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Risks of Surgery

RISKS OF SURGERY

While the vast majority of people undergo and recover from surgery without any problems, no medical intervention is completely risk free. Unfortunately, some people suffer postoperative complications. I have compiled a list of general complications and explained briefly about each of them. It is not an exhaustive list but covers several scenarios. For an individual procedure, some of the below risks may not apply and there may be other specific risks for that procedure or for the individual undergoing the procedure. These will be explained to you during your preoperative consultation.

REDUCING YOUR RISK

As part of my efforts to reduce your risk during surgery, I prepare for your surgery as much as possible. There may be some things that I ask you to do in advance such as lose weight, stop smoking, control your blood sugars if you are a diabetic, attend a preassessment clinic or stop certain medications. I endeavour to explain fully to you the procedure you are undergoing, what it can achieve and the potential risks to you. Please see the section on Preparation for Surgery for more detail. I also only operate in fully accreditated hospitals and clinics and work with a highly qualified support team.

GENERAL ANAESTHETIC

General anaesthetics are very safe nowadays. However, you may experience some nausea or sickness following an anaesthetic. This is usually temporary and settles spontaneously or with anti sickness medications. Problems that can occur during the anaesthetic include movement of the breathing tube or chest problems. To reduce your risk during the anaesthetic, I will often ask you to attend a preassessment clinic in advance of your surgery. This allows an assessment of your medical status and for any necessary investigations e.g. blood tests, tests for your heart or lungs to be carried out before surgery. Your anaesthetist will then have more information about your physiology which can help in deciding which type of anaesthetic you have. Before a general anaesthetic, you will also be asked to abstain from food and drinks for up to six hours. This is for your own safety during the anaesthetic and it is important to follow these instructions. If you are a diabetic, additional arrangements and adjustments to your diabetic medication may have to be made while you are fasting. After the anaesthetic, it is important for your chest to breathe in and out deeply and if feasible to mobilise out of bed as soon as possible. (Restrictions on mobility may be in place after some types of surgery.) 

ALLERGIC REACTIONS

It is very important to inform Ms Nugent of any allergies or allergic-type reactions that you may have had in the past e.g. latex, penicillin. I will then ensure that you do not receive these allergens. In the unfortunate event of a new allergic reaction occuring while under my care, you will receive full treatment for this. It may mean simply stopping a medication and using an alternative. In more severe cases, adrenaline and steroids may need to be administered and more intensive care to support you until your recovery.

THROMBOEMBOLIC EVENTS

Long surgical operations and periods of immobility increase your risk of blood clotting in the deep veins in your legs. These clots can travel to the lungs and cause chest pain and difficulty breathing. In severe cases, they can be fatal. To reduce your risk of this happening if you are on hormonal therapy, I may ask you to stop this in advance of surgery. Apart from during minor surgical or some local anaesthetic procedures, you will be asked to wear graduated TED stockings and you may have automated calf pumps placed around your legs. If you are staying overnight, you will receive blood thinning injections. In some circumstances, I will ask you to continue these injections at home. This is all done to reduce your risk of blood clots. Should you run into problems with blood clots, the most common treatment is a course of blood thinning medication such as warfarin.

BLEEDING

Bleeding can occur after any surgical procedure. In the vast majority of cases, this is minor and stops spontaneously or after firm pressure for 15 minutes. In a minority of cases, either the bleeding does not stop or it causes a build up of blood (haematoma) under the skin. In this situation, you may need to return to theatre to stop the bleeding and to remove the haematoma. For larger surgical cases, I will take a sample of your blood in advance to type it. This is in case a blood transfusion is necessary. However, I will only give you blood if it is clinically necessary to do so. For a small group of my patients who are on blood thinning medication because they are at risk of heart problems, blood clots or strokes, I do not stop this medication in advance of surgery. This is only where the surgery is minor e.g. a small skin lesion being excised and the risk of a stroke, blood clot or heart attack while off the blood thinners is higher for the patient than the risk of bleeding after the procedure. 

INFECTION

Unfortunately, a small percentage of surgical patients suffer from postoperative infections. These can be quite minor and simply require different dressings or a short course of antibiotic tablets. Other infections can be more severe and require a prolonged course of antibiotics e.g. an infection in the bone and/or returns to theatre to clean the wound. In general infection will slow down the healing process and can adversely affect the outcome of surgery. If an implant such as a breast implant or a metal plate for a hand fracture gets infected, it usually needs to be removed to fully treat the infection. There are some things that can help reduce your risk of infection. These include not smoking, controlling your blood sugar if you are diabetic and looking after your surgical wound. For some procedures, I will give you antibiotics during the procedure.

DELAYED HEALING

Delayed healing can happen for a number of reasons. It may be due to a combination of reasons. It is more likely to happen if you have problems with your wound in the early stages such as an infection or if you are a diabetic or on medications such as steroids. If you smoke, have poor nutrition, poor circulation or have a lot of scar tissue in the area, this can also increase your risk of delayed healing. Certain parts of the body are also more prone to slow healing e.g. lower legs and feet. Should you run into problems with slow healing, I will look after you during this process. I will try to treat any potential causes of this and look after your wound as well.

