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Procedure

The goal of breast reconstruction is to restore one or both breasts to near normal shape, appearance, symmetry and size following mastectomy, lumpectomy or congenital deformities.

Due to significant evolution in breast reconstructive technique over the past decade, it is now possible to reconstruct the breast to look almost exactly like its natural equivalent, either by using implants or tissue grafting.

Whilst subtle differences in contour, volume and sensation may exist in comparison with the prior breast, the new shape will be aesthetically appealing and attractive and will convincingly mimic the natural shape and appearance.

Outcomes studies repeatedly demonstrate the significant improvement in how patients feel about themselves and their restored shape following the procedure, and the psychological benefits are as such clearly proven.

What is breast reconstruction?

Breast reconstruction can be performed either immediately at the time of the mastectomy or on delayed basis after all related treatments have been completed.

The decision is typically based on several factors – some related to cancer itself and others relating to the nature and rate of progress of the treatments associated with it. Procedures timed at either point can deliver highly impactful results.

There are several different types of technique employed for breast reconstruction:

  • Breast reconstruction with implants – this is only possible if the mastectomy or radiation therapy have left sufficient tissue on the chest wall to cover and support a breast implant. For patients with insufficient tissue on the chest wall
  • Breast reconstruction with flap – this is preferred among those who don't want implants or do not have sufficient breast tissue to support an implant. This method relies on natural (‘autologous’) donor tissue delivered to the treatment site via a flap technique. The most common method of tissue reconstruction uses lower abdominal skin and fat to create a breast shape, typically harvested from the ‘pinchable’ area between your belly button to the pubic bone. The thigh and buttock areas are also commonly employed as a donor flap sites, dependent on candidate suitability 

Breast reconstruction is most commonly performed by plastic surgeons and at a facility or hospital such as the Cadogan Clinic that is inspected at regular intervals by the Care Quality Commission (CQC), to ensure patient safety and best practices, by plastic surgeons who are on the specialist General Medical Council register for plastic surgery.

Why do people have breast reconstruction?

Breast reconstruction is a safe and highly effective surgical procedure to enhance the contours and shape of the breast following mastectomy or lumpectomy, or if the breast shape suffers from a congenital deformity.

The breast shape and volume are restored to a more natural appearance and proportion, delivering significant aesthetic and psychological improvements to the patient.

Who is suitable for breast reconstruction?

You may be a suitable candidate for breast reconstruction surgery if:

  • You are in good psychological and physical medical health
  • You are able to cope well with your diagnosis and treatment 
  • You have a positive outlook and realistic goals for restoring your breast and body image 
  • You do not have additional medical conditions or other illnesses that may impair healing 
  • You are aware that results are highly variable and that the reconstructed breast may not have the same exact sensation, feel or appearance as the breast it replaces
  • Visible incision lines will be present on the breast, whether from reconstruction or mastectomy

What to expect

CONSULTATION 

The first step for all of our breast reconstruction patients is to meet with the surgeon we feel is best placed to perform your procedure for a consultation. At the consultation you will be able to discuss with your surgeon what your hope to achieve from the procedure, as well as discuss in detail what may or may not be possible given your existing anatomy.

Your surgeon will take you through the options available to you, and which is the most preferential for you given your stated ambitions. Having established this, several key measurements will be made and standard clinical photography will be taken.

One of the key considerations at consultation for breast reconstruction relates to which technique is to be employed – implants or flap technique – and if the latter is preferred, whether an abdominal, thigh or gluteal donor site is to be chosen. Your surgeon will talk you through this in detail.

Finally a comprehensive discussion regarding risks and complications will take place, alongside a discussion regarding what to expect in the post procedure and recovery phase. Your previous medical history will also be recorded (including previous surgery, medications, allergies etc.) and an assessment of your fitness for surgery.

If your surgeon feels you are a good candidate for surgery, you are then invited to consider whether you would like to proceed for surgery or otherwise following a two week 'cooling off' period.

Within this period you are welcome to come in and discuss your potential surgery with your surgeon as many times as you like.

PRE – PROCEDURE

If you choose to proceed with surgery, the next time you come into the Clinic after your final consultation will be the day of your procedure. Before admission the following behavioural changes are recommended / required:

  • In the 6 weeks before your procedure we recommend smoking is discontinued as patients who smoke have a higher risk of healing more slowly and complications (see FAQs)
  • In the week before your procedure you must cease taking Aspirin or any medication that contains Aspirin
  • In the 6 hours prior to surgery you must not consume food or any drink, other than small sips of clear fluid (e.g. still water, black coffee, black tea) which are allowed up to 2 hours before admission

DAY OF THE PROCEDURE

On the day of your procedure we ask that you arrive for your admission an hour before the agreed start time of surgery. At this point a nurse will come and record blood pressure and other relevant vitals, you will meet with your anaesthetist and your surgeon who will make the final mark-ups.

The procedure itself takes place undergeneral anaesthetic over the course of two to three hours, with the exact process determined by the procedure type chosen – implant or flap – and if the latter, there are various different techniques dependent on where exactly the flap is to be sourced.

POST PROCEDURE & RECOVERY

You should not feel much pain during the procedure, but you may have some for a few days or weeks afterwards. You'll be given painkillers if you need them.

Following the procedure, you will recover in our ambulatory recovery rooms for between two to three hours, dependent on the scale of the procedure. Once our specialist nursing team are happy that your initial recovery is complete and you are safe to return home, you will be allowed to leave the Clinic accompanied by a friend or member of your family.

Once home you will have access to our dedicated on-call nursing team 24 hours a day, 7 days a week. This team of specialists are dedicated to your comfort and pain control, and are there to field any questions you may have in the immediate post operative phase.

