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Long and short term complications

Bruising of the skin (Ecchymosis)

When blood migrates into the skin, the skin first turns blue after a day or two. Over a period of 10 days it further turns into green and finally yellow before disappearing completely. No ointments should be used to speed up this resorption of blood. They could only add a rash.

Blood collections (Hematoma)

When even more blood accumulates in the virtual spaces between subcutaneous fat and breast tissue, this is called a hematoma. They also are quite common.

Their natural course is to convert to hard nodules -over a period of weeks- which sometimes can be felt and trouble the patient.

They also disappear very slowly, over the course of months.

 

Large blood collections in a matter of hours after surgery points to a bleeding vessel. It is very rare, but needs to be adressed immediately. The incision is reopened, the implant removed and the bleeding vessel identified and coagulated. The breast is rinsed from blood clots. The implant is repositioned and the incision closed again. If done so, no untoward results occur, not even capsular fibrosis. The incidence of this complication is less than 2%.

Seroma

A seroma is an accumulation of blood plasma in a pocket between subcutaneous fat and breast tissue. It can be diagnosed by it's fluctuating aspect ( think of water mattress) and by puncturing it, retrieving a clear yellowish and slightly viscous liquid.

Treatment is easy : either it can be evacuated in several sessions or -if painless- it will go away by itself . Seroma are very rare in breast surgery, less than 1%

Death of Tissues (Necrosis )

The risk of not having enough blood supply to the tissues is proportional to

It is therefore a real problem in very large reduction and not so much in breast lifting.

 

Sometimes it is the underlying breast tissue that does not get enough blood supply.

A partial necrosis can develop over a week and the waste products seek their way through the scar, which at first looks normal. Then part of the skin breaks down.

 

In very large breasts, it is sometimes recommended to remove the nipple-areola area and graft it back as a free graft to enhance the survival chances. This possibility should be discussed before surgery

 

Treatment of necrosis

It takes months to get rid of necrotic tissues and reconstructive surgery needs to be done to restore the appearance of the breast. If the nipple is completely necrotic, a new one has to be reconstructed with grafts.

 

Infections

Primary infections of the breast due to contamination of the tissues during surgery is extremely rare. I never saw one case.

A secondary infection can of course occur after necrosis, because of inadequate antiseptical treatment of exposed tissues.

Infections need to be treated by :

 

Hypertrophic and Keloidal scars

Breast scars normally heal well except in darker skinned patients, where the risk for keloidal scar is always present. Here you can find the difference between hypertrophic and keloidal scars and their treatment.

 

A scar can get broader because of :

 

In a normal but broad scar, a surgical revision of the scar can be done after 6 months with better results than in a keloid scar.

 

Breast different in size

A difference in size can occur more frequently in very large breasts as the evaluation of the size can be tricky. One method to prevent this is to weigh the removed tissues left and right. But the breast can have different sizes to begin with.One should always wait for several months before making final judgements. The difference in volume can also be caused by hematomas or edema

 

Sensory disturbances of the nipple and areola

All techniques used today are developed with the preservation of the innervation to the nipple in mind. There is always some temporarily loss of sensation during a week or two and up to several months , due to the manipulation of the tissues.

As this nerve is less than 1 mm thick, if it is severed, there is no possibility to remediate to this problem. Ultimately, there will be some sensitivity coming back.

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