Breast reconstruction is now a routine process following a mastectomy, but patients often want to know how long it will be before the process is complete and they can feel like their breasts are back to normal. We spoke to Mr Venkat Ramakrishnan, an esteemed plastic surgeon who has an international reputation for microsurgical breast reconstruction.
Can a breast be reconstructed following a mastectomy?
Reconstruction of the breast following mastectomy is a routine procedure today, and the majority of woman who wish to have reconstruction tend to have this done at the same time as the breast removal.
There are many methods available, but reconstruction of the breast using the tummy fat is the gold standard – in suitable patients. Reconstruction using patient’s own fatty tissue provides a very natural looking and most durable breast. It feels normal, and it lasts a lifetime without the need for replacement.
What happens before the operation?
The first step is a consultation. During this, an assessment of the abdomen and the breasts will be undertaken, along with a detailed history.
I will discuss the most suited method of breast reconstruction for you, taking into consideration, the size, shape of the breast and availability of tissue from the tummy. If there is inadequate amount of fat in the tummy, we may look at options such as inner thigh or buttock tissue.
There will a further consultation, after your visit to the BRA (Breast Reconstruction Awareness) group. This is a patient group, of patients who have had such reconstructions in the past. You will be able to talk to them, hear their experiences and see the outcomes. You will also have some time to talk to the breast reconstruction nurse, who will go through the finer details of your stay in the hospital, including a visit to the ward.
Once we have decided to go ahead, then we will organise an appointment with the anaesthetist and preoperative assessment. On the same day, you will undergo a CT scan of the abdomen to give us a map of the blood supply in the tummy.
What does the surgery involve?
The surgery involves removal of the excess skin and fat from the tummy, similar to a tummy tuck. This tissue will be moulded into a breast and fitted to the chest. The very tiny blood vessels, supplying the fat with blood supply will be connected to the blood vessels in the chest. These are about 1 to 2 millimetres in size, and they are joined using a microscope.
If you are having the reconstruction at the time of the mastectomy, then all your breast skin will be preserved, so the scarring will be minimal.
How do you achieve symmetry when performing reconstruction surgery?
Since we are using the body fat, we can usually match the opposite breast within reason. If the other breast is very large or droopy, then we will reconstruct a more manageable or uplifted breast and perform the uplift or breast reduction on the opposite side at the same time. All the markings for the reconstruction or opposite side reduction or uplift will be done while you are upright, prior to the surgery, so we can achieve better symmetry.
How is nipple reconstruction performed?
The nipple is reconstructed at a second stage. By itself, it is a local anaesthetic procedure. It takes about 25 minutes and you can drive yourself in and have it done in the outpatients’. It is usually done six months following the reconstruction. If there chemo or radiotherapy, then the procedure will be performed six months after that.
Three to six months following the nipple reconstruction, we will tattoo an areola, which completes the reconstruction.
Will I need more surgery in the future?
Breast reconstruction using your own tissue does not need revisions later. If we had to use implants to rebuild the breast, then you may require an operation to remove and replace the implant.