We ask that you come in and see our nursing team 1 week after surgery to ensure your incision sites have been properly reviewed. At this juncture we also recommend you meet with one of our on site aestheticians to discuss ongoing treatment to support the healing and scarring process.

We ask that you come in to see your surgeon after 6 - 8 weeks for a final check up.

Why come to the Cadogan Clinic for your breast reconstruction?

  • Cadogan Clinic is an award winning specialist cosmetic clinic, with a track record of delivering safe, high quality cosmetic surgery  
  • Cadogan Clinic specialises in breast surgery and the latest surgical breast techniques. We have a roster of top breast specialists on our team
  • Unlike many of our competitors, we use the latest anaesthetic technologies to minimise your downtime, and allow you to return home on the day of your procedure 
  • Our nursing team provide a dedicated 24/7 oncall service during recovery – whatever your question, we can provide the answer 
  • We offer a complimentary consultation and treatment with our onsite team of aestheticians to ensure you heal quickly and scar well

What are the side effects and risks

Breast Reconstruction is a safe procedure, but it is common after all surgery to experience:

  • bruising and swelling
  • temporary numbness
  • a small amount of scarring 

As with all surgical procedures, breast reconstruction carries some risk and it is possible that you might experience:

  • Nausea 
  • Bleeding or Infection 
  • Poor healing of incisions and scarring
  • A collection of blood underneath the skin (haematoma)
  • Flap surgery includes the risk of partial or complete loss of the flap and a loss of sensation at both the donor and reconstruction site.
  • Implants carry the risk of breast firmness (capsular contracture) and implant rupture

Your surgeon will discuss these risks comprehensively at your consultation and explain how likely these risks and complications are, and how they would be treated.

Frequently Asked Questions

Your consultation is designed to be perfect opportunity to ask all the pressing questions that you have to your consultant, ahead of making a decision on surgery. It is vital that you are fully informed before making your final decision, and the consultation is therefore a key part of the education and decision making process.

Some good examples of questions to ask, include:

+ Am I a good candidate for this procedure?
+ Which technique would you recommend given my existing anatomy?
+ Do you think my goals are realistic given my existing anatomy?
+ Will I require a single surgery or multiple surgeries?
+ Can I see some before & after pictures of breast reconstruction procedures you have done previously?
+ How long will my recovery take?
+ Is it true that Cadogan offers 24/7 on call nursing service?
+ What can I expect in terms of bruising, swelling and scarring?
+ What are my options if I am unhappy with my results?

After your surgery, you will be asked to come in for a post-operative appointment to come back and see our nursing staff at the Clinic between 1 and 2 weeks after your surgery. At this point your incision sites will be reviewed, and your preliminary healing will be assessed.

After 6 weeks your surgeon will personally review your progress – again at the Clinic - and make sure you are recovering as expected. In addition, they will remove any stitches and advise you on the need for further dressings.

Throughout the recovery period you will have full access to our 24/7 on call nursing service, and full access to the Clinic and our post-operative facilities.

Our aim is to make you feel as comfortable as possible during the entirety of your recovery period.

As your anaesthetic or sedation wear off you will wake up in our recovery facilities at the Clinic. You may feel a little drowsy but this often wears off within a few hours. After several hours in recovery, you will eat and hydrate. At that point, you will be allowed to leave the Clinic by our nursing staff.

It is common to feel a little pain and discomfort in the immediate aftermath of surgery. This will wear off in due course. Our 24/7 on call service is open to all patients for any question or query they may have at this time.

You will not be able to drive yourself home after the surgery. You should arrange for someone to pick you up and take you home. In addition, you will need to ask someone to stay with you for the first 24 hours after your procedure.

Final results are typically first seen six or so weeks after your procedure, with ongoing improvements beyond this point likely as the healing process fully completes over the coming 12 to 18 months.

Your surgeon will be able to give you specific guidance at your consultation.

Certain lifestyle factors can increase the risk of complications during and after your surgery. These include smoking, drinking alcohol, being overweight and taking drugs (for medical or recreational use.)

The most common impact of smoking before your surgery is that it increases your chances of developing an infection and inhibits your body's natural healing processes. We insist that all patients stop smoking and using nicotine products at least six weeks before surgery. Reducing alcohol intake is also strongly advised.

Your doctor will discuss your current BMI and drug use at your consultation and advise you further on this.

Women who have had a mastectomy to treat breast cancer generally do not need routine screening mammograms on the side that was affected by cancer, although they will need to regularly on the other breast.

Whilst it is possible for women with reconstructed breasts to get mammograms, cancer is more likely to come back in the skin or chest wall, and is therefore more likely to be found on a physical exam.

If you have a breast implant and you need a mammogram, it is very important to find a facility where they have expertise and experience of performing mammograms on patients with breast implants. This is because images can sometimes be impaired by implants, and the implant will need to be carefully positioned to get the best images of the breast.

Having a breast reconstruction or not is a highly personal decision. It is important to understand that it is your choice, and your choice alone.

Some women choose not to have their breast reconstructed at all and feel that a flat chest is a better acknowledgement and expression of their post- breast cancer personality. Others are happy to simply wear a prosthetic breast in their bra rather than have to undergo more surgery, although some women find it restricts their choice of clothing.

Talking to other women who have undergone treatment is an important step to understanding what the right path is for you. Likewise your friends, family and the health professionals looking after you can help you come to the right decision for you.
The good news is that if you choose not to have a reconstruction initially, you can still consider a delayed reconstruction at a later date if you change your mind. Excellent results will still be possible for you at this later date.

ENQUIRE NOW

To enquire about a consultation with a Breast Reconstruction specialist, please complete the form below.

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