Procedures Resource Center Plastic Surgeon Info Contact Us Forum Blog Videos Home
 


Breast Reconstruction Risks and Complications

 

Pink Ribbon - Breast Reconstruction - Breast Cancer

 

Anytime a patient is put under general anesthesia there is a risk to the surgery. Breast reconstruction is surgery to recreate breasts after mastectomy - and can either be just the one breast that is affected with cancer or can include both breasts.  If a patient elects to have both breasts reconstructed, it is called "bilateral reconstruction".

Healing from breast reconstruction may be affected by:

  • previous surgery (mastectomy or lumpectomy)

  • chemotherapy

  • radiation

  • smoking

  • alcohol use

  • diabetes

  • other medication 

There have been a lot of advancements in the area of breast reconstruction over the last few years.  Plastic Reconstructive Surgeons are able to replace the look of breasts with either implants or using the patient's own tissue, but they cannot guarantee that the patient will have their sensation restored or that their scars will be completely eliminated.

 

 

Risks and Complications of Breast Reconstruction

 

 

 

 

As with any surgical procedure, infection can occur during or after the breast reconstruction operation.  Infections can sometimes occur if wound separation happens.  It is very important to make sure you take all of your prescribed antibiotic medication.  If an infection occurs with reconstruction with a breast implant and the area does not respond to antibiotics, the implant may have to be removed or explanted until it is cleared up. 

 

Signs to call your surgeon immediately:

  • Fever – temperature of 101 degrees or higher

  • Chills

  • Sweating

  • Excessive pain or redness from the incision site

  • General malaise

  • Drainage from the incision has a greenish tint

  • Bad odor coming from the incision site

  • Draining too steadily


All the above symptoms are signs of an early infection, and if caught early enough, then sometimes all the patient might need is an increase in antibiotics. Infections can cause a delay in wound healing as well as prolong the recovery time for breast reconstruction surgery.  Because of the risks that are associated with an infection with this surgery, you need to be in the best of health at the time or the procedure to give you the very best odds.

Read more about the signs and symptoms of an infection

 

 

 

 

A hematoma is a collection of blood inside a body cavity.

Read more about Hematomas

 

 

 

 

A seroma is a collection of the watery portion of the blood (in this case, around the implant or around the incision)

Read more about Seromas

 

 

 

 

Depending on the type of surgery that was performed for the breast cancer, it is not unusual for some loss of feeling in the breasts will happen from breast reconstruction surgery.  With a lumpectomy the entire breast is not removed, so there may still be significant feeling left. 

Lumpectomy:

If the patient had a lumpectomy before the reconstruction - then having some degree of numbness in the nipples and the surrounding breast tissue is normal.  In some cases, the numbness can be permanent. 

Plastic surgeons will tell their patients to give this at least a year before diagnosing this as permanent sensation loss, as nerve fibers grow at a very slow rate and can take months before the feeling comes back into the breast area.  Shooting pain from the nerves and tingling during breast lift recovery is also normal. This means the nerves are trying to regenerate, so these sensations are a good sign that the nerves are returning to normal function.

Mastectomy:

With a mastectomy however; all the breast tissue is taken - including the nipple/areola complex.  Reconstruction on a breast that had a mastectomy will not regain the feeling because of all the nerves that are severed during the initial breast cancer surgery.

Breast reconstruction will restore the shape of the breast - but not the feeling.  With time however; the skin on the reconstructed breast can become more sensitive.  This will not feel the same as the natural breast or before the mastectomy.

 

 

 

Skin or tissue necrosis following breast reconstruction is a rare complication; however there are increased risks with patients who fit a certain profile.  If a flap was made for the reconstructed breast from transplanted tissue (abdominal area) - this could possibly break down because of an inadequate blood supply.  If this should happen,  another surgery would have to take place with the dead tissue (necrosis) being trimmed away and the chest area closed.

