Are The Risks & Complications Of This Procedure?
Inherent risks and
complications, such as an allergic or negative reaction to anesthesia
are possible. General risks such as infection, hematoma
(collection of blood within the tissue), seroma (collection of fluid in
the tissues), tissue necrosis (tissue death) if adequate vascularity is
not maintained either during the procedure or during the healing phase
are also possible. Suture breakage and wound separation are possible
as well. Inflammation and non-infected pus may appear around
permanent and resorbable sutures.
loss or change in sensation, is to be expected, at least
temporarily. However, numbness can become a permanent complication.
Odd sensations, including burning, prickling, coldness, crawling, etc.,
during the healing process are common but should prove to be
temporary. In rare instances, increased sensation is possible
resulting in a painful, overly-sensitive feeling when touched even by
clothing. Itching and redness may also occur.
complications are asymmetry, hyperpigmented and keloid scarring, and
Should Perform This Procedure?
Choosing a surgeon can be the most difficult and important part of the process.
While many advise only to choose a board certified plastic surgeon,
meaning only choosing a surgeon who is a member of the American Board of
Plastic Surgery, verifiable on the American Board of Medical Specialties
there is more to consider before choosing a surgeon. Please see
our special Choosing A
Surgeon section with tips on how to locate and decide upon a surgeon
to perform your procedure. This section will launch in a new
window for ease of reference and so you don't lose your place.
Should I Expect At My Pre-operative Consultation?
consultations are designed as meetings with surgeons so that you are
able to evaluate what they have to offer, their preferred technique,
before and after photos, anesthesia preferences and other
protocol. This is a very important step in the surgical process as
this is how you will ultimately choose who to book with.
You may wish
to ask if you may bring a friend for emotional support when you call or
email to book an appointment.
Some surgeons don't allow this practice, while others fully understand
and do not mind. This fact will vary from practice to practice so
be sure to inquire ahead of time. You should also determine ahead
of time if there is a consultation fee, more often than not you will
have to pay a fee which may range from $50. to $500. to meet with the
surgeon. This fee is usually designed to separate the serious
patients from those who are just interested but have no intention of
ever having surgery. Consultations may range from only ten minutes
to several hours, depending upon the surgeon and sometimes this duration
does not reflect upon consultation cost.
and check-in, you will be asked to fill out paperwork which will include
your name, address, contact information as well as the contact
information of an emergency contact. Health information will be
taken as well including known allergies, lifestyle (prescription and/or
recreational drug-use, alcohol consumption, smoking, etc.). Completely
disclosing any known or possible condition is vital to your
safety. If you are having general anesthesia, something such as asthma
or smoking can severely impact your health while you are under.
Also, be very truthful about medications you may be taking or have taken
then meet with the surgeon for a physical examination of the body part
you are consulting about, as well as discuss your options, the
techniques available, anesthesia questions, or anything else you wish to
inquire about. This is an important meeting so do not be afraid to
ask the surgeon anything, or give your input in any way.
consultation you may be directed to a patient coordinator's office to
discuss fees, financing, etc. You am either choose to book at this
meeting or wait until you are finished consulting with other
surgeons. Estimates are usually only valid for one to six months
so be sure to inquire about this before you leave.
Are The Average Costs Of This Procedure?
procedures are usually performed in conjunction with breast lifts,
breast reductions or breast augmentations in those who have lost
volume. By itself this procedure averages at $2000. to $3,500. and
does not include anesthesia, operating room costs, medications or laboratory
tests. Check with each surgeon regarding costs as all practices
have different fees and these fees may prove to be less if the surgeon
has his or her own operating suite. Having your procedure in a
hospital often increases the associated costs.
Do I Prepare My Body For This Procedure?
