Before the operation, the surgeon will discuss the risks of a flap reconstruction with you. Some of these risks include:
Loss of the flap
Blood vessels supplying the flap may kink or get clots, leading to bleeding and a loss of circulation. If there are signs of problems with the blood supply, you might need another operation. If the blood supply is not good enough, this may cause the tissue to die, leading to a partial or complete loss of the flap. Problems with blood supply are more likely to happen if you smoke or have recently quit or are carrying extra weight. If the flap dies, you usually have to wait 6–12 months before having a reconstruction again.
Hardening of the flap
In rare cases, the fat used to make a TRAM or DIEP flap doesn’t get enough blood supply and dies. This is known as fat necrosis. Because it causes the affected area in the reconstructed breast to feel hard, fat necrosis can easily be seen and diagnosed on a mammogram. It can be left in place or surgically removed. Fat necrosis is more likely to happen if you smoke or have had radiation therapy.
Problems with the donor site
After an abdominal flap reconstruction, it may take time for the wound to heal, and fluid can collect (seroma) in the abdominal region. After an LD flap reconstruction, it’s common for fluid to build up (seroma) in the back where the muscle was taken from.
Hernia (abdominal bulge)
If you have had a DIEP or TRAM flap, you have a small risk of developing a hernia. A hernia occurs when part of the bowel sticks through a weak point in the abdominal wall. The risk of an abdominal hernia is greater with a TRAM flap than with a DIEP flap reconstruction because removing the TRAM flap can weaken the abdominal wall and cause a hernia. If you have any signs of a hernia, see your doctor.
Learn more about side effects and what to expect after a reconstruction.
→ READ MORE: Re-creating the nipple
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More resources
Dr Jane O’Brien, Specialist Oncoplastic Breast Cancer Surgeon, St Vincent’s Private Hospital, VIC; Clare Bradshaw, Clinical Nurse Consultant, Breast Assessment Unit, Fiona Stanley Hospital, WA; Rene Hahn, Consumer; Sinead Hanley, Consumer; Dr Marc Langbart, Specialist Plastic and Reconstructive Surgeon, Randwick Plastic Surgery, NSW; Melanie Law, Consumer; Sally Levy, Consumer; Annmaree Mitchell, Consumer; Ashleigh Mondolo, Breast Cancer Nurse Clinical Consultant, Mater Private Hospital Brisbane, QLD; Rochelle Osgood, Clinical Nurse Consultant – McGrath Breast Care Nurse, Sunshine Coast University Hospital, QLD: Dr Kallyani Ponniah, Head of Department, Breast Centre, Sir Charles Gairdner Hospital, WA; Meg Rynderman OAM, Consumer; Sarah Stewart, Breast Care Nurse, The Royal Women’s Hospital, VIC; Erin Tidball, 13 11 20 Consultant, Cancer Council NSW; Jane Turner, Senior Exercise Physiologist, Sydney Cancer Survivorship Centre, Concord Cancer Centre, NSW.
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