Breast Reduction Revision
Posted On: May 20, 2014 Author: Dr. Stuart Linder Posted In: Breast Reduction
Breast reduction revision is a very tricky operation because blood supply has already been violated once to the nipple areolar complex and therefore the Board Certified Plastic Surgeon must be very diligent and experienced with this technique. It is absolutely vital that the nipple areolar complex maintains its blood supply and that the base pedicle is not dissected. Revision can occur for a symmetric breast as well.
REVISION FOR HEMATOMA
Revision for hematomamay require evacuation of the hematoma with a drain placement. Revision of your skin flap with ischemia and skin loss can be associated with wet-to-dry dressing changes and subsequently debridement of the area and advancement flap closure.
WOUND SEPARATION AND DEHISCENCE
Wound separation and dehiscence may be associated with infection which needs to be treated prior to closure. Seroma formation can occur as well around the pedicle and this should be evacuated to prevent tension or pressure necrosis on the pedicle.
Cellulitis as described is usually associated with bacteria either streptococcus or staphylococcus aureus. This needs to be treated aggressively with intravenous antibiotics. Cellulitis will be treated with our patients immediately after surgery, given Keflex 750 mg p.o. b.i.d. and we may use Cipro 750 mg twice a day of they are penicillin allergic. We give all of our patients intravenously Ancef 1 gram unless they have pen allergies. We may then give Cipro or Vancomycin.
NIPPLE AREOLAR ISCHEMIA OR LOSS OF THE NIPPLE
If their blood supply is poor early on, this can often be salvaged by releasing sutures around the areola. The doctor needs to be diligent upon this.
Dog ears can occur. If they do, they can be removed over time by surgically excising them in a 4:1 elliptical fashion. Scarring must be determined, hypertrophic versus keloid. Remember, keloids are often worsened with revision excision and therefore it must be determined which one it is. Kenalog injections, steroids, are often used in order to reduce the scarring.
Fat necrosis needs to be resolved by debridement and cleaning the area with irrigation as necessary.
Asymmetry can be corrected once the breast is completely healed by revising the breast reduction and redoing the scars. Nipple areolar complexes are often asymmetric and these can be redone as well in order to regain symmetry.