Are You Looking For Breast Reconstruction in Leeds?

It is a sobering thought that around 1in 8 women will get breast cancer. Whilst breast conserving surgery is suitable for many, in others a mastectomy is advised or even preferred. When a mastectomy is performed there are a number of choices that can be made. The first is to remain flat, and to simply wear an external prosthesis in the cup of the bra. The second is to consider an immediate breast reconstruction. And finally the third is to consider a delayed breast reconstruction.

What Is Involved With Breast Reconstruction?

Breast reconstruction is major surgery. It is not always advised that the breast is reconstructed at the same time as a mastectomy for invasive breast cancer, especially if there is a chance that radiotherapy treatment will be required after surgery. This is because the radiotherapy can affect the breast reconstruction permanently. If we know in advance that radiotherapy is unlikely to be required, then an immediate reconstruction can be considered. This means the breast is removed (the mastectomy) and under the same anaesthetic the surgeon will perform the breast reconstruction. It is usually the case that a number of operations are required to complete the reconstruction, and this should therefore be regarded as a series of operations to complete the job. Some of these operations are done months later, and may involve procedures with implants, with fat transfer, further reshaping, the nipple reconstruction, tattooing for the areola, and surgery to the other breast is quite common to try to improve the match to the reconstructed side. Your own medical situation and factors assessed at examination must be taking into account

What we recommend for surgery will depend on several factors such as:

–     Are we reconstructing one or two breasts?
–    What options due to have to use your own body tissues e.g. how much lower abdominal fat do you have?
–    What is your tissue like on your back where we might take a tissue flap from and would this work?

–    Do you have hobbies that would be adversely affected by breast reconstruction? Swimming, rock climbing, horse riding or other competitive sports?
–    The degree of acceptance for the need for additional operations?
–    Can you allow the recovery time needed and the visits to clinics, and further surgery?

What Are The General Options?

Breast reconstruction at the same time as mastectomy can be performed with silicone breast implants alone, with tissue flaps alone or with a combination of the two. The approach used depends initially on what options you have for using your own tissue. If you are very slim, you may not have options that another women does have, and you may only have the option of an implant being used. Have a look at Mr Turton’s Breast Reconstruction Image Gallery with results using a few different approaches that he is skilled in. Please note that Mr Turton does not carry out the DIEP flap, but has excellent colleagues in Leeds that he works with who do this type of reconstruction. Please ask if you would like to be referred for that procedure.

When we carry out immediate reconstruction, we are removing the breast tissue that is under the breast skin, but usually trying to spare the removal of the breast skin itself to as great an extentt as is possible. Sometimes it might even be possible to spare the nipple, so that no breast or nipple skin is removed at all. When the nipple needs to be removed, it is generally because the cancer is too close to it, of that it needs to be removed as part of the technique involved or because of a disadvantaged starting breast shape.

The Implant -ADM breast reconstruction

This is the commonest type of breast reconstruction in the UK. In this situation a breast implant is usually placed. These implants are the same as the ones we use in cosmetic breast enlargement. Behind the breast is a muscle called the Pectorals Major. By lifting this muscle from its attachments to your ribs a space can be created behind the muscle where the silicone breast implant can be positioned. The muscle is not long enough to cover the whole implant. However, it will cover the top half of the implant when it is pulled down, giving a nice smooth transition from the upper chest skin to the thin breast skin covering the muscle and implant. However, to cover the lower half of the implant too, an artificial product called an ADM is stitched to the muscle to lengthen it. The bottom of the ADM is then stitched to the edges of the chest wall to close off the implant and fix it in place. ADM stands for Acellular Dermal Matrix. It is usually derived from pig (porcine ADM) or cow (bovine ADM) skin which has been derived specifically for use in soft tissue reconstruction. Mr Turton has been using this for over 10 years. The ADM is pre-treated in a special way that removes the animal cells and leave just the collagen material. It is a thin product that is white in colour and packaged in ultra-sterile packaging ready for use. The surgeon cuts it to the correct shape for your implant during the operation. Once the Implant and ADM are in place, the skin of the breast is closed over the top. Usually there is some gradual ingrowth of your body’s own tissue into the ADM in the months that follow surgery so that it becomes incorporated as part of you. The failure rate is about 2%. Implants require long term maintenance and do not last forever. With time some patients get capsular contraction which is the scar tightening around the implant. Around 10% of implants rupture within the first 10-years, but is often not detected (silent). A small number of patients get other problems like are not well defined but might be attributed to the implants. There is a rare risk of lymphoma occurring in the scar tissue around the implants (breast implant associated lymphoma) although it is usually treatable if caught early, but you should ask your surgeon about this.



The Latissimus Dorsi Flap (“LD Flap”)

Although Implants can sometimes be used on their own, there are occasions where additional skin and soft tissue cover is required over them. This might be a deliberate choice i.e. the patient deliberately selects this technique for personal preference, or it might be recommended by your surgeon as the preferable approach. It can sometimes be used where one technique using just implants has failed and so the LD flap becomes the backup procedure. The technique is a more major operation than the Implant-ADm method as it involves harvesting some of your own muscle the skin of your back, which is dissected from its attachments. We then create a space under the skin of the armpit and move the the latissimus dorsi muscle (completely separated now from your back and only attached to your body by its main blood supply, which has not been cut. These vessels enters the flap as major branches from big vessels in the armpit. These vessels run with the tendon of this muscle into the body of the muscle, and therefore keep it alive). The flap is therefore taken around to the front of the chest wall with it’s segment of overlying skin. Often patients are too slim for the LATISSIMUS DORSI flap to provide enough bulk to fully substitute your breast and therefore a breast implant is also placed underneath it. Healing takes a little longer and although the back feels numb and tight, most patients eventually find there are minimal overall functional problems. There are smaller muscles around the shoulder that provide a similar role to this muscle. The overall failure rate is about 0.3%. Sometimes some of the fat goes hard (fat necrosis).