Surgery Risks

SURGERY – POTENTIAL COMPLICATIONS

Whenever someone is having an anaesthetic, no matter what it’s for, then things can potentially go wrong. That is why no surgery should be considered ‘minor’.

All the following potential complications are standard for any operation, although some operations and some patients have an increased risk of developing them.

ANAESTHETIC ISSUES – which can affect heart, lungs, or brain.

Under the care of a specialist anaesthetist, general anaesthesia is very safe. However, complications can occur, and these include:

Trauma to the teeth, mouth, and throat (due to intubation)
Allergic reaction to anaesthetic medications – this can be very mild to life threatening.
Problems with respiration – lung concerns
Problems with blood pressure and cardiovascular system – heart and brain concerns
In extreme situations, any of the above issues (allergic; lung; cardiovascular) can be life threatening.

Your specialist anaesthetist will be able to discuss your anaesthetic with you and looks after all your post-operative pain management needs.

CLOTS

Superficial vein clots, which is a complication of the cannula or drip that’s placed in your vein.
Deep vein thrombosis – these can potentially spread to the lung and be life threatening. We implement several steps during and after surgery whilst you’re in hospital to minimise your risk of developing these.

Due to some of the affects of having surgery, including reduced general mobility, blood clots can develop in your veins, especially those in the legs. These are called “deep vein thrombosis” or DVT’s and they are a risk after any surgical procedure. It most commonly occurs with longer surgical procedures and those procedures that require extended bed rest.

DVT’s can be life threatening if they spread to your heart and lungs. We undertake several measures to help reduce the risk of blood clots from forming.

WOUND PROBLEMS

Wound Infection

Wound infection is a possible complication of any surgical procedure. It occurs when bacteria manage to enter the wound and proliferate.

Symptoms of a wound infection include:

Redness
Swelling
Increased localised pain
Wounds that open and do not heal
Pus formation

Several factors can contribute to wound infection, and it can develop at any time during the early stages of recovery. Some surgical procedures, and some individuals and more prone to wound infection – e.g. smokers, diabetics, higher BMI, immunocompromised states (including certain medications), poor wound care, non-compliance with aftercare instructions.

To reduce the risk of wound infection, it is vital that you comply with all your post-operative instructions, including taking any prescribed antibiotics and attending to your clinic appointments. Sometimes further surgery may be required to address the problems associated with wound infections.

Wound Dehiscence or Wound Breakdown

This is when a suture breaks and the wound fails to close. It’s an uncommon surgical complication and it is sometimes associated with wound infection. Treatment of wound dehiscence after surgery will depend on the severity but will likely include further surgery.

To reduce the risk of wound dehiscence, it is vital that you comply with all your post-operative instructions, including attending to your clinic appointments. A return to normal physical activities should only happen after you have been given all clear by your surgeon.

Tissue Necrosis

Necrosis refers to the loss, or death of tissues. Following any surgery, this can involve necrosis of the skin, fat, or even muscle. It is typically associated with wound dehiscence and may or may not be associated with wound infection. The cause is often multifactorial, however some surgical procedures, and some individuals are more prone to tissue necrosis – e.g. smokers, diabetics, higher BMI, immunocompromised states (including certain medications), poor wound care, non-compliance with aftercare instructions.

It is a significant complication and typically warrants further surgery (sometimes many).

PAIN

Pain is to be expected side after any surgical procedure. Its intensity and duration can vary based on the type of surgery and the individual’s pain threshold. Many of the larger plastic surgical procedures require several days in hospital primarily because we need to carefully manage your pain.

Your specialist anaesthetist will discuss your post-operative pain management. They will prescribe all the necessary medications to keep you as comfortable and as safe as possible.

While some pain is normal, severe, or increasing pain may indicate a complication and should be reviewed urgently.

BRUISING AND SWELLING

After any surgical procedure, it’s normal to experience some degree of bruising and swelling. Depending on the procedure, it can vary from very mild to sometimes quite significant.

As always, it is imperative that you comply with all your post-operative care instructions to help your recovery and not compromise your surgery.

It is important to understand that all bruises typically start to look worse before they get better, and often gravitate down the body. However, if you notice an increase in your bruising, and particularly an increase in swelling, then you will need to be reviewed.

BLEEDING

Wound Edge Bleeding – External

After any surgery, it is not uncommon to have some blood collect under the bandage. This is usually very mild, and self-limiting and typically does not require any intervention other than perhaps a change of dressing.

