Therapeutic Mammoplasty Breast Care We put our patients first by working as one team; leading and listening, and striving for the best. Together, we make the difference. Patient information Musgrove Park Hospital is part of Taunton and Somerset NHS Foundation Trust
Contents Introduction 2 What is a therapeutic mammoplasty? 2 Are there any alternatives to an operation? 3 Before the operation 3 The operation 3 Round block 3 Inferior pole mammoplasty 4 Therapeutic reduction mammoplasty 4 After surgery 5 Going home 5 Risks and complications 5 Specific complications 6 Follow-up 7 Long-term outlook 7 Further information 8 Contact us 8 Introduction This information is for women undergoing therapeutic mammoplasty and explains what happens during the operation, outlining the benefits, alternatives and risks of surgery. If there is anything you do not understand or if you have further questions or concerns, please speak to your surgeon or a breast care nurse. The contact details are listed at the end of this document. What is a therapeutic mammoplasty? This is an operation to remove a breast cancer (therapeutic) and reshape/remodel (mammoplasty) the breast after removal the cancer. It is different from a breast reconstruction in that you are not having a mastectomy and you are not having tissue, from another part of your body, brought into the breast space to fill the area where the cancer was removed. A therapeutic mammoplasty usually reduces the size of your breast by removing both skin and 2
breast tissue and is therefore most suitable if you have moderate to large breasts. You may need surgery to your other breast at a later date to improve the symmetry between your breasts. Are there any alternatives to an operation? The alternative to this surgery is to have a localised removal of the breast cancer (wide local excision) without remodelling your breast tissue or to have a mastectomy. Before the operation If you are a smoker, it is advisable to stop prior to your operation to reduce the risk of surgical complications. If you are on Tamoxifen you should stop taking it one month before your surgery. You will have routine blood tests taken together with a chest X-ray and/or ECG if required as part of a pre-operative anaesthetic assessment. We will offer you a second appointment to be seen by your surgeon before your surgery in order to discuss the procedure in detail and answer any more questions that you have. Your surgeon or the hospital photographic department may take pre-operative photographs of your breasts. There will be nothing that will identify you to anyone else on these and they are used as a record of your breasts before surgery. Your surgeon and anaesthetist will see you on the day of your operation. The surgeon will make some markings on your breasts prior to the operation. We will advise you about a suitable supportive bra to bring into hospital to wear following the surgery. The operation There are three types of operation (surgical techniques) that are called therapeutic mammoplasty. Round Block (Figure A) This operation is typically used when removing a breast cancer in the inner or upper part of the breast. A small donut of skin is removed from around the areola (brown pigmented area around the nipple). The cancer is then removed through this incision and the breast tissue on either side is Figure A 3
moved to fill the defect. The skin is then closed with dissolvable stitches and the resulting scar will be all the way around the areola. Inferior pole mammoplasty (Figure B) This operation is used when removing a cancer in the lower half of the breast. A small donut of skin is removed from around your areola. The breast tissue containing the cancer is then removed from the lower half of the breast along with the skin over the top of the cancer. The breast tissue on Figure B either side is moved to close the defect with the nipple lifted up into a higher position. This may result in some asymmetry with the other breast which may then need to be lifted up at another procedure in the future. The skin is then closed with dissolvable stitches and the resulting scar will be all the way around the areola and down to the bottom of the breast. Therapeutic reduction mammoplasty (Figure C) This operation can be used to remove a cancer in most positions of the breast. It is a suitable procedure to have done if your breasts are moderate to large in size. This operation both removes the breast cancer and reduces the size of your breast. The most common procedure is Figure C performed using an anchor-shaped cut leaving scars as shown in the diagram on the right (WISE pattern). Excess skin, the cancer and breast tissue are removed and the nipple is repositioned to suit your new breast size. The skin and breast tissue is then reshaped and closed with stitches. You may only have the breast with cancer operated on at first in which case you would probably need your other breast operated on at a later date to produce symmetry between your breasts. A tube drain may be placed into your operated breast to drain off the blood and fluid that collects during the healing process. 4
