Breast reconstruction

Breast reconstruction is a specialist plastic surgery procedure that aims to recreate the breast following mastectomy or other significant breast surgery.

Mr Chris Fenn, consultant plastic and aesthetic surgeon in Leeds, West Yorkshire is a highly skilled breast surgeon with considerable experience in performing breast reconstruction surgery. At Leeds Teaching Hospitals Trust, Mr Fenn is the plastic surgeon responsible for breast reconstructive surgery and undertakes the full range of breast surgery procedures including complex breast reconstruction.

Recognised by his peers for his expertise in the field of breast reconstruction, Mr Fenn regularly receives difficult breast surgery referrals from fellow plastic surgeons.

Why have a breast reconstruction?

The purpose of breast reconstruction is to rebuild the breast mound to match the other breast, sometimes even adjusting the other breast if necessary.

Many women feel self-conscious after having a mastectomy and find that breast reconstruction surgery helps to restore self-confidence and femininity.

How is breast reconstruction performed?

Breast reconstruction surgery is very much tailored to the individual. However, there are two main types of breast reconstruction; recreating the breast mound by inserting a silicone implant and rebuilding the breast using tissue from elsewhere in the body – usually the back or tummy.

When is breast reconstruction performed?

In some instances, breast reconstruction can be performed at the same time as the mastectomy. The advantages of immediate breast reconstruction are that patients only need one anaesthetic and only one stay in hospital. Often the skin of the breast is retained which gives the best chance of a natural look.

However immediate reconstruction isn't always an option and many women have their breasts rebuilt some time after their initial operation to remove the breast tissue. This is called ‘delayed breast reconstruction’ and is a better option for women who need radiotherapy after their mastectomy.

What does breast reconstruction involve?

Recreating the breast using an implant

Breast reconstruction using an artificial implant can be performed as a one-stage or two-stage procedure.

One stage immediate breast reconstruction

Following the removal of the breast tissue, a breast mound is created by inserting an implant into the space left by the breast removal. The pectoral muscle supports and protects the implant.

Two stage breast reconstruction

Performed more frequently than the one-stage operation, this procedure is generally used when the patient doesn’t have enough remaining skin to cover the implant following the mastectomy, or more bulk is needed to match the other breast.

The first stage involves the implantation of a ‘tissue expander’ under the muscle. To stretch the skin, a salt water solution is injected frequently into the expander over a month or two. As the expander gets bigger, the skin and muscle covering it stretches to accommodate its larger size.

Once the skin and muscle have stretched sufficiently, the tissue expander is removed in a second operation and the new breast is created by inserting a shaped silicone implant behind the chest muscle.

Rebuilding the breast using own tissue

There are a number of different ways to rebuild the breast using the patient’s own tissue. Each technique involves transferring a flap of tissue from another part of the body and using it to create the new breast mound.

The most common tissue flap procedures are the TRAM (transverse rectus abdominis muscle) flap and the latissimus dorsi flap. The TRAM flap uses tissue from the lower abdomen to rebuild the breast whilst the latissimus dorsi flap uses tissue from the upper back.

The flap can be transferred to the breast in two different ways:

A pedicle flap involves taking a flap of tissue, skin and muscle from the tummy or back and ‘tunnelling’ it to the breast area, whilst maintaining its connection with its original blood supply.

A free flap involves completely detaching the flap of tissue from its original site and transplanting it to the breast. Using microsurgery, the tiny blood vessels in the flap are connected to those in the chest.

How many operations are required?

In many cases a reconstruction involves at least one or two operations depending on the technique chosen. In some instances, additional surgery is recommended to adjust and revise the breast reconstruction. This is done to improve the size or shape of the breast and to ensure it matches the other breast.

Further surgery may be offered to adjust the normal breast to achieve symmetry and enable more comfortable bra and clothing wear.

What else can be done to improve the look and shape of the reconstructed breast?

There are a number of options available to adjust or improve the look of the reconstructed breast. This might involve changing the implant or using fat injection or fat grafting to improve the look and feel of the breast. Mr Fenn has considerable experience in using fat injection and fat grafting techniques and achieves a high level of patient satisfaction.

Nipple and areola reconstruction

Some women also opt for nipple and areola reconstruction. This tends to be performed several months after the initial breast reconstruction surgery and helps transform the reconstructed breast mound by giving the breast a focal point.
Tattoo is then used to colour the nipple and areola so they match the other breast.

How long does it take to recover from breast reconstruction surgery?

The length of stay in hospital and overall recovery time is very much dependent on the type of breast reconstruction performed. Generally, implant reconstruction involves a 2 night stay in hospital whilst tissue flap reconstruction may involve a 5-7 night stay.

You will have some pain and discomfort after surgery and may need to use painkilling medication for a few weeks after the operation.

After discharge, you will need to return to the hospital for a series of follow up appointments with Mr Fenn and the nursing team to ensure that your reconstructed breast is healing as it should.

If you have tissue flap reconstruction, you may find it uncomfortable moving your arm in the first few weeks, however a specialist physiotherapist will help you regain full mobility.

Once you feel well enough, Mr Fenn will recommend that you gradually increase your activity levels – although he will advise you not to embark on any strenuous activity such as lifting or vacuuming until he confirms you are ready to do so.

The amount of time you will need off work will depend on the type of breast reconstruction you have had and the nature of your job. This is something you can discuss with Mr Fenn and the nursing team during your follow-up care. 

How much does breast reconstruction surgery cost?

Private medical insurance does provide cover for breast reconstruction surgery but there is invariably a shortfall between the cover offered by the insurer and the surgical fee required. A quote for the additional amount is made once the extent and nature of the reconstruction is known following the consultation with Mr Fenn.

The procedure is also available on a self-pay basis. As the operation is tailored to your individual needs, you will be given a price after your first consultation with Mr Fenn.

How can I find out more about breast reconstruction surgery?

To find out more about breast reconstruction surgery call Mr Fenn’s secretary Claire Herbert on 0113 218 5971, email claire.herbert@spirehealthcare.com or complete an on-line enquiry form.

I’d like to book a consultation with Mr Fenn

If you would like to discuss breast reconstruction surgery with Mr Fenn, please call his secretary on 0113 218 5971 to arrange an appointment.

During the consultation, Mr Fenn will give you a physical examination and have an in-depth discussion with you about your medical history. He will then be in a position to advise you on the most appropriate type of breast reconstruction surgery for you.

To ensure that you make an informed decision, Mr Fenn will also discuss the risks associated with surgery and will encourage you to ask questions and take your time to think about the procedure before you decide to go ahead.








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