Breast Reduction Risks: Complications, Side Effects and How Common They Are

Every operation carries risk, and breast reduction surgery is no different. The reassuring part is that the risks of breast reduction are well studied, most complications are minor and treatable, and the serious ones are rare, particularly in non-smokers of a healthy weight. Knowing what can go wrong, how often it happens and what makes it more likely helps you weigh the operation up properly, and helps you spot a problem early if one does occur.

This guide covers the breast reduction complications and side effects that matter most, using figures from the largest published studies: wound healing, infection, bleeding, nipple and fat necrosis, sensation, breastfeeding, scarring and blood clots. It also explains who is at higher risk and what we do to keep that risk low. For the day-to-day healing process, see our breast reduction recovery guide, and for how the scars settle, our guide to breast reduction scars.

What Are the Risks of Breast Reduction?

Breast reduction, also called reduction mammoplasty or a boob reduction, removes breast tissue, fat and skin, reshapes what remains and moves the nipple higher. Its risks fall into two groups.

General risks of any operation:

• bleeding, including a haematoma (a collection of blood under the skin)
• infection
• blood clots in the legs or lungs
• reactions to the anaesthetic or other medicines

Risks specific to breast reduction surgery:

• delayed wound healing, or a wound opening up (wound breakdown)
• loss of blood supply to part of the nipple, areola or breast skin (necrosis)
• fat necrosis, which can leave firm lumps
• changes in nipple and breast sensation
• difficulty breastfeeding
• scarring, including thick or raised scars
• seroma (a collection of fluid)
• asymmetry, and changes in shape as the breasts settle

Each is explained below, with how often it happens and what is done about it. Our guide to the risks and complications of cosmetic surgery covers the general risks in more depth.

How Common Are Breast Reduction Complications?

The answer depends on what is counted and for how long, and two kinds of study give two different, equally honest figures.

National databases that track the first 30 days. The American College of Surgeons’ NSQIP database records complications after surgery across hundreds of hospitals. In 3,538 breast reductions, 5.1% of women had a surgical complication within 30 days and 2.1% had a major one, such as a deep infection or a return to theatre: roughly 1 in 20 and 1 in 50 (Fischer et al., 2014). A later analysis of 16,812 operations found an overall rate of 6.2% and a major complication rate of 3.0% (Simpson et al., 2019).

Studies that follow women for longer and count everything. Clinical studies that follow patients for months and record minor problems, such as a small area of slow healing or a stitch working its way to the surface, report higher numbers. In a review of 14 studies and 1,816 patients, the overall complication rate was 19.9% (Liao et al., 2023).

A fair summary is that about 1 in 5 women has a complication of some kind, most of them minor and managed with dressings or a short course of antibiotics, while a serious complication needing further surgery affects around 2 to 3 women in 100. Across the studies in that review, higher complication rates were not linked to smaller gains in satisfaction.

Is Breast Reduction a High-Risk Surgery?

No. For a healthy non-smoker, breast reduction is a routine operation with a low risk of serious complications. It is a bigger operation than a breast augmentation or a lift, because more tissue is removed and the scars are longer, so recovery takes a little longer and minor wound problems are more common. At Centre for Surgery it is performed as a day case under TIVA (total intravenous anaesthesia) and usually takes 2.5 to 3 hours.

The risk is not spread evenly. It is concentrated in women who smoke, have a high BMI, have conditions such as diabetes, or need a very large reduction. If none of those applies to you, your risk is at the lower end of the figures above. Our guide to whether cosmetic surgery is safe explains how to judge a clinic’s safety standards more generally.

Delayed Wound Healing and Wound Breakdown

Delayed wound healing is the most common complication after breast reduction. It usually affects a small area at the T-junction, the point in the breast crease where the vertical scar meets the horizontal one in an anchor-pattern reduction. The skin there is under the most tension and furthest from its blood supply, so it can be slow to knit together. It shows as a small scab or open area that may ooze a little.

Most areas of wound breakdown heal with regular dressings over a few weeks. The scar at that point can end up slightly wider, and can be tidied later if it bothers you. The risk rises with the size of the reduction: in women with very large breasts, where an average of about 1.4 kg was removed from each side, delayed wound healing affected 17.4% and wound dehiscence (the wound opening up) 9.2% (Zelko et al., 2023).

Technique matters too. A meta-analysis comparing the two main scar patterns found the vertical (lollipop) reduction had fewer complications overall and less wound dehiscence than the anchor (inverted-T) pattern (Li et al., 2021). A lollipop reduction is not suitable for every breast, though, and our guide to anchor vs lollipop breast reduction explains how the choice is made. Smoking is the biggest avoidable cause of poor wound healing, which is why we ask you to stop.

