BREAST CANCER RECONSTRUCTION
Before breast cancer removal it is important to discuss all your options with both your cancer surgeon and a reconstructive surgeon. Every woman will have different needs and different wishes and together we should be able to help you achieve the best possible therapeutic and aesthetic outcome.
If you require a lumpectomy or partial mastectomy, reconstructive techniques can help to ensure that the tumour is removed safely without misshaping the breast.
These so called 'oncoplastic' excisions utilise simple reconstructive techniques learned from breast reduction and uplift operations. Ask your cancer surgeon if he offers this technique, or if he recommends that you speak to a plastic and reconstructive surgeon.
If you require a total mastectomy, it is a good idea to involve a reconstructive surgeon as early as possible, to guide you through the options best suited to your needs. Good cancer surgeons work closely with their plastic and reconstructive surgical colleagues.
The main options for post mastectomy reconstructions are:
Breast implants can be placed under the chest muscles.
Breast implants can be used together with muscle tissue from the
back if extra skin is required.
Free tissue can be be transferred from the abdomen (this is
known as a DIEP or TRAM flap).
During the consultation there are many factors to consider with each type of reconstruction. The surgeon will guide you through this challenging time with advice on which type of reconstructive operation would best suit your needs.
2-5 NIGHT STAY
RECOVERY 6 WEEKS
Longer for TRAM flap
COMPLEX WOUND RECONSTRUCTION
Wounds may fail to heal for a variety of reasons, depending on a complex interaction between the patients' ability to heal and local factors at the wound site (such as infection, presence of dead tissue or problems with blood supply). Smokers will often have wound healing difficulties.
Newer techniques in wound management allow wounds to be closed more rapidly by improving the healing environment at the wound site. These techniques include vacuum therapy dressings, and newer Versa jet hydro-surgery debridement (which removes damaged tissues) and the insertion of artificial dermal (skin) substitutes. Occasionally a skin graft will be required.
Many of these procedures can be carried out as an out patient or day case.
Many patients seek the advice of plastic surgeons if they are concerned about the appearance of scars, or if contracted scar tissue is in some way causing impaired function or movement.
Simple techniques pioneered by plastic surgeons allow scars to be made less noticeable, for example by hiding them in natural skin folds. Contracted scars can also be lengthened to relieve discomfort.
Poor scars frequently occur as a result of poorly stitched wounds, delayed wound healing or infection, although some patients have a natural tendency to 'over heal' resulting in hypertrophic (pink and lumpy) scars. Patients with darker skin may have a genetic predisposition to keloid (raised and itchy) scars, which may need recurrent treatment.
After all procedures, I tend to close wounds in 3 layers using z-plasty techniques which minimise the impact of scarring. Wherever possible, wounds will also be hidden in natural skin creases. If surgery is necessary at sites where poor scarring is expected (shoulder, jaw, chest and back) patients will be pre-warned and closely followed up so that any hypertrophic scarring can be treated early with silicone.
RECOVERY 2-3 WEEKS
SKIN CANCER AND RECONSTRUCTION
All skin cancers are on the increase in the UK. This is in part because of our ageing population but also the continuing lack of awareness of the damage caused by sun exposure, especially burning. Early detection and an urgent biopsy are required to diagnose and treat skin cancers.
Most skin cancers can be removed under local anaesthetic. Some larger or more aggressive tumours may require extensive excision and reconstruction using local tissues, but can also normally be performed without the need for a general anaesthetic.
I work closely with dermatology colleagues and the country's premier skin pathologists based at the St John's Institute. I offer a same day service if patients require immediate excision, although all tissues are then sent for histology testing to confirm whether cancerous tissues are present. Waiting for definitive histology is a tense time for patients, but I hope to have results available within 1 week.
RECOVERY 2-4 WEEKS
Most plastic and reconstructive surgery should be covered by your medical insurer and most policies
will include hospital fees, the initial surgical consultation and follow up fees. Individual policies will vary,
but cosmetic procedures will not normally be covered.
I am registered with all of the leading insurance companies, including BUPA, Norwich Union, AXA, and PPP.
THE 3 MAIN AIMS OF SURGERY
Restore function to normal
Restore appearance to normal
Replace like for like tissue wherever possible
EXAMPLES OF COMMON RECONSTRUCTIVE SURGERY
Skin Cancer excision and reconstruction often using skin
graft or local flaps of tissue.
Breast cancer reconstruction, often using muscle flaps
Reconstruction of open wounds and ulcers, often using
skin grafts or vacuum dressings.
Facial deformity reconstruction, often involving all the
Hand and wrist surgery, again involving many techniques.
ARRANGE YOUR CONSULTATION
GENERAL AFTER CARE
Analgesia (pain relief) - Ibuprofen and paracetamol can be taken
Complete rest will be necessary for 48 hours
Daily tepid showers will be possible after 48 hours
Surgical skin tapes should be left in place for 2 weeks
The hospital or surgeon should be contacted if you develop a temperature
The hospital or surgeon should also be contacted immediately in rare cases of bleeding or
Patients should take care not to over exert themselves in the first few weeks and to keep
pressure off the wounds
Wounds will be checked and sutures removed normally at 1 week
I will see you routinely at 1, 2 and 6 weeks after surgery
Dressing care nurses may see you more often
Swelling reduces after a few weeks
Rehabilitation will be started as soon as possible
PLASTIC & RECONSTRUCTIVE SURGERY
Mr Matthew James
MB ChB, FRCS(eng), FRCS (plastics) BAAPS BSSH
DISCUSS A CONSULTATION
HERE TO HELP
BMI HOSPITAL BLACKHEATH
Independents Road, London SE3 9LG
ST THOMAS' HOSPITAL NHS
Westminster Bridge Road, London SE1 7EH
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DESIGN & BUILD