Like a Virgin “ Conical Breast Implants

11 January 2015/0 Comments/in Breast Plastic Surgery /by admin@staiano

Conical Implants “ for patients who are borderline for a breast lift.

During my consultations, I have a selection of breast implants to show patients. The conical implants always invite comment, usually along the lines of ooh, I don’t think I would like those or are those the Madonna implants?

However, the truth about these implants is very different. Conical implants are particularly good in patients who are borderline for a breast lift but do not want a large round implant, which might otherwise be necessary to ‘take up the slack’.

Breast Lift or Implants?

The main reason for patients requiring a breast lift (also known as mastopexy) is either following weight loss or after having children. Both of these things causes the breasts to get larger, whichstretches the skin and then smaller, however, the skin does not recoil back leaving extra redundant skin and causing the breast to droop. The best way to treat this is to remove this redundant skin and tighten the skin envelope, which is what is involved in a breast lift. However, many patients do not want the scarring and potential complications that come with a breast lift and would prefer to have implants. Furthermore, a breast lift in itself will not make the breasts bigger, and so a breast lift with implants may be required and this operation is challenging with an increased rate of potential complications.

Can I Avoid a Breast Lift?

Nobody wants a breast lift if they can avoid it. If you could have an operation with fewer complications and less scarring, then obviously that would be better. However, like most things in life, it is not always that simple! A breast lift is the most effective way to improve the shape of the breasts and some patients need a breast lift. There are three groups of patients:

Patients who need a breast lift

this group of patients need a breast lift and whether or not they have implants is a matter of choice, depending on whether they want the cup size to be bigger, but the lift is necessary. If this group of patients have breast implants without a lift, there is a risk of an elongated appearance to the breast where the implant is sitting in the right place but the breast is sitting low and ‘falling off’ the implant. This is sometimes referred to as a ‘Snoopy deformity’.

Patients who are borderline for a breast lift

this group of patients would benefit from a breast lift, which would give a better shape to their breasts, but it is not essential. It is this group of patients who may benefit from conical implants. Conical implants have allowed me to increase the number of patients who are in this group and I have seen a number of patients who have been seen by other surgeons and recommended to have a breast lift, but they did not want this. Many surgeons do not use polyurethane implants and so they do not have the option of using conical implants. Conical implants open up this option in patients who would otherwise need a lift.

Patients who do not need a breast lift

this group of patients may feel like they have lost volume in their breasts and want more fullness, but they do not need a lift and the fullness can be achieved with implants.
It is only after clinical examination that you will know which group you are in, so if you would like to come along to the clinic for an examination and to look at some before and after photographs of what is achievable with conical implants, then click hereto book a free consultation, or call us on 0121-454 3680.

Breasts after breastfeeding

21 July 2014/0 Comments/in Breast Plastic Surgery /by admin@staiano

Breastfeeding often accompanied with the strapline “the most natural thing in the world” has been proven to be the best option for your child’s health and development. This much we all know. But what happens when the breastfeeding stops? For better or worse “ many women agree that after the milk stops, their breasts change in both shape and size, and for some this can affect their self esteem and body confidence.

It’s the most natural thing in the world

Fluctuations in the shape and size of a woman’s breasts will be common throughout her lifetime. Puberty, weight loss or gain and the ageing process can alter both the volume and shape of a woman’s breasts. Pregnancy and breastfeeding are arguably the biggest game changers however bringing both positive and negative effects. No two women are the same and every woman’s journey and experience is different.

The most important thing to remember is that changes in your breasts are very normal and natural.
One of the most common experiences after breastfeeding is ptosis – which is the medical term for the drooping or sagging of the breasts. Breasts fill with milk throughout pregnancy and breastfeeding, and the skin stretches accordingly. When the breastfeeding stops, the milk disappears but the skin does not recoil. In other words, breasts do not always go back to their original shape or size.

Gravity also forces the breasts to droop and this can leave some women feeling frustrated about how their breasts have changed.

Options

Some fitness experts or Doctors will advise to do special exercises, which can help build up muscle again.

This can be a successful option for some. However, many women feel that plastic surgery is the best option for them. If you are thinking about plastic surgery to restore or enhance your breasts after breastfeeding, there are a number of areas to think about carefully. First of all, we recommend that you only consider surgery at least a year after your baby is born and when you have finished breastfeeding.

