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Possible problems with breast reconstruction

Men and women discussing breast cancer

This page tells you about the possible problems that may happen after breast reconstruction surgery. There is information about

 

A quick guide to what's on this page

Problems just after reconstruction surgery

Some women have complications right after breast reconstruction surgery, such as wound infection, fluid under the wound (seroma), or pain and discomfort. If a wound infection occurs with a breast implant, the implant may need to be removed. You will then need to wait for 3 months or so before having a new implant. 

One serious problem with body tissue reconstruction is that the tissue used to make the new breast (the flap) may die. If all of the tissue dies, you have to wait 6 to 12 months before you can try to have reconstruction again. This only happens to a small number of women.

Longer term problems with body tissue reconstruction

If there is a problem with the blood supply to the new breast, part of the tissue can die off over time. The area becomes painful and hard, then shrinks into a hard scar within the breast. You may also end up with a smaller breast.

After reconstruction using tissue from your abdomen (tummy) there is a small risk of a hernia in the future. A hernia is when the structures behind the muscle wall push through it. You may also get little folds of skin and fat at either end of your abdominal scar. You may need a small operation or liposuction to get rid of them.

Longer term problems with implant reconstruction

A fibrous capsule may form around the implant. The capsule can shrink, squeezing the implant. This happens in about 1 in 6 patients. It makes the breast painful and hard, and changes its shape. You may need to have the implant taken out. Many women worry about the implant developing a leak, but this is very unlikely unless you have a major injury to the breast. A leak can make the lymph glands under your arm swell up, but it doesn’t usually cause any other problems.

 

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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, such as

Wound infection

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.

Fluid under the wound

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.

Flap failure

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 develop some problem with 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.

Pain and discomfort

You will usually have some discomfort and pain after breast reconstruction. You may need painkiller injections for a day or so after the operation. Or you may only need regular painkiller tablets or liquid for a few days.

Some types of breast reconstruction may be more uncomfortable than others. For instance, if you have an abdominal wound, you may find bending and stretching uncomfortable for several weeks. You will need to support your abdominal wound with your hands when you bend or cough. This helps to ease the discomfort. You may need to take painkillers for longer than with other types of reconstruction.

If you have breast reconstruction at the same time as surgery for breast cancer you may find it uncomfortable to move your arms afterwards. But keeping them moving will really help. Do the exercises that your physiotherapist shows you. The exercises prevent stiff shoulders.

It is normal to feel tingling or numbness on the inner side of your arm. The sensation is due to nerve damage and should go away after two or three months. But some women may always have a little numbness.

 

Longer term problems with implant reconstruction

There can be problems after implant surgery, whether tissue expansion is used or the implant is just put in. Some women have

Hardening and changing shape of the implant

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, squeezing the implant. Doctors call this capsular contracture. It happens in about 1 in 6 patients. It makes the breast painful and hard, and changes its shape. If the shape changes a lot, you may have to have the implant taken out and replaced.

Leakage of the implant fluid

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. 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.

Unequal breasts if your weight changes

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.

A need to replace the implant

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

 

Longer term problems with body tissue reconstruction

The possible problems after reconstruction surgery with body tissue include

Loss of part of the flap

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 sort of problem is more common in heavy smokers or people with poor circulation.

Dog ears

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.

Abdominal hernia

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 abdominal hernia in the future because the surgeon removes part of the abdominal muscle. But hernia only happens in fewer than 5 in 100 cases (5%).

 

Finding support with breast reconstruction

You are likely to have emotional ups and downs after surgery for breast cancer and breast reconstruction. Even months afterward, 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. Your nurse will be able to 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. If you think it may help, ask your nurse or doctor to put you in touch with someone who has had similar surgery or even similar complications. 

You can also phone the Cancer Research UK nurses on freephone 0808 800 4040. The lines are open from 9am to 5pm, Monday to Friday. They will be happy to answer any questions that you have.

Contact one of the cancer information organisations listed on our breast cancer organisations page. You can also get a copy of a free leaflet for women considering breast implants produced by the medicines regulatory body, the MHRA. Other books and leaflets are listed in the breast cancer reading list.

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Updated: 31 July 2014