Nearly 58,000 women are diagnosed with breast cancer every year. Back in 2007 only 1 out of 10 were offered reconstruction from their surgeon or hospital. This was the main vision of the web site, to provide information for people to know they are able to make an ‘informed choice’ based on good information. Whatever reconstruction surgery or no reconstruction surgery decision you make, it can be a huge help with the mental and emotional aspect of the disease.
LD FLAP – LATISSIMUS DORSI (FROM THE BACK)
With my own reconstruction I knew exactly what procedure I wanted 3 days after I was told the devastating news that I had breast cancer. I met a friend of my sister in law’s who had been through breast cancer surgery recently and she had had an immediate reconstruction with an LD flap. She had also had skin saving surgery. The nipple had to be removed just in case cancer had spread to this area which is normal procedure. The breast tissue was then scooped out of the cavity (explained to me a bit like cutting the top off a boiled egg) then a circular piece of skin placed over where the nipple was. This is normally taken from the back area when taking the muscle (there are also different surgery ‘cuts’ that the surgeon can make on the breast – my surgeon used the boiled egg method where as some other surgeons may sometimes cut the breast across – find out which you prefer and which they do). The LD muscle from just under your shoulder blade is used by keeping this partially attached, which means the blood supply is not cut off. This muscle is pushed through under the arm pit into the breast cavity. As the blood supply is not cut, this means that there is usually good success rate of this procedure working. The strange thing about having this done is that when you tense the muscle (which would normally be under your shoulder blade) then the boob can tense and relax. Bit of a party piece sometimes!
Fat can also be used from your back to help form the breast and sometimes (as with me) the surgeon may need to use a small implant to match the size of your other breast as I didn’t have enough ‘fat’ to make a matching breast. My surgery was 10 hours long. Procedures have improved now and take a shorter amount of time. I knew it would be hard and I was in hospital for 11 days after the op. I did have a seroma on my back where the scar was and had to have this aspirated twice which was very painful. Recovery takes time and sometimes there are problems and surgery doesn’t always go to plan. You have to be prepared for all eventualities. Just remember, it is major surgery. Something that you can’t take lightly and you want to make your choice knowing all the pro’s and cons.
When I had my surgery they did a sweep of the lymph nodes (this was before sentinel biopsy was available) and unfortunately 10 out of 42 were infected. I think the surgeon didn’t think that this was going to be the case which is why he had agreed to the immediate reconstruction. Unfortunately, after my chemo and before radiotherapy was started, I had to have another small operation to have the implant taken out and an expander put in (like a balloon in the breast cavity) to save the skin from shriveling up with the radiotherapy. This was my only option. Over a course of a week or two I went back to the clinic for saline to be injected into the expander. A port is placed under the skin so that they can use a normal needle to inject saline in to ‘expand’ it bigger than your other breast. The port tube was underneath the bottom of the breast and it made wearing a bra quite uncomfortable as it pressed on the tube. I had the expander in for 6 months and then I had surgery to replace the expander with another implant.
I call my new boob Victoria Beckham as it won’t ever be tucked under my arm when I lie flat!
I may eventually have lipofilling (see information on www.breastcancercare.org.uk, www.macmillan.org.uk or www.breakthrough.org.uk re this procedure) to correct some dents that I have. I am also quite flat over the top of my breast so I’ve been advised that again, I can have lipofilling in this area too. I am more than happy with my new breast. Even though after surgery you loose all feeling in the area and it may never come back on my breast or on my back (some people have more feeling than others), the visual results are very good. I know it’s never going to be exactly the same as a normal breast but wearing a bra you would never really know. I can happily wear a bikini on holiday and I don’t think anyone would know I’d had a mastectomy and reconstruction.
Here I am on holiday with my lovely children – I can still wear a bikini and don’t feel conscious even after a mastectomy and reconstruction.
TRAM FLAP – TRANSVERSE RECTUS ABDOMINIS MUSCLE (FROM THE LOWER ABDOMEN)
I met a woman when treated with Herceptin therapy who had had the tram flap surgery and she wasn’t happy as she had problems with the wound healing. I had talked about this surgery with my surgeon and he wasn’t happy doing this type of surgery with me previously having a belly button piercing. He said that this would have damaged the nerves and may cause problems with healing. It’s a great way of getting a tummy tuck BUT it will leave you with a scar from one hip to the other. Surgery time is extensive so if choosing this, you have to be sure it’s what you want. With this type of surgery I also didn’t want to look down and see a huge scar across my tummy. I somehow can deal with the foot long scar on my back as I can’t see it and be reminded every day (unless I look through the mirror at my back) so it’s mentally easier to deal with. Again surgery will have improved from when I had my reconstruction.
The ‘easier’ option for reconstruction (surgery wise). Less problematic but may not feel or look as ‘realistic’ with no clothes on (especially if you have just the one breast done) but if you have to have both breasts done then I would have definitely chosen this surgery. The recovery time is much shorter.
LIPOFILLING OR LIPOMODELLING
When I was diagnosed in 2007 the first thing I asked my surgeon was ‘why can’t you just suck some fat out of my thighs/bum/tummy and inject this into the breast cavity? Unfortunately, I was a little too premature for this ‘advanced’ surgery. My surgeon had actually just been to France to learn and research this ‘new’ procedure but it needed to research and trial on cancer patients first before being able to offer it to them. They use this procedure in plastic surgery but it wasn’t available for a while for breast cancer reconstruction patients. My surgeon has told me that I can now be considered as a candidate for this but I feel there is no rush. As the procedure is new I would rather wait and see what the results are before agreeing to have this procedure.
