Dr. Marga is a board certified Plastic Surgeon with additional training as a Certified Lymphedema Therapist. She is the Founder of the National Institute of Lymphology and serves as a Medical Advisor to the Norton School. Dr. Marga promotes the the highest standard of lymphedema care for surgical patients nationwide.
Specific Surgical Complications
Complications have been associated with breast reconstruction and vascularized lymph node transfer to include, but not limited to the following:
Bleeding Blood loss in surgery requiring a blood product transfusion is unusual. When it does occur, you are at risk for a transfusion reaction or coming into contact with blood that carries the HIV, hepatitis B, or the hepatitis C virus. All blood is tested in the blood bank of our hospitals to ensure your safely. Yet, not all blood tests are 100% accurate.
Some post-operative bleeding into the surgical space is expected. If the bleeding is minimal, the drains will compensate for it. Marked swelling may require surgical removal of the blood.
Infection Post-operative infection is uncommon, but possible. We reduce this to a minimum by giving antibiotics prior to, during and after surgery. We continue your antibiotic pills at home until your drains are removed. Most infections are mild and resolve without incident. If a serious infection develops, hospitalization may be required with intravenous antibiotics and possible surgery. Wound infections that require further surgery as sometimes managed with a specialized wound sponge VAC. This negative pressure dressing helps to promote wound healing as quickly as is possible.
Loss of Sensation to the Skin Nerves that supply skin sensation may be cut or damaged during surgery. It can happen no matter how carefully the surgery is performed. If sensory loss occurs, the nerves slowly recover over a period of 1-2 years in about 85% of cases.
Hyperesthesia Some patients develop areas of hyper-sensitivity. This is normal and we encourage you to massage the area using a skin moisturizer. Lack of stimulation makes this condition worse and should be avoided.
Loss of Skin or Umbilicus Skin loss in the donor site, the breast reconstruction site and the umbilicus (belly button) is a rare complication. It is more common in smokers, diabetics and those who have had prior abdominal wall surgeries. This is rare and will usually involve only small areas that will eventually heal with good wound care. Secondary surgery may be required for wound revision.
Flap Loss / Total Flap Failure Microsurgery is a delicate art. Very rarely, despite every effort to control the behavior of the flap after surgery, failure may occur. This runs in the 3-5% range nationally and in the 1-2% in Dr. Marga's practice. If there is any question about the health of the flap in the first few days after surgery, a return trip to the operating room to inspect and correct problems may be required. Should the flap fail, it would require removal and consideration of other reconstructive options. Some patients elect to undergo a second flap immediately, while others wait 3 months to return to the operating room.
Once you are discharged from the hospital, it is exceedingly rare to experience a flap failure and is most times associated with some form of trauma, like a fall.
Reconstruction Flap Fat Decrosis Small areas of the reconstructed breast can become firm. Additional surgery may occasionally be necessary to remove these areas. There is a possibility of contour irregularities in the flap from fat necrosis.
Fat necrosis occurs as the blood supply in that region of the flap is not robust enough to keep the tissue healthy and supple. Fat necrosis rarely will make you ill and will not keep you from doing all things that you desire. It may however be bothersome to you and you may elect to have it removed. If not, you should learn to "know" your fat necrosis, you should perform self examinations and notify us if your exam changes.
Surgical Site Weakness Although we use the most modern techniques of perforator flap breast reconstruction, some patients relate that they experience a sensation of abdominal wall weakness. All efforts are directed at preserving all motor nerves of the abdominal wall and no muscle is ever surgically removed. With time, this sensation usually resolves. Physical activity and massage can help.
Implant Associated Complications Breast implant surgery has been associated with a 50% failure rate at 7 years nationally. Dr. Marga takes this very seriously and will provide you with all the time you require to discuss the risks of using breast implants for reconstruction. Common complications include, but are not limited to capsular contracture, infection, extrusion, pain, asymmetry, migration, deflation/rupture, gel bleed, incorrect size, palpability, visibility, and emotional stress.
Mammographic Changes Counter-balancing surgical procedures on the opposite breast may affect your following screening mammograms. The placement of an implant behind a breast will obscure some of the breast tissue and therefore will make your mammogram less informative. Breast reduction and lift procedures have been associated with the formation of benign calcifications that can be seen on mammography. These calcifications will be new and have a different appearance than those calcifications of breast tumors. If you have current benign calcifications and have a reduction or lift, these calcifications will appear in a new location. Fat grafting to the breast will likely alter your future mammograms.
