With some breast reconstructions further surgical procedures may be required. This can be for several reasons.
To complete the aesthetics of the reconstructed breast.
To obtain symmetry with the remaining breast
The procedures are secondary to the main reconstructive surgery. As with all surgery there are pros and cons, and as a secondary operation it would be up to the patient to decide if they wish to have this done. All are to obtain the best possible outcome aesthetically between the reconstructed and the remaining breast.
This procedure usually takes place about 3 months after the original surgery. It is a relatively straight forward procedure performed as a day case under a local anaesthetic as there is no sensation in the reconstructed breast.
The reconstruction can take place at the same time as the breast reconstruction but this is quite unusual.
As a delayed procedure the positioning of the nipple is more accurate in relation to the opposite side as the reconstructed breast has had a chance to settle.
Not all patients elect to have this done. It is a matter of personal choice, however it does add realism to the breast and helps obtain symmetry especially if the opposite nipple is obvious through clothing.
It has to be said that the reconstructed nipple is likely to flatten over time.
There are several methods of reconstruction. The method of choice for Mr Ramakrishnan is a ‘star flap’ used as a twin flap method.
This procedure is simple and only requires an out patient appointment and takes about 30 minutes.
A coloured, semi permanent pigment is applied to the skin of the breast mound using a small needle. The nipple is covered with a small dressing for 48 hours and kept dry. After the dressing is removed you are able to shower or bath as normal. Over time the colour will fade, but can be repeated.
Before and After
Both of these procedures involve fat transfer by either removing it from the breast or introducing it into the breast to help contour the breast and obtain symmetry with the opposite side.
Liposuction is when the fat is broken up with a long hollow tube called a cannula (tube), and the fat is suctioned out. This reduces contour excesses.
Lipofilling or autologous fat (auto fat). This is a two step procedure. The fat is harvested through a liposuction cannula (tube) from the abdomen or hips and once extracted is aspirated and centrifuged to remove damaged fat cells prior to injection. Once treated the fat cells are then injected with a small syringe (after the area has been numbed) into the contour defects.
Before and After
When surgery is undertaken to the opposite breast it is almost always to reduce the remaining breast in order to achieve symmetry with the reconstructed one. This is particularly beneficial to a large breasted patient following a mastectomy.
Less often a breast is enlarged by using an implant. This can be useful in a small breasted patient who has an implant reconstruction and enables the women to have larger breasts if she feels this would be of benefit.
A Mastopexy procedure is carried out to uplift the remaining breast. This can be effective if the remaining breast is droopy. However this is not a permanent remedy as gravity and the passing years will eventually mean the breast will naturally drop down again.
The main disadvantages with surgery to the opposite side are possible complications as with any surgical procedure and scarring on the remaining breast.