POOR SCARRING

While most people find their surgical scar heals well, sometimes it can be raised or stretched. Poor scarring is more likely to happen if you have suffered from an infection or delayed healing or if your skin type predisposes you to hypertrophic or keloid scarring. Your scar will be placed in the best position possible at the time of surgery e.g. in a natural skin crease. Afterwards once the wound has healed, the scar can be treated e.g. moisturisation, massage, topical silicone, steroid injection or scar revision.

PROLONGED OR ABNORMAL PAIN

Generally pain after plastic surgery procedures is manageable and can be well controlled with pain killers. For larger procedures such as breast reconstructions or extensive body contouring, more extensive analgesia may be required in the early stages. A small group of patients suffer from more prolonged or severe pain and/or hypersensitivity. This can be due to bruising or damage to nerves surrounding the surgical wound e.g. a neuroma or after a complication such as infection or following on from a pre-surgery pain disorder. Sometimes there is not a satisfactory explanation for the pain developing. Should this happen, it is treated with a specific range of pain killers. Sometimes more specialised techniques such as desensitisation programmes or nerve blocks are required. If necessary, I will refer you to a pain specialist.

FAILURE OF GRAFT OR FLAP SURGERY

When undergoing graft or flap surgery (movement of body tissues (usually skin) from one area to another) in plastic surgery, the tissues that are being moved sustain some disruption to their blood supply. This may be complete in the case of a skin graft or partial in the case of most skin flaps. It requires time to recover from this disruption or to establish a new blood supply. The human body is very adaptable and usually does this very sucessfully. Occasionally the blood supply remains insufficient or fails to establish itself. Unfortunately the transferred tissue will not survive in these conditions. If it is only a small or non-crucial part of the transferred tissue that fails, it may be possible to treat it without further surgery. If it is a crucial part of the transfered tissue or a substantial amount of the transferred tissue, then further surgery is usually required to repair the damage or reconstruct the area. This is more likely to happen in people who smoke or have poor circulation but is a potential risk for everyone undergoing this type of surgery.

FAILURE OF IMPLANTS

Implants such as silicone breast implants or metal plates and screws for fracture fixation work very well for the majority of patients. However when they run into problems, they often need to be removed. It is sometimes possible to replace the implant but not always. Sometimes it can be replaced after a period of time without it. Examples of when a breast implant fails include if it gets infected or if it ruptures. A metal implant can fail if it gets infected or breaks or becomes displaced out of position. I only use implants that meet the industry safety standards. I have never used the PIP implants that have recently been in the media due to their substandard quality of silicone. Should you have problems with an implant, I will advise you on the best course of action and will endeavour to resolve the problem in the best possible way.

ASYMMETRY

Most people have minor asymmetries when you compare one side of the body to the other. The majority are not obvious unless specifically pointed out. After any type of surgery on the surface of the body, there can be some asymmetry afterwards compared to the opposite side of the body. This is usually minor and does not require any intervention but occasionally the asymmetry is very noticeable or significant enough to require another surgical procedure. Breast reconstruction is one area of plastic surgery where it is common to have a further procedure after the main reconstructive surgery to get better symmetry between the two breasts.

UNDER OR OVER CORRECTION

When undergoing plastic surgery procedures such as body contouring, alteration of features or reconstruction of different areas of the body, it is important to get the balance of the procedure right. Sometimes very small surgical changes result in significant changes in appearance. Most of the time the balance is correct, but sometimes the area is undercorrected or overcorrected. If significant or troublesome, this may require additional surgery to correct the problem. In general, undercorrection of an area is easier to correct than overcorrection. Both can be difficult problems to correct.

NEED FOR REVISION SURGERY

While the majority of patients do not require any further surgery after their planned procedures, a small group of people will require revision or corrective surgery later on. The reasons for revision surgery are many and some are complex. It may be due to a complication postoperatively that compromised the result e.g. an infection or a tendon repair rupture or to a failure to achieve the desired result from an operation either functionally e.g. movement of a joint after a joint replacement or in terms of appearance e.g. after a rhinoplasty (nose reshaping). Sometimes it arises out of a failure to understand what was achieveable by the procedure or unexpected difficulties during the procedure e.g. excessive scar tissue. If you need to undergo revision surgery, it is vital to have good preoperative consultations and to prepare as well as possible for the surgery. Revision surgery is always more difficult and complex than the primary surgery.

WHAT TO DO IF YOU HAVE A COMPLICATION FOLLOWING SURGERY?

If you are still in hospital when the complication occurs, Ms Nugent and the nursing staff will look after you during this time. If additional specialists are needed, Ms Nugent will arrange for them to see you. If you are at home, Ms Nugent advises you to contact the hospital where your procedure was carried out or her practice so that she can be informed of your problem. You will then be advised on what to do and you will often need to be reviewed by Ms Nugent sooner than your planned review.