The risks associated with any surgical procedure vary and also depend on the patient’s existing medical problems.
Some patients are at much higher risk for complications, especially those who have diabetes, are obese and/or high blood pressure. Patients who actively smoke are setting themselves up for major complications post-surgery. Patients who’ve had a prior mastectomy and radiation therapy to the chest are also at high risk for complications.
Being at risk for higher rates of complications doesn’t mean the patient should never have reconstructive surgery, but your doctor may advise delaying it and recommend lifestyle changes such as adjusting current medications, quitting smoking, etc. The goal is to set the patient up for success.
There are a number of risks common to any surgical procedure, such as bleeding, infection, reaction to anesthesia, or unexpected scarring. Hematoma (accumulation of blood at the surgical site) can delay healing. The risks of infection and seroma formation (fluid collecting in the breast pocket) are higher with patients undergoing immediate reconstruction compared to those who delay reconstruction. Any breast reconstruction also poses a risk of asymmetry and the possible need for an unplanned surgical revision. Persistent pain is another potential complication of all types of breast reconstruction.
RISK ASSOCIATED WITH IMPLANTS
Implants have some unique problems that may develop. A thick scar, called a capsule, forms around the implant as part of the body’s normal reaction to a foreign substance. Capsular contracture occurs when the scar becomes firm or hardened. This may cause pain accompanied by changes in the texture or appearance of the breast. Implants can rupture and leak, deflate, or become displaced. The chances of capsular contracture or rupture increase with the age of the implant. These complications can usually be remedied with surgery to loosen the capsule and remove or replace the implant as needed. An implant tends to remain firm indefinitely.
It’s important to note, however, that research has shown that the use of silicone implants does not pose additional health risks or complicate breast health or healing.
RISK ASSOCIATED WITH FLAP TECHNIQUES
Flap surgery includes the risk of partial or complete loss of the flap and a loss of sensation at both the donor and reconstruction site. If there is a problem with the flap, a re-exploration procedure is performed and if a large portion of the flap develops inadequate blood supply, another reconstructive technique may be necessary. Abdominal flap procedures can result in decreased muscle tone and weakness in the abdomen, or lead to an abdominal hernia. Arm weakness may occur after LD flap surgery.
No matter which technique is used to rebuild a breast, a woman’s chest skin will change over time with age, weight, and hormonal changes. Therefore, the shape of the breast will also change over the years and revision procedures may be needed if the patient desires them.