Elizabeth's Booby Blog

Mastectomy and Reconstruction – The science bit

Some people like  to know all the facts and find all the sciencey medical stuff really interesting (these are usually the same people who you see twitching their curtains to see what the neighbours are up to) while others prefer to just know I’ll be going in to hospital with one set of boobs and coming out with another. So I will leave it up to you how much or how little you want to know!

From the mastectomy side theres not much to know, its fairly straightforward (Im sure the surgeon would disagree with me on this! But from a descriptive side its not too complex)

They have decided I need a mastectomy not a lumpectomy (where they just remove the lump) as my cancer is in more than one place and my boobs are quite small (ahem….) so removing just the cancer would be complicated and look terrible.

The surgery itself will take 6 hours (as I will be having immediate reconstruction), they will make an oval incision and remove all the breast tissue leaving a skin pocket for the reconstruction. They will also remove my sentinel node (the first lymph node cancer would spread to) this will be removed and examined during surgery to decide if any more need to be removed. To find the sentinel node they will inject the breast with a blue dye (I’m assuming a medical type dye and not just the inside of a Biro) and then scan under the armpit which will provide them with a ‘map’ of my lymph nodes (clever stuff!)

Once the mastectomy has been completed the reconstruction can take place.

The number of ways they can reconstruct breasts is amazing!

The decision on whether to have a reconstruction and what type of reconstruction to have depends on many factors and these are all discussed during the consultation. I opted for an expanding implant with Strattice (which I will explain a bit further down).

flapTissue flap reconstructions are also an option for some people and these techniques use flaps of your own tissue (with or without an implant), including the skin, usually taken from your back or lower abdomen, or from the thigh or buttock. This is then reshaped to form the new breast. These feel more natural than implants alone but will still feel different to natural breasts.

There are two ways in which surgery involving a tissue flap may be done:

Pedicled flap – the flap remains attached at one end to its blood vessels which means the blood supply to the muscle doesn’t need to be cut
Free flap – the flap is completely detached from the body along with its blood vessels and re-attached by microsurgery in the position of the reconstructed breast.

They can take tissue from various places on the body
flap reconstructLD – latissimus dorsi (tissue taken from the back).
TRAM – transverse rectus abdominis muscle (tissue taken from the lower abdomen).
DIEP – deep inferior epigastric perforator (tissue taken from the lower abdomen).
SIEA – super inferior epigastric artery (tissue taken from the lower abdomen).
SGAP – superior gluteal artery perforator (tissue taken from the upper buttock).
IGAP – inferior gluteal artery perforator flap (tissue taken from the lower buttock).
TUG – transverse upper gracilis (tissue taken from the inner thigh).

tattooThe surgeon said I didn’t have enough tissue in my abdomen for that type of reconstruction (not sure how thats worked out as I’m sure I’ve got enough in there for a couple of Jordan’s!) The same applied to the thighs. While there may have been enough tissue in my bum, I have a tattoo on my lower back and bum in memory of my son I lost in 2010 and I would be devastated to lose/disfigure that)

I therefore opted for implant reconstruction. Although this doesn’t, as I initially thought, just  involve removing the old breast and putting a silicone pouch into the gap. Much more sophisticated than that!

implantDuring the reconstruction my surgeon will put a tissue expander implant in. I will wake up with fairly small boobs and after the surgery has healed (usually about 3 weeks later) The implant will gradually be inflated with saline (salt water).  The saline solution is injected into a port just under the skin. They find the port with a rather clever magnet device that when hovered over the boob will point to the port! Gradually expanding the implant this way slowly stretches the muscle and overlying skin. This will be done over time until they are the best size (must resist the temptation to request pints to be injected not just the 50ml at a time that is usual!). When the surgeon and I are happy with the size, I will then have the expander removed and a fixed size implant fitted. I won’t be able to have them topped up during my course of Chemo so will have to settle for my little breasticles for a few months. reconstructo

I will also be having something called a strattice matrix. This technique uses a material derived from pig skin that has been treated, processed and preserved so it can safely be left in the human body. This surgical mesh  provides a ‘hammock’ that cradles the breast implant, helping to create a natural shape, contour and droop (a nice droop, not the golf balls in tights droop that I currently have!). The mesh is attached to the chest muscle making a space in which the implant can be placed for internal support. Because it has almost the same structure as human skin, it becomes part of your body. And doesn’t smell of bacon.

And that is how my boobs will be made, considering I can’t even make a cake quite how this is achieved is beyond my comprehension. But boy am I glad there are people out there smart enough to develop and carry out this kind of surgery!

I’m thinking of pitching “The Great British Breast off” to the BBC….Watch this space!

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About the author

Elizabeth