Tuberous breasts

These are not complications, but the tissue's normal response to reshaping surgery:

• Moderate pain and a feeling of pressure during the first 48 to 72 hours, controlled with the prescribed pain relief regimen.
• Breast swelling and edema during the first 2 to 3 weeks, somewhat longer than in a simple augmentation because of the work on the gland.
• Mild bruising around the areola, which is gradually reabsorbed in 7 to 14 days.
• A feeling of tightness in the lower pole, the area that has been actively expanded. It improves as the skin and gland adapt.
• Temporary changes in nipple and areola sensation, which are common because of the periareolar approach. In most cases they return to normal within 3 to 6 months.
• Puckering of the skin around the areola in the first few weeks, typical of the purse-string suture used to reduce the areolar diameter. It gradually smooths out.
• A periareolar scar that is pink at first and goes on maturing and fading for up to 12 to 18 months.
• Temporary asymmetry between the two breasts while the swelling goes down and the tissue settles, especially marked when the grade of tuberosity was different on each side.

Most patients return to sedentary activities after one week, office work after 7 to 10 days and high-impact sport from 6 weeks onward. The final shape is not assessed before 6 to 12 months.

Issues that, while not serious, may arise during recovery or the first few months:

• Residual asymmetry. This is the most common in this condition. A tuberous breast case starts from two breasts that differ from each other, and the goal is a substantial improvement in shape, not absolute symmetry. Minimal asymmetry is an expected result, not a technical failure.
• Widening or flattening of the areola over time, due to the tension borne by the periareolar suture. It may require a minor revision under local anesthesia.
• Hypertrophic or hypopigmented periareolar scar, more visible in patients with a predisposition or with light-toned areolas.
• Partial recurrence of the lower pole constriction, when the fibrous band has not been sufficiently released or the tissue tends to retract. It may require a touch-up.
• Double-bubble deformity, a visible crease between the original fold and the newly created fold. It is a risk specific to this surgery and is corrected in a second stage if it persists.
• Seroma: a build-up of fluid around the implant. It usually resolves on its own or with needle aspiration in the clinic.
• Significant hematoma requiring surgical drainage.
• Rippling, or visible implant folds, which is more likely here because the lower pole starts out with little tissue coverage.
• Implant malposition or descent, which may require a further operation.
• Fat necrosis, oil cysts or palpable irregularities when fat transfer has been used. They are usually benign, but must be differentiated by ultrasound.
• Partial reabsorption of the grafted fat, which is why two or more sessions are sometimes planned from the outset.
• Prolonged loss of sensation in the nipple and areola, which in a minority of cases may not fully recover.
• Delayed healing, especially in patients who smoke or with excessive skin tension in the lower pole.

Most of these situations are managed in the clinic with close follow-up. It is also worth knowing that the touch-up rate in tuberous breasts is higher than in a conventional augmentation, not because of complications but because of the nature of the deformity: a second refinement stage is part of the surgical plan in a proportion of cases, and this is explained before operating.

Serious complications, with low incidence, that every well-informed patient should know about before signing a consent form:

• Partial or total necrosis of the nipple-areola complex. This is the complication that carries the most weight in this surgery. The combination of a periareolar approach, radial incisions in the gland and expansion of the lower pole temporarily compromises the blood supply to the areola. The risk is low with proper planning, but it multiplies in patients who smoke, which is why giving up smoking is a non-negotiable requirement.
• Capsular contracture. The body always forms a capsule around the implant; in a minority of cases it thickens and hardens, changing the shape and feel. Strict asepsis protocols and modern technique have notably reduced its incidence.
• Periprosthetic infection, early or late. In the most serious cases it makes it necessary to remove the implant temporarily and operate again months later.
• Implant rupture or wear in the long term. Today's implants do not have an expiry date, but they are not permanent devices and may need to be replaced over the years.
• Deep vein thrombosis and pulmonary embolism, a risk present in any surgery under general anesthesia, minimized with antithrombotic prophylaxis and early mobilization.
• Reactions to general anesthesia, assessed and minimized by the anesthesiologist in the preoperative evaluation.
• BIA-ALCL (breast implant-associated anaplastic large cell lymphoma): a very rare condition historically linked to certain macrotextured implants. Patients are informed of it in the consent form and lifelong clinical follow-up is established.
• Effect on future breastfeeding. This deserves a specific mention: unlike a standard augmentation, here glandular ducts are cut and reshaped. Many patients can breastfeed normally, but the likelihood of it being affected is higher than in a conventional augmentation and it must be discussed openly in consultation before operating.