Most patients will experience few, if any, complications but it is important to be aware of possible problems.
Failure of the operation due to loss of blood supply: Microsurgery is a complicated procedure. The artery, vein or both can become blocked in the first few days following the reconstruction. If this is the case, you will need to return to the operating theatre to have the vessels unblocked. In up to 5% of cases the blood flow to the newly reconstructed breast is not re-connected and the rocedure fails. This failure is more likely in smokers. An alternative method of breast reconstruction may then be offered. Sometimes part of the skin that has been used to reconstruct the breast has an insufficient blood supply and dies away, leaving the rest of the reconstructed breast intact. If this occurs then the dead skin and tissue may need to be trimmed in a second operation.
Very rarely, there have been reports of the tummy button dying away leaving the patient with a scar where the tummy button was.
Bleeding: Bleeding may occur requiring a second operation or the need for a blood transfusion.
Infection: If any of the wounds become infected, you may require treatment with antibiotics and this could prolong your hospital stay.
Scars and wound healing: You are left with noticeable scars. All scars are red and raised initially and begin to settle over a 12-month period. Occasionally, the scars can become red and raised permanently and can itch. These are known as hypertrophic, or keloid, scars and are difficult to treat. The scars may also stretch. Once the wounds have healed, massage of the scars, using a non-perfumed moisturising cream, for ten minutes, four times a day, will help scars to fade.
Wound healing can be slow, particularly in the tighter central part of the wound on the abdominal wall and sometimes dressings are needed for a few weeks.
This is more common in patients who are overweight and who smoke. This tends to leave more obvious scars that are tethered – these may be improved by a further operation.
Swelling and Seromas: Swelling above the scar is usually present following the operation and is due to a collection of the tissue fluid that normally drains to the groin. This swelling or oedema settles within a few months.
A collection of fluid may develop under the abdominal skin following removal of the drains. This is known as a seroma. It can be left alone if it is causing no problems such as discomfort and the body will absorb the fluid. Occasionally it is necessary to draw off a large collection of fluid with a syringe and needle in the outpatients department.
Breast Asymmetry (unequal size and/or shape): Asymmetry with the normal breast can occur. If the size difference is significant, surgery to the normal breast may be offered to achieve a more symmetrical result. This surgery can be in the form of reducing the size of the other breast, hitching it up (mastopexy) or making it larger (breast augmentation).
Change in Abdominal Shape/Risk of Hernia: The abdominal wall may be changed following the procedure, one side being slightly more full than the other. There is a risk of a hernia forming at the site where the abdominal muscle was taken from (rare in DIEP flap surgery). It is very rare for the tummy button (umbilicus) to be moved away from its central position.
Numbness and Loss of Feeling: The sensitivity of the inner thigh may be affected. It can sometimes become numb.
There is numbness in the lower part of the abdominal wall after surgery. This is usually temporary but could be permanent. Sensation or feeling to the new breast is usually reduced to both the new breast and the abdominal wound following this surgery. It is important to avoid accidental injury e.g. burn, as you may not feel pain in these areas. Direct heat e.g. hot water bottle should never be applied to these parts of the body after this surgery.
Fat Necrosis: Occasionally, you may develop small lumps or nodules in the reconstructed breast tissue. This happens when the blood supply to a small area of fat is reduced and the fat breaks down into either a fluid collection or scar tissue. It is not harmful to you but all breast lumps should be reported to your doctor to rule out any more serious cause.
If you require any further information or advice, please contact any of the following:
Plastic Surgery Breast Nurse RVI (Monday – Friday 8am – 5pm)
Telephone: (0191) 282 0194
Sister or Nurse in Charge – Plastic Surgery Outpatient Department RVI
(Monday – Friday 8am – 5pm)
Telephone: (0191) 282 4228
Sister or Nurse in Charge – Ward 47 RVI
(at any time)
Telephone: (0191) 282 5647