Once you book your surgery,
you are usually asked to come by for a separate meeting called a
pre-operative appointment. This procedure is designed to allow
discussion of more concerns, protocol specific to the preparation,
surgical and recovery process, pre-operative and post-operative
instructions. At this meeting you will receive instructions on what to
eat, what to take and how to prepare your body for your procedure as
well as how to care for yourself after the procedure.
instructions include cessation of all aspirin or vitamin E-containing
products and supplements, as well as cessation of diet pills, alcohol
consumption, recreational drug use, and smoking. You should
attempt to get your body in its best condition to decrease your chances
of complications. Complications can arise if you continue to
consume alcohol, recreational and some prescription drugs, some supplements,
and smoking. View our chart below to give you an idea of what can
happen if instructions are not followed:
excessive bleeding and bruising
coagulation; excessive bleeding and bruising
disrupt blood flow, poor healing, necrosis
coagulation; excessive bleeding and bruising
excessive bleeding and bruising, increases effects of
pills and other stimulants
coagulation; excessive bleeding and bruising
excessive bleeding and bruising, negative impact on liver,
increases or decreases effects of anesthesia, vaso-constriction;
can disrupt blood flow, poor healing, necrosis
Although many vitamins and
supplements can be harmful before and after surgery, there are also
helpful vitamins and supplements recommended to stimulate healing.
These may include Alpha Lipoic Acid, Arnica Montana, Vitamin A, Vitamin
B Complex, Bromelain, Copper, Vitamin C or Vitamin C Ester,
Chromium polynicotinate, VItamin D3, Folic Acid, L-Carnitine, L-glutathione,
MSM (Methyl Sulfonyl Methane), N-acetyl-L-cysteine, Niacin, Selenium,
taurine, Thiamine and Zinc. Please see our Helpful
Vitamins & Supplements section.
discuss the desired areolae size during this meeting, as well. The
areolae size is usually measured in millimeters in diameter. Size
is usually determined in relation with the size of the breast, or the
preference of the patient. it might be prudent to reduce the
desired size a few mm to compensate for natural stretching. It is
often thought of to go too small than go too large as you can always have
the scar and areola
tattooed (micropigmented) for evenness and for scar camouflage.
Mental preparation is also a
good idea as not being prepared for your experience can cause unnecessary
anxiety and fear. Also, not knowing what to expect can cause
anxiety when something as normal as bruising and discomfort
arises. Be sure that you know what to expect, what is normal, and
what is not so that you are better prepared during your recovery.
Support during this time is vital, so we invite you to join us on our Breast
Surgery Message Boards to speak with other patients who may be feeling
exactly the same as you currently are or others who have already been
through your current phase in the recovery process.
Is This Procedure Performed?
When you arrive at
the surgery center or hospital, you will be instructed to change into a
surgical gown. You may have already been told you could take an
oral sedative such as diazepam or lorazepam to ease pre-surgical
anxiety, as well as Zofran, or similar, to lessen the nausea often felt
after anesthesia. You may see your surgeon at this time and
discuss anything which you may have thought of over night, you may also
then meet the anesthesiologist who is going to administer your
anesthesia during your surgery. Your surgeon may also measure the
placement of your areola and make pre-surgical markings with a Sharpie-type
pen or similar single use, pre-surgical marker while you are in a
have changed into your gown you may be lead to the pre-surgical area for
IV insertion and medication administration. Once your IV and
saline drip is in, your anesthesiologist will be able to infuse
medications for nausea or anxiety, and eventually to sedate you and for
pain management. You will have a blood pressure cuff placed
around your arm, and monitoring adhesive pads placed on your chest
and/or arms; these will be hooked up to equipment which will monitor
your blood pressure and heart rate. You will also have an
oximeter placed on your finger or toe
which will be connected to this machine. This device measures the
arterial oxygen saturation and will alert the surgical and recovery
teams if you are not breathing deeply enough or not getting enough
oxygen, in general. If it is removed, or it doesn't have a proper
contact, an alarm will sound to alert the team. The oximeter is
just as important as your heart rate and blood pressure. If you
are not getting proper oxygen saturation, your cells are not receiving
the vital oxygen they need to survive. When this happens, it is
referred to as hypoxemia. Typical normal oxygen
saturation is between 95% to 99%, some patients even 100%.
