Complications

Immediate Complications

Be aware that discomfort and pain are always present, but their intensity and duration are highly variable from patient to patient and they depend on the nature of the procedure performed. Some may experience mild discomfort lasting a few days and requiring moderate post-operative precautionary measures, while others may experience more intense pain that prevents them from going about their regular activities. Routine treatment with analgesics according to pain intensity is always given during the post-operative period.

The immediate or early complications that may occur are as follows:

• Bleeding: external (hemorrhage) or internal (hematoma) bleeding is caused by one or more blood vessels that may be damaged after the procedure. There is a distinction between hematoma and ecchymosis (bluish bruising), which is normal after a procedure.
  Hematoma presents clinically as a swollen, taut area filled with blood accompanied by pain. Bleeding from the operative wound may also be present. If bleeding is present, a new procedure may need to be performed to stop the bleeding (hemostasis) and drain pockets of blood. To reduce the risk of hematoma, aspirin and all anti-inflammatory medication must not be taken for at least ten days prior to the procedure.
• Thromboembolic complications: a blood clot may form in the vein of a leg, resulting in deep vein thrombophlebitis (sural phlebitis) or pulmonary embolism if the clot travels to the lungs. Thromboembolic complications are more likely to arise after long procedures, in overweight patients, in patients treated with oral contraceptives, and in smokers. Preventive measures include wearing compression stockings during and after the procedure, and sometimes using intermittent pneumatic compression (IPC) during a risky procedure. Preventive anticoagulation may be instigated by the anesthesiologist according to the determined risk level. Mobilization soon after the procedure limits the risk of thromboembolic complications.
• Pneumothorax: this very rare complication is an abnormal presence of air in the thoracic pleura (a membrane containing a virtual space between the lungs and the thoracic cavity). Pneumothorax (collapsed lung) may occur during breast or chest surgery as well as during abdominal or thoracic liposuction. Clinical signs are chest pain, difficulty breathing, and reduced oxygen levels. The diagnosis must be confirmed with a chest X-ray and possibly a thoracic scan. Treatment may involve simple surveillance or the insertion of a thoracic drain, generally performed by the intensive care anesthesiologist.
• Digestive perforation: this infrequent complication may arise during abdominoplasty or during abdominal liposuction. It occurs when the digestive tube is accidentally punctured, manifesting as intense abdominal pain, an abdomen that is very hard to the touch, and a halt in digestion sometimes accompanied by vomiting. Emergency operation is required and is performed by a visceral surgeon specializing in digestive surgery.
• Fat embolism: this is an uncommon complication occurring in buttock lipofilling when blood vessels are obstructed by fat. The prognosis primarily depends on whether pulmonary or cerebral vessels are obstructed. Prevention requires skill in performing subcutaneous rather than intramuscular buttock lipofilling.

Delayed Complications

Delayed complications may require mandatory treatment (for medical reasons or to avoid subsequent complications that could be even more serious), or they may be treated with the sole aim of improving the visual results. This may involve touch-ups or, in some cases, performing the procedure all over again.

The following complications require medical treatment:

• Surgical site infection: an infection of the operative site results in pain, redness, heat at the site, and sometimes fever. The diagnosis will be made after clinical examination, and blood tests may be performed to confirm the diagnosis. Treatment with antibiotics is usually sufficient, but sometimes a second operation is required. For prosthetics in particular (breast, buttock, or others), it is important to note that if an infection is related to an implant or foreign material inserted in the body, the implant usually must be removed. This may result in having a prosthesis only on one side for several months, if an infection has required one of the implants to be removed.
• Lymphatic effusion (seroma): this occurs more frequently in procedures that involve extensive skin lifting. Seroma is an accumulation of lymphatic fluid at the surgical site and is diagnosed when fluid is present in the operative area. Drainage may be required at the doctor’s office. Very rarely, surgery must be performed again.*
• Healing problems: if the operative tissues receive poor oxygenation due to high blood pressure, hematoma, infection, or tobacco use, the tissues will not heal properly. This may delay healing and the skin may present cutaneous necrosis (death of skin tissues). Most of the time, treatment involves applying tulle gras to encourage healing (second-intention healing), but another procedure may be needed to remove the necrosis and prevent infection.
• For breast implants, some specific complications may require surgery to be performed a second time. Periprosthetic capsular contracture, improper positioning of the implant, late-forming seroma, or implant rupture may require subsequent procedures.

The following complications do not necessarily require treatment or re-operation:

• Changes to sensitivity: sensations of numbness, or lack of sensation, are experienced frequently and generally resolve within a few days or weeks. It is important to note that it takes eighteen months for nerves to fully repopulate. Assessments of sensation recovery must not be made until after this period.
• Scarring problems: scars can be wide, thick (even keloidal), hyper- or hypo-pigmented, or retractile.
• Imperfect results: this can be caused by a misunderstanding of the results to be achieved (regarding the size or shape of the breasts or nose), asymmetric results, visible scarring, inadequate correction of the initial result, irregularities, excess skin, residual fat, the presence of “waves” in breast implants, and so on.

In all cases, it is essential to speak with your surgeon about the risks and benefits of performing a second procedure or touch-ups, as the second operation may also result in unsatisfactory results and, in some cases, the best solution is to tolerate an imperfection rather than to risk worsening the results.

During the pre-operative consultation, the anesthesiologist will inform the patient of the risks associated with anesthesia. It is important to be aware that anesthesia may cause unpredictable reactions in the body that may be easy or difficult to control. Working with a perfectly competent anesthesiologist operating in the context of a scheduled surgery reduces the risks to near statistical insignificance.

In fact, anesthetic techniques, products, and surveillance methods have progressed immensely in the past twenty years, providing optimum safety especially when the operation is performed under non-urgent circumstances and in a healthy patient.