Breast Surgery Side Effects

Cording, also described as axillary web syndrome, can occur after axillary surgery such as full axillary dissection, sentinel node biopsy and after excision of masses from the axillary tail of the breast. It presents as a visible and palpable cord of subcutaneous tissue running from the axilla to the elbow.

It is thought to be a superficial thrombophlebitis (inflammation of the superficial veins), a variant of Mondor's disease (superficial thrombophlebitis of the breast). http://www.ncbi.nlm.nih.gov/pubmed/21987036

Other authors describe it as an inflammation of the lymphatics in the upper arm.

Cording generally resolves in about 12 weeks. Anti-inflammatory drugs can help, as can massage, range of motion exercises, and physical therapy.

Adhesions is a term used for intra-abdominal scarring from prior surgery or infection.

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.

Dr Attai, Thanks for your answer. Having already tried Gabapenten and several similar drugs, and physical therapy, and acupuncture, I would be interested in what the "other treatments" were. Also I should have been a little more specific with my question. I really wanted to know if SURGICAL repair was possible.

We primarily have experience using perforator flaps for breast reconstruction, so I’ll answer from that perspective. Arm lymphedema does not directly affect breast reconstruction, although there are reports of arm lymphedema improving after reconstruction using your own tissue (such as DIEP, GAP, or other perforator flaps). Trunk lymphedema (including breast), while not affecting the survival of the flap, can result in prolonged edema of the breast skin overlying the flap, leaving the reconstructed breast with a heavy, “wooden” character. We have seen this edema gradually resolve in some patients, however, over a period of up to two years, and it is possible that the flap is actually helping with this.

Richard M. Kline Jr., M.D.

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.

Great question!

In fact, I've posted on my blog about this very topic:
http://breast-cancer-reconstruction.blogspot.com/2008/11/avoiding-denervation-of-abdominal.html

The DIEP flap procedure preserves all the abdominal muscle. However, preserving all the muscle won't matter if all the motor nerves supplying it have been cut during the surgery. A muscle without a healthy nerve supply will lose it's tone, strength and function.

If the DIEP surgeon does not take great care to identify and preserve motor nerves supplying the abdominal muscle then the benefits of the DIEP can be lost: the abdominal muscle can become weak, lose its tone, and the risk of abdominal bulging or even hernia increases. Occasionally a nerve has to be cut because it interferes with the blood supply of the flap (eg travels between 2 necessary perforators). In these instances the nerve should be repaired at the end of the procedure. Typically, damage to 1 motor nerve will not cause any issues long term; it's damage to multiple nerves that leads to muscle problems.

I hope that helps.

Dr C
http://www.PRMA-enhance.com

To understand lymphedema, an understanding of the lymphatic system is important. As was explained in more detail in an separate answer, the lymphatic system is a vast network of pipe-like structures (called vessels) that collect fluid from the spaces around our cells and return it to the circulatory system. The system is 'closed', like the plumbing in a house.

Lymphedema (lymph= the fluid in lymph vessels; edema=swelling) happens when the lymphatic system gets damages. When there is damage to the 'plumbing', the fluid can leak out. Instead of getting put back into the circulatory system, the fluid that leaks out of the damaged vessels accumulates in the area of the leak. This can occur in the arms, legs or even abdomen.

What causes the damage? There are several causes. One is physical trauma caused by an accidental injury, or in the case of cancer, surgery. Surgeons often remove lymph nodes during cancer surgery as a way of detecting if the cancer has spread. To reduce the risk of lymphedema, surgeons can now remove far fewer lymph nodes than in the past (see Sentinel Lymph Node Biopsy). Removal of lymph nodes causes damage to the system. Radiation can also cause damage to lymphatic vessels.


Learn more about lymphedema causes, prevention and treatment and watch a documentary about lymphedema: http://www.cancerquest.org/lymphedema-introduction
Watch a documentary about sentinel lymph node biopsy: http://www.cancerquest.org/sentinel-lymph-node-biopsy

After my reconstruction surgery I had significant pain for almost three years. I finally helped alleviate it with a proper fitting bra. My guess is that since you are having the pain at night, you are not wearing a bra, which helps support the implants and the muscles holding the implants.

Part of my problem was that I couldn't find a bra at all that would work for me because I'm a B cup in projection, but a D cup in width, so I just went with very tight camisoles. That wasn't enough support and the pulling (although I didn't know I had pulling at the time) was stretching the tissue and nerve endings. I have found a great bra from Victoria Secret that has no underwire and a light padding to help fill in the projection problem.

I suggest you try wearing a bra at night and see if that helps. If not, an additional MRI to rule out any residual problems is warranted.

luckily this is less of a problem with many more women these days who undergo sentinel lymph node biopsy, rather than a complete axillary dissection and therefore removal of most of the lymph nodes. women who have a complete dissection must be careful with that arm, e.g. no blood draws to that arm, or to wear gloves when gardening, to prevent injury/infection. if signs of lymphedema should occur, it is important for a woman to see a physical therapist and/or occupational therapist e.g. to learn arm exercises and to get a compression sleeve to reduce swelling.