When your anesthesiologist
infuses a pre-surgical sedative, you may feel very relaxed and
sleepy. Many patients go right asleep, others drift in and out of
a state of consciousness. This assists in relieving the tension
often experienced by patients before they go into the O.R. to begin
surgery. You may or may not remember this part of your procedure.
are anesthetized by your chosen method, and your vitals are determined
as stable, your urinary catheter is then placed
(which is not always necessary so inquire beforehand). Your surgeon will
begin to scrub the breasts, upper chest, abdomen and side of the ribcage
with either Betadine (povidone-iodine, 7.5%), pHisoHex (hexachlorophene,
3% ) or Hibiclens (chlorhexidine gluconate, 4%) or similar-type antibacterial
surgical scrub. This will lessen your chances of a bacterial infections
from naturally occurring bacteria such as Staphylococcus aureus
(S.aureus) which lives on our skin.
After you are well-scrubbed
and draped, your vitals are again determined as stable. Your
surgeon may then choose to draw circles on the areolae and the
surrounding breast envelope either freehanded, or preferably, with an
areola-stencil. The size is usually predetermined at your
pre-surgical appointment and possibly discussed again right before
After the areola circles
have been drawn, your surgeon then begins the first incision. The
areola is left on a pedicle [: n. Part of a skin or tissue graft that is
left temporarily attached to the original site. pl pedicles] of
underlying tissue to maintain a good blood supply. In the diagram
a superior pedicle technique has been used. A variation
might be the superior medial pedicle technique in which the pedicle
stems from the 1 or 2 o' clock position. A pedicle branching from
underneath, called an inferior pedicle technique, is also a
commonly utilized. Medial pedicle techniques use a pedicle
branching from the center of the chest, and the lateral pedicle
technique, branching from the outside of the breast. Another
possible technique is the posterior pedicle where the pedicle is
maintained underneath and does not hinder the placement of the areola
complex. You may want to discuss the technique your surgeon plans
to use and inquire as to why it may be his, or her, method of choice.
After the tissue is excised
your surgeon may choose to use a permanent suture technique as discussed
earlier. This would require suturing of the edge of the outer
tissue to the edge areola with a nonresorbable suture material made from
polypropylene or nylon. The suture material is then gathered like
a drawstring bag and the areola and breast envelope are drawn
together. This supports the tissue and relieves tension from the
incision line as it heals. After this step is completed, the
incision is then fully closed with resorbable sutures. Your
surgeon will then usually apply paper tape, such as Steri-Strips, over
the incision line and then you will be dressed in your support bra.
After your surgery is over,
your catheter is usually removed and your anesthesiologist will turn off
the anesthetic gases and increase the oxygen. You may then have
your endo-tube removed and an oxygen mask placed over your nose and
mouth. You will then be wheeled into the recovery area and your
vitals monitored until you are able to breathe well enough on your own
without oxygen assistance.
Should I Expect During My Recovery?
Immediately after surgery, you may feel very
disoriented, very confused and possibly emotional because of the
anesthetics. If you feel nauseated be sure to let the recovery
nurse and anesthesiologist know. Your anesthesiologist or surgeon
may administer an anti-nausea medication intravenously. The
recovery team will continue to monitor your heartrate, blood pressure
and oxygen saturation. After a few minutes, they will begin
to say your name to rouse you from your sleep. If you were intubated,
you may notice when you try to speak that your throat may be a little
sore, this is a normal sensation due to the endo-tube.
You may also feel
nauseated. You may feel cold or hot depending upon your own
body. If you feel either, do let the recovery nurse know so they
can either get you another blanket or remove the heated blanket you may
have covering you. if you feel any pain, do let the recovery team
know so that you may be given pain medication, however, you usually will
not feel pain because of the local anesthetics. If you are
nauseated you may have to be given pain medication intravenously, but
your anesthesiologist may have you wait until you are more aware and capable
of speaking clearly. You will nod off and on during this time and
your oximeter may sound if you are not breathing deeply enough, thereby
not receiving enough oxygen.