Infection After Breast Reduction

Most infections after breast reduction are superficial, affecting the skin around the wound, and clear with oral antibiotics. In an analysis of 4,545 breast reductions, superficial skin and soft tissue infections made up 45.8% of all early complications (Nelson et al., 2014). Deep infection needing further surgery is uncommon.

The signs to look out for are spreading redness or heat around a wound, pain that is increasing rather than easing, an offensive discharge, or a temperature above 38°C. Contact us straight away if you notice any of them.

Bleeding, Haematoma and Seroma

A haematoma is a collection of blood that builds up under the skin, usually in the first 24 to 48 hours. The typical sign is one breast becoming suddenly more swollen, tight, painful and bruised than the other. Small haematomas settle on their own; larger ones are treated by returning to theatre to remove the blood and stop the bleeding. This is why aspirin, ibuprofen and other anti-inflammatories are stopped two weeks before surgery, and why we review any supplements you take. Our guide to breast haematoma after surgery covers the signs and treatment.

A seroma is a collection of clear fluid that tends to appear later, often after the first week, and feels soft and squashy. Small seromas are reabsorbed by the body; larger ones can be drained with a needle in clinic.

Nipple Necrosis and Loss of Blood Supply

During a breast reduction, the nipple and areola are moved higher while still attached to a bridge of breast tissue called a pedicle, which carries their blood supply. If blood flow through the pedicle is poor, part or all of the nipple and areola can lose its blood supply and the tissue dies. This is nipple necrosis.

It is rare in routine reductions and more likely with very large reductions and in smokers. Even in very large, heavy breasts, complete loss of the nipple and areola was reported in 1.7% and partial loss in 5.9% (Zelko et al., 2023). Partial loss usually heals with dressings, sometimes leaving a paler or irregular area. If the whole nipple is lost, it can be reconstructed later, with medical tattooing to restore colour.

The warning sign is a change in the nipple’s colour in the first few days: darkening, turning purple or black, or becoming unusually pale and cold. Call us without delay if you notice this, because early assessment matters. In the very largest reductions, the surgeon may recommend a free nipple graft, where the nipple is removed and replaced as a skin graft; this avoids the risk of losing it but means no sensation and no breastfeeding afterwards. If that applies to you, it is discussed at consultation, not decided on the day.

Nicotine narrows the small blood vessels the nipple depends on, which is why smoking is the single biggest avoidable risk factor for necrosis. You need to stop all nicotine, including vaping and patches, for four weeks before and four weeks after surgery.

Fat Necrosis

Fat necrosis happens when small areas of fatty tissue inside the breast lose their blood supply. It shows as one or more firm, usually painless lumps, often months after surgery, and many soften over time. It is not dangerous and is not cancer, but any new lump in the breast should be checked, and fat necrosis can sometimes need an ultrasound or mammogram to confirm what it is. Tell the screening team that you have had a breast reduction whenever you have a mammogram.

Changes in Nipple and Breast Sensation

Most women notice some change in feeling after breast reduction. The nipples and parts of the breast skin may feel numb, or oversensitive, in the first weeks and months. For most, sensation improves gradually as the nerves recover, which can take a year or more, but a minority are left with a permanent reduction in nipple sensation, and occasionally increased sensitivity. The risk is higher with larger reductions. Our guide to losing feeling in your nipples after breast reduction explains why it happens and what to expect.

Can You Breastfeed After a Breast Reduction?

Often, yes, but not always, and it depends mainly on the technique. A systematic review of 51 studies found that breastfeeding success depended on whether the column of breast tissue between the nipple and the chest wall was kept intact. Where it was fully preserved, the median breastfeeding success rate was 100%; where it was partly preserved, 75%; and where it was not preserved, only 4% (Kraut et al., 2017).

Most modern reduction techniques keep the nipple attached to the tissue beneath it, which gives you the best chance. Even so, some women produce less milk after a reduction and need to supplement. If you are planning children, tell your surgeon at consultation so the technique can be planned around it. Pregnancy after a reduction can also change the size and shape of your breasts, which is worth considering in your timing; our guide to the right age for a breast reduction covers this.

Breast Reduction Scars

Every breast reduction leaves permanent scars. A lollipop reduction leaves a scar around the areola and a vertical line down to the crease; an anchor reduction adds a horizontal scar along the crease. Scars are red and firm for the first few months and usually fade to fine, pale lines over 12 to 18 months.

Some people form thicker, raised scars (hypertrophic scars) or keloids, which are more likely with darker skin or a family history of problem scarring. Small puckers of skin at the ends of the horizontal scar, called dog ears, often flatten as the tissues settle and can be tidied with a minor procedure under local anaesthetic if they don’t. Silicone gel or tape from four to six weeks, and keeping scars out of the sun for at least three months, both help the final appearance. See our full guide to breast reduction scars.

