Secondary breast reconstruction procedures

Skin necrosis means that skin cells die. This can sometimes happen after mastectomy. Risk factors include smoking, high blood pressure, and uncontrolled diabetes. It can delay treatment and require additional surgery.

Treating skin necrosis: Skin necrosis can be treated surgically or non-surgically. Examples include:

• Surgically removing the dead skin
• Allowing the dead skin to shed on its own
• Dressing the wound and allowing time for healing
• Using skin flaps (skin from another part of the body) to replace the skin

Fat necrosis means that fat cells have died, and a cyst or scar tissue can form on or near the surgery site. It may feel like a lump. The skin around the lump may look red, bruised, or dimpled. The lump can be solid or filled with an oily fluid.

Treating fat necrosis: If a fat necrosis lump is causing pain or tenderness, a surgeon can remove it or drain it. If it is not causing these problems, treatment may not be necessary. The lump may change in size, stay the same, or go away on its own.

This means the breasts are uneven in how they look—by size, shape, or breast level. Breast asymmetry is common, whether a woman has had breast reconstruction surgery or not. This can be due to genetics, hormonal changes, or changes in weight.

Reasons this can happen after breast reconstruction surgery include:

• Having reconstruction on only one breast
• An implant that shifts position

Correcting breast asymmetry: There are different ways surgeons can reposition a breast to create a balanced look. One method is a breast lift. This involves removing extra skin so that the breast sits higher on the chest.

Risks after nipple reconstruction include:

• Swelling
• Flattening
• Bleeding
• Signs of tissue necrosis (tissue that dies), such as color changes or scabs

Let your healthcare team know right away if you experience any of these.

Addressing nipple reconstruction issues: There are many ways to address nipple reconstruction problems. These include:

• Home care according to your surgeon’s instructions
• Surgical revisions such as fat or skin grafting
• A repeat nipple reconstruction surgery
• Surgical removal of tissue necrosis
• 3D nipple tattooing

Radiation therapy can damage breast skin and tissue. If you are considering breast reconstruction surgery and you also need radiation, talk with your doctors about timing surgery and radiation in a way that treats the cancer and reduces the risk of breast reconstruction issues.

Addressing radiation issues: Surgeons can address radiation effects in several ways, including:

• Fat grafting
• Revising an implant reconstruction with a tissue reconstruction
• Fat necrosis removal

Talk with your plastic surgeon about options.

Capsular contracture happens when a capsule of scar tissue forms around the implant, which can make the breast feel firm or hard. It can sometimes affect breast shape. In severe cases, capsular contracture can be painful.

Fixing capsular contracture: If capsular contracture is severe, a surgeon usually removes the capsule and implant. This is also called capsulectomy. Then, the surgeon can place a new implant. In some cases, this can mean positioning the new implant over the muscle instead of under it. Visit the Explant surgery page to learn more about capsulectomy.

Acellular dermal matrix (ADM), or regenerative tissue, may also be added to support the new implant and help prevent capsular contracture from happening again.

When an implant shifts, it means the implant moves to a different position on the chest. Sometimes, capsular contracture can cause an implant to shift position.

Repositioning a shifted implant: A surgeon can correct this shifting in different ways, such as adding ADM to better support the implant.

A rupture is a tear or hole in the outer shell of the breast implant.

• When saline implants rupture, they deflate. Because saline is salt water, a saline implant rupture is usually considered safe.

Addressing a saline implant rupture: Surgeons remove the empty implant shell.

• Silicone implants may rupture “silently,” which means a leaking implant produces no symptoms. The thick silicone gel usually stays contained within the breast pocket without leaking into soft tissue. Still, a rupture may cause symptoms including lumps, pain, soreness, and capsular contracture.

Addressing a silicone implant rupture: Your doctor will likely recommend removing the silicone implant, even if there are no symptoms.

When a saline or silicone implant is removed due to rupture, a plastic surgeon can often replace it with a new implant. Visit Implant reconstruction to learn more.

Some people may decide they don’t want a new implant after they experience a leak. In this case, they may choose to have tissue reconstruction or to go flat.

After implant reconstruction, the skin can sometimes appear rippled or wrinkled for many reasons. These can include scar tissue, weight loss after surgery, or an implant that may not be big enough for the capsule around it after tissue expansion or after post-surgery swelling is reduced.

Rippling is more likely to occur:

• With saline implants
• When the implant is placed over the muscle

Correcting skin rippling: A surgeon may perform fat grafting or revision surgery to correct the rippling.

Flap loss happens when the tissue moved to the breast from another part of the body does not get enough blood flow. Without enough blood supply, part or all of the flap may die.

Flap loss can delay treatment that is planned after surgery. Risk factors include:

• Smoking
• High blood pressure
• Uncontrolled diabetes

Flap loss can also add unexpected treatment costs.

Treating flap loss: Areas of tissue that die, or become necrotic, need to be surgically removed. After your surgeon removes them, you may need to wait several months to heal before having revision surgery. Revision options include using tissue from a different part of the body or using an implant to reconstruct the breast. Some women may choose to go flat after flap loss.

A hernia is a bulging of an internal organ through a tear in the muscle or tissue, usually in the belly. This can sometimes happen after tissue-based breast reconstruction in the area where tissue was removed and used to create the new breast. Hernia is a relatively rare complication with tissue-based reconstruction.

Treating hernia: A hernia can be repaired with surgery.