A mastopexy refers to a procedure in which excess skin is removed to tighten surrounding tissue and to reshape and support the new breast contour. This operation can also reduce the size of the areola, the darker skin around the nipple.
There are risks and complications associated with this operation.
ALTERNATIVE TREATMENTS
Alternative forms of non-surgical management consist of not undergoing a mastopexy
Every surgical procedure involves a certain amount of risk and it is important that you understand these risks and the possible complications. In addition, every procedure has limitations. An individual’s choice to undergo a surgical procedure is based on the comparison of the risk to potential benefit. Although the majority of patients do not experience these complications, you should discuss each of them with your surgeon to make sure you understand the risks, potential complications, and consequences.
Change in Nipple and Skin Sensation
You may experience a loss or increased sensitivity of the nipples and the surrounding breast that usually resolves in 6 to 8 weeks. Partial or permanent loss of the nipple and skin sensation is rare.
Areola Spreading
The areola may stretch and become visibly larger and wider. This is due to the stretching of the surrounding breast tissue and skin elasticity. Additional procedures to reduce the size of the areolas may be performed.
Asymmetry
Breast asymmetry naturally occurs in most women before surgery. Changes to the nipple shape, size, or symmetry may also occur after surgery; this may require additional surgery to correct.
Skin Contour Irregularities
Contour and shape irregularities may occur. Visible and palpable wrinkling may occur. One breast may be smaller than the other. Nipple position and shape may not be identical. Residual skin irregularities at the ends of the incisions or “dog ears” may occur. This may improve with time, or may require additional surgery to correct.
Skin Laxity
Patients with significant skin laxity will continue to have the same lax skin after surgery. The quality or elasticity of the skin will not change after surgery, and will in fact, get worse over time due to the ageing process. This may occur quicker for some than others.
Breast Feeding
A Mastopexy may affect milk supply, however does not always necessarily mean you can not breastfeed.
Not Lifetime Devices
The results of a breast lift will not last forever. Ageing, weight changes, pregnancy, or general lifestyle factors may impact results – patients may opt to undergo an additional lift in future if desired.
Unsatisfactory Result
Although good results are expected, the precise degree of improvement cannot be guaranteed. There is no warranty expressed or implied, on the results that may be obtained. The outcome’s subjective nature also means dissatisfaction is a possible outcome regardless of the successful outcome of the surgery. In some situations, it may not be possible to achieve optimal results with a single surgical procedure. It may be necessary to perform additional surgery to achieve your desired results.
Surgical Anaesthesia
Both local and general anaesthesia (including sedation) carry risks and complications. These may include injury and even death.
Allergic Reactions
Local allergies to tape, stitches, topical preparations, or injected agents can occur. Serious life-threatening, systemic reactions including shock (anaphylaxis) may occur in response to the drugs used during surgery and/or medication prescribed after surgery. Allergic reactions may require additional treatment.
Cardiac and Pulmonary Complications
Pulmonary complications may occur secondarily to both blood clots (pulmonary emboli), fat deposits (fat emboli) or partial collapse of the lungs after general anaesthesia. Pulmonary emboli can be life-threatening or fatal in some circumstances.
Inactivity and other medical conditions may increase the incidence of blood clots. Notify your surgeon of any history of blood clots or swelling in the legs prior to surgery. Cardiac complications are a risk with any surgery and anaesthesia, even in patients without symptoms.
If you experience shortness of breath, chest pain, or unusual heart beats, seek medical attention immediately. Should any of these complications occur, you may require hospitalisation and additional treatment.
Shock
In rare circumstances, surgery can cause severe trauma, particularly when multiple or extensive procedures are performed. Although serious complications are infrequent, infections or excessive fluid loss can lead to severe illness and even death. If surgical shock occurs, hospitalisation and additional treatment are required.
Pain
Pain of varying intensity and duration may occur and persist after surgery. Chronic pain may occur as a result of trapped nerves in scar tissue or due to tissue stretching.
After your surgery you will be given a full course of prescription pain medication. We DO NOT provide repeat scripts for schedule 8 narcotics, benzodiazepines, or other drugs of dependence.
