A Young Woman’s Guide To Breast Surgery


What can go wrong?


Infection
As with any operation, you run the risk of infection. With MRSA in the news, most hospitals routinely carry out swab tests to check for antibodies – this will be done at the Pre-Op Assessment Clinic. If you are having a breast reconstruction using implants, you have a slightly higher risk of infection and a short course of antibiotics will be given as a preventative measure before and after your op.

If you notice increased redness, a high temperature or a rash after any kind of surgery, you should get yourself down to your nearest A&E department. Infections are easily treated with antibiotics if you catch them early enough.


DVT
Deep vein thrombosis is a type of blood clot, which usually occurs with poor circulation. Any operation carries a risk of this but you are at greater risk if you smoke, are overweight, have poor circulation or are inactive for long periods of time. Blood clots are rare in young women but they can happen. You can reduce your risk by stopping smoking, eating healthily and exercising.

Many hospitals routinely hand out flight socks for longer operations and this is a good way of reducing your risk. If you have longer surgery like a mastectomy and/or reconstruction, you should try to wriggle your toes and circle your ankles regularly while lying down and, when you feel up to it, start moving about in the ward. The nurses can give you more information about preventing DVT. If you do get a blood clot, it can be successfully treated if it’s caught early on.


Scarring
Any operation will leave a scar, even cosmetic procedures. The size of the scar after breast surgery will depend entirely on the size of your lump and what operation you have. Some surgeons have preferred incision sites while others allow themselves to be dictated by the size and position of the lump that’s being removed.

Scars will take several years to fade but if you are unhappy with the appearance of yours, there are things that can be done cosmetically to improve them. Scar reduction creams, gels and plasters are available on the market, which have been clinically proven to improve the appearance of scars. Camouflage creams can also be bought – these are like a very thick foundation you can use to cover the scar and many are waterproof. Cosmetic surgery is another option. Again, you should discuss this with your consultant where appropriate or your GP.


Indents in the breast
If you have had a large amount of breast tissue removed along with the lump, you may be left with some indentations. Quite often this fill out over time but if there’s a marked difference you might like to discuss partial reconstruction, which can be done using your own tissue or an implant, or prosthesis, which fit into your bra.

Pain and discomfort
As with any operation, you may have some pain or discomfort afterwards. This should gradually improve but some women find the pain does not go away. If this is the case, you should discuss it with your GP or consultant – you should not put up with constant pain. Possible treatment options include non-steroidal anti-inflammatory drugs like ibuprofen or even acupuncture.

Numbness
The opposite of pain - sometimes the area that’s been operated on will be completely numb. Feeling can gradually return but often the area will stay numb and unfortunately there is no way of reversing this.

Wonky boobs
If you have a reconstruction, you can end up with wonky boobs. Many women will have several reconstruction operations to get a result they’re happy with. If you need any minor or major adjustments, you can discuss this with your consultant.

Capsular contracture
If you have a reconstruction using implants, you can end up with a capsular contracture. This is when the scar tissue around the implant hardens and squishes the implant. The result is a hard-looking implant under the skin and it can cause pain as well. If the capsular contracture is bad, it can be removed surgically under a general anaesthetic. Hardening usually occurs a year or two after the operation if it is going to.

Seromas and haematomas
A seroma is a build-up of fluid around the surgical site and a haematoma is a build-up of blood. Some people get them and some don’t – there’s no hard or fast rule. Drainage tubes will help to prevent them but if you do get either, you should go back to the hospital. If a seroma is very uncomfortable, it can be drained off with a syringe but sometimes doctors are reluctant to do this in case it returns. A haematoma can also be treated with drainage but sometimes it is necessary to remove it surgically.

Lymphoedema
If you have lymph nodes removed, you will be at risk of a condition called lymphoedema. This is where fluid builds up in your arms and hands and it can be extremely painful. It can be effectively treated early on so if your arms or fingers suddenly swell up after surgery, you should contact your hospital immediately. Things like insect bits and cuts on your arm on the mastectomy side should be treated immediately and you should avoid lifting heavy things. If you need to have blood taken or an injection, you should tell the nurse of phlebotomist so they can do this on the opposite side. In the case of a double mastectomy, a vein in your ankle can also be used instead.

Necrosis
This is where either skin or underlying breast tissue literally dies because there isn't enough blood reaching it after surgery. It usually occurs in older women, particularly those with low blood pressure or who have circulation problems. If you have very low blood pressure, you may be given a drug after surgery that elevates it slightly to prevent necrosis. If you do have tissue dying, it can be cosmetically corrected through additional surgery.

 


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