Hematoma, asymmetrical breast reduction result

I come from a family of doctors and found Raymond's initial consultation to be fairly normal, well spoken and with confidence I booked the surgery. The surgery was eventful - there was a hematoma which required a second immediate surgery to stop the bleeding.

After the first surgery the hospital nurse (not Doctor Goh nor any of his staff) held me back as she thought something had gone wrong - she thought the tissue seemed abnormally tight and hard and that something was wrong - she was right. There was a hematoma and I was put back under.

After surgery there was a huge amount of explanations as to why he had made a mistake - to the point I got sick of it and brought my family in to witness. Essentially apart from the surgery and hematoma - Raymond created a major discrepancy between my breasts in the reverse direction - where one breast was an F and the other a DD.. now they are a B and a D... the nipples are totally different sizes and the distances between the inframammary fold relative to nipple position - as well as the nipple sizes.. totally out of proportion/different sizes and asymmetrical.

Raymond continually made a point though of pointing out how different my breasts had been before... and the difficulty of the surgery... implying that the post operative differences were a result of pre-operative conditions... However as someone who is a UQ lecturer and who has family medical lecturers who have taught med students for decades... - with all of us having full access to both pubmed and UQ's medical databases - the research asserts that there's a very low correlation for pre and then post volumetric asymmetry in breast reductions - usually post surgical asymmetry relates to positioning - like nipple positioning for instance... but basically if volumetric asymmetry happens these days.. sounds like it's surgical error. And also... what terrible bedside manner!

Additionally - aside from the hematoma.. my GP keeps on trying to call as it sounds like something went wrong with my heartbeat and blood pressure during surgery... not that Valley Plastic Surgery have got in touch about that.


... And finally at one point 4 weeks post surgery the nurses left me in the back office for a whole half hour topless without anyone in the room- they were off trying to find a doctor who unfortunately never pitched up.. ...but half an hour is a long time to wait half naked and scarred in a back room of a plastic surgeons... Not that it matters but it caused me to miss a work meeting. Finally both the normal bandages and the sensitive bandages caused a horrible allergic rash which required ointment which only a senior nurse caught on to several weeks after the rash had started.

I've now started to avoid this practice as it's beginning to feel like... with surgical errors, hematomas, allergic reactions, being left in a back room for half an hour half-naked that it's in my best interests to not engage at all with this practice.

Basically, for $15,000 I would expect a better outcome than this. You be the judge. - Here are the photos.

I'm still considering getting in touch with AHPRA.. and so should anyone that has a bad plastic surgery outcome or surgery outcomes - or in fact any poor medical outcomes. In current years AHPRA are putting a stronger spotlight on plastic surgeons and this year I completely understand why that is.

Further to the above post - I thought it best to illustrate the discrepancies between nipples sizes using a ruler. This is a scale rule - so 1:1 measures in millimetres/centimetres. I have taken photos with measurements just under the nipple line and across the nipple; horizontally and vertically down the nipple. I've also included as close as possible a side by side of both for reference. On the left side nipple you can see the nipple is clearly both horizontally and vertically approximately 5 centimetres. On the right side the nipple is clearly 3.5 centimetres. This is a diametrical difference of 1.5 centimetres.

For those that are maths wise - this means that the left is literally 70% of the size of the right side nipple (3.5/5) or in the reverse - the right nipple is literally 1.4 times the size of the left nipple. In the world of medicine this is not a great outcome. Surgeons aim for as close as possible; as minimally invasive as possible and for very subtle surgical differences these days - even your everyday GP doing a basic excision is well aware that size guides major differences in costs and rebates and try to keep discrepancies to a minimum.

This is highly unusual in breast reductions as although the surgery is an imprecise science and art - surgeons have a high level of discretion over nipple sizes. It is actually the reason I chose VPS as I had originally thought they had fairly good surgical skills in this arena..

Why is this important and why is this potentially risky medicine? Basically Valley Plastic Surgery and Dr Raymond Goh have said they would do a revision where I wouldn't pay the surgeons fees to fix the errors of the previous surgery - an excision of extra tissue to the left breast ie reduction and lift and presumably reduction of the much larger nipple size (but presumably still paying the anaesthetists and hospital/clinic fees).

This may sound generous (although it is still carrying a $5,000 additional cost) but the reason I am reluctant to go down this pathway is that EVERY single breast reduction surgery carries the risk of nipple necrosis and ultimately nipple loss.
And in the case of a second surgery, given the blood supply to the nipple has already been impacted; the risk of nipple necrosis and nipple loss is further elevated. It is a serious and massive concern - especially given the complications of the first surgery (hematoma). Basically you would hope one breast surgery costing $15,000 is sufficient given the risks of a second surgery and the already impaired blood supply and trauma to the breast and risks of a second major surgery (further trauma and impairment to blood supply).

Don't listen to me though - here is some med speak: ''Secondary breast reduction is complex and poses significant challenges to surgeons. Complication rates exceed those of primary reduction, commonly caused by impaired vascular supply of the nipple-areolar complex.''

''Breast re-reduction is complex and poses significant challenges for surgeons. Complication rates significantly exceed those of primary reduction [4], with necrosis or loss of the nipple areola complex (NAC) being respected by many surgeons. Most of these complications can be attributed to impaired vascular supply of the NAC after revision surgery.''

Basically secondary nipple/breast surgery is really risky to an already impaired blood supply to the nipple. Considering after my first surgery my nipple initially went black and sloughed off black skin... I am slightly horrified by the idea. I genuinely find it really scary and am worried I would potentially lose a nipple. And every normal doctor I've talked to has advised me against it.

It would have been great to have just had similar size nipples which most would expect for a surgery costing $15,000.

And I would really still love to have somewhat normal looking nipples and am considering possibly cosmetic tattooing... it's not a perfect solution but much safer so if anyone has any recommendations, please do let me know if this has worked for you to partially rectify this sort of error?

Citation: Broer PN, Moellhoff N, Aung T, Forte AJ, Topka C, Richter DF, Colombo M, Sinno S, Kehrer A, Zeman F, Rohrich RJ, Prantl L, Heidekrueger PI. How to Approach Secondary Breast Reduction: International Trends and a Systematic Review of the Literature. Aesthetic Plast Surg. 2021 Dec;45(6):2555-2567. doi: 10.1007/s00266-021-02243-1. Epub 2021 Apr 5. PMID: 33821309; PMCID: PMC8677686.