Unfavourable results following reduction mammoplasty

Lakshmi Saleem, Jerry R John, Lakshmi Saleem, Jerry R John

Abstract

Breast reduction is a common cosmetic surgical procedure. It aims not only at bringing down the size of the breast proportionate to the build of the individual, but also to overcome the discomfort caused by massive, ill-shaped and hanging breasts. The operative procedure has evolved from mere reduction of breast mass to enhanced aesthetic appeal with a minimum of scar load. The selection of technique needs to be individualised. Bilateral breast reduction is done most often. Haematoma, seroma, fat necrosis, skin loss, nipple loss and unsightly, painful scars can be the complications of any procedure on the breast. These may result from errors in judgement, wrong surgical plan and imprecise execution of the plan. Though a surfeit of studies are available on breast reduction, very few dwell upon its complications. The following article is a distillation of three decades of experience of the senior author (L.S.) in reduction mammoplasty. An effort is made to understand the reasons for unfavourable results. To conclude, most complications can be overcome with proper selection of procedure for the given patient and with gentle tissue handling.

Keywords: Breast; complications; fat necrosis; reduction mammoplasty; seroma.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Left: 20 year follow-up of breast reduction with inferior pedicle and inverted T incision. Following the procedure, the lady begot three children and all were breast fed. Right: The axillary pad of fat was removed in a second sitting, 20 years after the breast reduction
Figure 2
Figure 2
Flattened breasts with loss of volume and projection. This unmarried lady presented for revision mammoplasty after undergoing reduction elsewhere
Figure 3
Figure 3
Left: Young girl who underwent a massive reduction. Right: Post-operative result. Note the presternal webbing
Figure 4
Figure 4
Left: Skin marking prior to vertical mammoplasty. Middle: Post-operative result. Right: Late follow-up. The vertical scar below the inframammary crease is still prominent
Figure 5
Figure 5
Left: 17-year-old girl with unequal tubular breasts. She underwent liposuction and circumareolar breast reduction. Right: Post-operative result
Figure 6
Figure 6
Complications encountered in the senior author's practice of 468 reduction mammoplasties over three decades
Figure 7
Figure 7
Left: The lady underwent the Wise pattern inferior pedicle breast reduction with removal of 1800 g from the right side and 1700 g from the left side. Middle: Post-operatively, the right areola was dusky, with a lot of local ooze. A hematoma was drained at 48 h. Right: Nipple loss on the right side
Figure 8
Figure 8
Left: 19-year-old girl underwent a combination of liposuction and open reduction. Middle: Wound breakdown on right side. Patient was lost to follow-up. Right: Late result, with loss of projection of nipple and depigmented areola
Figure 9
Figure 9
Left: 20-year-old girl underwent a superior pedicle vertical mammoplasty with removal of 950 g from right side and 935 g from left side. Middle: Post-operative result. Right: 1 year after, she requested for revision of the right areola. An ellipse has been marked on the superior aspect for excision

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Source: PubMed

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