Asymmetry, Shape Changes and Revision

Almost every woman starts with some difference between her breasts, and a small difference in size, shape or nipple height after surgery is normal. Your surgeon plans the reduction for each side separately to improve symmetry, but perfect symmetry isn’t possible. Our guide to uneven breasts explains why.

The breasts also change shape as they heal. They sit high and look square at first, then soften and drop into their final shape over three to six months. Over the following years, the lower part of the breast can stretch a little, and weight change or pregnancy can alter the result. Some women want a small revision later, most often for a scar, a dog ear or a minor difference between the sides; these are usually straightforward procedures.

Blood Clots: DVT and Pulmonary Embolism

A deep vein thrombosis (DVT) is a clot in a leg vein; if part of it breaks off and travels to the lungs, it becomes a pulmonary embolism (PE). Both are rare after breast reduction. In 25,909 operations, DVT occurred in 0.06% and PE in 0.09% of women under 65; in women aged over 64 the risk was about four times higher, at 0.32% and 0.37% (Davé et al., 2020).

Your clot risk is assessed before surgery, in line with NICE guidance, and the main protection is getting up and walking soon after the operation, drinking plenty of fluids and avoiding long periods of sitting still. Your surgeon will tell you whether any medicines, including hormonal contraception or HRT, need adjusting beforehand. Pain or swelling in one calf, sudden breathlessness or chest pain after surgery needs urgent attention: call 999.

Anaesthetic Risks

Breast reduction at Centre for Surgery is carried out under TIVA, given entirely through a drip by a consultant anaesthetist, which is associated with less sickness afterwards and a quicker return to alertness than inhaled anaesthetic gases. Serious reactions to anaesthesia are rare in healthy patients. Your anaesthetist reviews your medical history, medicines and any previous reactions before surgery.

Breast Reduction Risk of Death

Death after breast reduction is extremely rare. The complications that could, in theory, threaten life are a blood clot travelling to the lungs, a severe bleed and a serious reaction to the anaesthetic, and every one of them is rare in healthy patients. The pre-operative assessment, clot-prevention measures, careful control of bleeding during surgery and a consultant anaesthetist are there to keep them that way. If you have significant heart, lung or blood-clotting problems, your surgeon will tell you honestly whether surgery is safe for you.

What Is the Regret Rate for Breast Reduction?

Regret after breast reduction is uncommon, and satisfaction is among the highest of any breast operation. A meta-analysis of studies using the BREAST-Q questionnaire found that satisfaction with the breasts rose from 22.9 to 73.0 out of 100 after surgery, with psychosocial, physical and sexual wellbeing all improving to levels comparable with women who have never had breast problems (Wang et al., 2023). For many women, relief from neck, shoulder and back pain starts almost as soon as they wake up.

When women are unhappy, it is most often about size (smaller or larger than they hoped), scars, or loss of nipple sensation. Talking through the size you want in detail beforehand helps; our guide to what cup size you will be after a breast reduction explains how that is planned.

Who Has a Higher Risk of Breast Reduction Complications?

Large studies consistently point to the same risk factors (Fischer et al., 2014; Nelson et al., 2014; Simpson et al., 2019):

• Smoking. In one analysis, active smokers were 2.7 times more likely to have a major complication. This includes vaping and nicotine replacement.
• A high BMI. Complications rise with each obesity class, reaching nearly 12% in women with a BMI over 40, compared with about 6% overall.
• Diabetes, high blood pressure, steroid use and bleeding disorders.
• Long operations and very large reductions, which raise the risk of wound healing problems and necrosis.
• Combining breast reduction with other body-contouring surgery, which was linked with more major complications. Adding liposuction alone was not.
• Age over 64, mainly for blood clots.

Having one of these doesn’t rule surgery out, but it may change the plan. Your surgeon may suggest reaching a stable, lower weight first, or bringing a medical condition under better control, if that would make the operation meaningfully safer.

How We Reduce the Risk of Breast Reduction Surgery

At Centre for Surgery, the steps below are built into every breast reduction:

• The surgeon who assesses you is the surgeon who operates. All breast reductions are performed by GMC-registered plastic surgeons.
• A full medical assessment before surgery, including a baseline mammogram if you have a personal or family history of breast cancer.
• Stopping nicotine for four weeks before and four weeks after surgery, and aspirin and anti-inflammatories for two weeks before.
• Marking with you sitting or standing upright, because the breasts change shape when you lie down.
• The right technique for your breasts: a lollipop pattern where it is suitable, an anchor pattern where more skin needs removing, the nipple kept attached to its blood supply, and liposuction breast reduction for women whose breasts are mainly fatty and who don’t need a lift.
• Day-case surgery under TIVA at our CQC-regulated hospital on Baker Street, rated Good overall.
• Dissolvable stitches, a wound check at 7 to 10 days, a surgeon review at six weeks and your surgeon’s direct number to call in the first 24 hours if you are worried.
• A two-week cooling-off period after consultation, so you have time to weigh everything up before you commit.

