AESTHETIC MEDICINE AND SURGERY
SKIN CANCER AND DERMATOLOGIC SURGERY
All surgical procedures, even for patients in good health, carry some risk and can result in unpredictable complications. Post-bariatric patients are at increased risk for post-operative complications.
It is of the utmost importance to implement all preventive measures to mitigate the risks where possible, by reducing and eliminating common risk factors such as smoking, obesity and concomitant disease, which are open to treatment before the operation. Likewise, it is crucial that patients follow meticulously all indications given by the surgeon post-operatively; correct wound management (sterility), intake of prescribed medications, appropriate pressure garments etc.
Despite the above-mentioned preventive measures, some complications may still occur, fortunately to a minor extent in the majority of cases. Systemic complications, e.g. anaesthesia-related, are very rare. The complications related to post-bariatric breast augmentation and uplift are mainly:
- bleeding: minor bleeding is normal after surgery and applying pressure with a swab is sufficient to control it;
- haematoma: a localised collection of blood, quite rare, which can occur within the first 24 hours after surgery. In the most severe cases it is necessary to reopen a portion of the wound to drain the blood and correct the root cause;
- seroma: a collection of clear yellowish fluid (serum) around the implants; small seromas can resolve spontaneously, whereas larger ones may need needle aspiration for their management;
- infection: thanks to the post-operative antibiotic administration, the risk of infection is very low. If an infection does develop, further specific antibiotics and local disinfection are required. In most severe cases implant removal and repositioning at a later time, once the infection has fully healed, may be necessary;
- wound dehiscence: breaking open of the surgical incision along the suture. This is a rare complication which, if minor, heals spontaneously with dressings. If wound dehiscence is extended, it is treated with a new suture;
- loss of nipple sensation: this is usually temporary; it may take many months for full recovery;
- nipple loss (partial or total necrosis of the nipple-areola complex): this is extremely rare. Nipple reconstruction is possible at a later time with satisfactory results;
- asymmetry: breasts can differ in shape, dimensions or nipple position. A slight difference is considered normal; if it is conspicuous, correction can be performed after six months;
- capsular contracture: in a low percentage of cases, the scar tissue that normally builds up around implants forms a tight and thickened fibrous capsule, which contracts the implant and makes it hard and misshapen. In severe cases surgical correction is needed;
- implant rupture: this is very rare, usually due to trauma to the breasts;
- implant rotation: this is rare and presents as a change in breast shape, when anatomical implants (tear-drop shaped) are used. Sometimes secondary surgery is needed to reposition the implant;
- recurrence of breast descent: the ageing process, with loss of elasticity and tone of tissues, is not stopped by a mastopexy; it does not impede the progressive redescent of tissues with time. This is mainly by the patient’s skin and mammary gland characteristics. The risk is higher in ex-obese patients, due to the loss of elasticity and tone in the tissues following massive weight loss;
- pathologic scars (hypertrophic/keloids): scarring, despite preventive measures (paper taping, silicone gel, sun protection) can develop pathologically, both as a consequence of a personal predisposition and of complications (e.g. infection, wound break-down): widened, uneven, pigmented scars. In such cases, once the scar has settled for at least 6-12 months, scar revision may be necessary.
It is noteworthy that for people in good health, whose pre-operative blood tests are within the normal range, statistics show that the incidence of serious complications is very low. If complications do occur, it is crucial for patients to be emotionally stable in order to face and overcome them. In this respect, support from partners and/or relatives can play a major role in the recovery process, thus it is advisable to avoid having surgery without a support network. Additionally, an open and honest dialogue with the surgeon, who must be promptly notified of any doubts, is essential to correctly manage complications.