Possible problems that come with breast reconstruction

Though breast reconstruction techniques have been improving for more than fifteen years, and there are fewer and fewer problems, there are still certain complications that can occur as with any major medical procedure.

Problems immediately following surgery

• Wound infection
• Fluid under the wound
• Flap failure
• Pain and discomfort

Wound infection

Infection is a risk in any surgery. It is the most common problem with tissue expansion reconstruction. You'll need antibiotics and rest. 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 chemo 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 will have two or more drains into the wound to drain off any fluid that collects. These are usually long thin tubes attached to vacuum bottles.

Despite the 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 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.

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, less 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 be taken back into the operating room. About 3 to 5 out of every 100 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 have 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.