Breast reconstruction


York Plastic Surgery is one of the regions leading Plastic Surgery clinics, providing plastic, reconstructive and cosmetic surgery, including breast reconstruction and surgery for facial palsy.

All our cosmetic surgery is performed by Consultant Plastic Surgeon Chris Dunkinwho has more than 10 years clinical experience delivering high quality, high value, clinical solutions to both men and women of all ages.

Chris Dunkin is a specialist in reconstructive surgery. He is a NHS Consultant Plastic Surgeon at the James Cook University Hospital in Middlesbrough and Nuffield Health Hospitals in York and on Teesside. He specialises in breast reconstruction, facial palsy surgery (smile surgery), head and neck reconstruction, lower limb reconstruction and mole and skin lesion removal and reconstruction.

You'll never meet a salesman at York Plastic Surgery either. Your initial consultation will be with Chris Dunkin himself and all surgical treatments are conducted at The Nuffield Private Hospital right here in York. Its not only convenient, but it's York's premier private hospital where you can also be rest assured the cleanliness and service will be second to none.

>> Book a consultation with our Consultant Plastic Surgeon.

Chris Dunkin is happy to receive referrals from General Practitioners, other Hospital Consultants and patients to discuss reconstructive surgery at Nuffield Health York Hospital.

What is breast reconstrution?

The treatment of breast cancer involves surgery to remove the tumour often combined with radiotherapy and sometimes chemotherapy. Some women can have the breast lump removed (lumpectomy) or a wider area of breast tissue (wide local excision). Others need removal of the whole breast (mastectomy). 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.

Women with breast cancer are best cared for by a team that includes Breast Surgeons, who are experts in treating breast cancer, and Plastic Surgeons, who are specialists in breast cosmetic surgery and reconstruction.

What is breast conserving surgery?

Some women can have their breast cancer removed and the breast remodeled, using breast reduction techniques developed by Plastic Surgeons. Not every woman is suitable for this type of treatment and you should discuss this with your surgeon.

When can I have breast reconstruction?

You can have breast reconstruction at the same time as your mastectomy (immediate reconstruction) or any time afterwards (delayed reconstruction).

How do you rebuild a breast?

There are two main ways to rebuild a breast – with an implant or by using your own tissue (autologous reconstruction). Each technique has its advantages and disadvantages and Mr Dunkin will help you decide which is the best technique for you. The final option is to do nothing. Unlike your breast cancer treatment, this is not surgery you have to undergo. All operations have 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.

Breast reconstruction with implants 

  • Implant-based reconstruction tends to be a simpler solution but the results are limited and certainly not as good autologous reconstruction. It is most suitable for slim women with small breasts.

  • 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.

  • The major potential problems with implants are infection (if this involves the implant then this may need to be removed and replaced later), wound healing problems and implant exposure, poor breast shape, asymmetry, visible or palpable implant, scarring around the implant (capsular contracture) that can be painful and the need for further surgery in the future to exchange the implant. It can be difficult to match the normal breast with this type of reconstruction. This form of reconstruction is not recommended after radiotherapy.

Autologous breast reconstruction

There is no doubt that your own tissue makes the best breast. An area of ‘spare’ tissue is transferred to the chest to make a new breast. The most common areas used are the back (latissimus dorsi or LD flap), the abdomen (transverse rectus abdominis myocutaneous or TRAM flap and deep inferior epigastric erforator oartery pr DIEP flap), the buttock (superior and inferior gluteal artery perforator or SGAP and IGAP flaps) and the inner thigh (transverse upper gracilis or TUG flap). The LD flap from your back is passed through to your chest keeping its blood supply intact (pedicled flap). The other flaps listed are transplanted to your chest where their blood supply is reattached (free flap or microsurgery).

Latissimus dorsi flap reconstruction with or without breast implant

In the right patient, a latissimus dorsi (LD) flap can reproduce a lovely breast. On its own, an LD flap will produce a small to moderate-sized breast. For a larger reconstruction, a breast implant is also used. Alternatively, fat transfer can be used 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 the 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 back usually settles nicely but is prone to produce fluid, which may require drainage in Dressing Clinic. The scar on the back usually settle well but occasionally requires revision. 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.

Implants can be combined with a biological material (dermal substitute) to rebuild a breast. Strattice® is one such dermal substitute that has been used with some success to avoid the need for the LD flap. This has some advantages and Mr Dunkin will discuss this if this is a suitable option for you.

Free flap breast reconstruction

This type of breast reconstruction is the ‘gold standard’, which means that in studies of thousands of women who after breast reconstruction, this method produces the most natural looking and feeling breast.

The most common technique uses skin and fat from the lower tummy (TRAM flap), which is very like the skin and fat of the breast. This is transferred and its blood supply reattached to small blood vessels in the chest. The lower tummy is closed with absorbable stitches, giving the same result as a “tummy tuck”. 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 (about 1:20 risk) the blood vessels become blocked and the breast reconstruction is unsuccessful. Partial loss is also seen. In the lower tummy, most patients are delighted with the “tummy tuck” result, although fluid build-up and slow healing are sometimes a problem.

How many operations will I need?

Once your new breast has settled down, further small operations are sometimes needed to improve the shape of the new breast, such as removing or adding some fat (lipofilling or fat transfer), or to improve the donor site (where the tissue was taken).

Breast reconstruction is completed by reconstructing a nipple and tattooing the areola (the pink part around the nipple).

What about my other breast?

Women often need surgery to improve the size and shape of the other side to match your new breast. This may be breast reduction, uplift (mastopexy) or enlargement (augmentation). Not all women choose to have a nipple reconstruction or surgery to the other breast – this is for you to choose.

Where can I find more information?

More useful information is available on the following websites:

British Association for Plastic Reconstructive and Aesthetic Surgeons (BAPRAS)

Breast Cancer Care website

What do I do now?

Our clinic is based at The Nuffield Health York Hospital.

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

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