Hematoma – Internal Blood Collection

Haematoma is another potential complication of any surgery. It is when blood collects inside the wound. It can result from the slow and gradual ooze from the internal wounds which slowly builds up and results in the associated swelling. Or it can be the result of a sudden bleed from an internal blood vessel resulting in a sudden swelling. This often occurs during the first few hours after surgery typically due to sudden changes in blood pressure or movement of the patient. However, it can occur several weeks after surgery typically due to non-compliance (doing too much too soon!). This will manifest in the sudden swelling of the surgical site and often pain. Small haematomas can often be managed without further surgery. However, larger haematomas will typically require a return to the operating theatre, and in extreme cases can be life threatening.

Blood Transfusions

Many of the larger body contouring surgery procedures can result in significant blood loss. We recommend all our patients take iron supplements prior to and after surgery. However, sometimes people will require blood transfusions either during a large surgical procedure or more frequently after if necessary. This is an important consideration for those individuals who have any personal or religious views against blood transfusions.

NERVE ‘DAMAGE’

Nerve ‘damage’ is to be expected after any surgery. The commonest manifestation of this is the ‘numbness’ that is often experienced adjacent to a surgical (or traumatic) wound. This is often temporary, but it can be permanent. For some operations, for example an abdominoplasty, permanent numbness to the skin above the wound is to be expected. This is not so much a complication but a normal outcome of the surgery.

However, in many other situations the sensation, if initially altered, will slowly return over a period of weeks or months. However, this is not always the case. Also, sometimes you may experience heightened sensitivity or pain due to nerve damage. Many times this is unpredictable and self-limiting, however not always.

Depending on the type of surgery, sometimes nerves which allow the muscles to work can be damaged. This would be extremely rare but always a possibility.

Ultimately you need to notify your surgeon of any unusual sensations or weakness you may experience post-surgery.

SEROMA FORMATION

A seroma is a collection of lymphatic fluid that occurs in the wound, under the skin. Surgery can damage and/or interrupt the normal flow of lymphatic fluid at the surgical site. This can result in lymphatic fluid accumulating in the surgical site and collecting in that closed space – the seroma. This typically manifests as swelling in the area and sometimes this may leak out from the surgical wound. It is a clear, largely odourless, yellow stained fluid.

Some surgical procedures are far more prone to developing seromas, such as abdominoplasties, thigh lifts (lipectomies), breast implant removal (explant) surgery.

Overall, it is a relatively minor surgical complication that is typically managed with needle drainage, often under ultrasound guidance. This may be required several times until it eventually dries up. On the rare occasion it may require further surgery.

EXCESSIVE SCARRING OR KELOID SCARS

All surgery involves scar formation, and no magic exists to prevent scars. Ideally all surgical wounds will heal as fine white lines. However, this is not always the case and some people, and some parts of the body, are prone to not scarring as well. Whilst impeccable surgical technique and aftercare are vital to ensure optimal scar quality, for a variety of reasons scars can sometimes become much thicker and more noticeable.

This will include hypertrophic and keloid scar formation, where the scar overgrows the wound edges and becomes thick and dark. Often a significant genetic predisposition exists for those who develop keloid scarring.

Treatment, if required, will require several things including possible scar surgery and steroid injections.

FURTHER SURGERY

The potential need or want for further surgery is always a potential consideration for any plastic surgery. Furthermore, some operations have a greater likelihood of requiring further surgery to improve the aesthetic outcome. This can occur for a variety of reasons, suffice to say that the more complex and larger the surgery, the greater the potential need for further surgery.

Therefore, this fact will need to be considered, including any associated downtime and costs (direct and indirect) that will be incurred.

UNDESIRABLE AESTHETIC OUTCOME

There is always a potential risk of an undesirable aesthetic outcome after plastic surgery. This could manifest in any number of ways, but ultimately it’s when the results do not meet the patient’s expectations. This can arise due to several reasons including – surgical skills; patient non-compliance with aftercare; unrealistic expectations created by surgeon; unrealistic expectations desired by patient; a combination of any of these.

One of the key steps during your consultation is to ensure that your surgeon gives you, and that you have and understand, realistic expectations. Often the dream look that you may have may be impossible to achieve based on anatomical variations.

Further surgery can sometimes correct undesirable outcomes, but unfortunately even the best of skills will not meet unrealistic expectations.