Medical Oncologist
Reconstruction
Reconstruction complications: infection, necrosis and implant loss
The main complications after breast reconstruction are infection, skin losing its blood supply, fluid or blood collecting, and with implants the risk of losing the device. With a flap, the transferred tissue can fail. Most are managed without losing the reconstruction, and the difference is usually how quickly they are reported.
MM
Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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The short answer
What can go wrong with a reconstruction?
Infection, skin that loses its blood supply, fluid or blood collecting, and with implants the risk of losing the device. With a flap, the transferred tissue can fail. Most complications are managed without losing the reconstruction, and the difference is usually how quickly they are reported.
Why reconstruction carries more risk than mastectomy alone
A longer operation, a device or transplanted tissue under skin with a fragile blood supply, and in the case of a flap a second surgical site. Each adds its own opportunity for a problem.
The two that matter most
Infection around an implant, because antibiotics alone often cannot clear it and the implant may have to come out. And skin dying over a reconstruction, because the covering is what holds everything in.
What genuinely reduces your risk
Stopping smoking well before surgery, keeping diabetes well controlled, and reporting changes the same day rather than waiting. Those three do more than anything else within your control.
Keep the ward number where your family can find it, not only in your own phone.
!
Ring the ward the same day
Contact the hospital immediately if you have a fever or shivering, if redness is spreading from the wound, if the skin over the reconstruction turns dusky, purple, blisters or breaks down, if swelling is rapidly increasing, if there is thick or foul-smelling discharge, or if a flap becomes cold, pale or very dark. With a flap the first days are when blood supply problems occur, and a prompt return to theatre is often what saves it.
What can happen
The main complications, and what is done
Most are managed without losing the reconstruction.
Infection
Treated with antibiotics, and sometimes admission for intravenous treatment. Around an implant it is more serious, because the device gives bacteria a surface antibiotics struggle to reach.
Skin flap necrosis
Preserved skin losing its blood supply. Small areas are managed with dressings; larger ones may need the dead tissue removed and, over an implant, can mean losing it.
Report any darkening skin the same day.Flap failure
Transferred tissue losing its blood supply, usually in the first days. Uncommon, and monitored closely for exactly this reason. Prompt return to theatre often saves it.
Implant loss
Removing the implant because infection cannot be cleared or the skin has failed. Reconstruction can usually be attempted again later, often with your own tissue.
Raises the risk
- Smoking
- Poorly controlled diabetes
- Radiotherapy to that side
Not sure whether this applies to you?
Ask an oncologistSide by side
When each problem tends to appear
When
What to watch for
The first two or three days
Flap blood supply problems; bleeding and haematoma
First week
Skin darkening or blistering; early infection
Weeks one to four
Wound infection; seroma once drains are out
Months
Fat necrosis lumps; delayed implant infection
Years
Capsular contracture; implant rupture; asymmetry
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Have a question about your situation?
Call the helpline or leave your details, and someone will help you arrange a consultation at the CION centre nearest you. One helpline serves every CION centre.
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Words you will hear
The vocabulary, in plain language
- Necrosis
- Tissue dying because its blood supply has failed. Applies to skin, to fat, or to a whole flap.
- Explantation
- Removing an implant, usually because infection cannot be cleared or the skin over it has failed.
- Debridement
- Removing dead tissue so the rest can heal. Sometimes done at the bedside, sometimes in theatre.
- Flap monitoring
- Frequent checks of a flap's colour, warmth and blood flow in the first days, sometimes hourly.
- Take-back
- An unplanned return to theatre, usually to rescue a flap or stop bleeding. Prompt take-back is what saves most flaps.
- Delayed reconstruction after loss
- Reconstructing again months later after a failed first attempt. Usually possible, often with a different method.
Being straight with you
What the numbers mean for you
Complication rates vary substantially by operation, by whether you have had radiotherapy, and by the surgeon's volume. Ask yours for their own figures rather than reading general statistics, because the spread between centres is wide.
Losing a reconstruction is not losing the option
Women describe implant loss as devastating, and it is. It is also usually recoverable: reconstruction can be attempted again months later, often with your own tissue, which tolerates a difficult bed better.
A complication can delay cancer treatment
This is the real reason your team takes wound problems so seriously. Chemotherapy cannot start over an infected wound. Reporting early protects your cancer treatment, not just your reconstruction.
Ask what the plan is if something fails
Before surgery, ask what your surgeon would do if the implant became infected, or the flap did not survive. Hearing the answer while you are well is far easier than hearing it in a crisis, and it tells you whether the team has thought past the good outcome.
Smoking is the one factor you fully control
It narrows the small vessels keeping preserved skin and flaps alive, and it raises every complication rate on this page. Stopping weeks before surgery genuinely changes your odds, and some surgeons decline reconstruction in current smokers for that reason.
Commonly believed
What families assume when something goes wrong
A complication means the surgeon made a mistake.
Most complications after reconstruction come from blood supply to thin skin, from infection, or from how tissue responds to a long operation. They occur in good hands at good centres. What varies is how quickly they are recognised and acted on.
We should wait until morning rather than disturb the ward.
With a flap, the first days are exactly when blood supply fails, and a prompt return to theatre is what saves it. Wards expect these calls at night. Waiting is what turns a rescuable problem into a lost reconstruction.
Losing an implant means reconstruction is over.
It is devastating and it is usually recoverable. Reconstruction can be attempted again months later once infection has cleared, and many surgeons switch to your own tissue, which brings its own blood supply to a difficult bed.
Antibiotics will clear an infection around an implant.
Often they cannot on their own, because the device gives bacteria a surface that antibiotics struggle to reach. That is why infection around an implant is treated more urgently than a simple wound infection, and why same-day reporting matters.
Questions we are asked
Common questions about complications
How likely is it that something goes wrong?
Most women get through reconstruction without a major complication, though minor problems such as seroma and delayed healing are common. Rates differ considerably by operation and centre. Ask your surgeon for their own figures rather than relying on general numbers.
What does a failing flap look like?
Pale, cold and slow to refill, or dark purple and congested. This is exactly what the nursing checks in the first days are looking for. If you notice a change between checks, say so immediately rather than waiting for the next round.
If I lose an implant, can I try again?
Usually yes, after several months once the infection has cleared and the tissue has recovered. Many surgeons switch to your own tissue for the second attempt, because it brings its own blood supply to a difficult bed.
Will a complication delay my chemotherapy?
It can, because chemotherapy cannot start over an infected or open wound. This is the main argument against combining everything into one operation, and the main reason to report problems the same day rather than waiting.
Does smoking really matter that much?
Yes, more than for most operations. It narrows the vessels keeping preserved skin and flaps alive and raises every complication rate. Some surgeons will not offer reconstruction to current smokers. Stopping weeks beforehand genuinely helps.
What is the lump I can feel months later?
Most often fat necrosis, particularly after a flap or fat grafting, which is harmless. It cannot be told apart from a recurrence by touch, so it needs an ultrasound rather than reassurance. Report each new lump.
Can complications be prevented?
Not entirely, but risk is reduced by stopping smoking, controlling diabetes, choosing a method suited to whether you need radiotherapy, and reporting changes early. Those are the levers that actually exist.
Should this put me off reconstruction?
Not on its own. Most women do well, and the page lists what can happen rather than what usually does. Use it to know what to report and when, and to ask your surgeon for their own complication rates before deciding.
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Sources
- Cancer Research UK — Problems after breast reconstruction
- National Cancer Institute — Breast reconstruction after mastectomy
- Breast Cancer Now — Breast reconstruction
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.