As surgical techniques and surgical instrumentation have advanced, surgical complications have become less frequent and less severe. However, surgical complications have always been a hurdle that surgery cannot fully surmount. Breast cancer surgery is a large and varied procedure, and some complications common to surgery may occur, as well as those specific to post-breast surgery, and some specific complications may occur as a result of new procedures.
Bleeding
Bleeding is one of the most common postoperative complications of all surgeries. Currently, usually only tens of milliliters of bleeding occurs throughout breast cancer surgery, and the risk of postoperative bleeding is greatly reduced, but it should not be taken lightly. If there is sudden postoperative swelling in the surgical area, large amounts of bright red drainage fluid or blood clots in the drainage bottle, or even pallor and panic and cold sweats, be sure to notify your healthcare provider promptly, as this is likely to be a ruptured blood vessel bleeding.
More commonly, capillary bleeding from the surgical wound, which is one of the components of postoperative drainage fluid, usually stops gradually within a few days after surgery, and the drainage fluid changes color from dark red to light red to yellow. The duration of postoperative wound bleeding is usually prolonged in those with poor coagulation, preoperative chemotherapy, and localized infection.
Local effusion
Breast cancer surgery, especially when total mastectomy and axillary lymph node dissection are extensive, is associated with fluid exudation before wound healing. These leaks usually drain out of the body by negative pressure drainage. Once there is poor drainage, such as a blood clot, necrotic tissue blocking the drainage tube, or if the drainage tube is removed too early, localized fluid may accumulate.
Lymphatic leak
Lymphatic leak is common after axillary lymph node dissection and rare in anterior lymph node biopsies. Because of the structural limitations of the lymphatic vessels, the commonly used intraoperative electric knife is unable to coagulate them all, so they are left open postoperatively. Although most intraoperatively severed capillary lymphatics will close on their own as the wound heals, there may be individual lymphatics that do not close for a long time and therefore form a lymphatic leak.
Oedema of the upper extremity
Upper extremity edema is a unique complication after axillary lymph node surgery. The incidence of upper extremity edema after axillary lymph node dissection is 5% to 40%, with approximately 1% to 3% in severe cases, whereas upper extremity edema is less likely to occur after anterior lymph node biopsy. Upper extremity edema is a chronic and progressive process, and the incidence increases gradually over time. After axillary lymph node dissection, some upper extremity lymphatic return is interrupted, and postoperative scar formation can compress lymphatic vessels to further obstruct lymphatic return, which can be further exacerbated by combined axillary effusion, infection, and radiation therapy. The obstruction of lymphatic return can then lead to upper extremity edema.
Upper extremity dysfunction
Upper extremity dysfunction on the affected side is a common complication after breast cancer surgery, especially after axillary lymph node dissection, with the most common symptom being limited shoulder abduction and supination.
Some people who undergo radical breast cancer surgery have greatly affected upper extremity function because the pectoralis major and minor muscles, which are involved in shoulder motion, have been removed. In patients who undergo other surgeries that preserve the pectoralis major and minor muscles, especially axillary lymph node dissection, axillary scar pull can cause shoulder joint motion impairment, and inadequate functional exercise of the upper extremity can cause muscle wasting atrophy, and nerve damage can bring about muscle neurogenic atrophy, which can be a key factor in causing upper extremity dysfunction. In addition, lymphedema can also lead to limited upper extremity movement, the latter in turn may worsen the former symptoms, and the cycle repeats itself, forming a vicious circle.
Operative area infection
Infection of the surgical area is less likely to occur with breast cancer surgery. However, the chance of infection is elevated when combined with local fluid collection, blood collection, and lymphatic leakage. In general, the drains are the only part of the surgical area that is directly connected to the outside world, so the most common route of infection starts at the drains and spreads along the drains.
Pain and sensory abnormalities in the operative area
When breast cancer surgery is extensive, there is likely to be extensive destruction of sensory nerves. Usually, pain is a response of the body to the stimulus of surgical injury and is usually mild and tolerable. There may be localized numbness or abnormal sensation in the surgical area due to the destruction of sensory nerves by the surgery. However, a sudden onset of severe or progressively increasing pain is often indicative of an abnormal condition, such as infection, incisional dehiscence, or bleeding, and requires prompt notification to the surgeon.
Necrosis of the flap
The flap refers to the skin separated from the surgical area as well as the subcutaneous fatty tissue. Flap necrosis is most common in breast cancers with large tumors, especially those with skin invasion. In these patients, more skin needs to be removed and the strain on the skin when suturing the remaining skin can be greater, which may affect the blood supply to the skin causing ischemic necrosis. In addition, the subcutaneous tissue preserved during surgery is too thin and can affect the blood supply, leading to flap necrosis.
Contraction, displacement, and rupture of the prosthesis envelope
Prosthesis is a commonly used material for breast reconstruction after total mastectomy for breast cancer. Although currently commonly used breast implants are histocompatible with the body, as a foreign body, the body will form a fibrous membrane envelope around the implant after surgery. For those with milder rejection reactions, no further other adverse reactions will occur. However, for some patients, this fibrous envelope wrapping the prosthesis will continue to grow, thicken, and contracture, resulting in hardening, deformation, and displacement of the prosthesis. The occurrence of hematoma in the surgical area can also greatly increase the incidence of contracture. In addition, external forces or the influence of the prosthesis itself may also lead to displacement and rupture of the prosthesis.
Other
Other rare complications may occur after breast cancer surgery, such as prolonged bed rest leading to crushing pneumonia or atelectasis; life-threatening pulmonary embolism due to deep vein thrombosis in the lower extremities from reduced activity or even embolus dislodgement; and abdominal wall hernia due to weakness of the abdominal wall after breast reconstruction using an abdominal flap.
The list of surgical complications, but do not be intimidated, after all, the risk of complications is still low, and postoperative attention to the detection of various abnormalities, timely inform the doctor to receive formal treatment, the majority of patients can be safe through the period after surgery.