Short-term complications from surgery
Haematoma
There is a small risk of haematoma formation and post-operative bleeding after breast surgery, which can cause pain and significant bruising. Small haematomas can resolve naturally, but larger ones may need surgical excision. Monitor the area for signs of infection.
Infection
All surgical procedures carry a risk of infection, and patients who are obese, diabetic, older or smokers have a higher rate of wound infection. Patients will be told to monitor their surgical site for signs of infection (e.g. redness, heat, swelling, increased pain at the site) and report these to their medical team.
Restricted range of motion
Patients may be advised to not lift their arms about 90 degrees until any drains in the chest wall or axilla have been removed, in order to reduce the risk of bleeding or seroma formation. This may result in restricted range of movement in the shoulder. Patients will be given a programme of post-operative arm exercises during their stay in hospital, and may require referrals to a physiotherapist if they are not progressing in regaining this range of motion. If mobilised properly, the range of motion in the shoulder should return to its pre-surgery range.
Seroma
A seroma is a collection of clear fluid that accumulates in the surgical cavity. After mastectomy, this can form between the skin flaps and chest wall, causing a balloon-like swelling with obvious fluid movement. These may also develop in the axilla after surgery. Small seromas may be left to resolve on their own, but large seromas, especially when persistent, can result in a poor cosmetic outcome if not managed. Seromas may be aspirated, and these aspirations may be repeated until the seroma resolves. A small seroma drain may need to be placed to aid adherence of the skin flaps to the chest wall. Practitioners should be aware that repeated aspirations increase the risk of infection.
Tissue and fat necrosis
Tissue necrosis occurs when the blood supply to the skin and underlying tissues is compromised during surgery, and oxygen supply to the cells is reduced. This may happen when mastectomy skin flaps are very thin, and the necrotised tissue may need to be removed to let the remaining tissue heal. Patients who smoke have an increased risk of tissue necrosis.
Fat necrosis occurs when fatty tissue that has been damaged or necrotised forms a firm lump or oil cyst. These often resolve over time without treatment.
Long-term complications from surgery
Cosmetic issues
While cosmesis remains a focus of breast conserving surgery, where appropriate, patients may notice their breast is smaller and sits higher than the other breast, and occasionally there may be a noticeable distortion. A partial breast prosthesis may be used to correct the appearance under clothing, or corrective breast reconstruction techniques may be carried out in more severe cases. Fat tissue may also remain after a mastectomy, which produces a swollen area at the end of the mastectomy scar. Patients should speak to their surgeon if this is causes concern.
Nerve pain or numbness
Some patients may experience persistent discomfort in the breast, chest wall or arm following breast and/or axillary surgery. Patients may also report phantom nipple pain after mastectomy. Long-term pain can be experienced as hot, burning, sharp or stabbing in nature, and may be due to neuropathic pain from nerve damage. Some patients may be able to manage neuropathic pain with anti-inflammatories, while others may require comprehensive pain assessment and extensive pain management.
Numbness may be felt down the park of the arm and in the axilla after axillary node dissection and may be permanent. Patients should take care to protect the numb area from sunburn, sharp objects or anything that may cause injury.
Weight imbalance after mastectomy
The removal of the breast, particularly if it is large, can cause changes in posture, and as a result, lead to neck, back or shoulder discomfort. This can be alleviated with a well-fitted prosthesis and physiotherapy.
