Plastic & Reconstructive Surgery - Breast

Breast Reconstruction

Nipple Reconstruction

Inverted Nipple Correction

Breast Asymmetry
Plastic Reconstructive Surgery Breast Hampshire
 
Breast Reconstruction
 
Why under go a Breast Reconstruction?

Following a diagnosis of breast cancer, it is usually necessary to remove part, or all, of the breast tissue. This leaves behind a defect that varies from a slight volume difference to the other side to a complete mastectomy where there is no remaining breast at all. It will be up to your breast surgeon as to which method to use to give you the best chance of a cure. Once the cancer has been removed, it is now possible with modern techniques to reconstruct the missing breast.

Who can have a Breast Reconstruction?

According to the guidelines published by the Government (NICE guidelines), every woman who undergoes mastectomy should be offered reconstruction at the time of her breast surgery. This is called 'immediate' reconstruction. If there is a need for radiotherapy after the mastectomy, this can be damaging to the reconstruction and so we prefer to wait until any radiotherapy has finished before reconstructing the breast. This is called 'delayed' reconstruction.

How is it done?

There are many different ways of approaching breast reconstruction. The type of reconstruction depends on your preference as well as the tissues you have available to spare. Essentially the types of reconstructive technique can be classified as follows:


1. I mplant only
- the simplest option. It takes very little time, and gives a simple breast mound. However, in terms of symmetry and shape, it has the least good long term cosmetic outcome. It may be necessary to expand the skin first using a special expandable implant. Implants have a   limited lifespan.
 
    Breast Augmentation Implant Hampshire
2. Implant plus autologous tissue
- this involves taking some tissue from elsewhere (usually the skin and muscle of the back) and swinging it forwards over an implant to recreate the breast shape. It takes longer than implant alone and involves a scar on the back, but it allows the implant to be shaped in a more pleasing way. The implant's lifespan is still limited.
 
Breast Augmentation Implant Autologous Tissue Hampshire

3. Autologous only
- this is the gold standard of reconstruction. It involves taking only your own tissue, without the need for an implant, and using that to shape the new breast. Most commonly this is taken from your tummy (DIEP flap or TRAM flap), but we may also use your thighs or back, depending on the size of breast we are attempting to match and where you have adequate tissue. It avoids the need for an implant.
 
Breast Augmentation Autologous Tissue Hampshire
 
At your initial consultation, I will examine your general health. We will then discuss in detail the pro's and con's of each reconstructive approach until we are both absolutely happy with our choice of reconstruction.

At this stage a photograph is taken which forms part of your medical record. It will not be used for publication or teaching purposes without your express written consent.
 
What are the risks?

Breast reconstruction is now a safe and reliable procedure, achieving dramatic results. However, it needs to be done by a surgeon who performs these procedures on a regular basis if the risks are  to be minimised and the benefits maximised.

Although bleeding is meticulously controlled throughout the procedure, it is possible to get a collection of blood under the skin which may require a return to the operating theatre to have it washed out. Infection is rare, but occasionally antibiotics may be needed. An infected implant would have to be removed.

The risk with implant-based reconstructions is much the same for Breast Augmentation . However, the risk of implant extrusion (the implant appearing through the scar) is higher as there is no breast tissue covering it.

For autologous reconstructions, the biggest risk is that the 'flap' (as the tissue used for the reconstruction is known) does not accept its new blood supply and all or part of it dies. The risk of this is about 2%, so the chances are small that something so significant will occur. On the other hand, there are lots of small things that can happen, such as asymmetry, infection, delayed wound healing etc... but these are generally easy to deal with.

The Surgery

Prior to the surgery, you will be given all the information you need in terms of how best to prepare for the operation. The surgery itself is performed under a general anaesthetic (with you asleep). It takes about 2 to 6 hours to complete (depending on the type of reconstruction). There will be drains placed under the new breast and in the donor site (where the tissue was taken from to create the breast) in order to avoid fluid collections. The incisions are closed with dissolvable sutures and covered with layers of tape.
After the Surgery

After a general anaesthetic it is normal to feel tired and out of sorts, but this is temporary. For implant reconstructions, you will be in hospital for 1 to 2 nights. For autologous reconstructions, you will be in hospital for 4 to 5 nights.