When you are released is
usually determined by your oxygen saturation levels and level of
awareness. When your anesthesiologist and surgeon have determined
if you are well enough to leave, you will be released to your caretaker
and driven home. You absolutely can not drive yourself home
after a surgical procedure. You will need a caretaker to assist
you by waking you for your meds, to fix you something to eat, possibly
assist you in walking to the bathroom if you are dizzy from your medications,
retrieving items for you such as ice packs, drinking water, etc.
Your surgeon should give you post-operative instructions that you should
follow carefully. These instructions will include activity levels,
icing instructions, wound care, personal hygiene instructions,
etc. If you should have any questions or concerns or feel pain
which is not manageable, call your surgeon or the on-call nurse
immediately. Should you begin bleeding or vomiting uncontrollably,
have your caretaker bring you to the hospitable and call your surgeon or
the on-call nurse immediately to have them meet you at the hospital.
You will usually sleep most
of the remainder of the day, waking only for medications or bathroom
breaks. You should try to eat something light such as soups,
Jell-O or protein shakes (although please check the labels carefully for
problematic additives such as high levels of vitamin E or other
anti-coagulants). Eating will help keep nausea at bay and keep
your strength up as well. You should also be drinking plenty of
You may feel more alert
later on that night and feel like watching TV or reading a book.
However, do not over-exert yourself any time during your recovery.
Even if you feel well, you mustn't cause your blood pressure or heart
rate to raise as this can cause a hematoma to occur. You
will more than likely have slight to moderate bruising, as well as swelling
and breast tenderness. Any discomfort should be alleviated by your
prescribed pain medications. Should any severe pain develop,
please contact your surgeon or the on-call nurse as soon as you can.
More than likely, you will
just sleep, waking only to eat, take medications or go to the
bathroom. Be sure to take your temperature regularly. A high
temperature could mean an infection.
You should not lift any
items over 3 lb., nor should you bend over nor reach above your
head. Do be careful when walking up or down stairs, or even so
much as down the hallway to the bathroom. Your medications can
make you dizzy and possibly cause you to fall. Wearing a shirt
which buttons or snaps in the front is recommended.
If your hair is long,
keeping your hair in a ponytail or braid is recommended as your hair can
become quite tangled. This will keep your hair tangle-free and out
of your face.
You may notice sensations
such as sharp pains, tingling, tickling, intermittent throbbing and
other sensations during the course of your recovery. Know your
body, although these are usually normal, anything intolerable could be a
By the next day you may feel more alert and active. Remember
not to over-exert yourself in any way, as you are still at risk for a
hematoma. Your appetite may be increased and you may doze off
throughout the day. Continue to take your medications and
temperature regularly. Your surgeon's instructions should guide
you throughout the course of your recovery.
Day 3 - 5
You will notice your awareness and restlessness will increase during
these days, as well as your appetite. Should your medications make
you nauseated, you should take them with food if directed. Be sure
to continue drinking plenty of fluids. Your surgeon might have you
begin showering a few days after surgery. Sponge baths may
be taken before then if you feel as though you are in need of freshening
Day 7 - 10
Your first scheduled post-operative appointment is usually within 5 to
10 days, depending upon your surgeon's protocol. Your surgeon will
be able to evaluate your recovery and make any adjustments in your
care. Your surgeon may or may not change the bandages or have you
remove them completely.
Any remaining swelling,
bruising and tenderness will usually dissipate over the next few
weeks. Your resorbable sutures may begin to fall out by now, if
not your surgeon may have you return for removal or instruct you on
removing them yourself. If irritation develops around the sutures,
please let your surgeon know.