If you decide to have either a breast augmentation or a breast lift, both are significant operations and you will need time to recover. Lifting and carrying a baby might prove difficult in the initial stages of recovery, so we suggest waiting at least until your child starts walking. In addition, this gives time for your hormones to settle after giving birth, which can take up to a year. In an ideal situation, it’s best to have surgery when you have finished your family completely. This lessens the likelihood of repeat operations on your breasts as they are unlikely to change as much again.

Breast lift, breast implant or both?

There are different operations you can consider with your surgeon. The most common after breastfeeding is a breast lift. This is a procedure which involves removal of excess skin to lift the breast. During the procedure, the nipple is lifted to a higher position and the width of the breast is narrowed to create a better shaped breast.

It is important to be aware that scars will be inevitable and the extent of the scarring depends on the amount of tightening that is required. Scars are red and visible for the first 3 months but often fade within 6- 18 months.

A breast lift can change the shape of your breasts however it does not always address the issue of volume or size. The breasts sit higher after a breast lift but you may still feel they lack the volume you desire. If this is the case, you may choose to have a breast enlargement as well as a breast lift. This operation is called an breast lift with implants or augmentation mastopexy and it involves implants being inserted into your breasts as well as the excess skin being taken away. It can be done in two operations or it can be performed in one operation, although it is technically more difficult.

The right decision for you

Many women report renewed confidence in their bodies after undergoing a breast reshaping operation. Whatever you decide, it is important to make sure you take time to discuss the right options for you with a Consultant Plastic Surgeon (not with a patient advisor or anyone else unqualified) and think carefully about what is right for you both physically and emotionally. At The STAIANO Clinic we offer emotional support and counselling to help you make the right decisions for you and your body and we always advise that family and friends support you on this journey.
If you would like to speak to Mr. Staiano or one of the team at The STAIANO Clinic don’t hesitate to call us on 0121 454 3680.

Request Details About Breast Lift

Polyurethane implants: 5 key questions, answered

23 June 2014/10 Comments/in Breast Plastic Surgery /by admin@staiano

Polyurethane breast implants are used widely for breast augmentation surgery in South America, Europe and Australia. Although popular with high satisfaction rates, they have also sparked controversy in the past. Here are the key 5 questions and answers about Polyurethane implants.

1. What are they?
Polyurethane breast implants are silicone implants with a foamy texture on the outside of the implant. They are manufactured by a German company called Polytech.

2. What are the benefits?
The most significant benefit of Polyurethane implants is the reduced risk of capsular contracture. Capsular contracture is where scar tissue forms around the implant after breast augmentation surgery. This is a natural part of the healing process. In some cases however, over a period of time, the scar tissue can squeeze the implant. This will cause the breasts to harden and they can become painful. With a polyurethane implant, the textured foam layer prevents these harmful, later stages of capsular contraction. The scar tissue grows into the foamy texture and the implant becomes part of the breast tissue. With other types of implants, studies have shown that the chances of capsular contracture can be as high as 20% (1 in 5 women), 10 years after the operation has taken place. With polyurethane implants, the chances of capsular contracture were just 1%, up to 15 years post operation.

In addition, the polyurethane implants are also less likely to rotate in the breast, as the implant is more firmly attached to the breast tissue than with other types of implants.

3. What are the risks (including cancer)?

As the implant becomes part of the breast tissue, it can be difficult to remove it. If a removal needs to take place due to infection for example, it can make the operation more difficult. The implants were also controversially linked to cancer studies carried out in the 1990s. In a series of trials, a high level of one of the chemicals used in the polyurethane implant was injected into rats and the rats developed the disease. However, this chemical has never been shown to cause cancer in humans and has been found in patients who do not have breast implants. After further studies, an FDA panel calculated the risk to be 1 in 1 million, the equivalent to smoking one cigarette in the lifetime of a patient!. In other words “ negligible. It is important to note that cancer has never been linked to polyurethane implants in a human being.

There is a rare type of cancer that has been linked with breast implants, but this has been associated with all breast implants, particularly textured silicone implants. I have written a blog post about it here.
4. Will I need to get them replaced in the future?

