Complications in Breast Surgery

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Most breast operations are categorized as low-morbidity procedures, but a variety of complications can occur in association with diagnostic and multidisciplinary management procedures. Some of these complications are related to the breast itself, and others are associated with axillary staging procedures. This article first addresses some general, nonspecific complications (wound infections, seroma formation, hematoma). It then discusses complications that are specific to particular breast-related procedures: lumpectomy (including both diagnostic open biopsy and breast-conservation therapy for cancer), mastectomy; axillary lymph node dissection, lymphatic mapping/sentinel lymph node biopsy, and reconstruction.

Section snippets

General wound complications related to breast and axillary surgery

Because it is a peripheral soft tissue organ, many wound complications related to breast procedures are relatively minor and frequently are managed on an outpatient basis. It therefore is difficult to establish accurate incidence rates for these events. As discussed later, however, reported studies document that surgical morbidity from breast and/or axillary wound infections, seromas, and hematomas occur in up to 30% of cases. Fewer than half of these cases require a prolongation of hospital

Incisional dog-ears

Heavyset patients who have thick axillary fat pads are especially prone to being left with triangular or cone-shaped flaps of redundant skin and fatty tissue along the lateral aspect of the mastectomy incision, commonly known as “dog-ears.” Frequently the incisional dog-ear is not readily apparent while the patient is lying supine on the operating room table, but when she sits or stands upright postoperatively, these unsightly protrusions of axillary fat become obvious. Because they are

Breast fibrosis, breast lymphedema, and chronic/recurrent breast cellulitis

The presence of long-term adverse sequelae related to breast-conservation therapy for cancer is being acknowledged and reported increasingly [59], [60]. These complications are secondary to the combined tissue effects of surgery and radiation therapy. The European Organization for Research and Treatment and the Radiation Therapy Oncology Group have proposed that late effects of breast-conservation therapy (including breast edema, fibrosis, and atrophy/retraction) be graded according to the Late

Sampling error

The primary potential risk specifically associated with a diagnostic open biopsy is related to missing a cancerous lesion and resecting adjacent fibrocystic tissue, thereby misdiagnosing the patient. This complication exists with palpable masses as well as with screen-detected nonpalpable lesions.

The risk of misdiagnosis with palpable breast masses can be minimized by complete preoperative breast imaging, including mammography and ultrasonography. Palpable lesions that have a

Complications related to axillary staging procedures

The axillary nodal status remains the most powerful prognostic feature in staging patients who have invasive breast cancer. Surgical staging of the axilla is necessary for most newly diagnosed patients, because currently available imaging modalities can easily miss small nodal metastases. The conventional level I/II ALND is the standard means of evaluating the axilla, but lymphatic mapping and sentinel lymph node biopsy has emerged recently as a viable alternative strategy for accurately

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    Support for this manuscript is via an Interdisciplinary Fellowship Grant from The Susan G. Komen Breast Cancer Foundation.

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