terms of using a tissue expander and the ultimate result, you would really need to submit photos for any meaningful evaluation.

Talmage J. Raine, MD, FACS (retired) · Answer

Sounds like a lot of problems here.  Do you smoke?  No revision until you stop.  A revision with scar revisions and a submuscular implant is possible.

	Talmage Raine MD FACS

	dr@drraine.com

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