Risks & Complications of Autologous Breast Reconstruction
Every surgical procedure involves a certain amount of risk. It is important that you understand the risks involved. An individual’s choice to undergo a surgical procedure is based on the comparison of the risk to potential benefit.
Bleeding – it is common to have a small degree of oozing at the wound edges, and you will have a couple of drains to remove any excess bleeding from inside the wound for the first few days after the operation. Although any bleeding points are cauterised during the procedure, it is possible that you may develop a collection of blood under the skin. It is possible, though unusual, to experience a bleeding episode during or after surgery. Should post-operative bleeding occur, it may require emergency treatment to drain accumulated blood, or a blood transfusion. Do not take any aspirin or anti-inflammatory medications for ten days before surgery, as this may increase the risk of bleeding. Non-prescription “herbs” and dietary supplements can increase the risk of surgical bleeding.
Infection – An infection is quite unusual after this type of surgery. Should an infection occur, treatment including antibiotics or additional surgery may be necessary.
Seroma – this is a fairly common complication. When you suffer a graze, you will probably have noticed a clear fluid seeping from the raw area for a few days. This is a normal response to injury and is known as serous fluid. After this operation there is a large raw area under the skin of the abdomen and the body responds in the same way, leaking serous fluid. Generally this lasts for only a couple of days and the drains remove the fluid, but it can continue for a few weeks. If this fluid continues to be produced after the drains are removed, it will collect under the skin and may become uncomfortable, but it can be easily and painlessly removed by sliding a needle through the scar in the abdomen taking the fluid off with a syringe.
Flap failure – this is a fairly rare complication. Any flap needs a good blood supply and occasionally it does not get the supply it needs. In this case the flap will die. Often it can be salvaged by returning to theatre and identifying and eliminating the source of the blood flow inadequacy, but occasionally the surgeon is unable to save the flap. The dead tissue would need to be surgically removed, and further options for reconstruction would need to be discussed.
Skin scarring – All surgical incisions produce scarring. The quality of these scars is unpredictable. Abnormal scars may occur within the skin and deeper tissue. Scarring is more prominent following delayed breast reconstruction operations.
Excessive scarring is most common in patients with a family history of excessive scarring, in patients that already have such scars, and in Afro-Caribbeans. However, generally a patient’s individual tendency to such scarring cannot be diagnosed in advance. It is important to realise that the rate at which scars heal and fade varies considerably from patient to patient.
In some cases, scars may require surgical revision or other treatments but may remain permanently excessive.
Change in nipple and skin sensation – You may experience a change in the sensitivity of the nipples and the skin of your breast. Permanent loss of nipple and skin sensation can occur after a breast reconstruction. Nipple sensation may be lost if nipple graft techniques are used.
Unsatisfactory result – There is the possibility of a poor cosmetic result from breast reconstruction surgery. You may be disappointed with the size and shape of your breasts. Asymmetry in nipple location, unanticipated breast shape and size may occur after surgery. Breast size may be incorrect. Unsatisfactory surgical scar location and excess of skin in the corner of the breast (dog-ears) may occur. It may be necessary to perform additional surgery to improve your results.
Permanent skin discoloration – Is rare after most forms of surgery. Permanent staining may result if the patient sunbathes or uses ultraviolet sun beds whilst any visible skin bruising remains.
Asymmetry –There can be no guarantee that the breasts will be identical following surgery.
Delayed healing – Wound disruption or delayed wound healing is possible. Smokers have a greater risk of skin loss and wound healing complications.
Herniation/Bulging – this is relevant to TRAM flap Procedures, as some of the Rectus Abdominis muscle and the surrounding thick fibrous tissues are cut and/or removed for the reconstruction. The abdominal wall is weakened by this operation leading to the possibility of a bulge or hernia under the skin of the abdomen.
Revision Surgery – After the tissue is moved from the abdomen to the breast, it changes shape and size as the tissues heal over the first few months. Your surgeon may recommend another small operation to improve the final outcome of your reconstruction.
Recurrence – although this is not strictly a complication of the reconstruction, it should be mentioned that having a breast reconstruction must not interfere with treatment for the breast cancer, and having a reconstruction would not stop a recurrence of the cancer, if it were to occur.
Additional Surgery Necessary
Should complications occur, additional surgery or other treatments may be necessary. Even though risks and complications occur infrequently, the risks cited are particularly associated with autologous breast reconstruction. Other complications and risks can occur but are even more uncommon. The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee or warranty expressed or implied as to the results that may be obtained.
Deep Venous Thrombosis, Cardiac and Pulmonary Complications: Surgery, especially longer procedures, may be associated with the formation of, or increase in, blood clots in the venous system. Pulmonary complications may occur secondarily to blood clots (pulmonary emboli), fat deposits (fat emboli) or partial collapse of the lungs after general anaesthesia. Pulmonary and fat emboli can be life threatening or fatal in some circumstances. Air travel, inactivity and other conditions may increase the incidents of blood clots travelling to the lung causing a major blood clot that may result in death. It is important to discuss with your surgeon any past history of blood clots of swollen legs that may contribute to this condition. 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 might require hospitalisation and additional treatments.
Smoking, Second-Hand Smoke Exposure, Nicotine Products (Patch, Gum, Nasal spray): Patients who are currently smoking, use tobacco products, or nicotine products are at a greater risk for significant surgical complications of skin dying, delay the healing and additional scarring. Individuals exposed to second-hand smoke are also at potential risk for similar complications attributable to nicotine exposure. Additionally, smokers may undergo a significant negative effect from anaesthesia and recovery from anaesthesia, with coughing and possibly increased bleeding. Individuals who are not exposed to tobacco smoke or nicotine containing products have a significantly lower risk of this type of complication.
It is important to refrain from smoking at least six weeks before surgery and until your surgeon states it is safe to return, if desired.
Female patients’ information: It is important to inform your surgeon if you use birth control pills, oestrogen replacement, or if you believe you may be pregnant. Many medications including antibiotics may neutralize the preventive effects of birth control pills, allowing for conception and pregnancy.
Intimate Relations after Surgery: Surgery involves coagulating of blood vessels, and increased activity of any kind may open these vessels leading to a bleed or hematoma. Increased activity that increase your pulse or heart rate may cause additional bruising, swelling and the need for return to surgery and control of bleeding. It is wise to refrain from sexual activity until your surgeon states it is safe.
Medications: There are many adverse reactions that occur as the result of taking over the counter, herbal, and/or prescription medications. Be sure to check with your surgeon about any drug interactions that may exist with medication that you are already taking. If you have an adverse reaction, stop the medication immediately and consult us for further instructions If the reaction is severe, go immediately to nearest hospital. When taking the prescribed pain medication after surgery, realize that they can affect your thought process. Do not drive, do not operate complex equipment, do not make any important decisions and do not drink any alcohol while taking these medications. Be sure to take your prescribed medication only as directed.