Bleeding
If a bleed occur during surgery, it may require emergency transfer to a tertiary facility. A bleed that occurs after surgery is often known as a hematoma; this usually occurs within the first 3 weeks but can occur at any time. It may require emergency intervention to drain accumulated blood.
In breast implant surgery, hematoma may contribute to capsular contracture, infection or other problems.
If a blood transfusion is necessary to treat blood loss, there is the risk of blood-related infections such as hepatitis and HIV (AIDS).
Increased activity too soon after surgery can lead to increased chance of bleeding. It is important to follow pre and postoperative instructions. Heparin medications that are used to prevent blood clots in veins can produce bleeding and decreased blood platelets. Unless cleared by your surgeon, avoid herbal supplements, aspirin, anti-inflammatory medications for at least 14 days before and after surgery.
Healing Issues and Wound Separation
The surgical area may not heal normally or may take a long time to heal. Areas including nipple may become necrotic (die). Wounds may separate after surgery. This may result in colour changes, shape changes, swelling, bleeding, or infection. It may require frequent dressing changes or further surgery; resulting in prolonged recovery and additional expense.
Issues with healing are more common in patients who smoke, have used steroid drugs, after chemotherapy/radiation to the treatment area, diabetes or other medical conditions, after massive weight loss, or excessive heat or cold therapy.
Damage to Deeper Structures
There is the potential for injury to deeper structures including nerves, blood vessels, muscles, and lungs (pneumothorax) during any surgical procedure. The potential for this to occur varies according to the type of procedure being performed. Injury to deeper structures may be temporary or permanent.
Fat Necrosis
Fatty tissue found deep in the skin might die and may result in areas of firmness within the skin. Additional surgery to remove areas of fat necrosis may be necessary. There is the possibility of contour irregularities in the skin that may result from fat necrosis.
Seroma
Although swelling usually occurs after surgery. Excessive fluid may accumulate following surgery, trauma or vigorous exercise. This may require drainage.
Lymphedema
Persistent swelling (lymphedema) can occur in the legs after surgery.
Venous Thrombosis
Thrombosed veins, which resemble cords, occasionally develop in the area of the breast or around IV sites, and usually resolve without medical or surgical treatment. It is important to discuss with your surgeon any birth control pills you are taking. Certain high estrogen pills may increase your risk of thrombosed veins.
Skin Sensitivity
Bruising and swelling normally occurs after surgery. Although uncommon, swelling and skin discolouration may persist for long periods of time and, in rare situations, may be permanent. Itching, tenderness, or exaggerated responses to hot or cold temperatures may occur after surgery. Usually this resolves during healing, but in rare situations it may be permanent.
Nerve endings may become involved with healing scars during surgery. While there may not be a nerve injury, the small nerve endings during the healing period may become too active producing a painful or oversensitive area due to the small sensory nerve involved with scar tissue. This can usually be resolved with non-surgical intervention.
Sutures
Most surgeries involve sutures, these may be dissolvable or may require removal by a medical professional. There are usually multiple layers of deep internal sutures. You may notice these sutures after your surgery. Sutures may spontaneously poke through the skin, become visible or produce irritation.
ADDITIONAL RISKS AND COMPLICATIONS
A mastopexy does leave permanent, noticeable scars on the breasts – with appropriate postoperative care these will fade over time.
The revision rate for a full mastopexy is 1 in 4 (based on best practices worldwide). This means that 1 in 4 patients will need an additional procedure to touch up or correct a complication.
This may be a revision under a local anaesthetic (such as resizing the areola). Or this may be a revision under a full general anaesthetic (such as performing the lift again).
The rate of revision largely depends on the patients’ skin quality and elasticity. For example, if a younger patient, requires a full lift then it can be concluded that the skin quality was suboptimal to begin with – which is what led to the reason the lift was required in the first place.
It is impossible to determine the skin quality and elasticity prior to surgery, some patients may wish to undergo an additional lift at 8 months postoperative, some patients may wish to undergo an additional lift at 19 months postoperative, some patients may wish to undergo an additional lift at 10 years postoperative.
