What are the possible complications of simple mastectomy?

Updated: Feb 11, 2019
  • Author: Kanchan Kaur, MBBS, MS (GenSurg), MRCSEd; Chief Editor: Erik D Schraga, MD  more...
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Answer

Answer

Early complications of simple mastectomy include pain, infection, hematoma, and flap necrosis. A study by Chatterjee et al indicated that simple mastectomy has a higher rate of wound complications, bleeding, infection, and overall complications than does breast conservation surgery, although early postoperative complication rates are still low for both procedures. The study, which utilized the National Surgical Quality Improvement Program database, included 6682 patients who underwent breast conservation surgery and 3339 patients who were treated with simple mastectomy. [9]

In general, simple mastectomy is not very painful. Patients feel slight discomfort and soreness at the wound site, which are easily managed by taking mild analgesics. However, a retrospective study by Nooromid et al from a single US academic medical center reported that discharge prescriptions for opioids were provided in 96.1% of cases of simple mastectomy, with the mean value of morphine milligram equivalents prescribed at discharge being 242.3. [10]  A study by Linnaus et al indicated that compared with advanced residents, postgraduate-year (PGY) 1-2 residents in the United States tend to prescribe fewer opioids for simple mastectomy patients. [11]

The risk of postoperative wound infection is approximately 5%; this may result in wound breakdown if not appropriately managed.

Hematoma generally develops within 24 hours after the operation but is a very rare complication. Patients notice swelling of the wound site and bruising over the breast. Flap necrosis is an uncommon complication; causes include thin flaps and a wound that is under tension.

Delayed complications of simple mastectomy include seroma [12] and shoulder stiffness. The observed rates of seroma after a mastectomy range from 2.5% to 51%. [13, 14] It may be necessary to perform needle drainage on one or more occasions. [15] Shoulder stiffness is a temporary and self-limited side effect.


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