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Complications after reduction mammoplasty

 
, medical expert
Last reviewed: 08.07.2025
 
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Reduction mammoplasty is a fairly extensive surgical procedure, during which large areas of tissue are sometimes removed, and the total area of wound surfaces can also be significant. All this increases the likelihood of local complications.

The following types may be encountered during reduction mammoplasty.

  • Early postoperative:
    • hematoma;
    • wound suppuration;
    • divergence of wound edges;
    • areola necrosis (marginal or complete);
    • marginal necrosis of skin-fat flaps;
    • fat necrosis.
  • Late postoperative:
    • pronounced cicatricial changes;
    • impaired sensitivity of the skin, nipple and areola;
    • relapse of mammary gland hypertrophy;
    • deformation of the nipple and areola;
    • deformation and/or ptosis of the gland.

The reasons for the development of postoperative complications are often technical errors made during the operation, which, in turn, arise as a result of miscalculations in preoperative planning and incorrectly performed markings.

  • Early postoperative complications

Hematoma. Hematoma occurs in 2% of cases and most often occurs in the first day after surgery. Even the use of an active drainage system does not always prevent blood accumulation in the wound. The presence of a tense hematoma can lead to disruption of the blood supply to the flaps, the nipple-areolar complex and wound suppuration. Treatment of this complication consists of evacuating the hematoma and eliminating the source of bleeding.

Wound suppuration. Local infection may result from hematoma formation or fat tissue necrosis. Treatment involves drainage and removal of non-viable tissue. In the case of a widespread process, antibiotic therapy is prescribed.

Divergence of wound edges. Failure of the wound suture is usually a consequence of technical errors by the surgeon. In some cases, the wound sutures are removed intentionally to improve the blood supply to the nipple-areolar complex or skin-fat flaps.

Necrosis of the nipple-areolar complex and skin flaps. Complete necrosis of the nipple and areola is extremely rare. The frequency of marginal necrosis of the areola, according to various authors, does not exceed 1.5%. The main cause of this complication is violations of surgical technique, which include:

  • rough separation of the tissue stem and its too rough de-epidermization;
  • twisting of the leg;
  • compression of the leg by surrounding tissues or hematoma;
  • insufficient thickness of the stem due to excessive tissue resection;
  • excessive compression of the mammary glands by the bandage.

The main signs of impaired blood supply to the nipple-areolar complex and flaps are cyanosis and severe tissue edema.

Treatment consists of eliminating all those factors that led to disruption of tissue nutrition (up to the opening of the edges of the skin wound). If the situation cannot be stabilized, then it is necessary to form a full-layer transplant of the nipple-areolar complex.

Necrosis of adipose tissue is more common with large resections of the mammary glands and is manifested by an increase in body temperature and pain.

Necrotic fat must be removed through surgical access, after which the wound is drained and treated as infected until complete healing.

  • Late postoperative complications

Formation of pronounced scars is a fairly common complication of reduction mammoplasty. One of its objective causes is the location of the suture line perpendicular or at an angle to the "force" lines of the skin. More significant scars, which have a tendency to hypertrophy, are always located near the sternum. Therefore, surgical techniques that exclude this localization of scars are more preferable. Even the use of super-strong non-absorbable inert material does not prevent stretching of scars around the areola and going down to the submammary fold. This is not surprising, since without applying a suture with tension on a vertically located wound, it is impossible to achieve a satisfactory aesthetic result.

Widespread scars can be excised, but not earlier than 6 months after surgery with the application of multi-row sutures.

Changes in nipple and areola sensitivity, as well as skin sensitivity after reduction mammoplasty, are quite common, especially after major reductions. Skin sensitivity usually improves gradually over several months after surgery.

The extreme form of sensitivity disorder - nipple anesthesia - occurs in 10% of cases and also depends on the volume and method of the operation. The patient should be warned about this possibility in advance.

Recurrence of breast hypertrophy may occur in patients with juvenile hypertrophy. To avoid this problem, some surgeons suggest resorting to this type of surgery no earlier than the patient's 16th birthday.

Deformation of the nipple and areola. Deformations of the nipple-areolar complex can be divided into three types: 1) formation of an inverted nipple and flattening of the contour of the nipple-areolar complex; 2) dystopia of the nipple-areolar complex; 3) deformation of the contour of the areola.

The cause of nipple retraction is cicatricial contraction of the tissues of the nutrient dermal pedicle, including the ducts of the nipple-areolar complex. This can be avoided by limited mobilization of the nipple during surgery or by dissecting the ducts at its base several months after the intervention. Another cause of flattening of the nipple and areola contour may be excessive removal of glandular tissue. A flattened nipple-areolar complex is difficult to correct. An attempt to change the situation can be made by applying a tightening purse-string suture around the areola.

It should be emphasized that nipple and areola deformations occur in more than 50% of cases, regardless of the method used and the volume of tissue resection. Therefore, the possibility of this complication developing should be discussed in a preliminary conversation with the patient.

Dystopia of the nipple-areolar complex usually occurs vertically. The main reason for the displacement of the areola is the postoperative drooping of the lower half of the gland. In this case, the areola and nipple are too high, not at the top of the gland cone. Dystopia is corrected by shortening the vertical suture going to the submammary fold, with the displacement of the nipple-areolar complex downwards.

Deformation of the areola contour includes its size being too large or too small, asymmetry, and an irregular teardrop shape. In most cases, the causes of deformation are incorrect or inaccurate preoperative marking, rotational displacement of the areola during wound closure, and insufficient mobilization of the pedicle with significant displacement of the nipple-areolar complex.

Deformation of the mammary glands. Changes in the contour of the mammary glands after surgery may be characterized by flattening of the gland, its excessive drooping with too high a position of the nipple-areolar complex, as well as an aesthetically unacceptable breast shape. This problem occurs due to stretching of the skin of the lower half of the mammary glands, drooping of the glandular tissue with a fixed position of the nipple-areolar complex. Preventive measures include mandatory fixation of the gland during surgery to the fascia of the pectoralis major muscle or to the periosteum of the 2nd or 3rd rib, removal of the optimal volume of glandular tissue - so that the mammary gland does not remain too heavy after surgery.

In general, clinical practice has shown that the frequency of postoperative complications is directly dependent on the amount of tissue removed. According to J.Strombeck, in cases where the mass of resected mammary gland tissue exceeded 1000 g, the total number of complications was 24%, and with a resection of 200 g - only 2.5%.

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