Here’s Lisa’s story
Like Jo, I had an LD Reconstruction following mastectomy, back in 2012. I was very pleased with the results, but also like Jo, I had a dip in the curve of the breast, just above the bra line. I also had some tightness around the arm pit and shoulder when I moved my arm, and the whole thing felt numb and hard.
My surgeon had told me that we could look at lipo-remodelling post recon, when things settled down. To be honest, looking back, my motives were cosmetic, I wanted a more natural shape, to look better in clothes but the procedure benefitted me more than this.
Lipo remodelling requires the patient to have a certain amount of body fat (not a problem for me). It was to be done as day surgery, where very small incisions would be made in my thighs and stomach (6 in total), then fat would be extracted, and then pumped back into the breast. Sounds so simple! Each small incision would be held together with a couple of dissolvable stitches.
They also put in more fat in the breast than needed, as the body will re-absorb a certain percentage – which is why more than one procedure can be needed.
The bit I must stress, for those who haven’t seen lipo on the TV, is that the process for removing fat is pretty vigorous, and as a patient, you know about this afterwards! It wasn’t as bad as I feared though. I was only in surgery a short time, and home after tea with just some paracetamol needed. I was back at work after a day, although I wouldn’t recommend this as I was pretty groggy from the anaesthetic.
I can strongly recommend a comfy sports bra for a few days after and also some decent spanx type underwear for at least a week (day and night) – cycling shorts style preferable! This reduced the swelling and bruising on my stomach and thighs and I was comfier and supported! My surgeon knew what she was talking about with this tip.
The stiches dissolved well, leaving no scars on my thighs, stomach or breast and the dip was gone. However for me the best part of lipo remodelling was the reduction in tightness, tenderness and the whole thing felt softer – I got my ‘natural bounce’ back, so to speak!
Over time my body did reabsorb a percentage of the fat, as the surgeon had said, and the dip started to reappear, although not to the same extent. Being a perfectionist, and taking extreme pride in her work, my surgeon suggested I had a second round of lip remodelling, which I had a few months later. That was two years ago now, and I’m still really pleased with the results.
A nipple can be reconstructed with your skin from your breast but my surgeon has advised that this wouldn’t be possible for me as I’ve had radiotherapy and the skin would basically die. My friend’s reconstruction who I saw 3 days after my breast cancer diagnosis, had had this done and it looked very, very realistic. After creating a nipple, they tattoo the areole, to match the colour of your other nipple.
Specialists can create a 3D looking nipple by clever use of tattooing. When I went to the Younger Womens Breast Cancer Forum run by Breast Cancer Care (www.breastcancercare.org.uk) I talked to a surgeon who was there giving a presentation. He said ‘why have you gone to all the trouble of having the reconstruction and not had the nipple done or tattoo?’ He said ‘it’s like having a face without a nose’.
In October 2012 I had a nipple tattoo. It needs to be redone to match better but I’m already pleased with the results and makes everything look more symmetrical.
PROPHYLACTIC OR DOUBLE MASTECTOMY WITHOUT RECONSTRUCTION
For some women, they do not want any reconstruction at all and are quite happy having a double mastectomy without reconstruction of any kind. There are a few ladies who are going to provided their photos on the reconstruction site to give you an understanding of what this would look like. There are some excellent support groups now in the UK if you do not want any reconstruction.
These are the other reconstruction surgeries that may be available to you therefore ask your surgeon about them:-
- DIEP – deep inferior epigastric perforator (from the lower abdomen)
- SIEA – super inferior epigastric artery (from the lower abdomen)
- SGAP – superior gluteal artery perforator (from the upper buttock)
- IGAP – inferior gluteal artery perforator flap (from the lower buttock)
- TUG – transverse upper gracilis (from the inner thigh)
INFLAMMATORY BREAST CANCER – IBC
Not everyone can have a reconstruction. Although all breast cancer sufferers should be supported to get the breast reconstruction they need there are times when it isn’t advised, particularly when Inflammatory Breast Cancer is involved. Inflammatory Breast Cancer is an aggressive form of breast cancer that doesn’t always present as a lump but can show as a rash, bruising, thickening of the skin, inverting of the nipple or as a number of other symptoms including pain in or around the breast area. In fact if there are any changes to your breast or you notice anything unusual we recommend that you get it checked as soon as you are able. If you have these symptoms you should discuss this with your doctor before any decision on reconstruction takes place.
For all these procedures and the most up to date information see the detailed information sheets and booklets that you can request from Breast Cancer Care, Breast Cancer Now, Macmillan and Cancer Research UK cancer web sites. You can download them or request them in the post. Search for reconstruction or reconstruction surgery.
Breast cancer diagnosis and treatments
Types of Surgery
LDFlap – Latissimus Dorsi
Tram flap using the stomach muscle
Daily Mail article on Strattice Mesh
In this new technique, normal implants are still used to rebuild the breast, but the pigskin graft works like an internal bra, cradling the implant and allowing some of the natural droop of a normal breast.
Not only that, but some women will be able to have their reconstruction done in an all-in-one operation, rather than the two ops normally needed. The graft, known as the Strattice graft, is pigskin stripped of all pig cells, so that the body doesn’t reject it.
Although this is a USA link – PRMA Plastic Surgery provide a really excellent infographic about breast reconstruction and the surgeries
PRMA Breast Reconstruction Infographic
The consultant information link on www.nhs.uk should advise which Consultant provides which surgery at which hospital.
Please see the Consultant Information on this web site for specific consultant information.
The British Association of Plastic Reconstructive and Aesthetic Surgeons gives a complete guide to breast reconstruction.
Comprehensive information about reconstruction techniques, believe this is produced and put together by a reconstructive surgeon
This link is from the National Mastectomy and Breast Reconstruction Audit 2011. It provides some interesting information about breast cancer reconstruction.