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Possible problems with breast reconstruction

Find out about the possible problems that may happen after breast reconstruction surgery.

Problems immediately after surgery

Breast reconstruction techniques have been improving for more than 20 years. There are fewer and fewer problems. But some women have complications right after surgery.

Infection is a risk in any surgery. It is the most common problem with tissue expansion reconstruction. If you develop an infection you will need to rest and take antibiotics. Usually, this clears up the infection over a week or so.

If you’ve had implant reconstruction or tissue expansion and the infection continues, your surgeon may need to take the implant out. You may need to wait for about 3 months before having another implant.

If you’ve had immediate reconstruction and need chemotherapy after your surgery, wound infection can be a major problem. Chemotherapy drugs will stop the natural healing process. So you won’t be able to start chemotherapy until the infection is cleared up and the wound completely healed. Delaying chemotherapy for more than 6 weeks after surgery means it may not give you as much protection against the breast cancer coming back.

After any surgery, it is normal for fluid to be produced. You may have two or more drains into the wound to drain off any fluid that collects. The drains are usually long thin tubes attached to vacuum bottles. Even if you have drains, fluid can sometimes collect under the wound. This is called a seroma. If blood has collected, it is called a haematoma. If there isn’t much fluid, it may be absorbed by your body. If there is too much for your body to reabsorb, your surgeon or breast care nurse will remove it using a small needle and syringe. 

If you’ve had implant reconstruction and the fluid continues to build up, you may need to have the implant taken out and put back in later.

Seroma used to be quite common after flap reconstruction from the back. But surgeons have improved techniques so that it is now much less likely.

The main problem with body tissue reconstruction is that the flap of tissue used to make the new breast may die. With a flap that stays connected to its original blood supply (a pedicled flap), this is much less likely. Fewer than 1 in 100 pedicled back flaps fail. Similarly, fewer than 1 in 1000 pedicled TRAM flaps fail completely.

However, free TRAM flaps and DIEP flaps have to be disconnected and reconnected to a new blood supply. With these techniques, about 1 in 10 flaps develops some problem with the blood supply in the first 48 hours after surgery. If this happens, you will need to go back to the operating theatre urgently.

About 3 to 5 out of every 100 flaps fail completely (3 to 5%) and the cells in the whole flap die. If this happens, you will need to have surgery to remove the flap.

If your flap fails completely, you will need to recover fully from the operation and problems. You will need to wait 6 to 12 months before you can try to have reconstruction again. The best options then will be either a back flap or reconstruction with tissue expansion and an implant.

Longer term problems with implant reconstruction

There can be problems after implant surgery, whether you have tissue expansion or the implant put in directly.

The main long term problem after implant surgery is that a fibrous capsule may form around the implant. Although silicone is safe, it is still foreign to the body. The normal reaction of the body to any foreign tissue is to form a fibrous covering around it. The fibrous covering is known as a capsule.

Over some years, the capsule can shrink and squeeze the implant. Doctors call this capsular contracture. It happens in about 1 in 6 patients. It makes the breast painful and hard and changes it's shape. If the shape changes a lot, the implant might need to be taken out and replaced.

Many women worry about the implant developing a leak. This is very unlikely as the gel in the implant is quite thick. But you could get leakage if you have some major injury or blow to the breast. Minor bumps and bangs won’t cause a leak and nor will air travel. If you do get a leak, it can make the lymph glands under your arm swell up. But it doesn’t usually cause any other problems.

If you lose or gain a lot of weight, your reconstructed breast may no longer match the other one. It's not usually possible to make the breasts exactly the same on both sides. But your surgeon may be able to make them more equal with further surgery. You could have an operation on your other breast. Or the surgeon could replace the breast implant with a larger or smaller one.

Some implants may need to be replaced after 10 or 15 years or so.

Longer term problems with body tissue reconstruction

There are possible problems after reconstruction surgery with body tissue.

Loss of tissue in part of the flap can happen with any body tissue breast reconstruction. It is more common with TRAM flaps that keep their original blood supply (pedicled TRAM flaps) and with DIEP flaps. The blood supply to part of the flap is lost and the tissue in that area dies. First of all, the area becomes painful and hard. Then the affected part of the flap shrinks, making a hard scar within the breast. You may also end up with a smaller breast. This problem is more common in heavy smokers or people with poor circulation.

With abdominal flap reconstruction, little folds of skin and fat can sometimes develop at either end of your abdominal scar. Doctors call these dog ears because that’s what they look like. Most small dog ears settle with time, but you may eventually need to have a small operation or liposuction to get rid of them. You can have this under local anaesthetic, usually about 6 months after your original surgery.

A hernia is a hole or weakness in a muscle wall that allows the structures behind the muscle wall to push through. After abdominal flap reconstruction, there is a small risk of an abdominal hernia in the future because the surgeon removes part of the abdominal muscle. But a hernia happens in fewer than 5 in 100 cases (5%).

More support and information

You are likely to have emotional ups and downs after surgery for breast cancer and breast reconstruction. Even months afterwards, many women find it helpful to talk about their feelings and ask about things that worry them.

Your breast care nurse is probably your first source of support. They can talk you through a lot of worries and put your mind at rest. 

Other women who have already been through similar surgery can also be a great help. You can ask your nurse or doctor to put you in touch with someone who has had similar surgery or similar complications.

For information, phone the Cancer Research UK nurses on freephone 0808 800 4040, from 9am to 5pm, Monday to Friday.

Information and help

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