Stephen McCulley, Reconstructive and Aesthetic Surgeon. MBChb, FCS(SA)Plast, FRCS(plast)

Using tummy skin and fat is one of the most successful procedures to reconstruct the breast

Procedure In Brief
This involves the removal of the skin and fat from the lower tummy (the same tissues as taken during a tummy tuck operation) which is then used to reconstruct the breast. The tummy skin and fat is the closest like for like replacement of the breast. It is for this reason it can produce very life like reconstructions. However, most importantly this type of ‘own body tissue’ reconstruction will last a life time. This is done by re-attaching this tummy tissue into the breast with microsurgery. If  this is done as an immediate reconstruction at the same time as the mastectomy, then the breast skin is usually kept and the tummy tissue is used to give the breast shape and to form a nipple. However, if it is done at a later date (delayed reconstruction) then the tummy skin is also used for the new breast skin. Stephen McCulley is a national expert at this operation having mastered it over a 15-year period performing this weekly in both private and NHS hospitals. His success rates are over 99% with outstanding cosmetic results. With an established team of consultants this operation has now become a reliable 3-4 hour operation (this used to take 8-10 hours) enabling rapid patient recovery and shorter hospital stay.

Microsurgery
The blood vessels are the ones that are re-attached in the breast area with microsurgery to keep the tummy flap alive. These blood vessels pass through the tummy wall muscles to get to the skin and fat. When all the muscle is left behind the flap is called a DIEP (Deep Inferior Gastric Artery flap). However, in some cases the muscle around these blood vessels needs removing also. This then becomes a TRAM flap (Transverse Rectus Abdominus Muscle flap). These are essentially the same operation except for the small amount of muscle removed. Stephen McCulley tends to perform a DIEP flap in 75% of patients.

Advantages Of Using The Tummy
– Using the patient’s own tissue (fat) to reconstruct the breast means it will closely resemble a normal breast in the texture and movement.
– The new breast will naturally ‘droop’ like normal breast tissue and therefore should achieve the same shape as the other breast.
– Generally the results of this type of reconstruction improve over time as the breast changes in size and shape.
– This type of reconstruction is regarded world-wide as one of the most successful and is successful in 99% of patients.
– Surgery is completed in one operation.
– The patient’s tummy will have a flatter and slimmer appearance following surgery.

Disadvantages Of Using The Tummy
– Although much faster it is still a big operation taking 3-5 hours to perform, with a 2-3 month recovery period.
– The operation has a 1-2% failure rate, but this depends on risk factors including, obesity, smoking, past surgical procedures, other illnesses and whether radiotherapy has been used to treat the cancer.
– A scar will be left on the tummy from where the skin and tissue has been removed.
– Although uncommon, patients might experience some pain, weakness or bulging in the tummy. There is also a slightly greater risk of general complications such as pneumonia and blood clots following surgery.
– Patients will experience some numbness on the skin of the lower tummy.

Surgical Recovery & Final Outcome
– Length of stay in hospital – usually 5 days.
– Length of surgery – usually between 3-5 hours.
– Time restricted to bed – 2 days, in which the patient will be fitted with a bladder catheter for 24-48 hours.
– Time to walking – patients should be able to walk after 3-4 days of recovery, and then walk without discomfort after 10-14 days.
– Time to exercise – patients should be able to exercise after 4 weeks of recovery.
– Time to full recovery – patients should feel fully recovered and able to return to work by 2-3 months.
– Dressings – patients will wear dressings on the breast and tummy for 2 weeks.
– Bras & clothing – patients are advised to wear a pressure garment for 4 weeks.
– There is around a 6% risk of experiencing problems with the tummy – pain, bulging in the tummy, skin infection, fluid collection, wound breakdown and the possibility of having a hernia.
– There is a 5% chance of experiencing reconstruction problems – lumps in the tissue, part or total failure of the reconstruction succeeding.
– There are few long term problems associated with this type of surgery, apart from the tummy remaining weaker than before surgery.

Please do not hesitate to contact us if you have any questions or would like to obtain costs for either insured or self pay patients. Please note there are some excesses liable with insured patients. All details can be obtained from Stephen McCulley’s secretary.