Sentinel Lymph Node Mapping Procedures
Breast surgery procedures that involve cutting through breast tissue, similar to a breast biopsy, can potentially interfere with diagnostic procedures to determine lymph node drainage of breast tissue to stage breast cancer.
Sun Exposure
Surgical incisions are susceptible to damage from UV rays for up to 12 months following surgery (even if covered) and may result in pigmentation issues.
Travel Plans
Any surgery holds the risk of complications that may delay healing and delay your return to normal life. There are no guarantees that you will be able to resume all activities in the desired timeframe.
Long-Term Results
Subsequent alterations in the appearance of your body may occur as the result of ageing, sun exposure, weight loss, weight gain, pregnancy, menopause, smoking, drug & alcohol use, or other circumstances not related to your surgery.
Female Patient Information
Many medications including antibiotics may neutralise the preventive effect of birth control pills, allowing for conception and pregnancy.
Intimate Relations After Surgery
Activity that increases your pulse or heart rate may cause additional bruising, swelling, or bleeding. This may require additional surgery. Refrain from intimate physical activities as instructed on the postop instructions.
Mental Health and Elective Surgery
All patients who undergo elective surgery must have realistic expectations which focus on improvement rather than perfection. Complications or less than satisfactory results are sometimes unavoidable and stressful. Although many individuals may benefit psychologically from the results of elective surgery, effects on mental health cannot be accurately predicted.
Smoking, second-hand smoke, the use of tobacco or nicotine products (patch, gum, or nasal spray), greatly increases the risk of surgical complications. Risks include, tissue necrosis, delayed healing, wound breakdown, infection, scarring, hematoma formation, bleeding, increased or prolonged bruising and skin colour changes. This may require additional surgeries with expense.
Patients must abstain from smoking and/or the use of nicotine products for at least 6 weeks before and after surgery (ideally 12 weeks).
The clinic may request a nicotine test prior to surgery. If the test returns a positive result your surgery will be cancelled, and the total cost of hospital and anaesthetic fees for the scheduled surgery will be forfeited and not returned.
The clinic is able to recognise the signs of poor wound healing which result from smoking/ nicotine products and may request a nicotine test. If a secondary surgery is required, patients are required to pay an additional surgeons’ fee of $1000. This is separate to third-party fees.
Every surgical procedure has associated risks and complications. The practice of medicine and surgery is an art, not an exact science. Although good results are expected, they are not guaranteed. There is no warranty expressed or implied, on the results that may be obtained.
In some situations, it may not be possible to achieve optimal results with a single surgery. Additional surgeries may be necessary at some time in the future and it is impossible to predict when.
When working with tissue and skin, results can be unpredictable and it is unknown how your tissue may respond or how you will heal after your surgery.
Results may depend on: skin quality, genetics, environmental factors, smoking, alcohol & recreational drug use, sun exposure, hormonal influences, general health of your body, ageing, pregnancy, stomach sleeping and patient compliance.
If you develop a complication as a result of your original surgery you may need a revision. This will require further expenditure.
Patients who are not in a good financial position to be able to afford a potential revision should NOT undergo surgery.
Pre and Post Operative Instructions
For a successful outcome – it is vital that you follow the instructions that have been provided to you.
Support Person
It is the patient’s sole responsibility to provide a support person for the ongoing care after surgery. If a support person and a health care professional needs to be arranged this will incur additional fees.
Disclaimer
Informed-consent documents are used to communicate information about the proposed surgical treatment along with disclosure of risks and alternative forms of treatment(s), including no surgery. The informed-consent process attempts to define principles of risk disclosure that should generally meet the needs of most patients in most circumstances.
However, informed-consent documents should not be considered all-inclusive in defining other methods of care and risks encountered.
You may be provided with additional or different information that is based on all the facts in your case and the current state of medical knowledge. Informed-consent documents are not intended to define or serve as the standard of medical care.
Standards of medical care are determined based on all the facts involved in an individual case and are subject to change as scientific knowledge and technology advance and as practice patterns evolve.
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