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Possible complications of a tissue flap breast reconstruction

Loss of circulation

There is a risk of bleeding or loss of circulation to the whole tissue flap with all of the tissue flap methods of breast reconstruction. This can happen if the blood vessels that supply blood to the tissue flap becomes kinked or blocked, or are actively bleeding.

After surgery, medications will be given to encourage blood flow through the blood vessels. The breast(s) will be monitored closely so that any changes in blood flow to the tissue flap are found early. If there is a severe lack of blood supply or a bleeding vessel, further surgery may be needed. In the rare situation that the tissue flap dies, surgery will be needed to remove the reconstructed breast.

Tissue flap necrosis

Tissue flap death may be more likely with pedicled flaps because they have less blood supply than free flaps. Tissue flap death is uncommon in free tissue flap breast reconstructions, affecting about 2 out of 100 women. The rare cases of tissue flap death usually happen in the first 2–3 days after the breast reconstruction surgery.

Fat necrosis

In some situations, areas of fatty tissue moved from the back or abdomen to the breast(s) may not receive enough blood and can die. This is called fat necrosis. Fat necrosis can feel hard to touch but is easily diagnosed as non-cancerous. Areas of fat necrosis may need to be removed by surgery. Fat necrosis typically develops 1–3 months after the breast reconstruction surgery.

Abdominal weakness (after LD, TRAM or DIEP flap breast reconstructions)

Some women find that movement of their arms and shoulders is affected in the medium to long term after LD flap breast reconstruction. Other muscles in the back help to make up for the lost strength of the latissimus dorsi muscle. However, reduced movement can affect some occupations and some physical/sporting activities (such as tennis and climbing).

About one in ten women who have a TRAM flap breast reconstruction experience a weakened abdomen. In a few cases (3%), a hernia may develop, where tissue protrudes through the weakened abdominal wall. Hernia is more common with the pedicled procedure because more abdominal muscle is moved. Hernias that become very painful or significantly interfere with function can be repaired with surgery.

To help avoid these possible complications a mesh may be inserted during breast reconstruction surgery, to replace the abdominal muscle removed with the TRAM flap.

Although abdominal weakness is less likely with DIEP flap breast reconstructions, some women also have weaker abdominal muscles in the short term after DIEP flap reconstructions because the muscle has been split to remove the blood vessels.

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