Western Mail

Offering a gold standard in breast cancer reconstruc­tion

Having a mastectomy can severely dent the selfesteem of breast cancer patients. But consultant­s in Wales want to reduce that emotional distress through impressive new procedures


Two specialist surgeons have formed a unique partnershi­p – breast and plastic surgeons working closely together in both the NHS and private sector in Wales.

Consultant breast surgeon Eleri Davies and consultant plastic surgeon Amar Ghattaura have joined forces so patients can receive immediate breast reconstruc­tion in a procedure carried out on the same day as the mastectomy.

“Patients diagnosed with breast cancer requiring a mastectomy should be given choices of the options in terms of reconstruc­tion,” said Ms Davies, specialist at the Breast Centre University Hospital Llandough and the Spire Hospital, Cardiff.

“Getting the cancer out is the priority, but by working together we can make sure all the suitable options for reconstruc­tion are available.

“It is important that patients know that there are newer techniques available and we can potentiall­y achieve better cosmetic results.”

Breast surgeons, who deal with the cancer, can also carry out some reconstruc­tion work, such as implants, sometimes enhanced with a patient’s own tissue.

But by teaming up with the plastic surgeon at Morriston Hospital, in Swansea, her patients access other complex microsurge­ry techniques, such as transplant­ing tissue from the abdomen, buttock, back, or thigh to mould a breast.

“Not all patients are suitable for an immediate reconstruc­tion because they may need further radiothera­py or chemothera­py treatments. Each patient is different. Some women never want reconstruc­tion,” Ms Davies said.

“I will select patients I think are suitable for the procedure and then refer to the plastic surgeon for his opinion to ensure we can achieve the best outcome for the patient.”

Amar Ghattaura, consultant plastic surgeon at Morriston Hospital Swansea and Spire Cardiff, has a specialist interest in breast reconstruc­tion following cancer surgery.

Mr Ghattaura is currently the only plastic surgeon offering complex microsurgi­cal breast reconstruc­tion privately in Wales.

The DIEP (deep inferior epigastric perforator) procedure is sometimes described as the “gold standard” in breast reconstruc­tion after a mastectomy because the end result is most often a natural, warm, soft breast constructe­d from the patient’s own abdominal skin and fat.

Complex microsurge­ry techniques are similar to transplant surgery, and involve detaching the tummy tissue with arteries and veins and transplant­ing to the chest and reattachin­g the arteries and veins.

He said: “During the same operation the tissue is moulded into the shape of the breast and the tummy is closed.

“You can then effectivel­y mould the new breast like putty to improve the shape. If necessary this may involve liposuctio­n or fat injections. The process is more artistic.”

Not all patients may be suitable for the procedure, the doctors said.

A woman opting for the DIEP procedure could expect to spend six to eight hours in surgery for a single breast reconstruc­tion, five to seven days in hospital and recovery time of three months.

Mr Ghattaura, who learned the technique while working at the Royal Marsden Hospital, in Chelsea, and in Belgium, carries out around one of these complex microsurge­ry cases a week.

“Some women have aversions to implants from the start because they are made from synthetic material, or because they need to be changed in the future,” he added.

“For the majority of women referred to me, they are coming for a DIEP flap because they feel it gives them the best, most natural result, which is lifelong.”

Vivienne Russell, who decided to have her ovaries removed after both her mother and grandmothe­r died of ovarian cancer, was diagnosed with breast cancer last year.

The Cardiff resident having undergone the initial diagnostic procedure at University Hospital Llandough immediatel­y opted to have both breasts removed and underwent the DIEP procedure at the same time at Morriston Hospital.

Surgeons removed fat within her stomach and transplant­ed it into her breasts – a procedure the 55-year-old described as “incredible”.

She said: “As soon as I was diagnosed I told Eleri that I wanted both of my breasts removed – and I think they were a bit taken aback by how quickly I made the decision.

“I was a big-breasted woman and for some reason I always thought I would get breast cancer, even though I was told size made no difference.”

After she was sent home to think about her options, a week later the operation took place.

“The procedure, which took 11 hours, was absolutely amazing. I felt like I’d been hit by a train afterwards but it went fine.

“I still have confidence issues when I take off my clothes but I will be having further operations as they wait for the breasts to soften over time.

“I never wanted to have silicone implants, which I guess was the easy option at my age, because people judge you without knowing your background.

“These are made completely out of my own body and even contain veins taken from elsewhere on my body.”

The mum of two, whose daughters may carry the cancerous gene, said she could not fault the dedication of staff at the Swansea hospital.

“I cannot praise them enough.”

 ??  ?? > Eleri Davies, consultant breast surgeon, and consultant plastic surgeon Amar Ghattaura
> Eleri Davies, consultant breast surgeon, and consultant plastic surgeon Amar Ghattaura

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