Risks – Latissimus Dorsi +/- Expander and Implant

Multi-staged process

• Your breast reconstruction will be undertaken over three to four stages.
• Each stage is spaced approximately 3 months apart.
• Each stage becomes increasingly less demanding.
• The entire process usually takes approximately 1 year. The process is fairly flexible such that the stages can be organized to fit your life and your schedule.

Life and breast reconstruction

• Your life will not be put on hold for the duration of your breast reconstruction. Instead it will be punctuated by a series of procedures with relatively normal life in between.

Relationships and breast reconstruction

• First and foremost, this surgery is for you. However, having multiple surgeries spaced over 1 year can also be difficult for those around you. It is important to think about and discuss the process with your partner or support person.
• The process will have immediate effects on your
  • Partner
  • Children
  • Work relationships
• It is healthy and important that you think about these issues and formulate pre-emptive strategies to help you through your breast reconstruction.

The risks associated with this form of breast reconstruction are related to your general health and the presence of co-existing medical conditions.

• Smoking
• Diabetes
• BMI (body mass index)
• Massive weight loss (>20kg)
• Immuno-suppression.

• Pain and discomfort
• Infection
• Delayed wound healing

You will have a general anaesthetic at one of several major hospitals in Adelaide.

Your anesthetist will outline the process and the risks of anaesthesia prior to your procedure.

Some risks to consider are

• DVT (a clot in the deep veins that may travel to vital organs)
• Chest infection
• Anaphylaxis
• Injury to teeth

Bleeding

• The surgery covers a large surface area. You may require a blood transfusion postoperatively (usually of your own donated blood).

Latissimus dorsi function

• This is a large powerful muscle, which is responsible for a pulling, rowing or “chin-up” motion on one side.
• This operation sacrifices the function of your latissimus dorsi muscle
• You will never be as strong with that specific motion on the side of your breast reconstruction.

Shoulder range of motion

• short term (less than 3 months)
  • you may have some limitation of shoulder motion
• long term
  • unless you have pre-existing shoulder problems, it is very unlikely that your range of shoulder motion will be affected.
  • Even if you have pre-existing shoulder problems, with the right guidance, it is likely that you will regain your pre-operative level of function.

Seroma

• This may require repeated drainage by your surgeon in the post-operative period

Scarring

• Back
• Reconstructed breast
• Hypertrophic or keloid

Changes to sensation

• Your reconstructed breast will have diminished and altered sensation that may be patchy in nature.
• You may feel a sense of fullness to the side of your breast due to the change in sensation
• You will have altered sensation to your back region where the flap was taken
• You may feel a sense of bareness or loss of padding to your back where your flap was taken. Patients report some discomfort when sitting against firm surfaces for extended periods. You may prefer to sit favoring your un-operated side.

Implant related risks

• Palpability
• Malposition
• Rotation
• Rippling
• Capsular contracture
• Rupture
• Anaplastic Large Cell lymphoma (an extremely rare form of cancer that can develop around breast implant capsules).

Asymmetry

• Recurrence of asymmetry related to ageing, weight changes, skin laxity and implant related issues
• Revisional surgeries related to recurrence of asymmetry and implant related issues