Surgical Risks of Breast Surgery and Reconstruction
Making the decision to undergo surgery, regardless of the operation, can be overwhelming. At Breast Reconstruction Associates, we understand that discussing the surgical details in plain English as well as reviewing the potential risks involved imparts the needed information that leaves patients feeling informed and confident.
A few of the general risks associated with any surgery are bleeding, infection of the surgical site, blood clots, and adverse reactions to general anesthesia. During your consultation with your plastic surgeon, you will review these general risks as well as the risks specific to breast surgery and/or reconstruction in detail. Although most women do not experience the following complications, here is a brief preview of the risks that will be covered in your discussion:
Fluid collections
Fluid or blood (seroma or hematoma) may accumulate between the skin and underlying tissues following surgery. Drains may be left in place after surgery to prevent this accumulation. Should this problem occur after drain removal, it may require additional procedures for drainage of the fluid.
Changes in sensation
The surgery will alter the sensation to the nipple, areola and surrounding breast skin. It’s important to discuss the possible extent of these changes with your surgeon, as it will depend on what type of surgery has been recommended for you.
Potential loss of the nipple-areola complex
If you are having a procedure that spares the nipple and areola, there is a risk of decreased vascular supply to these structures which can lead to necrosis (or death). This can either be self-limiting or require intervention.
Mastectomy flap necrosis
The breast skin remaining after mastectomy can have trouble healing from a lack of blood supply. When the blood supply is low enough, breast skin can die. This is more common in larger breasted women. Tobacco use and previous radiation history can also increase the risk of mastectomy flap necrosis.
Delayed wound healing
Wounds may separate after surgery. This may require daily home wound care or further surgery to correct the defect.
Microvascular thrombosis
Autologous breast reconstruction is associated with the risk of clot formation within the artery or vein providing circulation to the flap. This most commonly occurs during surgery but can happen afterwards, usually within the first 24-48 hours after surgery. This requires a second operation to attempt salvage of the tissue. The risk of this occurring is low and will be discussed in further detail with your surgeon.
Failure of the reconstruction –
Regardless of the method selected (implants, DIEP flap, or other flap), the reconstruction can fail which leaves the patient with a flat chest wall. Alternative methods would be considered if the patient elects to proceed with secondary reconstruction. In general, in properly selected patients, failure is uncommon.
At Breast Reconstruction Associates, we are committed to helping you navigate your surgical options, weigh the risks and benefits of surgery, and make the best decision specific to your care. Reach out to our plastic surgery office in Fort Worth, Austin or Oklahoma City if you have questions. We are here as a resource for you.
FAQs
The most common risks include fluid collections (seroma or hematoma), changes in sensation, delayed wound healing, and infection. While these risks exist, most women do not experience serious complications when surgery is performed by a qualified plastic surgeon.
A seroma is a buildup of fluid, while a hematoma is a collection of blood that accumulates between the skin and underlying tissues after surgery. Surgeons often place drains after surgery to prevent this. If it occurs after drain removal, additional drainage procedures may be required.
Surgery can alter sensation in the nipple, areola, and surrounding breast skin. The extent of these changes varies depending on the type of procedure performed, so it’s important to discuss this with your surgeon during your consultation.
Mastectomy flap necrosis occurs when the remaining breast skin loses adequate blood supply and begins to die. It is more common in larger-breasted women and in patients with a history of tobacco use or prior radiation therapy.
In the event that a reconstruction fails — whether using implants, a DIEP flap, or another method — the patient may be left with a flat chest wall. Alternative reconstruction methods can be explored if the patient chooses to pursue a secondary procedure. Failure is uncommon in properly selected patients.
Microvascular thrombosis is the formation of a clot in the artery or vein supplying blood to a reconstructed flap. It most commonly occurs during surgery or within the first 24–48 hours afterward and requires a second operation to attempt to save the tissue. While serious, the risk is considered low.
The right reconstruction method depends on several individual factors, including your body type, medical history, cancer treatment plan, and personal goals. A consultation with a board-certified plastic surgeon at Breast Reconstruction Associates will help you weigh the risks and benefits of each option — whether implants, DIEP flap, or another approach — so you can make a confident, informed decision.