At Fitzwilliam Clinic we carry out the following types of breast reconstruction surgery:
- Breast reconstruction
- Nipple reconstruction
What is breast reconstruction?
Breast reconstruction surgery is usually carried out on patients who have undergone a mastectomy. A mastectomy is the removal of one or both breasts, either partially or completely, and is commonly used to treat breast cancer.
What is a tumour?
A tumour is a lump of tissue. Tumours can be benign and cause no symptoms or problems at all. But even benign tumours can grow, or be located in an awkward place, and must therefore be removed.
A tumour can also be malignant, which means that it grows without restriction and in some cases also spreads within the body. The term “cancer” which refers to malignant tumours, covers a wide variety of different tumour diseases.
Removing a large tumour, especially if it is a malignant one, can leave the patient with considerable tissue damage. The amount of function lost and the effects on the patient’s appearance depend on the location of the tumour. It is after such operations that reconstructive plastic surgery comes in.
What happens when you have breast cancer?
Breast cancer is the most common form of cancer among women in the Western world, and represents about ten per cent of all cancers. Today it is more widely known that modern plastic surgery can create a new breast to replace a cancerous one that has been removed. The removed tissue is then usually replaced with an artificial implant. Each patient is treated as an individual, with the decision for reconstruction made according to the position of the cancer and after discussion between the surgeon and patient.
What does surgery involve?
The simplest way to construct a new breast is to use an implant. Often, however, so much skin has been removed that the remaining skin is stretched too tightly over the chest to allow an implant to be simply put under it. More skin must be obtained, and this can be accomplished in several ways.
One method to use is a tissue expander, which is a small silicone balloon placed under the skin and chest muscles. These tissues are then stretched by gradually filling the balloon with a saline solution via a valve beneath the skin. When they have stretched sufficiently, which often takes several months, the balloon is replaced by a permanent implant.
Another method of obtaining skin is by taking a skin flap from the outer part of the chest, rotating it to cover the taut area, and adding a breast implant.
A third way is to borrow a muscle from the back, including the overlying skin, and transfer it complete with blood supply, via a small tunnel made beneath the skin from the back via the armpit, to the front of the chest. This tissue from the back can be used alone to restore the breast, if it is to be a small one, or it can be combined with an artificial implant.
In most cases only one breast is rebuilt – unlike an ordinary breast enhancement operation. The natural breast contains glandular tissue, which droops and also makes the nipple stand out. This natural appearance can not be imitated by an implant, and there will therefore always be some asymmetry after reconstruction of a single breast.
What happens after surgery?
Immediately after surgery, your reconstructed breast will be covered with dressings. At first, your new breast will be larger than your other breast. This is usually due to inflammation and swelling after surgery. It should gradually get smaller over a few weeks or months.
Once the dressings are removed, you can gently shower the wound with clean water. Pat the wound area dry with a clean towel – don’t rub it. Once the wound has healed you can have baths or showers as normal. Wash with lukewarm water and unperfumed soap, rinsing the wound line well.
Surgeons generally advise that once the wounds have fully healed, women should massage the skin and scars over the reconstructed breast daily with body oil or cream. This keeps the skin supple and in good condition.
A firm supportive sports bra must be worn for 4 – 6 weeks after surgery.
What is the recovery time?
Many women want to know when they can get back to doing everyday things like driving, carrying the shopping or doing the housework and gardening. This will vary, depending on the type of surgery you’ve had and on how you feel. It’s a good idea to discuss this further with your surgeon or breast care nurse.It’s usually fine to start driving again when you feel that you could safely do an emergency stop or move the steering wheel around suddenly, if necessary. Some women find that this is possible within a few weeks of the surgery and others find that it takes longer. Some insurance companies have specific guidelines about when you can drive again after an operation, so you should check this with your car insurance company.
Is it possible to have a new nipple?
If the nipple has been removed during breast cancer surgery, a new one can be created. The nipple can be created in various ways – half the nipple from the other breast can be moved to the site of the operation, or small bits of skin can be cut out of the reconstructed breast where the nipple should be located, and wrapped together to create a protrusion. A nipple can also be constructed with tissue from an earlobe or toe.
After the nipple has been constructed, the areola can be created with a skin graft from the inner thigh or by borrowing some of the areola on the other breast.
It is now more common to create the new areola by tattooing. Brown and pink pigments are used for the tattoo, and the result looks quite natural – tattooing may need to be repeated.
Can nipples be reduced in size?
Reducing the size of the areola is usually part of a breast reduction but can also be done as a separate operation. An incision is made around the areola and some of it is cut away, and when the incision is closed the areola is smaller. This leaves a scar around the nipple, which usually turns into a thin white line over time.
If a larger portion of the areola is removed it is sometimes necessary to make a small vertical incision down towards the crease below the breast. If the nipple itself is enlarged it can also be reduced. The usual reason for a large, sagging nipple is breast-feeding.
What does the surgery involve?
A nipple reconstruction or reduction is a minor operation that can be performed with local anaesthetic. There are several methods of reducing the size of the nipple. The most common one is to cut away some of the skin on the stem and make it shorter. This will leave a very small scar. It is also possible to remove a wedge-shaped piece of the nipple, but with this method some of the milk ducts are severed. Dissolvable sutures are usually used.
What happens after surgery?
Only slight pain may be present after the operation, and simple pain killers will help. The patient can usually return home shortly after the operation.
The nipple should be initially protected from pressure. A light bandage is applied, and the patient should avoid putting pressure on the area by wearing a supportive sports bra.
For further information on any surgical procedures or
to book a consultation, please contact us at:
Fitzwilliam Clinic, 70-72 Lisburn Road, Belfast
Tel: 028 9032 3888