How Risky is Second Reduction? (photo)

I had reduction in 1978. Already approved for 2nd reduction but concerned about increased risks. One doc says she can take more than 500g off each side. 2nd consult doc does not want to risk repeat BR and 3rd doc says the most he can remove is 200g per breast and recommends leaving areola in tact due to risk of cutting blood supply to nipple - limiting tissue removal to area below.nipples. I'm wondering if venous congestion will complicate procedure or prevent proper healing?

Doctor Answers 3

How risky is a second breast reduction?

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Thank you for the photos. You had your first reduction over 30 years ago. There's random blood supply reestablished around the nipple/areolar complex. You are at slightly higher risk of having some partial areolar loss. Without the benefit of an in person examination, I tend to agree with the third surgeon. It is safer to remove inferior breast tissue (and that is where you have most of the breast volume) and not cut around the areolae. I believe that removal of 500gm/breast will leave you disproprtionately too small. Just because insurance requires you to have that much removed, I do not think this will leave you with a good aesthetic outcome. Good luck.

Concerns about Repeat Breast Reduction?

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Thank you for the question and pictures.

The concern with repeat breast reduction surgery is related to blood flow to the remaining tissue;  if too much tissue is removed in one operation the blood flow to the remaining tissue (including nipple/areola)  may be compromised.   Part of the tissue that is left in place is called the “pedicle"; this segment of tissue is responsible for delivering the blood supply to the nipple/areola tissue.   Must be taken during repeat breast reduction surgery to avoid cutting the  pedicle that is responsible for “delivering” blood flow to the nipple/areola complexes.  If this does occur,  tissue necrosis may result.

Generally speaking, I would expect much of the blood flow to the breasts  and breast skin to have  been reestablished after 30 years. However, I would agree that it is best to be  cautious and avoid moving the nipple/areola complexes,  if possible ( and of course still achieve a desired outcome).

 It is not clear to me that the “venous congestion” that your breast skin demonstrates will necessarily translate to an increased risk with repeat breast reduction surgery.

I hope this helps.

Secondary breast reduction

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A second breast reduction is always a bit more complicated and certainly there is higher risk for nipple loss or congestion.  A proper evaluation in person is important.  Good luck.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

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