There is a lower chance of needing replacement as the chances of capsular contracture are significantly decreased. However, you should always consider that there may be a need to have your implants changed in the future.

5. How do I decide whether to have polyurethane implants?

There are many factors to consider when choosing breast implants, and my previous blog on choosing the right breast implants may help you understand other types of implants and what to consider. There are many factors involved and it’s important that you discuss the right implants for you. I highly recommend talking to as many women as possible who have had surgery and doing your own independent research.
Speaking to a consultant like myself can also help! If you have any questions, do not hesitate to contact me on [email protected].

What is the Best Post-Surgical Bra?

14 March 2014/0 Comments/in Breast Plastic Surgery /by admin@staiano

What Type Of Bra Do I Need Following My Surgery?

There are several things to consider when choosing a post-surgical bra. You will need a supportive bra that is comfortable and fits snugly. It should not be too tight because, although the bra is necessary to control swelling, it will be counterproductive if it digs in and causes discomfort. It is important that your bra is not wired and so a sports bra or dedicated post-surgery bra would be best.

Post-surgical bras often come in sizes small, medium, large and extra large, rather than the traditional 32, 34, A, B, C, etc. because they have a degree of flexibility or ‘give’ in the material. They also often have some degree of adjustment, which is usually in the form of two or three rows of eyes for the hooks to hook in to. You should make sure that the bra opens either at the back or the front because a lot of sports bras need to be put on over your head and this may be uncomfortable in the days following surgery. Front fastening is best but can be more difficult to find.

What Size Bra Should I Buy?

Your back size should not change following surgery, although the cup size will be affected. It is important to be aware that your bra size might vary in the weeks and months following surgery and so you should be prepared to alter or adjust your bra during this time. For patients having a breast enlargement “ it is always difficult to predict the cup size you are likely to be.

I recommend that you buy a selection of bras around the size that you hope to achieve and keep the receipts and the labels on them so that you can return them later if they are obviously unsuitable. For patients having a breast reduction “ many patients seeking breast reduction are wearing the wrong size bra and so I recommend that you get a professionally fitted bra before considering surgery.

It may be that a well-fitting bra will alleviate many of the symptoms that you are suffering from. When choosing a post-surgical bra, it may be worthwhile choosing a bra with the next size up on the band size that you currently are “ this will allow for swelling. The cup size is very difficult to predict and so a range of sizes may be needed. I can give you guidance on this. For patients having a breast lift “ the breast should be around the same size that it was before surgery. Clearly the shape will be different, with the volume sitting higher on your chest and a small amount of volume will be removed with the skin that is taken away, but you will be in a broadly similar cup size to what you were before.

Do I Need To Buy A Bra Before My Surgery?

For patients having a breast enlargement “ I will provide you with a postsurgical bra immediately following your surgery and you should wear this day and night for the first 4-6 weeks following surgery. I will give you an idea of the size of bra you will need should you wish to purchase one.
For patients having a breast reduction or breast lift “ you will have dressings on your breasts immediately following surgery which will act like a bra and so you will not need to worry about a post-surgical bra to start off with. The dressings will be removed after a week and you will need to bring your post-surgical bra with you to the dressing clinic appointment.

What Bra Do You Recommend?

Front opening post surgical bra

If you can find a bra that you are comfortable in and feels supportive, then you are half way there. Try to avoid a bra with a wire and ideally get one with a wide band that is less likely to dig in. I mainly use bras manufactured by Plie as they offer good support, have useful adjustability and are front fastening. The grid below shows the sizes available and for patients larger than XL, I use Macom bras which go up to size 40HH.

Sizing Chart for Plie Bras

	A	B	C	D	DD
30	Small	Small	Small	Medium	Medium
32	Small	Small	Medium	Medium	Large
34	Medium	Medium	Medium	Large	Large
36	Large	Large	Large	Large	X Large
38	X Large	X Large	X Large	X Large	X Large

Macom Bra Sizing

XL 38- HH
XXL 40 “ HH
You can purchase post-surgical bras here or by calling the clinic on 0121-454 3680.
The cost of the bras are £35 each (delivery is free).

Buy Our Recommended Post Surgical Bra Here

Subscribe To My Blog Post

I want to be a DD and nothing else will do!

