Breast reconstruction


Welcome to Tees Plastic Surgery, one of the regions leading private clinics for breast reconstruction. Reconstructive surgery is provided on the NHS for most conditions – ask your family doctor or hospital specialist. If you choose to see us privately or if you have private health insurance you can come to the Nuffield Health Tees Hospital Stockton-on-Tees and BMI Woodlands Hospital Darlington - the regions leading private hospitals.

All your care will be provided by Consultant Plastic Surgeon Chris Dunkin and his expert team All your procedures will be performed by Mr Dunkin who has more than 15 years experience delivering high quality, high value, clinical solutions to both men and women of all ages. At Tees Plastic Surgery you can be assured you will receive the best quality of care and a level of service that is second to none.

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What is breast reconstruction? 

Every year Plastic Surgeons change the lives of women recovering from breast cancer by performing breast reconstructive surgery. The treatment of breast cancer involves surgery to remove the tumour often combined with radiotherapy and chemotherapy. Some women have the breast lump or a wider area of breast tissue removed (breast conserving surgery). Others need removal of the whole breast (mastectomy). Further treatment in the form of radiotherapy, chemotherapy and hormone treatment may be offered. Guidelines from the National Institute for Clinical Excellence (NICE) recommend that all women with breast cancer should have the opportunity to discuss breast conserving surgery and breast reconstruction. Ideally this should be with a Plastic Surgeon who specialises in breast reconstruction. Women with breast cancer are best cared for by a multidisciplinary team of specialists that includes Breast Surgeons and Oncologists, who are experts in treating breast cancer, and Plastic Surgeons who specialise in breast reconstruction. Not all women want or are suitable for breast reconstruction – your breast team will guide you.

Are there alternative to breast reconstruction? 

Some women can have their breast cancer removed and the breast remodelled, using breast reduction techniques (therapeutic mammoplasty). Not every woman is suitable for this type of treatment and you should discuss this with your Breast Surgeon and Plastic Surgeon.

Do I have to have reconstruction? 

This is all about choice. Unlike your breast cancer treatment, reconstruction is not surgery you have to undergo. This is why it is important that you see a specialist so you can discuss your options and help decide if this is something you want to undergo. All operations have potential risks and breast reconstruction is no different. It is important that you carefully weigh up the risks and the benefits to make the right decision for you.

When can I have breast reconstruction? 

This is your choice. You can have breast reconstruction at the same time as your mastectomy (immediate reconstruction) or any time afterwards (delayed reconstruction). It is usually best to have delayed reconstruction if your breast team think you are likely to have radiotherapy or chemotherapy. Again discuss this with your specialists.

If I choose reconstruction – how will you do it?  

Again this is about choice. There are a number of ways to rebuild breasts and we will go through this with you in clinic. Essentially we can your own body tissue (autologous reconstruction) or use an implant or use a combination of the two. Each technique has its advantages and disadvantages and as specialists in all aspects of reconstruction we will help you decide the best technique for you. 

Breast reconstruction with implants?   

Implant-based reconstruction uses a silicone implant placed under your skin and pectoral muscle to rebuild your breast shape. It tends to be a simple solution but the results are limited and generally not as good as autologous reconstruction. It is most suitable for slim women with small breasts who have not had radiotherapy. Young women with BRCA gene mutations often choose immediate reconstruction with implants after bilateral risk-reducing mastectomy.

One or two relatively short operations are required and these can be done as day case procedures (you go home the same day). In the first operation, an expandable implant is placed partially under the pectoralis major muscle via the mastectomy scar. Once you have healed the implant is expanded until the desired size is reached. At the second operation the expander is replaced with a permanent implant. In immediate reconstruction the definitive implant is placed at the first operation. Implants can be combined with a biological material (dermal substitute or acellular dermal matrix) to rebuild your breast. 

Your hospital stay is short after implant-only reconstruction and most women recover and return to normal activities quite quickly. In the short term the main problems with implant-based reconstruction include bleeding (haematoma), infection that may affect the implant and need removal and later replacement, wound healing problems and implant exposure. If we use dermal substitute then we often see persistent fluid drainage (seroma), redness of your breast (red breast syndrome), problems with healing and we may need to remove the device and/or your implant.

In the medium to long term we see poor breast shape, asymmetry, visible or palpable implants, scarring around the implant (capsular contracture) that can be painful and you are likely to need further surgery in the future to exchange the implant and deal with the capsular contracture. It can be difficult to match your normal breast with this type of reconstruction and we don't recommend this strategy if you have had or are likely to need radiotherapy.

