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.
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.
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