Breast Reconstruction (cont.)
Marga Massey, MD
Leigh A Neumayer, MD, MS, FACS
Galen Poole, MD, FACS
Mary L Windle, PharmD
Lee P Shulman, MD
IN THIS ARTICLE
Wound healing complications including infection and contour or shape irregularities can occur with all forms of reconstruction. Infection can be higher with those forms of reconstruction that require the placement of breast implants or donor site mesh. Several physical conditions may place a woman at higher risk of infection and likely shape irregularities. These conditions include obesity, diabetes mellitus, smoking, connective tissue disorders, prior irradiation, or medical conditions that require a woman to take steroid medications. Bleeding requiring a blood product transfusion is relatively rare. However, small blood collections, or hematomas, may require a small operation to remove the blood and prevent future infection or poor shape to the surgical site. Collections of serum, or seromas, may accumulate in a flap reconstruction donor site, which may require aspiration with a needle and syringe in the doctor's office.
Other complications can include pain or lack of sensation in a flap donor site or breast reconstruction site. The abdomen can be weak following a TRAM flap as can the back and upper arm in the setting of a latissimus dorsi flap. Abdominal wall hernias can occur following TRAM or DIEP flaps, although they are less frequent in the DIEP flap reconstruction patients.
One significant complication of flap reconstruction is fat necrosis, where a portion of a flap reconstruction has poor blood supply. A woman can notice hard portions of her flap that may feel like the initial breast cancer. Women diagnosed with breast cancer should continue monthly self breast reconstruction site exams. Lumps felt in a flap based reconstruction should be brought to the attention of a women's plastic and oncologic surgeon. Annual mammography of a reconstructed breast should be discussed with the surgical oncologist.
Breast implant reconstructions have been associated with numerous complications, the incidence of which increases with time and when the patient has required irradiation. Patients may develop pain at the reconstruction site as a scar develops around the implant. This is known as capsular contracture. This scar tissue may become so significant that the shape of the reconstructed breast is altered to such a significant degree that women may require additional surgical procedures to remove the scar tissue (capsulotomy or capsulectomy). Once a woman develops capsular contracture, she is at continued risk for recurrent capsular contracture requiring additional, repeat operations. It is not uncommon for patients with initial implant-based breast reconstructions complicated by capsular contracture to seek flap-based reconstructions. It is important for these women to seek information from qualified plastic surgeons who offer a complement of flap-based reconstructions when facing recurrent capsular contracture.
Breast implant reconstructions can also require additional surgical procedures to address implant wrinkling, folding, migration, inappropriate size, or deflation/leakage/rupture. The incidence of the problems should be discussed with the plastic surgeon.
As with all surgery, complications to the body may occur such as heart attack, stroke, pneumonia, kidney problems, and the formation of blood clots in the legs or lungs, and potentially death. All women should have a complete physical exam and discussion of the development of these possible medical problems with their treating physicians prior to any form of surgery, including breast reconstruction.
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