Breast reconstruction using your own body tissue (autologous breast reconstruction)?    

There is lots of research to show that your own tissue makes the best breast (autologous reconstruction). In this type of procedure we transfer ‘spare’ skin, fat and perhaps muscle to make your new breast. The most common areas we ‘borrow’ from are your back (latissimus dorsi or LD flap), your tummy (transverse rectus abdominis myocutaneous or TRAM flap and deep inferior epigastric artery perforator or DIEP flap), your buttocks (superior and inferior gluteal artery perforator or SGAP and IGAP flaps) and you inner thigh (transverse upper gracilis or TUG flap and profinda artery perforator or PAP flap). The LD flap is a pedicled flaps – it is passed from your back to your breast keeping its blood supply intact. The other flaps listed are transplanted to your chest and their blood vessels joined in your chest to make your new breast (free flap or microsurgical reconstruction).

Latissimus dorsi breast reconstruction?     

The latissimus dorsi (LD) flap can reproduce a lovely breast in the right woman. We can produce a moderate sized breast (B-C cup) using the LD flap alone. If you need a bit more volume then we use an implant too or we use fat transfer later on to add more volume to the new breast. This is a bigger operation than implant only reconstruction. 

The skin and muscle from the back replace skin and breast tissue removed at mastectomy. If an implant is used then this provides more volume and breast shape. It takes about three hours and requires a couple of nights in hospital. The LD flap is usually very reliable but occasionally problems are seen with partial and total flap loss. The scar on your back usually settles well but occasionally stretches. If an expander or implant is used then this can suffer the same problems described above. Further operations may be required in the medium to long term because of the implant.

Free flap breast reconstruction? 

This type of breast reconstruction is the ‘gold standard’, which means that in studies of thousands of women after breast reconstruction, this method produces the most natural looking and feeling breast in the long term. But it may take a few procedures to achieve the final result. 

The most common technique uses skin and fat from the lower tummy (TRAM flap), which is very like the skin and fat of your breast. This is transferred and its blood supply reattached to small blood vessels in your chest. The lower tummy is closed giving the same result as a ‘tummy tuck’ (abdominoplasty). The operation takes about 5-7 hours and you stay in hospital for about 4-5 days. This operation is no small undertaking and is not suitable for every woman. Occasionally the blood vessels become blocked and the breast reconstruction is unsuccessful (about 1:50 risk). In the lower tummy, most patients are delighted with the ‘tummy tuck’ result, although slow healing and poor scars are occasionally seen.

How many operations will I need?

Once your new breast has settled down, further small operations are sometimes needed to improve the shape of you new breast, such as lipofilling or fat transfer. Studies show that on average it takes 3-4 procedures to complete breast reconstruction.

Can you make me a new nipple?  

Your breast reconstruction is completed by reconstructing a nipple and tattooing the areola (the pink part around the nipple). Nipple reconstruction is a small procedure done with you awake as a day case. Tattooing the pink/brown part is done afterwards to complete the result. Some women choose just to have tattooing. 

What about my other breast?   

Women often ask us to improve the size and shape of their other breast to match their new one. This may involve making the other breast smaller (breast reduction), less ‘droopy’ (uplift or mastopexy) or larger (breast augmentation). We often combine this with the further small procedures described above to minimise the number of operations you need. Not all women choose to have a nipple reconstruction, areolar tattooing or surgery to the other breast – this is for you to choose.

Can I have both sides done (bilateral breast reconstruction)?   

Some women need both breasts removed (bilateral mastectomy) such as with a cancer on both sides or if they have the BRCA gene mutation (like Angelina Jolie – link to Mail online article). In this case you can request bilateral reconstruction. We use the same techniques. It just takes a little longer for us to do and takes you a little longer to settle down. 

Can I get more information on breast reconstruction

More useful information is available on the following websites:

British Association for Plastic Reconstructive and Aesthetic Surgeons (BAPRAS)

Breast Cancer Care website

Paying for treatment

Tees Plastic Surgery offers Consultant-delivered state-of-the-art reconstructive and cosmetic surgery procedures at the Nuffield Health Tees Hospital Stockton-on-Tees and BMI Woodlands Hospital Darlington. Health insurance will cover most reconstructive surgery or you can pay for yourself. Please contact your insurance company to discuss this before you make an appointment. 

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What do I do now?

Our clinic is based at the Nuffield Health Tees Hospital Stockton-on-Tees and BMI Woodlands Hospital Darlington.

Please contact us on 0844 272 5951 for a consultation
or click on the link below to email us.

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