Possible longer-term problems after breast reconstruction - after risk-reducing mastectomy
There are some longer term problems that might occur after breast reconstruction.
When any foreign body, such as an implant, is put into your body, your immune system responds by forming fibrous scar tissue (a capsule) around it. Over a few months this tissue can contract (shrink) as part of the natural healing process. If this contraction is severe, you may have tightening, hardening and changes in the shape of the reconstructed breasts, which may be uncomfortable. Most capsular contractures form in the first year, but some may occur much later.
In a few cases the implant and capsule may have to be surgically removed, a replacement implant inserted at the same time. Between 10 and 20 in 100 women (10–20%) will develop a capsular contracture that needs further surgery.
Abdominal hernia is a complication following a TRAM flap or a free TRAM flap. This is due to the abdominal muscle being removed, which may weaken the abdominal wall. If this is a risk, your surgeon may put in a protective gauze mesh to replace the muscle and so reduce the risk of it happening.
Using a flap from your back (latissimus dorsi) may limit your shoulder movement, because of the loss of muscle. More commonly, you may have aches and pains in the shoulder and back after exercise. This can sometimes make it difficult to do everyday activities like getting in and out of the bath, or can affect your ability to do some sporting activities, such as tennis, skiing, climbing etc.
Some women who have had a latissimus dorsi flap (LD flap) develop a chronic seroma cavity on the back which continues to fill with fluid. Sometimes injecting a steroid into the cavity can resolve this but if fluid fills the cavity over many months an operation to remove it may be required.