Vasoconstrictor infiltration in breast reduction surgery: is it harmful?

The efficacy of vasoconstrictor infiltration in reducing blood loss is well known. However, adrenaline infiltration is potentially harmful to tissues. The question of whether or not adrenaline infiltration is harmful in breast reduction surgery remains unanswered. We retrospectively reviewed the notes of 100 consecutive cases after bilateral breast reduction (n = 200 breasts) with preoperative infiltration of a vasoconstrictor solution (10 ml adrenaline 1:10,000, 20 ml lignocaine 1%, 70 ml saline 0.9%, resulting in an adrenaline concentration of 1:100,000), looking specifically at postoperative complications that could be secondary to adrenaline infiltration. Two breasts developed a 'haematoma'; both were of small volume. Six breasts developed a 'minimal wound' problem which involved the T-junction. 'Wound breakdown' was noted in five breasts and again involved the T-junction in most cases. 'Wound infection' occurred in eleven breasts. There was one case of partial 'nipple necrosis'. Complications occurred in 12.5% of breasts and 21% of patients. We feel that this complication rate is within acceptable limits.