Pig skin ‘bra’ gives women a more nat­u­ral look af­ter a mas­tec­tomy

FOR women who choose breast re­con­struc­tion af­ter a mas­tec­tomy, there is a new op­tion. Les­ley Bruce, 65, a busi­ness coach, un­der­went the pro­ce­dure, as she tells CAROL DAVIS.

Irish Daily Mail - - Good Health -

THE PA­TIENT

MY BUST has al­ways been large. As I got older, it started to give me back pain, so a few years ago I planned to have a breast re­duc­tion. But in Novem­ber 2015, my left breast started to feel un­com­fort­able, as if I had an in­ter­nal bruise.

My GP ex­am­ined me and couldn’t find any­thing, but said that hav­ing large breasts made it harder to de­tect any lumps, so she re­ferred me for an ul­tra­sound scan and mam­mo­gram. They didn’t find any­thing ab­nor­mal ei­ther.

In April 2016, I went ahead with the bust re­duc­tion. They re­moved 1.2kg of tis­sue and sent it to a lab (as is stan­dard prac­tice) and found that I had duc­tal car­ci­noma in situ (DCIS), a pre-can­cer­ous con­di­tion where ab­nor­mal cells form in a milk duct.

Doc­tors sug­gested mon­i­tor­ing me rather than treat­ing it be­cause there was no cer­tainty it would be­come can­cer­ous. But it wor­ried me to know I was at risk of can­cer de­vel­op­ing, so I saw the breast sur­geon Raghavan Vidya, who rec­om­mended a left mas­tec­tomy fol­lowed by re­con­struc­tion.

I wanted to go ahead but didn’t like the pic­tures of breast re­con­struc­tions: a fleshy lump with no nip­ple. I just wanted my breast to look as nat­u­ral as pos­si­ble, as soon as pos­si­ble, and to keep my own nip­ple if I could.

Then Dr Vidya said she was us­ing a new breast re­con­struc­tion pro­ce­dure called Braxon. This in­volves a mesh made of spe­cially treated pig skin which acts a bit like an in­ter­nal bra to hold a sil­i­cone im­plant in place.

Ap­par­ently, the pig skin can be moulded into a nat­u­ral breast shape and in­te­grates well in the hu­man body.

UN­LIKE pre­vi­ous im­plants, this goes in front of the chest mus­cle, so the sur­geon doesn’t need to cut through mus­cle to in­sert it. This means a shorter re­cov­ery time and less pain.

In June 2016, I had the mas­tec­tomy and re­con­struc­tion in a four-hour op­er­a­tion un­der gen­eral anaes­thetic. I left hospi­tal the next day with a tube to drain fluid away, which was col­lected in a can­is­ter.

I was re­lieved to see that I still had my own nip­ple, so my breast looked nat­u­ral. Five days af­ter the surgery, Dr Vidya re­moved the drain. Grad­u­ally, my left breast set­tled down. It re­laxed un­der grav­ity and changed shape and po­si­tion — go­ing from look­ing like a dense tennis ball to look­ing sim­i­lar to the right breast.

I’m so re­lieved that the threat of can­cer has gone, and that I still have a nat­u­ral-look­ing bust.

THE SUR­GEON

RAGHAVAN VIDYA is a con­sul­tant on­coplas­tic (a spe­cialty com­bin­ing can­cer and plas­tic surgery) and re­con­struc­tive breast sur­geon. AROUND one in ten women in Ire­land de­velop breast can­cer, and four in ten need a mas­tec­tomy (to­tal re­moval of the breast). Of these, around 30 to 40 per cent opt for re­con­struc­tion, be­cause be­ing di­ag­nosed with breast can­cer and then hav­ing a mas­tec­tomy can have a huge psy­cho­log­i­cal ef­fect on a woman’s self-es­teem.

Sur­geons some­times use mus­cle taken from the woman’s back to re­con­struct the breast, but this of­ten leads to arm and shoul­der weak­ness. We can also of­fer a deep in­fe­rior epi­gas­tric per­fo­ra­tor (DIEP) flap, where we take tis­sue from the ab­domen, com­plete with a blood sup­ply. But with both pro­ce­dures, the pa­tient has a sec­ond sur­gi­cal site which can also cause pain.