Your bruising should be faded or almost faded by now, however this will
depend upon your body's propensity towards bruising. You will notice
the incisions will begin to darken and begin to enter the unattractive
stage. This should last about 3 months. The scars will get worse
usually before they get better, so patience is a necessity during the recovery
You should no longer need
pain medications and should have well completed your course of
antibiotics by now, barring any problems which require additional
medications, of course. You are usually still under activity
restraints for another week and should still be wearing a supportive
bra. Support is vital during the scar maturation
Oftentimes, activity restraints are lifted at the 3 week mark, but
always listen to your own surgeon. Should you be allowed to return
to normal activity levels, please do so cautiously. You may find
that you tire easily during this stage as your body is still
recovering. You may feel as though you can sprint a mile, it is
often advised you should not. Go easy and always wear a supportive
bra or other garment which supports your breasts.
You may still notice odd
sensations throughout the course of your recovery. This will occur
as your feeling returns and your body heals.
What To Look Out For
Please contact your surgeon or the on-call physician immediately if you notice any of the following:
bleeding from your suture lines
pus or cloudy discharge from your incision areas, nipples or elsewhere
a foul odor from your incision areas, nipples or elsewhere
blisters or implant extrusion (if applicable)
bottoming out of the implant (if applicable)
displacement of the implant (if applicable)
inability to pass waste (both liquid and solid)
numbness of the legs (unless you had lipo as well)
uncontrollable dizziness not related to the pain relievers
deflation (if applicable)
Please contact your surgeon or the on-call physician AND go to the emergency room as soon as possible if you notice any of the following:
passing blood through urine, feces or spitting up blood
abrupt and severe swelling and discoloration (aside from normal swelling)
blackening of the skin (which is clearly NOT a bruise)
loss of consciousness not related to sedatives
What to do in case of a complication:
#1 STAY CALM
Have your emergency numbers handy and contact, or have your caretaker contact, your surgeon or the on-call physician to let them know of your problem as soon as you can.
If you are going to the emergency room don't forget to tell your surgeon WHICH hospital
Bring all of your medications with you to the hospital
It may be cautionary to pack an overnight bag ahead of time "just in case"
If you are able, keep a written journal (and if possible photos) of your symptoms and complaints
This procedure will
result in scars around, at the rim of, or on the areolae itself. For some this
may be faint, for others, very obvious. Depending
upon your body's healing capability, this scar may result in a thin,
light line or a darker red, or raised scar. Clearly, there are several
stages of scar tissue development, often the redness of the incision
line is most visible at three (3) months post-surgery. After this stage
the scar may continue to fade and the tissue flatten. Please discuss scar
treatments with your surgeon in advance so you know what to do while the
scar tissue is forming, instead of after when it can be too late. Please
see our Scar Treatment Section for more
Scars can also
result in a hypo-pigmented [: lacking pigment, or color] line in some patients, resulting in lightened areas of
skin where the melanin production has been compromised. Areola
tattooing, also know as micropigmentation, can counter these effects by
depositing pigments into the scar tissue thereby blending the lightened
parts into the surrounding tissue. Please know that scar tissue is
more difficult to tattoo than normal skin so be sure to choose a
micropigmentation technician who is well-experienced in tattooing scar
tissue. Please see our Areola
Repigmentation Section for more information.
Else I Should Know?
Temporary and permanent puckering may be an
issue in areola reduction surgery. This results in an appearance
similar to the gathered section of a drawstring bag. Oftentimes,
puckering dissipates between the second and 6th week, others may take
longer. Steri-Strips, or other paper tape may assist in hastening
this process, however, fluid can also collect under paper tape so use
caution and only under your surgeon's advice.
Revision surgery is
possible, although uncommon. In the event of a revision surgery,
this can also be performed under local anesthetic only in-office and
require very little downtime.
Inflammation of the permanent
suture, if utilized, is also a possibility and should be watched during
the initial recovery stage. Although, always an infection
possibility, delayed infection is very rare. Inflammation, however
depends upon the individual. This may result in wound opening, pus
or weeping, and raised scar tissue under the areola wherever the
underlying permanent suture is. If this continues, do alert your
surgeon. Inflammation soon ceases after the removal of the
Irregular scarring may be an
issue for some patients. If this should occur, there are options
available. Again, please see our Scar Treatment Section
if this turns into a permanent issue.
eMedicine Medical Information
(Updated on 02/25/10)
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