One week after your surgery you will visit the dressing clinic to have the dressings changed. I will see you in my clinic the following week.


Returning to work and play

As a general rule, it takes about 3 weeks before you will be getting back to light duties such as office work, driving a car, or light shopping. It takes about 6 weeks before you can start living life as usual and going to the gym. It will be about 3 months before you are truly feeling yourself again.

I will see you for a review at 2 months at which point a decision can be made as to whether you would like anything further done  to match the breasts up (eg Breast Reduction , Mastopexy , Fat Transfer ), or whether you would like to go ahead with Nipple Reconstruction .

We can achieve amazing things with breast reconstruction with new microsurgical techniques. However, it is impossible to make a breast that will stand up to close scrutiny as there will be telltale scars of surgery and a residual degree of asymmetry. However, if you look normal in a bra, in clothes or in a swimming costume, then the surgery is a success.






Nipple Reconstruction
 
Why undergo a Nipple Reconstruction?

During mastectomy for breast cancer, the nipple is usually sacrificed as part of the cancer resection. When the breast is reconstructed, the reconstructed breast does not have a nipple. There are rare conditions such as athelia and amastia, where there is a congenital lack of a nipple or even an entire breast. The nipple can also be lost or damaged due to trauma. In all these scenarios, it is possible to rearrange the local tissues to reconstruct a new nipple.

Who can have a Nipple Reconstruction?

Anyone who wants a new nipple can have one reconstructed. It may be more difficult in cases where there has been significant scarring to the area (for example, severe burns), but there are techniques that can be used even in these circumstances.

Following nipple reconstruction, it is possible to tattoo the areola back in (the coloured round area surrounding the nipple).

How is it done?

There are many different ways of performing a nipple reconstruction. The technique I have found to be most reliable in terms of effect and longevity is known as the 'C-V Flap'

This involves raising the skin and fat at the front of the breast in a special design and rearranging the tissues into a 3-dimensional nipple shape.
Nipple Reconstruction Hampshire


At your initial consultation, I will examine your general health and we will then discuss in detail exactly how and where the nipple is to be placed.

At this stage a photograph is taken which forms part of your medical record. It will not be used for publication or teaching purposes without your express written consent.


What are the risks?

There are very few risks associated with nipple reconstruction. In a few cases, the blood supply to the new nipple is poor and part of the reconstruction does not survive. Should this happen, however, it is usually minor and settles with dressings.

The new nipple will shrink to some degree over time. To counteract this, I make the nipple about 30% larger than necessary. Even with this precaution a few reconstructed nipples will flatten to an extent that repeat surgery is required.

As with all surgery, there is a small risk of infection, and occasionally antibiotics are required.

The Surgery

Prior to the surgery, you will be given all the information you need in terms of how best to prepare for the operation. The surgery itself is performed under a local anaesthetic (with you awake). It takes about 30 minutes to complete. The incisions are closed with sutures and covered with tissue glue.
A special dressing is placed over the new nipple that prevents pressure.


After the Surgery

Nipple reconstruction is a simple day case procedure. You will be fine to leave the hospital on the day of your surgery.

The dressing is shower resistant, but not bath proof.

One week after your surgery you will visit the dressing clinic to have the dressings changed. You will need to continue with special pressure relieving dressings for a further 3 weeks. I will see you in my clinic at 2 months at which point we can book an areola tattoo if desired.

Returning to work and play

As a general rule, nipple reconstruction should not have any effect on your day to day life. It is important to keep pressure off the new nipple for the first month, but this should not stop you leading a normal active life.

A new nipple can make the difference between a good breast reconstruction and a great breast reconstruction. It is a quick and simple operation with high patient satisfaction scores.
 





Inverted Nipple Correction


Why undergo an Inverted Nipple Correction?