8 November 2013/0 Comments/in Breast Plastic Surgery /by admin@staiano

When talking to patients considering breast surgery, I always ask what bra cup size they would like to achieve “ some patients have a very clear view ‘I’d like to be a DD and nothing else will do!’, while others are not so specific ‘I’d like to look natural, be comfortable and in keeping with my frame’.

I always ask the question because cup size is the way that we talk about breast size but I then always say that I cannot guarantee the final cup size.

The bra size is made up of two measurements, there is the chest size, 32, 34, etc., and the cup size, A, B, C, etc. The chest size should not change following breast surgery (there may be a temporary increase due to swelling) and it is the cup size that is likely to be affected. However, the precise change in the cup size is difficult to predict for several reasons:

bra size is relative. The bra size is measured by measuring the circumference of your chest (this is the chest size), then the circumference around your bust. The difference between the chest circumference and the circumference around your bust gives the cup size. 1 inch difference is an A cup, 2 inches is a B cup, 3 inches a C cup and so on. Because the cup size is the difference between your chest and your bust circumference, it is not an absolute measurement, an A cup will be different for a person with a wide chest compared to someone with a narrow chest. Therefore, I cannot show you a photograph of a pair of breasts and tell you the cup size, because the same sized breasts on you may be a different cup size if your chest circumference is different to the person in the photograph.
bra size varies between manufacturers. I often have patients tell me that they wear a C cup in one make of bra or a D cup in another make
people often wear the wrong bra. Most people could probably fit in to one cup size bigger or one cup size smaller than they normally wear if they were to adjust the strap size. It may well be that someone who is a 34D could wear a 36C or a 32DD.

Having said all that, bra size is all we have got to go on, so I always ask what cup size you would like to be. Just don’t be surprised when I say that I can’t guarantee that I will achieve it!

Watch My Webinar To Learn More About How To Choose The Right Breast Implants

Only The Best Breast Implants

1 August 2013/0 Comments/in Breast Plastic Surgery /by admin@staiano

I often get asked ‘what are the best breast implants?’. Like most things, there is no one answer to this question otherwise we would all use those implants. Most plastic surgeons will only use the best quality breast implants from the top manufacturers like Allergan, Nagor, Polytech and Mentor, which is why very few of us ever used PIP implants.

Most of these carry a lifetime guarantee and have a proven track record in terms of capsular contracture and implant failure rate.

Nagor

Nagor implants are manufactured in the UK and their premium round implants are the Impleo range. They also have the CoGel range, which is their anatomical (or teardrop) implants. They have dense texturing with a double shell and come with a lifetime warranty. The warranty covers capsular contracture as well as shell failure, however it is important to be clear about exactly what the warranty covers:

they will provide a replacement implant as well as an implant for the other side
they will allow a size change above and below the replacement implant
they will not cover any of the other costs associated with surgery

Polytech

Polytech is a German company who manufacture polyurethane foam coated implants. They also have a range of silicone implants, however, it is their range of polyurethane foam coated implants that I use mostly. Polyurethane foam implants have always been known to have a significantly lower rate of capsular contracture when compared with silicone implants and this makes them particularly appealing. However, there was a study done that suggested that some products of the foam could cause cancer in rats in an experimental setting and this led to their use being greatly reduced in this country.

They have continued to use them in Brazil and there is a large experience of their use in Australia and there is no evidence to suggest that they cause cancer in humans. Nevertheless, this is something that you should discuss with your surgeon and do your own research on, because you must weigh up the pros and cons of having them.

I think that they are good implants but have an open and honest discussion with patients and give them the information to allow them to make an informed decision. You can read more about them here.
Polytech polyurethane implants also come with a lifetime warranty which includes:

exchange of implant in case of shell rupture for lifetime of the patient
free of charge exchange of the implant in case of capsular contracture Baker grade III or IV up to 10 years after implantation
free of charge exchange of implant in case of implant rotation or dislocation for up to 10 years after implantation
the original implant can be exchanged for an implant of the same type and the size may be chosen freely
the hospital costs associated with exchange of implants will not be covered, however there is an additional insurance policy provided with Polytech implants which provides up to £1500 per implant to go towards the cost of revision surgery required within 2 years of implantation.

