Local Flap (LD) Reconstruction

What are the risks and side effects of surgery?

Having surgery should be a very positive experience. Complications are infrequent and usually minor. However, no surgery is without risk and it is important that you are aware of these potential problems.

Scars

Scars are across the back in line with the bra. Depending on the exact type of mastectomy, the breast scars will be slightly different. The main options are:

• A leaf shaped scar on the breast at the edge of the skin paddle if a total mastectomy is performed and skin and breast tissue has been removed.
• A circular scar around the edge of the skin paddle from the abdomen used to recreate the areola if a skin sparing mastectomy is performed with removal of the areola and nipple.
• A scar in the crease under the breast if a nipple sparing, skin sparing mastectomy is performed.

Bruising and swelling

Bruising and swelling is very common and may take several weeks to settle.

Haematoma

This is clotted blood that collects in the breast or back. It occurs in 1 to 4 percent of women who undergo a breast reduction. If a haematoma develops, it is likely to do so within 4 to 6 hours post-surgery.

Any increase in swelling or pain should be reported immediately so that timely treatment can be given. Sometimes patients need to have this collection of blood removed with another short operation. This does not normally delay your recovery or change the cosmetic result.

Infection

The risk of infection is inherent with any surgical procedure, albeit very uncommon in elective breast procedures. Antibiotics are administered during surgery and for 10 days after surgery to minimise the risks. Less than 1% of patients develop an infection post-operatively and rarely require any intervention, apart from further antibiotic treatment.

Numbness, reduced sensation or oversensitivity

A reduction in sensation in the breast or back occurs in most patients and often recovers to some degree, although it may never completely recover. Occasionally patients feel that nipples become more sensitive.

Wound healing problems

These are rare but can occur around the nipple, at the T junction (where the horizontal and vertical scars meet) or the back. These healing difficulties can range from minor problems, such as small scabs or areas of wound separation, to major issues, such as skin or nipple loss. Although very rare, skin grafting to close the wound may be required thus resulting in further surgery.

Patients who have diabetes, smoke, are obese or elderly are at an increased risk of delayed healing.

Seroma

This is a collection of clear fluid under the skin, which sits in a pocket. This spontaneously reabsorbs over the course of a couple of weeks, although it can be drained with a needle if it feels tight. Vary rarely a surgical procedure may be required if it does not reabsorb.

Dog-ears

These are soft tissue prominences where the scar stops. In most cases these settle over the course of 3 months. A small local anaesthetic procedure may be required to remove any excess that remains.

Asymmetry

Each breast is slightly different and will continue to be so following surgery; remember, “they are sisters and not twins”. However, if you have noticeable asymmetry prior to your surgery, then this can be corrected as part of the surgery as discussed with you.

Further excision

It is possible that when the tissue is assessed under the microscope the lesion has not been completely excised. In this instance, more tissue may need to be removed in a second operation.

DVT/PE

Following any surgical procedure it is possible to develop a blood clot in your legs, which could potentially break off and travel to your lungs. If the blood clot is large enough, it could prove fatal.

The overall risk for cosmetic surgery is less than 1%, but in order to reduce any risks of a DVT/PE, you will be provided with special stockings to wear in bed together with a blood thinning injection, if you are not mobile or have previously had a DVT or PE.

Fat necrosis

Sometimes areas of fat within the flap scar form hard lumps called fat necrosis. Usually, no specific treatment is required, and the problem settles down over approximately a 12-month period.

Volume loss with time or abnormal movement of the breast

As the muscle remains active, it does not always cease contracting and moving, which can cause unwanted twitching of the breast. This is like the movement seen in submuscular breast augmentation. This issue can be managed by dividing the tendon and/or the nerve during surgery.

I routinely divide the tendon to prevent any pulling of the breast but do not typically divide the nerve. Routine nerve division can lead to muscle atrophy and potential volume loss over time. Since most patients do not experience these contractions, I only divide the nerve, if necessary, at a later stage, to avoid muscle wasting.