Cornwall Breast Surgeon Iain Brown
Cornwall Breast Surgeon Iain Brown

Consent

Risks and Complications in Oncoplastic Breast Surgery


Giving your Informed Consent for your breast surgery requires an appreciation and understanding of the potential risks and complications of the procedure.

The information below lists the risks and complications of each of the main Oncoplastic Breast surgical procedures.

It is very important that all of my patients have had chance to read the leaflet prior to signing their actual consent form before surgery.



Risk And Complications Information

General Risks of Surgery

Anaesthetic risks
Discomfort / pain – acute/chronic
Bruising / Haematoma (requiring return to theatre)
Infection
Wound Healing (impaired, delayed)
DVT/PE

Specific Risks For Standard Breast Procedures

  • Breast Biopsy/Wide Local Excision
    Scars
    Deformity/Asymmetry
    Need for further surgery
    Impact of future radiotherapy

  • Localised Wide Local Excision
    As for WLE
    Use of Isotope (safety and half-life explanation)

  • Sentinel Lymph Node Biopsy & Ax Node Sampling
    Impaired arm/shoulder movement
    ICBn damage
    Lymphoedema
    Seroma
    Blue Dye allergy/anaphylaxis (quote %)
    Possible need for further surgery (clearance)

  • Axillary Node Clearance
    Impaired arm/shoulder movement
    ICBn damage
    Lymphoedema
    Use of Drains
    Seroma

  • Mastectomy
    Scars
    Deformity
    Dog-ears
    Wound healing problems
    Impact of radiotherapy
    Use of Drains
    Seroma

Specific Risks For Oncoplastic & Reconstructive Procedures

  • For all procedures:
    Type and extent of scars
    “.... .unable to guarantee symmetry of shape, volume”
    “…unable to guarantee will not require further surgery”

  • WLE with Breast Reshaping (volume displacement)
    Palpable irregularity of repaired gland
    Type and extent of scars
    Skin envelope necrosis
    Fat necrosis
    Need for further surgery
    Unpredictable effects of XRT

  • Therapeutic Mastopexy/Mammaplasty
    Type and extent of scars
    Skin envelope necrosis
    Fat necrosis
    Sub-optimal healing (T-junction breakdown)
    Need for re-excision/mastectomy
    Unpredictable effects of XRT

  • Skin Sparing Mastectomy (immediate reconstruction)
    Skin envelope necrosis (smokers, low BMI)

  • One Stage Expander/ Implant
    Implant palpability, rippling, rotation
    Deep implant infection requiring explantation for 3 months
    Capsular contracture
    Inflation port – palpability, position, malfunction

  • Two-stage Expander then Implant
    As for one stage but need for hyper-expansion
    Need for second op understood

  • Latissimus Dorsi (autologous)
    Donor site morbidity:
    Extent of scar
    Back contour uneven (fat harvest)
    Skin necrosis
    Reduced shoulder strength and function
    Persistent seroma
    Flap:
    Partial or full flap failure (<2%)
    Twitching of flap
    Flap atrophy (volume loss)
    Fat necrosis (lumpiness, vol loss)

  • Latissimus Dorsi (with implant)
    As for autologous LD but with additional implant risks:
    palpability, rippling, rotation, deep implant infection requiring
    explantation for 3 months, capsular contracture.

  • Pedicled TRAM Flap
    Donor site morbidity:
    Extent of scar
    Wound healing problems incl dehissence
    Reduced abdominal wall strength and function
    Mesh repair – bulge, risk of incis hernia
    Flap:
    Partial or full flap failure (~ 5%)
    Flap atrophy (volume loss)
    Fat necrosis (lumpiness, vol loss)

  • Nipple Reconstruction
    Partial necrosis (<5%)
    Full necrosis – nipple loss (<1%)
    Loss of projection over time

  • Lipomodelling/ Fat Grafting
    Donor Site:
    Bruising/Haematoma
    Discomfort – acute/chronic
    Numbness
    Uneven contours
    Ridges
    Inadvertant Internal Injury (theoretical only)
    Recipient Breast:
    Infection
    Swelling
    Bruising
    Lumpiness / Fat necrosis/ Cyst Formation
    Uneven contours
    If previous cancer (theoretical risk of increased local recurrence – unproven in largest European Centre Series – Lyon, Milan)
    Changes to future mammography (theoretical increased need for further biopsies – not proven)

 

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