Therapeutic mammoplasty: what are the possible complications of surgery?

Written by: Mr Brendan Smith
Published: | Updated: 16/05/2023
Edited by: Laura Burgess

If you and your oncoplastic breast surgeon have opted for therapeutic mammoplasty as the surgical procedure to treat your breast cancer, you may be wondering what the possible complications are with the operation. One of our expert consultants Mr Brendan Smith outlays everything that you need to know when it comes to therapeutic mammoplasty and the risks of surgery.

Are there any complications to having surgery?

All surgery carries some element of risk but the general complications include:
 

  • Haematoma - bleeding into the tissues following surgery and can occasionally lead to patients returning to the theatre to stop the bleeding and remove the blood (3-4 in every 100 women).
     
  • Wound infection - which can occur after any type of surgery and may need treatment with antibiotics.
     
  • Deep venous thrombosis (DVT)/pulmonary embolism - this can happen after any operation and general anaesthetic. Risks are reduced by wearing preventative stockings and giving an anti-clotting injection in certain cases.
     

What are the specific risks of therapeutic mammoplasty?

Here I outline the potential risks related specifically to therapeutic mammoplasty. They include re-excision (need for further surgery). If we are unable to get a clear margin of normal tissue around the lump then further surgery will be required on your breast. This accounts for 20 per cent (or two in 10) of cases nationally for a routine lumpectomy. We will not know this until you have a consultation with your results between one to two weeks later. If this is needed it can sometimes be done through the same incision, as a day case and performed within four weeks but other times a mastectomy may be advised.

Delayed wound healing (T-junction necrosis) can also occur. The blood supply at the point where the vertical scar meets the horizontal scar (the T-junction) is the poorest and this area is vulnerable. The skin may fail to heal initially and will separate leaving a raw area. This is occasionally extensive, requiring regular dressings for several months until the wound is fully healed. This is more common in therapeutic mammoplasty if the tumour lies close to the skin. Delayed healing can occur in three to five per cent (between three and five cases out of every 100).

Nipple complications are also a real possibility. The operation by its nature partially disrupts the blood supply to the nipple. There is a small but definite risk of nipple loss from this type of surgery, either total or partial (less than 1% or 1 in 100 cases). The risk is greater the closer the tumour is to the nipple. Loss of, or altered, nipple sensation is a more common complication seen in 30-50% of patients. This may be a temporary or permanent symptom.

Another potential complication is asymmetry. There may be some lasting differences in the size and shape of your breasts following surgery, which may be significant. You may desire the breast on the other side to be reduced to provide a good match in size and shape. This wouldn’t normally be done until at least six months after radiotherapy if it was required.

It goes without saying that scarring is also quite likely. Initially, the scars will be fine and appear as bright red lines. In most cases, the scars will usually heal satisfactorily and soften, becoming much paler and less obvious after 12 months or so. Some patients have a tendency to form red and lumpy scars (hypertrophy) or keloid scars, which are broad raised scars. The scarring will be permanent.

Fat necrosis is a common complication with this type of surgery due to interruption to the delicate blood supply of the fatty tissue within the breast. Occasionally, this fat dissolves and turns into a yellow, oily fluid that can leak through the wound closure. It more commonly results in a lump or hard nodular areas within the breast and may occur several months after surgery. Any breast lumps found should be checked with your GP and/or mentioned at your follow-up appointment. 
 


If you would like to discuss your surgical options for breast cancer you can book an appointment with Mr Brendan Smith via his Top Doctor’s profile today. 

By Mr Brendan Smith
Surgery

 

Brendan Smith is a highly trained and dedicated consultant oncoplastic breast surgeon with over 18 years of consultant specialist practiceThis wealth of experience has resulted in leading expertise across the field of oncoplastic breast surgery, such as breast reconstructionbreast cancerbreast reduction, breast augmentationbenign breast diseases and revisional breast surgery.
 
He has an extremely strong background in teaching and training breast reconstruction techniques to those in training and consultant professionals also. He has been a course director for the level 2 Oncoplastic Breast Reconstruction Surgery course at the Royal College of Surgeons and Association of Breast Surgery of the UK and Ireland Since 2011. He is also joint course director for the Oxford Oncoplastic Breast Surgery Course, teaching on it since its inception in 2013. He is also a faculty member for the Level 1 Oncoplastic Breast Reconstruction Surgery course formally at the Royal College of Surgeons and now the Association of Breast Surgery of the UK and Ireland.

He qualified in 1991 from Charing Cross and Westminster Medical School, completed his college fellowship exams (FRCS Eng) in 1996 and achieved a research fellowship studying the ‘Detection of micrometastases in breast cancer’ gaining a higher Masters of Surgery degree  (MS University of London) in 2003. As a dedicated career breast surgeon from this early stage, he gained his senior surgical training through the University of Oxford Surgical rotation in 1996 completing his FRCS exit examination (Gen Surg) in 2004. During senior surgical training in 2003 he succeeded in gaining his first choice preference of one of the first National UK Oncoplastic fellowships at the Christie and South Manchester University Hospitals.
 
Throughout his career, he has been dedicated to treating his patients using modern and innovative techniques in oncoplastic breast surgery to try and avoid mastectomy, where possible, including therapeutic mammoplasty, lipofilling (fat transfer), partial breast reconstruction using perforator flap techniques and neoadjuvant systemic treatment when necessary.
 
 He has extensive experience in breast reconstructive techniques using nipple-sparing or skin-sparing mastectomy, pre pectoral and partial sub pectoral ADM breast reconstruction, and autologous and implant-assisted LD flap reconstruction. He also works with an experienced plastic surgeon for patients having DIEP or free TRAM flap breast reconstruction.
 
He was appointed as the first Oncoplastic Breast surgeon at the Royal Berkshire Hospital in 2004. He set up the oncoplastic breast unit and has continued to develop it introducing new technology and techniques over the last 18 years. He has trained many other practising oncoplastic consultants over that time many of whom now work in the Oxford surgical deanery.
 
Furthermore, he continues to contribute to his field in the form of research, currently focusing on extending the surgical research portfolio locally.

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