 

Patients with increased risks of necrosis occurring:

  • compromised wound healing - or wound separation

  • patients who smoke

  • patients with circulatory problems

  • diabetes

  • patients who have undergone chemotherapy or radiation

 

Necrosis can occur in the following places following breast reduction:

  • breast tissue

  • breast envelope

  • breast incision line

If tissue necrosis occurs after breast reduction, there is great promise with hyperbaric oxygen therapy HBOT. 

 

 

 

Fat necrosis occurs when fat cells lose blood flow. Fat cells are living cells and if there is no blood flow, they may die and cause "fat necrosis". The liquefied fat cells can harden overtime underneath the skin, causing firmness or contour irregularities. Surgical intervention might be needed to help alleviate some of the symptoms caused by fat necrosis.

Transplanted tissue can form lumps or “fat necrosis.”  Lumps in the breast area tend to cause anxiety - especially for the breast cancer patient.  If these lumps do not go away on their own, surgical intervention is normally performed to determine that cancer is not present.

"Fat necrosis is more common in larger resections. A study by Strombeck reported a 16% incidence of fat necrosis in obese patients having resections of more than 1000 g. However, the incidence of fat necrosis has been reported as low as 0.8% in 371 patients undergoing an average resection of 870 grams per breast". This problem may prompt later investigation or biopsies to differentiate these lumps from those associated with breast cancer.

 

 

 

Sometimes the incisions will pull apart and cause wound separation.  This does not require additional surgery.  It is treated with moist dressings or sometimes dry.  If this complications occurs, recovery time is much longer.

Read more about Delayed Wound Healing

 

 

 

Post operative blood loss is normally a rare complication with breast reconstruction surgery; however, if you do get this you should seek medical help immediately.  Blood transfusions may be necessary in severe cases. 

Your plastic surgeon will instruct you before the surgery to stop taking any anti-coagulants before your surgery, and an include aspirin and aspirin containing medications, Vitamin E, anti-inflammatories or Warfarin etc.

Read more about "Medications to Avoid"

 

 

 

 

  • Blood Clots (Deep Venous Thrombosis, Cardiac & Pulmonary Complications)

Blood clots are a risk that is associated with any type of surgery.  Any surgery that involves the use of general anesthesia for longer than 30 minutes carries a high elevated risk of causing internal blood clots.  Blood clotting is nature’s way of controlling bleeding after an injury or an incision is made, however; blood clots can become dangerous.  When a clot forms inside a blood vessel, it can interfere with your circulation or become lodged in an artery inside the heart, causing a heart attack.  Clots can also travel to the brain and can become the cause of having a stroke, as well as the lung in which it would end up being a pulmonary embolism.


At the initial consultation you will be asked to give your medical history along with any and all medication you are taking on a regular basis. It is this information that the surgeon will be able to ascertain whether or not you are at an increased risk of forming blood clots following surgery.


Patients who are at risk of forming blood clots:

  • Women who take birth control pills
  • Women who take Hormone Replacement Therapy
  • Women who are over the age of 40 years
  • Patients who are taking cancer treatments
  • Patients with heart problems
  • Patients who recently have been pregnant

The timeline for developing blood clots after breast reconstruction surgery can vary, however the greatest risk is the first few days following surgery, so it is important for the patient to get up and walk around as much as they can.

 

 

 

Swelling in the arm (lymphedema) or a part of the body that is caused from a build up of lymphatic fluids.  It can be caused by cancer or its treatment.  Lymphedema can happen right after surgery, especially if the breast cancer patient has had their lymph nodes removed under the armpit area.

Watch for signs of swelling or infection (redness, pain, heat, fever). Tell your doctor or nurse if your arm or leg is painful or swollen.

 

 

 

Post Breast Therapy Pain Syndrome is very complex with its symptoms. This complication can be defined as persistent neuropathic pain, and is often associated with symptoms of numbness, distortion of the sense of touch, edema, and pain that results from a stimulus to the skin located in the chest wall, axilla, arm, or shoulder of the surgical side.  

 

 

 

 

Complications at the donor sites for flap procedures, including abdominal hernias and muscle damage or weakness.

 

 

 

All implants have the potential for deflation or rupture to occur. Implants are not lifetime devices.  Read more about risks that contribute to this and why deflation/rupture can occur.

