This is an informed-consent document that has been prepared to help your plastic surgeon inform you of reduction mammaplasty surgery, and alternative treatment.
Women who have large breasts may experience a variety of problems from the weight and size of their breasts, such as back, neck, and shoulder pain, and skin irritation. Breast reduction is usually performed for relief of these symptoms rather than to enhance the appearance of the breasts. The best candidates are those who are mature enough to understand the procedure and have realistic expectations about the results. There are a variety of different surgical techniques used to reduce and reshape the female breast. There are both risks and complications associated with reduction mammaplasty surgery.
Reduction mammaplasty is an elective surgical operation. Alternative treatment would consist of not undergoing the surgical procedure, physical therapy to treat pain complaints, or wearing undergarments to support large breasts. In selected patients, liposuction has been used to reduce the size of large breasts. Risks and potential complications are associated with alternative surgical forms of treatment.
Rısks of reductıon mammaplasty surgery
Every surgical procedure involves a certain amount of risk. It is important that you understand the risks involved with reduction mammaplasty. An individual’s choice to undergo a surgical procedure is based on the comparison of the risk to potential benefit. Although the majority of women do not experience the following complications, you should discuss each of them with your plastic surgeon to make sure you understand the risks, potential complications and consequences of breast reduction.
Bleeding- ıt is possible, though unusual, to experience a bleeding episode during or after surgery. Should post-operative bleeding occur, it may require emergency treatment to drain accumulated blood or blood transfusion. Do not take any aspirin or anti-inflammatory medications for ten days before surgery, as this may increase the risk of bleeding.
Infection- an infection is quite unusual after this type of surgery. Should an infection occur, treatment including antibiotics or additional surgery may be necessary.
Change in nipple and skin sensation- you may experience a change in the sensitivity of the nipples and the skin of your breast. Permanent loss of nipple sensation can occur after a reduction mammaplasty in one or both nipples.
Skin scarring- all surgical incisions produce scarring. The quality of these scars is unpredictable. Abnormal scars may occur within the skin and deeper tissue. In some cases, scars may require surgical revision or other treatments.
Unsatisfactory result- there is the possibility of a poor result from the reduction mammaplasty surgery. You may be disappointed with the size and shape of your breasts. Although good results are expected, there is no guarantee or warranty expressed or implied, on the results that may be obtained. You may be disappointed with the results of reduction mammaplasty surgery. Asymmetry in nipple location, unanticipated breast shape and size, loss of function, wound disruption, poor healing, and loss of sensation may occur after surgery. Healing may result in a lost nipple requiring further surgery and reconstruction. There is no way to predict the final breast size (bra cup size) after surgery. It is possible that the breast may be smaller but the bra cup size may not change. Unsatisfactory surgical scar location or visible deformities at the ends of the incisions (dog ears) may occur. Liposuction may be necessary to thin breast tissue that is outside of the normal surgical location for reduction mammaplasty. It may be necessary to perform additional surgery to attempt to improve your results. Some techniques remove the ability to breast feed. Unsatisfactory results may not improve with each additional treatment.
Firmness- excessive firmness of the breast can occur after surgery due to internal scarring or fat necrosis. The occurrence of this is not predictable. If an area of fat necrosis or scarring appears, this may require biopsy or additional surgical treatment.
Delayed healing- wound disruption or delayed wound healing is possible. Some areas of the breast skin or nipple region may not heal normally and may take a long time to heal. It is even possible to have loss of skin or nipple tissue. This may require frequent dressing changes or further surgery to remove the non-healed tissue.
Smokers have a greater risk of skin loss and wound healing complications.
Asymmetry- some breast asymmetry naturally occurs in most women. Differences in breast and nipple shape, size, or symmetry may also occur after surgery. Additional surgery may be necessary to revise asymmetry after a reduction mammaplasty.
Breast disease- breast disease and breast cancer can occur independently of breast reduction surgery. It is recommended that all women perform periodic self examination of their breasts, have mammography according to american cancer society guidelines, and to seek professional care should a breast lump be detected.
Nipple changes- post operatively your nipple can develop eschar commonly known as scabs. This may make the nipple lumpy or have scant drainage. As this heals the nipple scar may lag behind in the healing process. There is the rare possibility of skin death of a portion or the entire nipple. This would then require additional surgery to correct, and additionel costs may occur.
Nipple shape- the shape of your nipples and areola after surgery will be different than they were prior to the surgery. The areola is made smaller. There can be asymmetry from side to side. They may not be round. Skin is a changing, growing, aging tissue and will change over time.
Shape- you breasts will be smaller, and the shape will be different from pre-operatively. The shape of the breast may appear boxy at first. This takes time to “settle in” and round out. You may not be happy with the new shape of your breasts. You cannot expect to have “perky” breasts with superior fullness after reduction surgery. This requires an implant. This operation is done to improve symptoms of large breasts and not to only improve appearance. With smaller reductions though, the post-operative shape is usually quite acceptable.
Breast feeding- although some women have been able to breast feed after breast reduction, in general this is not predictable. If you are planning to breast feed following breast reduction, it is important that you discuss this with your plastic surgeon prior to undergoing reduction mammaplasty.
Allergic reactions- ın rare cases, local allergies to tape, suture material, or topical preparations have been reported. Systemic reactions which are more serious may occur to drugs used during surgery and prescription medicines. Allergic reactions may require additional treatment.
Nipple and areolar necrosis:
While very rare, it is possible for the area areola (area around the nipple) and nipple to not have good blood flow after surgery which may result in the tissue dying. This will result in a wound and delayed healing. The nipple and areola may then be gone but may be reconstructed.
Long term results:
It is not possible to predict how pregnancy, weight change and aging will affect the results of a breast reduction. If you are considering significant weight reduction or pregnancy in the near future, breast reduction surgery may be postponed to avoid possible untoward effects and late unsatisfactory results.
Surgical anesthesia- both local and general anesthesia involve risk. There is the possibility of complications, injury, and even death from all forms of surgical anesthesia or sedation.
Addıtıonal surgery necessary
There are many variable conditions that may influence the long term result of reduction mammaplasty. Secondary surgery may be necessary to perform additional tightening or repositioning of the breasts. Should complications occur, additional surgery or other treatments may be necessary. Even though risks and complications occur infrequently, the risks cited are particularly associated with breast reduction surgery. Other complications and risks can occur but are even more uncommon. The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee or warranty expressed or implied, on the results that may be obtained.
The cost of surgery involves several charges for the services provided. The total includes fees charged by your doctor, the cost of surgical supplies, laboratory tests, blood bank, anesthesia, and hospital charges, depending on where the surgery is performed. Depending on whether the cost of surgery is covered by an insurance plan, you will be responsible for necessary co-payments, deductibles, and charges not covered. Additional costs may occur should complications develop from the surgery. Secondary surgery or hospital day-surgery charges involved with revisionary surgery would also be your responsibility.
Lnformed-consent documents are used to communicate information about the proposed surgical treatment of a disease or condition along with disclosure of risks and alternative forms of treatment(s). The informed- consent process attempts to define principles of risk disclosure that should generally meet the needs of most patients in most circumstances.
However, informed consent documents should not be considered all inclusive in defining other methods of care and risks encountered. Your plastic surgeon may provide you with additional or different information which is based on all the facts in your particular case and the state of medical knowledge.
Informed-consent documents are not intended to define or serve as the standard of medical care. Standards of medical care are determined on the basis of all of the facts involved in an individual case and are subject to change as scientific knowledge and technology advance and as practice patterns evolve.