We recommend that you defer any mammograms of augmented or reduced breasts for 6 months. Be sure to inform your mammography technician of your prior surgery.
Remember, breast reconstruction flaps do NOT require mammographic surveillance.
No Guarantee of Bra Cup Size Depending upon where you shop and the type of bra you prefer, you bra cup size may vary. With this in mind, Dr. Marga will not be able to guarantee a particular bra cup size reconstruction, augmentation or reduction. However, she will ask what size you would like to be and what style of bra you prefer. She enjoys the challenge!
Scars There is no such thing as scarless surgery. Many patients believe that plastic surgeons can perform surgery with little to no scarring. Plastic surgical techniques do provide us with an advantage when operating, but you still will have evidence of your surgical incisions.
Unknown Complications Allodermô regenerative tissue matrix is employed in some reconstructive methods. This product is a homograft and is tested by its manufacturer for human viruses in a process similar to the screening of blood products. There may be some yet-to-be-defined complications resulting from the use of Allodermô. If you prefer Dr. Marga not to use Allodermô in your reconstruction, please be sure to highlight this to her on the day of your consultation and again when you sign your informed consent form.
Lymphedema Dr. Marga is committed to providing natural breast reconstructions without the side effect of lymphedema. Any form of surgery can cause lymphedema even if lymph nodes are not removed. The risk of causing lymph edema is higher in procedures that harvest and transplant lymph nodes. We use only the most sophisticated surgical techniques for reconstruction and take note of any intervention that may result in lymphedema.
Please notify us immediately if you notice any arm or leg swelling after surgery as this may be new onset lymphedema or perhaps a deep venous thrombosis. Both conditions require urgent intervention.
New onset lymphedema will require lymphatic massage, bandaging, compression garments and possible additional surgery and may possibly be irreversible.
Incomplete Resolution of Lymphedema with Lymph Node Transfer Vascularized lymph node transfer is associated with an improvement in lymphedema in most surgical patients. Patients relate a decrease in extremity circumference, less "heaviness", and fewer infections. A complete "cure" of lymphedema is uncommon.
Deep Venous Thrombosis and Pulmonary Embolus Blood clots can form in your legs in the setting of any surgery and several weeks there after. If a blood clot forms in larger veins of the legs and pelvis it is called a deep venous thrombosis or DVT. If a DVT dislodges, it can migrate up into the lung. A blood clot in the lung is called a pulmonary embolus or PE. A large pulmonary embolus can be fatal (death).
We adhere to the most rigorous national recommendations to prevent deep venous thromboses and pulmonary emboli. All patients are placed on peri-operative anticoagulants and wear sequential compression boots prior to, during and after surgery. Selective patients are discharged to home on injectable blood thinners.
As with all medical interventions come some associated risk--the risk of using blood thinners is that of bleeding. You will be monitored closely for bleeding while you are on blood thinners in the hospital.
Pulmonary emboli typically make you feel short of breath and you may experience chest pain and a quickened heart rate. Please report to your nearest emergency room if you have these symptoms after returning home and notify Dr. Marga on her cell phone (843-743-8989).
Fat Grafting Pulmonary Embolus Fat grafting is a novel form of reconstruction that can be used to augment your reconstruction to establish symmetry. Fat from your body is harvested by traditional liposuction techniques and then is injected into your breast reconstruction site. If fat is inadvertently injected into a vein during this procedure, it can travel to the lung and cause damage there. When fat travels to the lung in this manner, it is referred to as a fat pulmonary embolus. If a fat embolus is large enough, this event could be fatal.
Dr. Marga has been trained in the technical aspects of liposuction and fat grafting. She has served as a participant of the ASPS Fat Grafting Task Force and has been a contributor to establishing national guidelines for fat grafting safety.
Systemic Complications As with any other surgical procedure, you may experience an unexpected medical emergency related to your underlying medical condition such as a heart attack, stroke, heart rhythm problem, pneumonia, or kidney problem. If severe enough, these problems could result in death.
All patient's in our center undergo a complete medical evaluation prior to surgery to identify any potential problems. Additional cardiology testing is required for some patients while at home.
Dr. Marga will address each of these potential complications for you in the context of your individualized patient consultation. This list is provided to you as a reference for your continued review should you have specific questions. Please allow 2-3 hours for your breast reconstruction consultation with Dr. Marga.