Complications after reduction mammoplasty

Reduction mammoplasty is a fairly extensive surgical operation, during which large areas of tissues are sometimes removed, and the total area of the wound surfaces can also be significant. All this increases the likelihood of local complications.

When reducing mammoplasty can meet their following types.

• Early postoperative:
  • hematoma;
  • suppuration of the wound;
  • divergence of the edges of the wound;
  • necrosis areola (marginal or full);
  • marginal necrosis of cutaneous fat flaps;
  • necrosis of adipose tissue.
• Late postoperative:
  • marked cicatricial changes;
  • violation of skin sensitivity, 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 the technical mistakes made during the operation, which in turn result from miscalculations of preoperative planning and improperly executed 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 the accumulation of blood in the wound. The presence of a strained hematoma can lead to a violation of the blood supply of the flaps, the nipple-areolar complex and suppuration of the wound. Treatment of this complication consists in evacuation of the hematoma and elimination of the source of bleeding.

Suppuration of the wound. Local infection can result from the formation of hematoma or necrosis of adipose tissue. Treatment consists in drainage and removal of nonviable tissues. At the extended process prescribe antibiotic therapy.

Divergence of the edges of the wound. The inconsistency of the wound suture, as a rule, is a consequence of the technical errors of the surgeon. In some cases, the sutures from the wound are intentionally removed to improve the blood supply of the nipple-areola complex or skin-fat grafts.

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

• rough allocation of the tissue stalk and its too crude de-epidermisation;
• twisting legs;
• compression of the surrounding tissue or hematoma;
• insufficient thickness of the leg due to excessive resection of tissues;
• excessive compression of the mammary glands with a bandage.

The main signs of the violation of the blood supply of the nipple-areola complex and flaps are cyanosis and pronounced edema of the tissues.

Treatment consists in elimination of all those factors that led to a disruption in the supply of tissues (up to the opening of the edges of the skin wound). If the situation can not be stabilized, then a full-layer transplant of the nipple-areolar complex should be formed.

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

Necrotized fat must be removed through the operative access, after which the wound is drained and led, as if infected, until complete healing.

• Late postoperative complications

The formation of pronounced scars is a rather frequent complication of reduction mammoplasty. One of its objective reasons is the location of the seam line perpendicularly or at an angle to the "power" lines of the skin. More significant scars, with a tendency to hypertrophy, are always located near the sternum. Therefore, surgery techniques that exclude this scar location are more preferable. Even the use of a strong non-absorbable inert material does not prevent the scars around the areola from stretching and going down to the submammar fold. This is not surprising, since without imposing a seam tension on a vertically placed wound, it is not possible to obtain a satisfactory aesthetic result.

Common scars can be excised, but not earlier than 6 months after the operation with overlapping multi-row sutures.

The change in the sensitivity of the nipple and areola, as well as the skin after decreasing Mom-Moplasty, occurs quite often, especially after large reductions. The sensitivity of the skin, as a rule, gradually improves within a few months after the operation.

The extreme form of sensitivity disorder - nipple anesthesia - occurs in 10% of cases and also depends on the volume and technique of the operation. It is necessary to warn the patient about this in advance.

Recurrence of mammary hypertrophy can occur in patients with juvenile hypertrophy. To avoid this problem, some surgeons suggest that this type of surgery should not be used before the 16-year-old age of the patient.

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

The cause of the entrainment of the nipple is cicatricial contraction of the tissues of the feeding dermal stem, including the ducts of the nipple-areolar complex. This can be avoided by limited mobilization of the nipple during surgery or dissection of the ducts at its base a few months after the intervention. Another cause of flattening the contour of the nipple and areola may be excessive removal of the gland tissue. The compacted sucker-areola complex is amenable to correction poorly. Try to change the situation by imposing a tightening sash around the areola.

It should be emphasized that deformations of the nipple and areola are found in more than 50% of cases, regardless of the method used and the volume of tissue resection. Therefore, the possibility of developing this complication 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 lowering of the lower half of the gland. Areola and nipple in this case are too high, not at the top of the cone of the gland. The dystopia is eliminated by shortening the vertical seam leading to the submammary fold, moving the nipple-areolar complex downwards.

To the contour deformation, areoles are considered too large or too small in size, asymmetry and irregular drop-shaped shape. In most cases, the causes of deformation are incorrect or inaccurate preoperative marking, rotational displacement of the areola when the wound is closed, as well as insufficient mobilization of the pedicle with significant movement of the nipple-areolar complex.

Deformation of mammary glands. Changing the contour of the mammary glands after surgery can be characterized by flattening of the gland, its excessive lowering with a too high position of the nipple-areola complex, and also aesthetically unacceptable form of the breast. This problem arises from the stretching of the skin of the lower half of the mammary glands, the descent of the glandular tissue with a fixed position of the nipple-areolar complex. Preventive measures include mandatory fixation of the gland during surgery for the fascia of the large pectoralis muscle or to the periosteum of the II or III rib, removal of the optimal volume of the gland tissues - so that the mammary gland does not remain too heavy after the operation.

In general, clinical practice has shown that the incidence of postoperative complications is directly related to the number of tissues removed. According to J. Strombeck, in those cases when the mass of resected mammary gland tissues exceeded 1000 g, the total number of complications was 24%, and when resected 200 g - only 2.5%.

[1], [2], [3], [4], [5], [6]