Read more about deflation or rupture

 

 

 

A breast implant can shift from its initial placement - giving the breast an unnatural appearance.  If this occurs, the patient will be able to feel the breast implant through the tissue.  Anatomical shape or tear drop shape implants are more inclined to rotate or shift in position than a round shape breast implant.

 

 

 

 

This is the most common complication of having breast implants. Capsular Contracture can occur after an implant has been in position for a few weeks or months. The fibrous tissue or capsule that normally forms around the implant tighten and squeezes the implant. There are different grades of capsular contracture.  Please read more to learn the signs and symptoms of this complication, new advancements with non-invasive treatments and also choices of surgical intervention.

Read more about Capsular Contracture

 

 

 

 

Extrusion is when the implant comes through the skin due to a compromise of skin loss or necrosis (tissue death).  This may occur when an incision has not completely healed closed, or if the breast tissue covering your implants weakens. Compromise of the blood supply can directly be linked to necrosis or loss of tissue around the breast surgical incision which can be connected to extrusion. 

Although, considered rare, extrusion can occur up to 1 to 2% of reconstruction patients using implants.  Patient’s who have undergone reconstruction due to breast cancer and are receiving radiation therapy has an increase of extrusion.  This is because radiation compromises the breast tissue. 

This complication, extrusion requires additional surgery and possible removal of the implant, which may result in additional scarring and / or loss of your breast tissue.  Smoking can lead to a compromised blood supply due to the fact that smoking deprives the tissue of oxygen in order to heal.

Read more about Extrusion

 

 

 

Fortunately most "bad reactions" to anesthesia are not life-threatening.  However, all forms of anesthesia including the different forms of local, can carry a risk of an allergic reaction.  Anesthesia exposes the body to controlled levels of toxic chemicals in order to make sure there is no pain felt during a surgical procedure. The main goal of anesthesia is to either stop pain temporarily or to induce a semi-conscious or unconscious state. Even though anesthesia carries a risk, the benefits outweigh any potential disadvantage.

The most important factor is making sure that whoever administers the anesthesia are board certified in anesthesiology. By doing this, you reduce the risks of any complication that might arise during surgery. All body functions and chemistry are monitored during your surgery to ensure a safe procedure.

The most common reaction or danger of having anesthesia is an allergic reaction to one of the medications used. This is addressed immediately by the attending anesthesiologist by monitoring your vital signs. If an allergic reaction occurs, your anesthesiologist is equipped to handle this immediately. Severe allergic reactions during anesthesia are fortunately rare.

It is very important to tell your anesthesiologist every medication you take on a regular basis, so that he can prevent any potential problem during surgery. 

Read more about anesthesia's risks and complications

 

 

 

Dog ears are small folds of skin which occur at either end of the scar, caused by a natural folding of the skin when the wound is closed. Dog Ears occur approximately five percent of the time.  Great care is taken during the surgery to avoid this complication however; sometimes this cannot be avoided.  

Small dog ears which are seen in the early post-operative period will normally settle on their own during the first six to nine months after surgery. If they do not settle after this time, they can be simply cut out in a minor procedure under local anesthetic.

See photos of "Dog-Ears"

 

 

 

Unfortunately patients who have breast cancer surgery and breast reconstruction are going to left with some permanent scars.  Most plastic surgeons do their best with minimizing these. 

All types of flap surgery result in scarring, both on the newly constructed breast and at the donor site.  The scars will fade over time, but will never completely disappear.  You will be more likely to be satisfied with this technique if you have realistic expectations for your results.

Permanent and wider scars are more common among smokers.  Information about hypertrophic and keloid scarring, and if you are at risk. 

Read more about scars

 

 

 

Although breast reconstruction with implants is the most common technique chosen, some patients are not happy with their results.  Removing the implants and replacing them with a different implant type or size resolves the patient's concerns.

 

 

 

 

 

More Breast Reconstruction and Breast Cancer Information:

 

 

 

 

  

Copyright - CosmeticSurgeryForums.com - A Cosmetic Surgery Support Network