In all cases the tissue that has been removed will be sent for routine histological examination. The results usually come back within a fortnight and patients receive a letter confirming the results. Very rarely something untoward is detected and patients will be recalled back for urgent review. If a cancer is detected it is highly likely that the treatment that will be required will involve a mastectomy as it is impossible to locate the exact site of the tumour within the breast. Obviously on the positive side the cancer will have been picked up at an early stage. Patients over the age of 45 who have not had a mammogram within a year of surgery should consider whether it would be appropriate to have one pre-operatively.
The scarring in the breast may be visible on routine mammography but will not affect the interpretation of the investigation. Breast cancers are not triggered by surgery to the breast and there is good evidence to show that rates of breast cancer are actually reduced following breast reduction almost certainly a result in the reduction of breast tissue.
What are the risks?
In the first few hours on returning to the ward bleeding may occur and this can accumulate resulting in a haematoma. The breast swells massively and patients need to return to the operating theatre for evacuation of the haematoma. This occurs in about 1:100 cases. There are usually no long-term side effects.
Sensory disturbance to the breast skin and nipple are described above. Some pain and discomfort will occur but usually resolves after a week or two. Some patients do experience a mastitis-like pain for a longer period and occasionally a course of medication is required. Some patients develop painful lumps in the breast. These are usually due to small areas of fat necrosis, and they will usually settle down over 2-3 months.
The commonest complication is wound infection. Occasionally antibiotics are required and dressing may be required for a longer period. In severe infections wounds can breakdown, usually at the bottom of the up/down scar at the T-junction. This is a relatively unusual complication in non-smokers, and patients of normal body weight. Patients who do smoke should refrain for 4 weeks before and at least 4 weeks after surgery. Usually the wounds will heal with simple dressings alone, though occasionally secondary surgery may be required.
In very severe infections the tissues can be damaged and skin loss can occur. Secondary surgery will almost certainly be required; very rarely this involves the use of skin grafts.
All attempts are made to make the breasts the same in terms of size, shape and nipple position however small differences are almost inevitable. If marked then revisional surgery may be required though this is usually deferred for several months as some differences may reduce as all the swelling settles.
The most serious complication following breast reduction surgery is nipple loss. Fortunately this is extremely rare. Should this occur the nipple and areola dies and a scab is formed which will eventually heal up leaving a scarred area. A new nipple can be reconstructed at a later date however these are poor imitations.
Following any surgery there is a risk in developing a deep vein thrombosis (DVT). This is a clot in the calf vein of the leg. In itself it may result in pain and swelling. The risk is that should the clot separate from the vein it can move to the lungs resulting in a pulmonary embolism. This is a potentially life threatening situation. All attempts are made to reduce the risk using compression stockings during and for two weeks after surgery, using pneumatic compression devices on the legs at surgery and in the immediate post-operative period, by encouraging early mobilisation, advising patients to stop the combined oral contraceptive pill four weeks prior to surgery and where it is felt appropriate using injections of blood thinning agents.
When complications do occur all attempts are made not only to remedy the problem in as speedy a manner as possible but also to optimise the final result. As with all cosmetic surgical procedures undertaken by Mr Sarakbi, there is a fixed fee policy which means that no further surgical charges are incurred for complications that occur within one year following the initial surgery. There may however (depending on the local hospital policy), be a charge for the hospital and the anaesthetist for repeat procedures occurring over 30 days from the original operation.
Should there be any concerns then the patient should seek advice. The contact numbers are provided below.
Most patients are delighted with the result of surgery and breast reductions are associated with very high rates of patient satisfaction. In many cases the operation is not simply a cosmetic procedure. Patients frequently experience functional benefits as a consequence of the reduction in the heaviness of the breasts. These include improvement of neck, shoulder and backache as well as a loss of the dragging sensation and chaffing in the crease under the breast.