These are the manufacturers that I use most often and I am happy to recommend them to my patients.

There are other manufacturers out there, such as Allergan and Mentor, who are major, reputable companies and produce good quality implants. They all have slight differences and I have samples of all of the implants that I use in the clinic to allow patients to see and feel them.

Ever since the PIP scandal, patients are becoming more aware of the implant manufacturers and this can only be a good thing. Most reputable surgeons should be happy to talk about the companies that produce the implants they are using and you should feel free to ask questions, after all, you will be paying for them.

For more information head over to our Breast Enlargement page.

How do I choose the perfect size breast implant for me?

12 June 2013/0 Comments/in Breast Plastic Surgery /by admin@staiano

When you are first thinking about having a breast enlargement, this might seem like any easy question. You may know someone who has had breast implants, so you ask them what implants she had and she says she had 390cc implants, so you think, her’s look great, so I’ll have 390cc implants too please.

Size is Not Important

Unfortunately, like most things in life – it is not that simple! The volume of the implant (in this case, 390cc) is only one factor when choosing which implant to have. In fact, when I am deciding on which breast implant to use on a patient, it is probably the last thing that I consider.

Watch my webinar where I talk about some of the difficulties in choosing breast implants

Width is Important

The first thing that I think about is the base diameter of your chest as this will dictate how wide an implant that I can use. This is crucial. If the implant is too wide for your chest, then you may get a web between your breasts (known as symmastia or synmastia), or there may be too much of the implant to the sides of your breasts and your arm will hit your breasts which will be uncomfortable. If the implant is too narrow it is not so bad, but it will not fill the footprint of your breast and so it is more difficult to give a nice shape to the cleavage.

You Cannot Compare Implants without Knowing More than the Volume

There are many different breast implants that have 390cc volume because implants come in different shapes and projections. The different shapes of implant are round, teardrop (also known as anatomical or shaped implants) and conical (the conical shape is only available in polyurethane foam implants).
There is also a variety of projections for each shape “ low, medium, high and extra high.

This means that a 390cc low projection implant will look different to a 390cc extra high projection implant. In fact, the low projection implant will have a wider base diameter than the extra high profile implant. This brings us back to the base diameter, which is the key when deciding on a breast implant.

how-do-i-choose-the-perfect-size-breast-implant-for-me

How I Choose a Breast Implant

When choosing a breast implant, the first thing that I do is to measure the base diameter of your chest. This is a fixed measurement and will dictate the size of implant that you can have.
The next step is to try on some sizers. I have a sizing kit in the clinic, which has sizing bras and vests and allows you to ‘try on’ different volumes in your bra to get an idea of the sort of size increase that you would like.

Cup sizes are unreliable and whilst I always ask patients if they have an idea of the cup size that they would like to be, I always stress that I am unable to guarantee a particular cup size. The sizing kit is more accurate and will give a good idea of what is achievable with the different volumes.

Finally, we go through some of my before and after photographs of patients with different shapes and different projections of implant to see what sort of ‘look’ you are after. Everybody is different and your final result will depend on the size and the shape of your breast before you start, but you can get an idea of what the different shapes and projections look like.

It is then a case of putting these pieces of information together to come up with a final cup size:

Base Diameter of your breast as established by my measurements

Volume of Implant as established by the sizers in sizing kit

Shape and Projection of implant as established by the ‘look’ you desire based on photographs

We call this The Trident Approach and it is a process that we have developed at The STAIANO Clinc

Sometimes, everything fits together nicely and it is relatively straightforward to come up with the implant that is right for you, but at other times, a compromise may be needed.

You May Need to Compromise on Size or Shape

The base diameter of your chest is set and you cannot change it and this will narrow down the range of implants that I can use in your case. Sometimes patients choose a certain volume of implant and then chose a certain shape, but it may not be possible to use an implant of that shape and volume in their breast.

The common situation when this occurs is when patients choose quite a large volume and may have a narrow chest. They may then go on to say that they don’t want too much fullness in the upper part of the breast and want a more natural look. It may be that in order to use an implant of the volume that they like, they will have to have an extra high projection, which will give a lot of fullness in the upper part of the breast. Alternatively, if they wanted a more natural look with a lower profile or anatomical implant, then they would have to accept a smaller volume of implant. We can have a discussion about this and you may want to go away and think about things.

