Persistent Lower Pole Fullness
This is the most common complication of a breast lift. It is usually caused by inadequate removal of breast tissue from the lower pole of the breast, so that there is a persistent bulge of the lower pole, which one surgeon colorfully calls the "mastopexy-wrecking bulge." This problem is common among patients treated with "skin-only mastopexies" because the skin stretches readily and cannot hold the breast shape. It is also commonly found in patients treated with "periareolar" or "donut mastopexies" because these techniques do not allow removal of breast tissue from the lower pole. They do avoid a vertical scar, leaving just the scar around the areola, which is the appeal of these limited-incision techniques, but this benefit is outweighed by the inability of these techniques to adequately tighten the lower pole and provide a lift. (See J.L.'s Photographs/Description)
As in any surgery, infection is a risk. Patients receive intravenous antibiotics at the beginning of the operation. After surgery, they take antibiotics for 24 hours,. This is short course of antibiotics recommended to help prevent infection. Longer periods of "prophylactic" antibiotics used in the past may be counterproductive, providing more opportunity for emergence of resistant organisms. "Comments: This patient is seen 8 days after a breast lift and implants. She appears to be recovering normally. However, 11 days after surgery, she has developed redness, soreness, and a mild fever (99.1 degrees Fahrenheit), indicating an infection. The infection cleared with oral antibiotics." M.J., age 32, supervisor, 6 children
Because the dissection is superficial, hematomas are uncommon for breast lifts alone (but may be due to the breast augmentation if this is done at the same time) and are signaled by marked discomfort and swelling, usually on one side, within the first 24 hours after surgery. Recognition is the key. If the patient returns to the operating room promptly for treatment, she is unlikely to have any problems from this.
Skin Loss/ Delayed healing.
Because skin circulation is partially interrupted by raising skin flaps, avoidance of smoking is important to reduce the risk of loss of skin along the wound margins. This is true in any procedure which involves raising skin flaps (facelift, abdominoplasty, and breast lift/reduction). If a small margin of skin loss occurs, the patient is reassured and instructed to keep the open area clean with soap and water, apply antibiotic ointment and a light gauze dressing. The wound is allowed to heal in on its own. Because wounds contract in from the sides and shrink as they heal, the resulting scar is often surprisingly small, and usually requires no treatment. Scars that widen as they heal may be treated later with a scar revision.
Although rare, it is possible to also lose portions, or all of the areola and nipple. Anything that interferes with circulation to the skin such as excessive tightness, an underlying hematoma, pressure on the skin, or smoking (due to nicotine), can lead to this complication, which is best avoided. Smoking cessation patches and gum also contain nicotine, the substance which causes the small blood vessels to tighten, so these also need to be avoided.
Some surgeons have expressed concern about combining a breast lift and implants, citing high complication rates, higher than what might be expected if the operations were done in stages. However, our study and others show no higher rate of complication rates for the combined procedure. Problems may be encountered when a surgeon uses a periareolar or inverted-T technique with implants because of the technical deficiencies of these techniques, which lead to a higher complication rate. Vertical mastopexy in combination with implants is safe and the combination procedure has a number of advantages over either operation alone. Any patient who is a candidate for a breast lift or augmentation done individually is a candidate for the combined procedure.