Looking after yourself in the first weeks matters too. Wearing a well-fitted surgical bra day and night, sleeping on your back and avoiding lifting all protect the wounds; our guides to wearing a compression bra after breast surgery and sleeping after breast reduction cover both.

Warning Signs After Breast Reduction: When to Call Us

Some discomfort, swelling and bruising are normal and improve day by day. Contact us straight away if you have any of the following. In the first 24 hours after surgery, call your surgeon on the direct number in your discharge summary; after that, call 020 7993 4849 (9am to 6pm, Monday to Saturday), or NHS 111 outside those hours:

• pain that is getting worse rather than better
• sudden swelling of one breast
• spreading redness or heat around a wound
• an offensive discharge from a wound
• a temperature above 38°C
• any darkening or colour change of the nipple, which needs assessing immediately

Call 999 for chest pain, sudden breathlessness or coughing up blood.

Breast Reduction Before and After

All patients whose photographs appear below have given written consent for their images to be used. Individual results vary.

Breast Reduction at Centre for Surgery

Breast reduction at Centre for Surgery is performed by GMC-registered plastic surgeons at our hospital at 95–97 Baker Street, regulated by the Care Quality Commission and rated Good overall. At your consultation your surgeon examines and measures you, explains which technique suits you and the risks that apply to you in particular, and advises honestly on whether your symptoms are likely to meet NHS criteria, supporting a private health insurance claim where relevant.

Your initial consultation is £100, redeemable against the cost of your procedure. Our breast reduction cost guide explains what affects the price, and your exact figure is confirmed in writing after your consultation. Finance is available through Chrysalis Finance, subject to status. If you are still deciding between procedures, our guide to breast reduction vs breast lift may help.

Frequently Asked Questions About Breast Reduction Risks

Is breast reduction worth the risks?

For most women with large, heavy breasts, the evidence says yes: satisfaction and quality of life improve substantially, and serious complications are uncommon. It is a personal decision, though, and the right answer depends on your symptoms, your health and how you feel about the trade-offs. Your consultation is the place to talk it through in detail.

If you are considering a breast reduction and want to understand the risks that apply to you, book a consultation with one of our plastic surgeons. Call 020 7993 4849 or complete the form below.

References

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2. Simpson AM, Donato DP, Kwok AC, Agarwal JP. Predictors of complications following breast reduction surgery: a National Surgical Quality Improvement Program study of 16,812 cases. J Plast Reconstr Aesthet Surg. 2019;72(1):43-51. doi:10.1016/j.bjps.2018.09.002
3. Nelson JA, Fischer JP, Chung CU, et al. Obesity and early complications following reduction mammaplasty: an analysis of 4545 patients from the 2005–2011 NSQIP datasets. J Plast Surg Hand Surg. 2014;48(5):334-9. doi:10.3109/2000656X.2014.886582
4. Liao CD, Xia J, Wang K, Zhao K, Glickman LT, Agrawal NA. A systematic review of the impact of patient factors on BREAST-Q outcomes after reduction mammoplasty. Ann Plast Surg. 2023;90(6S Suppl 5):S667-S673. doi:10.1097/SAP.0000000000003471
5. Zelko I, DeLeonibus A, Haidar J, Bahat D, Bishop SN. Nipple-sparing gigantomastia breast reduction: a systematic review. Ann Plast Surg. 2023;90(3):267-272. doi:10.1097/SAP.0000000000003415
6. Li Z, Qian B, Wang Z, et al. Vertical scar versus inverted-T scar reduction mammaplasty: a meta-analysis and systematic review. Aesthetic Plast Surg. 2021;45(4):1385-1396. doi:10.1007/s00266-021-02167-w
7. Kraut RY, Brown E, Korownyk C, et al. The impact of breast reduction surgery on breastfeeding: systematic review of observational studies. PLoS One. 2017;12(10):e0186591. doi:10.1371/journal.pone.0186591
8. Davé DR, Arora A, Zeiderman MR, Wong MS. Geriatric patients carry increased risk for deep venous thrombosis and pulmonary embolism in reduction mammaplasty: an analysis of 1897 geriatric patients among 25,909 cases from 2005 to 2017 NSQIP databases. Ann Plast Surg. 2020;84(5S Suppl 4):S264-S267. doi:10.1097/SAP.0000000000002242
9. Wang AT, Panayi AC, Fischer S, et al. Patient-reported outcomes after reduction mammoplasty using BREAST-Q: a systematic review and meta-analysis. Aesthet Surg J. 2023;43(4):NP231-NP241. doi:10.1093/asj/sjac293
10. National Institute for Health and Care Excellence. Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism (NG89). 2018, updated 2019. nice.org.uk/guidance/ng89