Breast Reconstruction Side Effects

There are different types of necrosis. Necrosis of the remaining breast skin is probably more likely to occur at the time of mastectomy than with delayed reconstructions, but even with immediate reconstructions this is usually not a problem. With regard to a flap used for breast reconstruction, I do not think there is a big difference in flap necrosis rates with immediate versus delayed reconstructions.

I have performed many silicone implant reconstructions over the years, and have never had anyone "reject" an implant. Thus, while I think the chances of this happening are very small, nearly anything is possible in medicine. As mentioned in one of the responses to the above questions, however, there are other issues that can develop over time with implants, such as capsular contracture formation or leaks, but most patients do well with implants.

By far the best result and state of the art today involves Nipple Sparing Mastectomy(NSM) and immediate reconstruction with DIEP or other Perforator flaps. For an optimal outcome, it is crucial to have a breast surgeon well trained in NSM and the right plastic surgeon. Ideally a one stage mastectomy and reconstruction can be done. Typically the breast would have a faint scar on the under surface of the breast. The DIEP donor site should be the same as a cosmetic tummy tuck. If the abdomen is not a good option, skin and fat can be obtained from the posterior thigh leaving a scar concealed in the fold beneath the buttock. This is my most recent innovation and is called the PAP flap.

One of the most common complications marring the reconstructive outcome is capsular contracture, or heavy, sometimes painful scarring around the implant, which can be seen with either saline or silicone implants. Other common problems include implant malposition, and asymmetry. While not really a side effect, implants are only made up to about 800 cc volume, which is not large enough to reconstruct many large breasts (in which case flap reconstruction with your own tissue may potentially provide more material). Other possible complications include infection, wound healing problems, skin loss, and chest wall deformities.

Richard M. Kline Jr., M.D.

I had diep flap reconstruction on 11/15. Unfortunately flap on rt side failed, so I have an implant on the rt and the flap on the left. I like the appearance and the feel of the flap versus the implant. The implant has really been causing a lot of trouble for me, and I may just have it taken out.. Make sure you really do your homework on this. It was a grueling 15 hour surgery for me. I also needed a blood transfusion after.

I don't regret my choice, but it is a little disappointing to go through all of that and not have optimal results. Good luck with everything.

The main advantage of the perforator flap over the transverse rectus abdominis (TRAM) flap is the reduction in donor site complications such as abdominal wall herniation and weakness. Nevertheless, there is still some risk of abdominal wall hernia. This is reported to be 0.7% according to Spear.

The other main long term complication of the DIEP flap is fat necrosis (12.9%) which can often be felt as a mass in the reconstructed breast.

If necrosis was removed and there is still hardness, then it is most likely from either 1) additional / remaining fat necrosis, or 2) edema (can feel hard, especially likely in radiated tissue). In either case, resolution is likely without additional surgery if you wait long enough (may take 1-2 years), although breasts will be smaller in either case. If pain is present, and fat necrosis is still present, then surgery to remove the rest of the dead fat may be indicated.

Richard M. Kline Jr., M.D.

Best to consult with a physical therapist to help design a program for increasing flexibility and scar management.