After surgery You will need to take regular painkillers following surgery. Most women are able to go home on the day of surgery. If a drain is placed during your operation then this is reviewed by the breast care nurses after seven days. Going home You will go home with dressings in place and wearing a soft supportive bra (no underwiring). This helps prevent the weight of the breasts pulling on the wounds and affecting the healing process. There may be some slight discharge from the wounds. You should wear a supportive bra for six weeks, only taking it off to shower. You are advised to avoid strenuous exercise for a minimum of six weeks. The length of time you need to take off work depends on the nature of your job but you will need to plan for at least two to four weeks. You may experience some pains in the breasts these will ease over the next few months. The breasts will be swollen and your nipple sensation may be altered. The swelling and bruising subside in a few weeks but can take 6-12 months for the scars and shape of the breasts to settle. You should allow only gentle contact with your breasts for about six weeks. If you feel unwell with a temperature, vomiting or notice significant redness of the skin on or around the breasts you should contact your General Practitioner as you may have an infection and may need antibiotics. During the day you can contact a breast care nurse on the numbers provided at the end of this document. Risks and Complications All surgery carries some element of risk. Common side-effects can include nausea and vomiting following general anaesthesia. As mentioned earlier, the breasts will be painful, swollen and bruised following the operation. 5
Specific complications Haematoma This is bleeding into the tissues following surgery and can occasionally lead to patients returning to theatre to stop the bleeding or remove the blood. Wound infection This can occur after any type of surgery and may need treatment with antibiotics or a return to theatre. Deep venous thrombosis This can happen after any operation and general anaesthetic. Risks are reduced by wearing preventative stockings (TEDS) and if you require a stay in hospital by giving an anti-clotting injection (Clexane). Delayed wound healing This is most commonly at the point where the vertical scar meets the horizontal scar if you have a therapeutic reduction mammoplasty (the T-junction). The blood supply to this area is at its poorest. The skin may fail to heal, and separate, leaving a raw area. Occasionally, this can be extensive and will need regular dressings for several months until the wound is fully healed. Nipple complications The operation by its nature partially disrupts the blood supply to the nipple. There is a small risk of nipple loss from this type of surgery, either total or partial loss. Your nipple sensation may be lost or altered and this may be a temporary or permanent symptom. Asymmetry There may be some lasting differences in the size and shape of your breasts following surgery and radiotherapy. Scarring Initially, the scars will be fine, bright red lines; in most cases the scars will usually heal satisfactorily and soften, becoming much paler and less obvious after 12 months or so. Some patients have a tendency to form red and lumpy scars (hypertrophy) or keloid scars, which are broad raised scars. The scarring will be permanent. 6
Fat Necrosis This is a common complication and in this type of surgery the risk depends on the relative amount of fat and breast tissue within your breasts that needs to be moved. This usually presents with firm or hard nodular areas within your breasts which may occur several months after surgery. Occasionally these can become inflamed with reddening of the skin and a burning sensation and discomfort and mimic an infection. This usually responds to antiinflammatories but occasionally can necessitate further surgery to remove the area of concern. Smoking or being overweight adds to any risks. Losing weight and stopping smoking will reduce your risk of complications. Speak to your General Practitioner for advice on giving up smoking and losing weight. Follow-up You will be given an appointment to return to the hospital seven days following your surgery. During this appointment, the dressings will be removed, your wounds inspected. You will receive the results from your surgery 10-14 days following surgery. Long-term outlook A therapeutic mammoplasty should, in time, give your breast a more natural looking result. It is not suitable for everyone undergoing a lumpectomy (wide local excision) and your surgeon will guide you as to whether it is a suitable technique for you. If needed radiotherapy to your breast after this procedure can change the size / shape of your breast. A therapeutic mammoplasty is used to improve the cosmetic outcome following your cancer surgery and whilst it usually achieves this outcome you have a greater chance of complications following the surgery. You will have annual mammograms for five years and then return to the breast screening programme. 7
Further information www.plasticsurgery.org The American Society for Plastic and Reconstructive Surgery www.surgery.org American Society for Aesthetic Plastic Surgery www.baaps.org.uk British Association of Aesthetic and Plastic Surgeons Further information and support regarding breast health is available from: www.breastcancercare.org.uk Contact us Consultant Surgeons Mr. J A Gill FRCS Secretary: 01823 342029 Ms A L Thorne FRCS Secretary: 01823 342104 Breast Care Nurses 01823 342454 Judy Reeves Lisa Graham Jane Boobier Louise Gardiner Emma Champion J Gill/Nov15reviewNov17 8