An­other op­tion is a sil­i­cone im­plant. With older tech­niques, the im­plant was held in place by the chest mus­cle, but this meant hav­ing to cut through the mus­cle to put the im­plant be­hind it, which could cause pain and shoul­der weak­ness af­ter­wards.

But now the im­plant can be held in place by Braxon, a kind of in­ter­nal bra that holds the im­plant and sits in front of the mus­cle, so there is no need to cut through it.

De­vel­oped in Italy four years ago, Braxon is made from col­la­gen (a struc­tural pro­tein) taken from the skin of a pig.

Af­ter be­ing treated to re­move cells and viruses (so the body won’t re­ject it), the skin be­comes a kind of mesh which is com­pat­i­ble with the hu­man body — the body’s own blood sup­ply will grow into it.

An­other ad­van­tage of pig skin is that it can be mod­elled into a nat­u­ral breast shape.

It comes in dif­fer­ent sizes, is pre-shaped and looks rather like a white bra cup, into which we put a sil­i­cone im­plant.

We sim­ply stitch Braxon to the chest wall and cover the front of the mesh with the pa­tient’s own skin and nip­ple so it looks like a nat­u­ral breast.

I pi­o­neered this pro­ce­dure in the UK as part of a multi-cen­tre Euro­pean project on Braxon three years ago. Now, 750 UK pa­tients have had it, and 3,000 in Europe.

It means min­i­mal surgery that re­stores body im­age and im­proves qual­ity of life, with min­i­mal pain and early re­cov­ery — pa­tients can go home the same day.

We are train­ing other sur­geons and this is now of­fered at a num­ber of cen­tres across Europe in­clud­ing Ire­land.

The mas­tec­tomy takes one to two hours, with an­other one to two hours for Braxon. In con­trast, a DIEP flap takes six to eight hours, while the op­tion us­ing mus­cle from the back takes four to six hours.

WITH the pa­tient un­der gen­eral anaes­thetic, I make an 8cm to 10cm in­ci­sion un­der­neath the breast, in the crease where it will not be vis­i­ble, re­mov­ing all breast tis­sue and us­ing heat to seal off blood ves­sels while leav­ing enough blood sup­ply to keep the skin healthy.

We then find the sen­tinel lymph node. Can­cer can spread via the lymph sys­tem, and the sen­tinel node is the one clos­est to the can­cer and the one where in­fected cells are most likely to spread first.

We lo­cate it us­ing dye to high­light it, then re­move it, send­ing the tis­sue to the lab for anal­y­sis, and wash out the cav­ity with sa­line.

The Braxon cup comes dried, so I leave it in sa­line for five to ten min­utes to re­hy­drate. Then I pop the sil­i­cone im­plant in­side, clos­ing the two slits over the im­plant to give a nat­u­ral shape, and su­ture it to the chest wall us­ing three or more stitches so it will not move.

Fi­nally, I close the in­ci­sion us­ing su­tures.

The mus­cle-spar­ing pro­ce­dure us­ing Braxon gives very good re­sults for women fol­low­ing a mas­tec­tomy, and comes with a life­time guar­an­tee.

This op­er­a­tion re­moves the can­cer and leaves the woman with a nat­u­ral-look­ing breast which should last for life.

WHAT ARE THE RISKS?

THERE is a small risk of bleed­ing or in­fec­tion, which could mean the im­plant would need to be re­moved.

IT MAY not be suit­able for pa­tients who have had ra­dio­ther­apy, as it causes scar­ring, or for smok­ers or pa­tients with a high BMI, as these both in­crease the risk of in­fec­tion.

SINCE Braxon is placed just un­der the skin, it can cause a rip­pling ef­fect, mean­ing pa­tients can feel the edge of the im­plant if they touch the area. To smooth it out, they may need fat injections.

‘THIS gives very good re­sults be­cause we do not have to cut through mus­cle, so pa­tients have less pain and a quicker re­cov­ery, and the cos­metic re­sults are good as it gives a nat­u­ral shape,’ says Monika Kaushik, a con­sul­tant on­coplas­tic breast sur­geon who also uses the technique. THE pro­ce­dure costs around €6,000 for a pri­vate pa­tient.

Re­lieved: Les­ley Bruce Pic­tures:ALAMY/PAULTONGE

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