When any foreign body such as an implant is put into your body, your immune system responds by forming fibrous scar tissue (a capsule) around it. Over a few months this fibrous tissue can contract (shrink) as part of the natural healing process. If this contraction is severe then you may have tightening, hardening and changes in the shape of the reconstructed breast. This may be uncomfortable and can spoil the match with your natural breast. Most capsular contractions form in the first year, but some may occur much later.

In a few cases the implant and capsule may have to be surgically removed, and a replacement implant inserted at the same time. Between 10 and 20 in a hundred (10–20%) women will develop a capsular contracture that needs further surgery. This is more likely if you have had radiotherapy before or after the implant was put in.

Your surgeon will aim to create a breast shape that matches your natural breast as closely as possible. It’s not possible to give a perfect match. If you’re not happy with the new reconstruction and feel that it does not match the other breast well enough, it is important to discuss this with your breast care nurse or doctor.

It may be possible to improve the match by having surgery on your other breast, or by replacing the implant with another one that is a different shape, size, or is positioned slightly differently. You may also need to have a further operation with a different type of reconstruction: for example if you have had a tissue expander reconstruction then you may need to have a flap created as well.

Abdominal hernia is a rare complication following a TRAM flap or a free TRAM flap. This is due to the removal of the abdominal muscle, which may weaken the abdominal wall. If this is a risk, your surgeon may put in a protective gauze mesh to replace the muscle and so reduce the risk of this happening.

Some patients who have had a latissimus dorsi flap (LD flap) develop a chronic seroma cavity on the back which continues to fill with fluid. Sometimes injecting a steroid into the cavity can resolve this but if fluid fills the cavity over many months an operation to remove it may be required.

Using a flap from your back (latissimus dorsi) may limit your shoulder movement, because of the loss of muscle. More commonly, you may have aches and pains in the shoulder and back after exercise.

Some women have some stiffness in the shoulder after a mastectomy so it's important to do exercises to help maintain the movement in the shoulder. Our nurses can send you a leaflet about exercises which may help. You will normally be seen by a physiotherapist who can teach you how to do them.