After successfully performing more than 1000 breast reconstructions using the patients’ own tissue, Mr Ramakrishnan continues to set a very high standard and success rate for breast reconstruction in the UK. As the demand and options for reconstructive surgery grow, your decision of which surgeon or which procedure to choose should be an informed and considered one. It is very important to find out about your choices, and which option is best for you.
One of the primary aims of this website is to give you an insight into what you can expect at each step, from your first consultation to being discharged.
The prospect of reconstructive breast surgery can be an incredibly difficult time, not only physically, but also emotionally. This website will provide a comprehensive resource for the patients considering breast reconstruction, with advanced techniques in this field explained
The primary aim of surgery is to remove the cancer from the affected breast and treat any affected lymph glands.
The cancer can be removed as a lump (called a lumpectomy) with a margin of normal tissue around it (called wide local excision). This leaves the majority of the breast untouched (breast conserving surgery). The alternative to this is to remove the whole breast (mastectomy).
A mastectomy or a wide local excision is advised dependant upon the type of cancer, size and evidence of other cancer cells elsewhere in the breast. With both options about four lymph glands from the armpit (and sometimes from behind the ribs) are usually removed at the time of the cancer excision (axillary node sampling).The nodes are checked for any cancer spread. If there is known cancer in the lymph glands then all the lymph glands are removed (axillary node clearance).
If a mastectomy is performed the only reconstructive options are total breast reconstruction. Venkat Ramakrishnan is a leading surgeon in breast reconstruction techniques.
A Mastectomy is removal of the breast. It is impossible to remove all breast tissue but as much as possible is taken. At the same time it is usual to remove some glands in the armpit. This is standard practice for all patients to ascertain whether or not cancer cells are present in these glands.
The breast is removed with most of the overlying skin. It is then closed leaving a straight scar on the chest. This is the most commonly performed operation. Breast reconstruction will or can be carried out at a later date (Delayed Reconstruction).
Skin- Sparing Mastectomy
In skin-sparing mastectomy the main difference is the amount of skin left behind. EMIR or CAMIR mastectomies are carried out when immediate reconstruction is planned.
EMIR (Envelope mastectomy with Immediate Reconstruction) is when a neat, single cut is made at the underarm side of the breast and the breast tissue removed leaving the breast skin and the nipple. The breast is then reconstructed.
CAMIR (Circum-areolar mastectomy with Immediate Reconstruction) is when the nipple is removed and the breast tissue taken away using that opening. The breast and the nipple is then reconstructed.
Removal of the nipple is thought to be preferable as this contains breast tissue. However there is now some evidence emerging to suggest that recurrence of breast cancer is no higher than when the nipple is removed, and in a selected group of patients the breast surgeon may decide to leave the nipple behind.
Before any major surgery an Anaesthetic assessment is carried out by an Anaesthetist. This is usually done a couple of weeks before surgery. The doctor will your take medical history and ask some general health questions. This helps to ascertain if you are fit for a lengthy procedure. You are assessed as low, medium or high risk from the anaesthetic point of view and this enables the Anaesthetist to take any necessary steps ensure your safety during surgery.
Some of the issues the Anaesthetist will be interested in are outlined below.
Are you fit?
Fit and slender patients tend to have fewer problems with anaesthetic, surgery, blood pressure, bleeding issues, coughing and chest infections. They are generally quicker at becoming mobile after surgery. This reduces the risk of Deep Vein Thrombosis (DVT). It is important that conditions such as high blood pressure, diabetes, asthma etc are well controlled prior to surgery.
Do you take non prescribed tablets or herbal remedies?
Patients are generally asked if they could stop taking any supplements, herbal remedies, homeopathic medication or complementary medicine not prescribed by a G.P. The reasoning behind this is that many of these remedies and tablets can cause excessive bleeding during surgery. Ideally this should be done at least 3 weeks before surgery but obviously if the operation is scheduled quickly then as soon as the patient can.
Do you smoke?
It is also advisable to stop smoking. Smoking causes the blood to carry less oxygen. This can prevent wounds healing, increases the risk of infection and can even cause tissue to die (necrosis) which for breast reconstruction using your own tissue would be disastrous. You should try to stop smoking for a minimum of six weeks, but ideally if time permits 3-4 months. Patches should be avoided as they are problematic for surgery.
Deep Vein Thrombosis (DVT) and Pulmonary Embolus (PE)
The formation of blood clots in the deep veins of the legs that travel to the lungs can be fatal. Death from Pulmonary Embolus is very rare. Precautions are always taken. The use of compression socks during surgery is common and some patients will receive blood thinning injections. Those at higher risk are patients who are overweight and/ or smoke.
The Anaesthetist along with surgeon will decide which pre- admission tests and blood tests need to be carried out.