The following list gives you information on the most common or most significant problems that can occur following surgery:

Anaemia

If you are found to have a low blood count (anaemia) after your operation, a course of iron tablets may be prescribed. After you are discharged from hospital, your GP may repeat the blood test to check your iron levels.

Asymmetry

Although every effort will be made to make your breasts equal in size and shape, you may find that there is a difference between the two breasts. This is quite normal, but if you have any concerns or questions please talk to your surgeon. If necessary, revision surgery may be performed to improve the look of your breasts. A degree of asymmetry in all women is entirely normal.

Blood transfusion

It is uncommon to require a blood transfusion after breast reconstruction, however, this may occasionally be required. If you have strong views or religious beliefs about this, please discuss any issues with your surgeon and anaesthetist before surgery.

Deep vein thrombosis (DVT) or Pulmonary Embolism (PE)

This is a blood clot in the legs (DVT) or lungs (PE) and is a potential complication following surgery and bed rest. People who are taking the oral contraceptive pill or hormone replacement therapy (HRT) and those who smoke are at the greatest risk. Occasionally clots can break off and pass to the lungs, known as a pulmonary embolus (PE). All patients are given compression (anti-embolism) stockings to try to prevent this problem. You may also be given blood thinning injections (low-molecular weight heparin LMWH) to reduce this risk.

Taking Tamoxifen may increase the risk of DVT/PE. If you have been prescribed Tamoxifen and are undergoing an autologous (own tissue) free-flap procedure you may be asked to stop taking it 4 weeks before surgery, and resume taking it 2 weeks after surgery. This will not affect your cancer treatment. This is variable between units so please check with your own surgeon/breast care nurse for the protocol at your hospital.

Depending on the unit, if you are undergoing an autologous (own tissue) free-flap procedure you may be recommended to go home with blood thinning injections (LMWH) to self-administer into your thigh or abdomen for 7 days post discharge. You will be taught how to give yourself the injections whilst you are an inpatient on the ward. In addition, you may also be asked to wear your compression (anti-embolism) stockings for a period of time after your operation. This is variable between units so please check with your own surgeon/breast care nurse for the protocol at your hospital.

Flap failure

There is a small chance that the flap or part of the flap may die. If its blood supply is insufficient, there is an approximate risk of 1-10% failure rate which varies between units. This is uncommon, and is most likely to happen within the first 24-48 hours post operatively. If this does occur you will need another operation to remove the affected area. Your surgeon will also discuss with you other reconstruction options that are available. Occasionally, it is possible to save the flap, if the problem with the blood supply can be rectified. This usually involves a return to the operating theatre and may involve borrowing a vein from another area of the body (arm or leg) to use in reconnecting the vessels to get them working again.

Fat necrosis

This is an uncommon, benign condition where fat cells within the breast reconstruction may become damaged/die and delay wound healing. It is usually painless and the body repairs the tissue over a period of weeks/months. Occasionally the fatty tissue swells and may become painful. The fat cells may die and their contents form a collection of greasy fluid which will drain to the skin surface. The remaining tissue may become hard. In severe cases the skin may die. It is uncommon to require further surgery.

Haematoma

This is a collection of blood underneath the skin, which may occur after surgery. The breast reconstruction may become painful and swollen. A second operation may be necessary to remove the haematoma.

Infection

A wound infection can occur after any surgical procedure. If this happens it may be treated with oral antibiotics and, if necessary, further dressings. In severe cases, a return to theatre is required to wash out the infected wound. After an infection the scars may not be quite as neat. Any major operation with a general anaesthetic carries a small risk of a chest infection, particularly among people who smoke.

Lymphoedema

Breast reconstruction is not thought to increase the risk of getting lymphoedema or worsen any pre-existing lymphoedema. If you are having lymph node surgery before, or as part of your mastectomy (e.g. sentinel lymph node biopsy, axillary clearance or sampling) then you are considered to be at some risk for lymphoedema. If you are deemed to be at risk, you will be given information and guidance on taking precautions and lowering the risk. For more information please visit: https://www.breastcancercare.org.uk/information-support/facing-breast-cancer/going-through-treatment-breast-cancer/side-effects/lymphoedema

Seroma

Sometimes serous (straw-coloured tissue fluid) fluid will collect in the breast reconstruction or donor site (where tissue is transferred from) – abdomen, back, thigh or buttocks after the drains are removed. Usually this is a small amount only and the body will gradually reabsorb the fluid over a period of a few weeks. Occasionally, a larger amount of fluid collects. This can be drained with a needle and syringe and may need to be done on several occasions.

Scars

Any operation will leave a permanent scar. Infection can cause a wound to re-open; this may lead to problems with scar formation such as stretching or thickening. At first, even without any healing problem, the scar will look red, slightly lumpy and raised. Regular massage of the scar using a light non-perfumed moisturising cream and using sensible sun protection measures, such as a factor 50 sun block, should help it to settle in time and fade over months/years. This may take up to two years. Some people may be prone to the development of keloid or hypertrophic scars which are raised, itchy, and red. If you have a tendency to produce scars like these, please discuss this with your surgeon. In the majority of cases, scars settle to become less noticeable. Occasionally revision surgery may be performed to improve the appearance of scars.

