The great majority of healthy people undergoing a male breast reduction procedure have an uneventful recovery and are pleased with the outcome of their surgery. However, as with all surgery, there is the potential for complications. Complications include those of having a general anaesthetic, complications that may occur with any operation and those that need particular consideration for male breast reduction. Serious complications are rare but as with all surgery could be life threatening.
General anaesthetic:
There are the risks of having a general anaesthetic such as allergic reactions, chest problems, for example a chest infection and the possibility of clots in the legs (deep vein thrombosis or DVT). A clot in the legs can move to lungs causing a pulmonary embolus which is a particularly serious complication. Underlying medical conditions e.g. asthma can be aggravated. In general, if you are healthy, modern anaesthetics are very safe. If you are concerned about your anaesthetic we can arrange for you to meet with an anaesthetist before your surgery for an assessment and a discussion.
Bleeding and haematoma:
During surgery great care is taken to stop bleeding. However after the end of the operation, particularly if the blood pressure is raised, a bleeding point may start bleeding again. This causes a build up of blood under the wound called a haematoma. Small haematomas usually are absorbed by the body over time. Larger haematomas may need to be removed with a further operation. Most people will then recover normally. It would be most exceptional to need a blood transfusion following a male breast reduction procedure.
Infection and slow wound healing:
As with all surgery there is the potential for wound infection. Most wound infections settle down with a short course of antibiotics. If a wound becomes badly infected the wound may open up and take time to heal up. If this happened regular wound dressings would be required until it was fully healed. Serious infections are rare.
Nipple necrosis (loss of the nipple):
During the operation the nipple is undermined and this can damage its blood supply. It is possible for there to be insufficient blood supply for the nipple in which case the nipple can die. In healthy non smokers this is a very rare complication. Problems with the blood supply to the nipple are more likely with reductions of very large breasts. With very large breasts it may be advisable to use a free nipple graft technique where the nipples are removed and replaced as a graft.
Seroma:
Seroma is a build up of tissue fluid in the wound. This causes swelling which may need to be drained but usually resolves on its own. Draining a seroma is usually done with a needle and syringe as an outpatient.
Scarring:
It is important to understand that scarring varies from one person to another. Some scars can be thin pale lines but this can never be guaranteed. Poor scars may stretch and be wide or become lumpy, hypertrophic or keloid. Keloid scars are lumpy and grow out from the incision that caused the original scar. Hypertrophic scars are more frequently seen than keloids. Hypertrophic scars become widened, thickened and red for a few months after surgery. They then settle down to a pale widened scar although this may take many months and even several years. Scars may be itchy and occasionally tender or painful.
Asymmetry:
Many men have some difference in size or shape of their breasts. One breast may be larger, the nipple may be at a different position on the breast or at a different level. The brown area around the nipple called the areola may be a different size. With a breast reduction the aim is to produce breasts which are as similar as possible. However, particularly where breasts are different before the operation, it is not uncommon for there to be some difference after the operation.
Over- or under- correction:
The amount of fat to be removed with liposuction is a matter for clinical judgment. There is the possibility that too much fat is removed or that you feel not enough fat has been removed. It is generally better to remove too little rather than too much as it is easier to remove more later than to put fat back.
Skin irregularities, skin laxity and skin excess:
The elasticity of the skin is a very important factor affecting the end result from liposuction. If the skin has little elasticity it is more likely that the skin will show irregularities following liposuction. With larger amounts of fat removal there is the possibility that the skin will be loose and wrinkled following the procedure. If you have loose skin which has lost its elasticity then the skin may not retract when the fat or glandular tissue is removed. This skin may then hang and leave a crease or fold under the breast. This often an issue following large amounts of weight loss or where a large volume is removed from the breast. Sometimes a better result will be obtained by removing the excess skin. However this will result in additional scars.
Lumpy tenderness:
Following liposuction the tissues under the skin tend to swell, may feel hard and be tender. This usually settles over a few weeks. In some people this may take longer but usually settles over a few months. Permanent lumpy tenderness is rare but possible.
The appearance of having had surgery
When a large glandular area is removed it leaves a gap in the tissues under the skin. Sometimes this results in a depression which gives an un-natural appearance. Frequently liposuction is used to smooth the edge of this ‘gap’ but it may not be possible to get rid of this appearance.
Changes to the nipple
Usually there no significant changes to the nipple. However you should be aware of some possible changes which may or may not be of concern to you. The feeling in your nipples may be changed following surgery and it is possible that they could be permanently numb. Occasionally the nipple may invert after surgery. The nipples or the areolae (brown circle around the nipple) may not be the same size after surgery and they may be asymmetrical.
Tenderness and pain
Following surgery the breast area will be painful and remain tender for several weeks. In some people the these symptoms may last several months. It is very unusual for symptoms to last longer than this or be permanent.
Deep vein thrombosis (DVT) and pulmonary embolus (PE)
Deep vein thrombosis is a blood clot forming in the veins, usually in a leg vein. A pulmonary embolus is where one of these clots breaks off and travels to the lungs. They are a recognised complication of surgery and they are serious complications: A pulmonary embolus can be life threatening. There are many factors that can increase the your risk such as a family history of clots, having previously had a clot yourself. Taking various medications or having certain illnesses can also raise the risk of developing DVT’s or PE’s. Being overweight or obese, having an operation and being inactive are some of the most common factors that increase the risk of deep vein thrombosis. For patients undergoing male breast reduction surgery precautions are routinely employed to reduce the risk. You can help to protect yourself by getting up and walking around as soon as you can following your operation and continuing to take regular short walks during the early stages of your recovery.
