Find out about the possible problems that might 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 after surgery.
After surgery, you're at risk of blood clots developing in your legs. There is also a small risk of a blood clot in your lungs.
To prevent blood clots, your nurses get you up as soon as possible after your operation. They encourage you to move around or do your leg exercises.
Also, during and after your operation, you wear special stockings (called anti embolism stockings or TEDS). And after your operation you might have injections to thin your blood for a while.
Tell your doctor straight away or go to A&E if you:
- have a painful, red, swollen leg, which may feel warm to touch
- are breathless
- have pain in your chest or upper back
- cough up blood
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 might 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 might not give you as much protection against the breast cancer coming back.
After any surgery, it is normal for the area to produce fluid. You might have two or more drains into the wound to drain off the fluid. The drains are usually long thin tubes attached to vacuum bottles. Even if you have drains, fluid can sometimes collect under the wound and create a swelling. This is called a seroma. If blood collects, it is called a haematoma.
Sometimes the fluid will be reabsorbed by the body and the swelling will go down on its own. But if the fluid doesn't go away after a few days, 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 might 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 might 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 any 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 different type of 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 covering might form around the implant. Silicone is safe but it is still foreign to the body. It is a normal reaction for the body to form a fibrous capsure around it.
Over some years, the capsule can shrink and squeeze the implant. Doctors call this capsular contracture. It happens in about 1 in 6 people. 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 because 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 the implant does 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 might no longer match the other one. It's not usually possible to make the breasts exactly the same on both sides. But your surgeon might 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 women who have implants develop a rare type of lymphoma of the breast but this is very uncommon.
You will have regular follow up appointments after surgery and your surgeon will check for any signs of lymphoma. Let your surgeon know if you notice any lump in the breast or if the breast becomes swollen. This type of lymphoma is usually easy to treat with surgical removal of the lymphoma and the implant.
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 people (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.