In some women, during development of the breast, one or both nipples can fail to become released from the structures tethering them to the deeper part of the breast. This leads to a nipple that forms a crease into the breast rather than protruding normally. It can also be a symptom of breast enlargement, either with weight gain or post-pregnancy.

Who can have an Inverted Nipple Correction?

There are 3 grades of nipple inversion:

1)    The nipple is easily protruded and will remain protruded when erect
2)    The nipple is protruded with difficulty and will slowly invert again
3)    The nipple remains inverted regardless of manipulation

Grades 1 and 2 can respond to manipulation and suction techniques to avoid surgery. In some grade 1 and 2 cases the nipples do not adequately respond to such stimulation and, along with grade 3 nipple inversion, surgery can be helpful. Although nipple inversion can occur in normal breasts, nipple inversion can be a sign of underlying breast disease, so contact your doctor if you have new nipple inversion in a previously normal nipple.

Inverted Nipple Correction Hampshire

How is it done?

During surgery, the nipple is brought out gently. With the nipple exposed, small cuts are made into the base of the nipple, and through these cuts the fibrous bands tethering the nipple are released. The cuts are then sutured together in such a way as to prevent the nipple from returning to its original position.

At your initial consultation, I will examine your general health and I will then examine the nipple carefully to determine whether surgery is the best option for you.

At this stage a photograph is taken which forms part of your medical record. It will not be used for publication or teaching purposes without your express written consent.


What are the risks?

There are very few risks associated with inverted nipple correction. The most common complication is that the procedure does not work as intended, and the nipple retracts again. It is sometimes necessary to repeat the procedure.
In order to release the nipple, it is necessary to cut through some of the shortened milk ducts behind the nipple. This makes breast-feeding after you have had the surgery potentially difficult.
As with all surgery, there is a small risk of infection, and occasionally antibiotics are required.

The Surgery

Prior to the surgery, you will be given all the information you need in terms of how best to prepare for the operation. The surgery itself is performed under a local anaesthetic (with you awake). It takes about 45 minutes to complete. The incisions are closed with sutures and covered with tissue glue.
A special dressing is placed over the everted nipple that prevents pressure.

After the Surgery

Inverted nipple correction is a simple day case procedure. You will be fine to leave the hospital on the day of your surgery.
The dressing is shower resistant, but not bath proof.
One week after your surgery you will visit the dressing clinic to have the dressings changed. You will need to continue with special pressure relieving dressings for a further 3 weeks. I will see you in my clinic at 2 months.

Returning to work and play

As a general rule, the surgery should not have any effect on your day to day life. It is important to keep pressure off the newly everted nipple for the first month, but this should not stop you leading a normal active life.

Breast Asymmetry

 
What causes Breast Asymmetry?

There is no such thing as an absolutely symmetrical pair of breasts. Everyone has a difference in shape or volume compared to the other side, no matter how small that might be. In some cases, however, the difference is enough to be very noticeable. The cause is most usually congenital (how the breasts develop). It can also be caused by surgery to remove breast lumps, leaving one breast larger than the other.
  
Breast Asymmetry Hampshire
Examples of Asymmetry

What can be done about it?

There are 5 ways to improve breast symmetry:

    1) Make one breast larger
    2) Make one breast smaller
    3) Make one breast larger AND one breast smaller
    4) Make both breasts larger, but one more so than the other
    5) Make both breasts smaller, but one more so than the other
 
How is it done?

At your initial consultation, I will examine your general health and we will then discuss in detail exactly how the breasts are symmetrical, what your goals are, and how they are to be achieved.

At this stage a photograph is taken which forms part of your medical record. It will not be used for publication or teaching purposes without your express written consent.

The actual techniques are summarised in other chapters on this website:

For information on making a breast larger, see Breast Augmentation
For information on making a breast smaller, see Breast Reduction and Mastopexy (Uplift)

Correcting breast asymmetry can give you a new lease of life. Although perfect symmetry is impossible to achieve (and indeed is unnatural), a great improvement can be gained using these techniques.
 
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