I am very happy to see you again and again to go over things to make sure that we are confident that we have chosen the best implant for you.

It may all seem daunting, but don’t worry, it usually comes down to some pretty simple choices.

It is important not to get too bogged down in deciding between the exact volume of implant. The result depends on many factors and the actual implant volume is only one factor. Whilst it is impossible to guarantee a cup size, breast augmentation delivers predictable and life-changing results and has a very high patient satisfaction rate.

Download my guide on ‘Breast Implants – Your Questions Answered’ here.

Only the best breast for Angelina Jolie

21 May 2013/0 Comments/in Breast Plastic Surgery /by admin@staiano

There has been tremendous publicity surrounding Angelina Jolie’s decision to go public with her decision to have a double mastectomy. It has helped to increase the profile of breast cancer and the BRCA gene and has empowered women around the world. So what sort of reconstruction has Angelina Jolie opted to go for? You would have thought that the likes of Angelina Jolie would have had the very best reconstruction available, wouldn’t you? I frequently get people in the clinic saying that they want the best reconstruction please, but in fact there is no ‘best’ reconstruction.

What is the ‘best’ breast reconstruction?

The best breast reconstruction is different for different people. It depends on your age, your medical history, your body shape, your breast shape, your job, your expectations and your social circumstances. The fact is that everyone wants the best breast reconstruction. It is the job of you and your surgeon to have a full and frank discussion (and often more than one discussion) to go through your goals and expectations and the options available to discover what is best for you. There are many ways of reconstructing the breast and if there was one best way, we would all just do that one.

So what breast reconstruction has Angelina Jolie had?

Angelina Jolie has had a bilateral breast reconstruction using implants and allograft. Allograft is a sheet of material derived from another animal (usually pig or cow), used to cover the implant. This is probably the shortest operation of all of the bilateral reconstructions, although it is often done as a staged procedure so may need more than one operation. It has the benefit of not leaving any scars anywhere else other than the breast and so complications are potentially less because there is no ‘donor site’ associated with reconstructions that use your own tissue (flaps). When people think of breast implants, they think of well known celebrities who have had breast enlargement, this is not the same as when implants are used for breast reconstruction. Breast enlargement involves enhancing the natural breast, whereas, when implants are used for reconstruction there is no breast to enhance, so the shape comes completely from the implant. For this reason, I always use teardrop implants for reconstruction as the shape of the breast following an implant reconstruction is the shape of the implant. The results are often good in a bra, but the breast lacks the natural movement of breast tissue and can often feel quite firm and high, however it is ideal for women with small, pert breasts and for women having a bilateral reconstruction (both sides), like Angelina Jolie. The benefits are that the surgery is shorter, the recovery is quicker and there are no scars elsewhere on the body, other than the breast. Perhaps this is why Angelina Jolie has chosen it, as it is probably the best option if you want minimum downtime and need to get back on your feet to look after children or work.

This lady is shown 5 months following double mastectomy and reconstruction with implants and allograft.

The ‘Jolie Effect’ “ You can still be beautiful and feminine after mastectomy

14 May 2013/0 Comments/in Breast Plastic Surgery /by admin@staiano

Angelina Jolie has announced today that she has undergone an elective double mastectomy to reduce her risk of developing breast cancer. We are becoming better and better at diagnosing and treating breast cancer to the extent that we can now look at various risk factors, in particular family history and genetic testing, to identify individuals who are at high risk of developing cancer, and treat them before the disease has had a chance to develop. This may sound like something out of science fiction, but in fact it is something that is increasingly done and widely available on the NHS. The news today that Angelina Jolie has undergone a double mastectomy for this reason will increase public awareness and help patients who are undergoing mastectomy or who have had mastectomy to realise that it is still possible to be beautiful and feminine after mastectomy. One can only imagine how difficult a decision this can be for any woman, and Angelina Jolie is to be commended for making these personal details public.

Breast cancer is the most common cancer in the UK and Angelina Jolie is one of a list of high profile celebrities who have been affected by it including Kylie Minogue and Sharon Osbourne. It can affect women as well as men and there are a variety of treatments including surgery, radiotherapy and medical treatments. Outcomes can be very good with a move towards less radical surgery and better reconstruction techniques, which means that women can lead normal lives following a diagnosis of breast cancer.

