All surgical procedures, regardless of their purpose, carry risk to some degree, and breast reconstruction is no exception. Even though most women do not encounter serious problems from surgery, complications can occur, including the following:
- Infection. Any opening in the skin presents an opportunity for infection to sneak in. Precautionary measures—maintaining sterile operating environments and cleansing the skin with antibacterial wash before incisions are made—are effective. If you are diabetic, obese or you’ve previously had radiation therapy to the breast or you’re currently taking chemotherapy, you’re more susceptible to infection. Infection is particularly worrisome if you have tissue expanders or breast implants, which can be contaminated by bacteria in the bloodstream or infection in the body. Depending on the degree of infection, antibiotics are usually prescribed; debriding (removing unhealthy tissue) may be necessary if large portions of tissue are involved.
- Seroma. Sometimes clear fluid from blood vessels accumulates in the tissue, despite the use of surgical drains and compression garments. Small pockets of fluid are usually resorbed into the body. Larger seromas may need to be drained with a needle and subjected to several more days with a surgical drain. Treatment is important, because seromas that harden can become infected and require antibiotics or require another trip to the operating room to repair the problem.
- Bleeding. Most women don’t experience bleeding after their reconstructive surgery, but sometimes a hematoma (a pocket of blood) forms when a blood vessel leaks into the surrounding tissue. As a precaution, for a period before and after your reconstruction, you should stop taking any vitamins, herbs and medications that thin the blood—your plastic surgeon will discuss this with you before your surgery. Like seromas, many hematomas are resorbed by the body. Hematomas need to be monitored closely; any that are persistent may require additional surgery to reopen the incision and drain the collection of blood.
- Stubborn wounds. Some people, especially older patients and those who are obese, experience delayed wound healing after surgery. Other factors can also influence how quickly a wound heals. Patients who develop infections, are diabetic or who have other chronic health problems tend to heal more slowly and should be monitored carefully during and after surgery.
- Necrosis. Tissue that doesn’t receive enough blood dies from lack of oxygen. This necrosis can occur in the breast skin, which tends to be fragile after mastectomy, or in a flap of fat, skin and/or muscle that is used to reconstruct the new breast. If an area of necrosis is large or doesn’t shrink without further attention, it may need to be surgically removed. If an entire flap dies, it must be removed (rebuilding the breast then involves a different type of flap or breast implants). This rarely happens, but it is more likely to occur in patients who smoke, have circulatory problems, or who have had radiation to the breast (radiation compromise blood flow).