Reconstructive surgery is now more common than it used to be, so techniques and implants are improving all the time, and the risks of complications are reducing. However, there are still some risks connected with any type of surgery and a few that are particularly connected with breast reconstruction. Being prepared for these possible problems will help you cope with them if they occur.

This will often be discussed in detail by your anaesthetist. After any type of operation you are likely to feel some pain and discomfort. Women vary greatly in how much pain they have after breast reconstruction. Many women will need to take painkillers for a few weeks or so after surgery. Make sure you ask for pain-relieving drugs if you need them. There is no need to suffer in silence – in fact, research suggests that patients with good pain relief recover more quickly after surgery. Other methods such as acupuncture or massage may help to reduce pain. You can ask your breast care nurse about this.

You may find it uncomfortable to move your arm initially after surgery, particularly if you have had reconstruction at the same time. It is important to continue to take painkillers so that you can use your arm, and to carry out the exercises suggested by the physiotherapist.

This can be a complication of any type of surgery. You may be given a course of antibiotics after your operation. If not, and infection occurs, antibiotics can usually quickly get rid of it. In a very small number of cases, infection continues despite antibiotics. If an implant has been used it may have to be removed in order to treat the infection successfully. In this situation, doctors generally advise waiting for a few months before having another implant inserted, or having a different type of reconstruction.

It is important to check your scars (incision lines) regularly once you are back home after surgery. Tell your breast care nurse or doctor immediately if you have any of the following:

• increased redness or a change in colour over the breast, around the scar area, or both
• discharge (fluid being released) from the wound
• a fever, with your temperature going above 38°C.

After breast reconstructive surgery, you will have drainage tubes inserted into the wound to drain away any fluid that may collect. These are long thin plastic tubes attached to vacuum drainage bottles. They are usually removed several days after your operation.

However, after removal of the drains, a collection of fluid (a seroma), or blood (a haematoma), can sometimes develop under the wound. The body may absorb these if they are small, but if they are large, they will need to be removed by a surgeon or nurse, using a small needle and syringe (aspiration). This fluid may continue to build up over a few weeks under the back wound, if you have had an LD flap, and may need regular aspiration.

If reconstruction is done using flaps of fat, skin and possibly muscle, there is a small chance that the blood supply to part of the flap or all of it, will not survive. Without an adequate blood supply, the flap or part of it will die. You may need another operation in this situation, either to remove the affected area or to try to improve the blood supply. You may also need long-term dressings until the area has healed. Your surgeon would then talk to you about other options for reconstruction.

This complication is more common with TRAM flaps or free perforator flaps than after an LD flap.

This is a sensation that often accompanies wound healing, so you may feel this where incisions have been made. This may be very uncomfortable, but it is important not to scratch the healing skin. The itching will decrease as the wound heals.

After immediate breast reconstruction (carried out at the same time as the prophylactic mastectomy), you may feel tingling sensations down your arms and you may experience some numbness in the upper and inner arm. This is an effect of the surgery on the nerves in that area, particularly if you have had a back flap operation. It may gradually fade over time, but may last up to a year after surgery and can sometimes be permanent.

If your reconstruction involved taking tissue from your abdomen, you will find bending and stretching uncomfortable for a few weeks after surgery. Supporting your wound with your hands when you bend should help.