Breast Reconstruction can give Natural and Long-Lasting Results

Just as the methods of diagnosing and treating breast cancer are advancing, so are the methods of breast reconstruction. A breast reconstruction is still a major undertaking and not every patient will be ready for it, but with advances in surgical techniques such as the DIEP flap and fat grafting, we are now able to give natural and long-lasting results. People often think of breast implants when thinking of breast reconstruction, but this is only one of the methods available. The majority of my reconstructions use the patient’s own tissues, either from the abdomen (DIEP flap) or the back (extended latissimus dorsi flap). These operations take longer and are more complex than using implants but once they are finished, the result is often more natural. Furthermore, even though the operations take longer, they will often allow you to avoid having further operations in the future.

Breast Reconstruction Requires an Investment of Time by both Patient and Surgeon

The way I see it, if you are considering having a breast reconstruction, you will probably need a certain amount of time in theatre and you can choose how you break up that time.
Option 1: you have a DIEP flap, which takes 8 -10 hours in theatre and is a big undertaking, but once it is done, you will probably only need minor procedures such as dog ear removal or nipple reconstruction. This is a way of frontloading all of the time in theatre at the beginning of your treatment.

Option 2: you have an extended latissimus doris flap (ELD flap). This takes about 5 hours in theatre and is not as major a procedure as a DIEP flap, but the reconstruction that it provides will be smaller. Obviously, if your breast is smaller, then it may be enough, however, usually patients with small breasts, have slim backs and so it may still not be quite big enough, and so there are then 2 options:

Option 2a: an ELD flap with an implant. An implant can be placed beneath the extended latissimus dorsi flap to enhance the volume, however implants do carry with them additional potential complications. Among the complications of implants is a condition called capsular contracture. This is hardening of the implant and can happen to any implant, but occurs more quickly in patients who have had or are having radiotherapy. If the implant develops capsular contracture, then it may need to be changed and this can happen after around 5-10 years, or sooner in the presence of radiotherapy. When the implant is changed, then there is a risk of capsular contracture occurring in the next implant and it can come more quickly second time around. This means that, although the operation is quicker, there is the potential for further surgery every 5 or 10 years afterwards and so the total time in theatre over the lifetime of the reconstruction will even out.

Option 2b: an ELD flap followed by fat grafting. If the ELD flap is too small and you do not want the potential problems associated with implants, then you can accept that it will be small to start with and then build it up with fat grafting at a later date. I like to wait at least 3 months between operations, but fat grafting can give a useful increase in volume to the reconstruction and can also be tailored to fill in contour irregularities or deficiencies. It may only be a modest increase in volume that fat grafting can give and so it may need to be repeated, depending on the size of the breast reconstruction that you require. So you can see, an ELD flap with implant may require further operations every 5 or 10 years, and an ELD flap followed by fat grafting may require further surgery every 3 months until it is up to the required size. Once the size is achieved, then a breast reconstruction using ELD flap and fat grafting is a permanent solution, similar to a DIEP flap and should age and mature with you.

Option 3: breast reconstruction using implants. A breast reconstruction with implants is usually a two-stage procedure. The first operation involves using a tissue expander to stretch the skin to allow the definitive implant to be placed. The second operation takes place a few months after expansion of the implant is achieved and allows the definitive implant to be placed. An implant reconstruction is the shortest of all of the operations and does not involve any extra scarring outside the breast and so is appealing from that point of view, however it is the least long-lasting of all of the forms of reconstruction. The resulting reconstruction often feels firm and does to have the natural flow or movement of a natural breast and it can often sit high. It is particularly good for patients with small breasts without much droop and for patients having a bilateral reconstruction. If hardening of the implant occurs (capsular contracture), then it is more obvious than an implant covered with an ELD flap and so may need to be exchanged sooner. As you can see, whilst it is a shorter operation to start with, it is a two-stage procedure and there is the potential for further surgery in the future.

Jonathan will be talking at the Younger Women’s Forumorganised by Breast Cancer Care on Friday 17th May 2013 in Birmingham.