Wound breakdown

Wound healing may sometimes be delayed. This may be because of tension on the wound, poor blood supply to the area, poor nutritional status and/or infection. Occasionally the wound may break down, resulting in; a longer hospital stay, increased hospital visits to have the wounds assessed and, possibly, further surgery. Smoking increases the risk of this as smoking can have an adverse effect on the healing of all surgical wounds. Eating a healthy diet promotes good wound healing. If you have been trying to lose weight, you may wish to take a vitamin or mineral supplement in addition to a healthy diet, but we advise you to take no more than your recommended daily amount.

Other important factors to consider

Body image

The majority of patients are pleased with the results of their surgery. However, not all surgery is completely successful and you may not be pleased with your cosmetic result. Occasionally, women feel very anxious about their treatment or have difficulty coming to terms with their new look because their breasts are not as they had imagined they would be or as a result of a complication. If you feel very anxious, worried about your treatment or depressed please speak to your surgeon or your breast care nurse specialist for more information about psychological therapy services available in your area.

Body Mass Index (BMI)

There is written evidence to show that wound healing is impaired dramatically the higher your body mass index (BMI). Some surgeons may ask that your BMI falls between a healthy range and does not exceed 35, this is in order to reduce the chance of a complication arising. Your surgeon may ask you to lose weight before agreeing to operate in order to achieve the best long-term results for you. The BMI limit is variable between units.

Intimacy

Initially, your breast reconstruction and donor site (abdomen, inner thigh, back or buttock) will feel tender and you may not feel up to intimate physical contact. However, you may resume your sex-life as soon as you feel comfortable. Patients having a flap from their inner thigh or buttocks may be unable to externally rotate their legs comfortably until 4 to 6 weeks after the operation. Breast reconstruction restores the shape of the breasts but cannot restore your normal breast sensation. With time, the skin on the reconstructed breast may become more sensitive, but it will not give you the same kind of pleasure as before a mastectomy.

Some women are concerned that their partner hesitates to touch them and this makes the woman feel less attractive. The most likely reason for this is that their partner is afraid of hurting them. Couples need to talk about their fears and feelings.

Sport

Some types of sport can usually be resumed within 6 to 8 weeks after surgery, but we suggest that you check with your surgeon or breast nurse first. If the sport involves strenuous upper body movements for example aerobics, golf, swimming and any racquet sports then it is advisable to return gradually to these activities and ensure you have a supportive sports bra on during the activity.

Supportive Garments

This varies between units. Please check with your surgeon/breast nurse whether you are required to purchase specific supportive garments (such as cycling shorts or body-shaper knickers) to wear after your surgery. You will almost always need to wear a supportive bra.

Possible complications following breast reconstruction surgery

Following breast reconstruction surgery you may experience one or some of these possible complications:

All types of reconstruction

  • Areas of specific discomfort where new breast mound is sutured to chest wall
  • Dissolving sutures spitting out
  • Feeling of heaviness/fullness to the reconstructed breast
  • Numbness or lack of sensation to reconstructed breast
  • Feeling of bulkiness under armpit to your reconstructed side
  • Red lumpy scars during healing process
  • Difficulty in getting bras to fit for duration of reconstruction journey

Free flap reconstructions

  • Some discomfort to the ribs above the reconstructed breast where the rib/cartilage may have been removed to allow the blood vessels to be reconnected
  • As the newly connected blood vessels are healing it is possible that you may experience tingling, electric shock or warm sensations in your chest, although this is less common

Abdominal (DIEP / MS TRAM / SIEA) flap reconstructions only

  • Delayed wound healing to centre of abdominal scar and/or umbilicus
  • Numbness or a loss of sensation to the incision line across the abdomen (donor site) and the area directly below the umbilicus
  • Tightness/firmness to the abdomen
  • Stepped appearance of abdomen scar due to difference in thickness between abdominal fat
  • Abdominal weakness , bulge or hernia

Thigh (TUG / DUG / PAP) flap reconstructions only

  • Wound healing issues to inner thigh (donor site)
  • Numbness or a loss of sensation to the incision line and sometimes the inner thigh or back of the thigh
  • If only one thigh is used as a donor site, your thighs may look uneven after this surgery

Buttock (SGAP / IGAP) flap reconstructions only

  • Wound healing issues to buttock (donor site)
  • Numbness or a loss of sensation to the incision site on the buttock (donor site)
  • If only one buttock is used as a donor site, your buttocks may look uneven after this surgery

IGAP flap reconstructions only

  • Risk of damage to sciatic nerve resulting in sciatica – a sharp, intense pain that radiates along the path of the sciatic nerve (which branches from your lower back through your hips and buttocks and down each leg)
  • Increased risk of formation of pressure-related wounds (IGAP flap)