The nipple is the protruding portion in the centre of the areola that carries the lactiferous (milk) ducts. Nipple correction surgery is often used to correct inverted, droopy, long, or large nipples. The surgery involves removing excess tissue in the region to create a size, shape and orientation that is considered more aesthetically pleasing for the patient.
The areola, the darker pigmented circle of skin around the nipple, may become enlarged or puffy. In an areola reduction, excess pigmented skin is trimmed and removed to create a more symmetrical & smaller appearance.
There are both risks, and complications associated with this operation.
ALTERNATIVE TREATMENTS
Nipple and Areola Reduction Surgery is an elective surgical operation. Alternativetreatment would consist of not undergoing the surgical procedure.
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 doctor to make sure you understand the risks, potential complications, and consequences.
Change in Nipple and Skin Sensation
You may experience a diminished (or loss) of sensitivity of the nipples and the skin of your breast. Partial or permanent loss of nipple and skin sensation can occur after a Nipple and Areola Reduction Surgery in one or both nipples. Changes in sensation may affect sexual response or the ability to breast feed a baby.
Areola Spreading
The areola may stretch and become visibly larger and wider. Additional procedures to reduce the size of the areolas may be performed.
Asymmetry
Some breast asymmetry naturally occurs in most women. Differences in terms of breast and nipple shape, size, or symmetry may also occur after surgery. Additional surgery may be necessary to attempt improvement of asymmetry after a Nipple and Areola Reduction.
Skin Contour Irregularities
Contour and shape irregularities may occur after Nipple and Areola Reduction. Visible and palpable wrinkling may occur. Nipple position and shape may not be identical.
Skin Discolouration & Swelling
Some bruising and swelling normally occurs following a Nipple and Areola Reduction. The skin in or near the surgical site can appear either lighter or darker than surrounding skin. Although uncommon, swelling and skin discolouration may persist for long periods of time and, in rare situations, may be permanent.
Breast feeding
An areola or nipple correction may affect milk supply.
Skin Sensitivity
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 chronic.
Scarring
All surgery leaves scars, some more visible than others. Although good wound healing after a surgical procedure is expected, abnormal scars may occur within the skin and deeper tissues. Scars may be unattractive and of different colour than the surrounding skin tone. Scar appearance may also vary within the same scar. Scars may be asymmetrical (appear different on the right and left side of the body). There is the possibility of visible marks in the skin from sutures. In some cases scars may require surgical revision or treatment.
Firmness
Excessive firmness of the breast can occur after surgery due to internal scarring or scarring around a breast implant if one is used. The occurrence of this is not predictable. Additional treatment including surgery may be necessary.
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.
Bleeding
It is possible, though unusual, to experience a bleeding episode during orafter surgery. Should post-operative bleeding occur, it may require emergencytreatment to drain accumulated blood or blood transfusion. Intra-operative bloodtransfusion may also be required. Hematoma may contribute infection or otherproblems. Do not take any aspirin or anti-inflammatory medications for 2 weeks beforeor after surgery, as this may increase the risk of bleeding. Non-prescription “herbs” anddietary supplements can increase the risk of surgical bleeding. Hematoma can occur atany time following injury to the breast. If blood transfusions are necessary to treat bloodloss, there is the risk of blood-related infections such as hepatitis and HIV (AIDS).Heparin medications that are used to prevent blood clots in veins can produce bleedingand decreased blood platelets.
Infection
Infection is unusual after surgery. Should an infection occur, additionaltreatment including antibiotics, hospitalisation, or additional surgery may be necessary.Individuals with an active infection in their body or weakened immune system should notundergo Nipple and Areola Reduction.
Sutures
Most surgical techniques use deep sutures. You may notice these suturesafter your surgery. Sutures may spontaneously poke through the skin, become visible orproduce irritation that requires suture removal.
Delayed Healing
Wound disruption or delayed wound healing is possible. Some areas of the breast skin or nipple region may not heal normally and may take a long time to heal. Areas of skin or nipple tissue may die. This may require frequent dressing changes or further surgery to remove the non-healed tissue. Individuals who have decreased blood supply to breast tissue from past surgery or radiation therapy may be at increased risk for wound healing and poor surgical outcome. Smokers have a greater risk of skin loss and wound healing complications.
Allergic reactions
In rare cases, local allergies to tape, suture material and glues, blood products, topical preparations or injected agents have been reported. Serious systemic reactions including shock (anaphylaxis) may occur in response to drugs used during surgery and prescription medicines. Allergic reactions may require additional treatment.
Pain
You will experience pain after your surgery. Pain of varying intensity and durationmay occur and persist after Nipple and Areola Reduction. Chronic pain may occur veryinfrequently from nerves becoming trapped in scar tissue or due to tissue stretching.
surgical intervention.
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 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.
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 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.
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.
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.
All surgery leaves scars, some are more visible than others. Abnormal scars may occur within the skin and deeper tissues. Internal scarring may result in excessive firmness to the area. Scars may be asymmetrical or a different colour to the surrounding skin. Scars may require additional treatment to correct. This may include, laser, IPL, topical creams, skin needling, or surgical intervention.
Breast Cancer
An areola and/or nipple reduction does not increase the risk of breast cancer. Patients with a personal or family history of breast cancer may be at a higher risk of developing breast cancer than a woman with no history. All women should perform self-examination of their breasts, have regular mammograms, and seek professional care should a lump be detected.
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 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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