What is a Mastectomy?
When a breast cancer is extensive in the breast it is usually the case that the whole breast should be removed. When we want to perform an immediate reconstruction we try to preserve the breast skin and so in this situation, removing the whole breast means leaving the skin but removing the nipple areola tissue and the underlying breast tissue from inside. Reconstruction is a challenging operation and should only carried out by surgeons with the necessary expertise.
What is an Autologous Reconstruction?
This means a breast reconstruction based on your own body tissue (autologous), without using an implant. Not everyone is suitable as it very much depends on having the right amount of tissue in a specific part of the body that is suitable to serve as the “donor” site. There are only very specific sites where we can take tissue from due to anatomy, fat deposits, looseness of the skin and blood supply. As an oncoplastic breast surgeon the technique that I am trained to do is the latissimus doors flap. This is a flap of skin, fat and muscle from the back. It remains attached to a deep blood supply that comes into the back from vessels that branch from the deep armpit vessels. When the flap is separated from its attachments on the back it is still kept attached to the blood vessels and the flap is then rotated to the breast area by creating a tunnel from the upper back, via the arm pit to the breast site. It therefore maintains its blood supply at all points and continues to do so once it is stitched in place. If an implant is required we need to use an implant that is either totally smooth and accept a higher capsular contraction rate and accept the implant must be round, or choose a textured implant so that we can make a wider choice, but accept some patients in rare situations can get an implant related lymphoma due to the implant- we now prefer to use a microtextured or smooth implant to try to minimise these risks which are thought to be very small in the UK at around 1 in 24,000 according to data from the MHRA. he most textured implant that we used to use, the Allergan style 410 has now been withdrawn from Europe pending review of the overall risks as its CE mark came up for renewal and the regulator was not provided with the information they required. So implant choices are more important than ever now.
The Nipple Reconstruction
I prefer to create the nipple reconstruction around 6 months after the LATISSIMUS DORSI flap has settled in place. I use a local skin flap with a graft that is placed inside to add a little shape.
The Final Result
A good LATISSIMUS DORSI flap very much depends on the patient having the right amount of tissue for it shape the breast. If there is insufficient tissue the reconstruction can look smaller, or it may shrink with the process of wound healing. I can employ lipomodelling in these cases to restore the fat. Otherwise it may be best to add a silicone breast implant under the flap.
The image featured here, is the completed result of my patient on whom I carried out an immediate mastectomy and fully autologous latissimus dorsi reconstruction and later completed her nipple reconstrution. Her result has remained stable for years since the operation.
To Find Out More
Please review further details on my web site. We can arrange an appointment or can may see a breast care nurse. There are many helpful resources about breast reconstruction. If you would like to see more images of my results I have a before and after gallery on breast reconstruction my web site too.