What Are The Risks of Tissue Flap Breast Reconstruction Surgery?

— -- Question: What are the risks of tissue flap breast reconstruction surgery?

Answer: Every time you transfer tissue to build a breast, you do it on a blood supply. So, many people think that you can just take fat, move it up to the breast, insert it, and it will be fine, but that's not true. That fat and that tissue has to have a blood supply; and that blood supply is either coming attached as a peticul, or is detached and the blood vessels are sewn together under the microscope. Whenever you do tissue transfer like this, you risk that the blood supply may not be enough, and you may lose part of the flap. And when I say 'lose part of the flap,' that means it doesn't get enough blood supply, it dies, it turns into a big scab, and it has to be debrided away in the operating room because half of it is no longer living.

Other more minor complications are that, where you take the tissue from, one might develop a hernia or a bad scar or need mesh, if it's in the abdominal wall, if both sides are taken. So it really depends on where the tissue is taken from, what the complications are.

If one takes it as a perforator or a free flap, less muscle is taken, and so there is slightly less risk of hernia and bulge, but a little bit higher risk that when the blood vessels are sewn in under the microscope, they may clog and the flap may not work. And so it takes some expertise and skill in doing these, and a reasonably healthy patient who doesn't smoke and doesn't a have a lot of other medical problems, to get these techniques to work well and to have a good cosmetic result.

If one takes tissue from the back, that's a very hardy flap -- that is called the latissimus dorsi micutaneous flap -- it usually doesn't come with enough tissue to avoid an implant, but it works very nicely in that it gives the implant a little natural sag, or tosis, which you don't get when you don't have a flap over your implant. The complications of the flap from the back -- the biggest one is the fluid collection under the skin called the 'seroma,' which can take sometimes up to a month to fully drain, and then the scar in the back; some women find that very problematic because they can't wear certain low-cut evening gowns and things like that.

And then in the more elaborate flaps, like the ones off the buttocks or the Ruben's flap off the flank, there are individual complications; but for the most part, they are very similar, and that's usually a blood supply problem, where the tissue doesn't get enough blood supply, and they partially die, partially scar, or partially become hard.

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