Breast OP Pioneers

Source: Eastern Daily Press
Aug. 11, 2004
by Rachel Buller

A pioneering operation that could ease the suffering of hundreds of breast cancer patients was carried out for the first time in Britain yesterday, at the Norfolk and Norwich University Hospital.

*Picture: Elaine Sasson, left, joined US doctor Bob Allen as he demonstrated ground-breaking breast reconstruction surgery.

A team of surgeons, led by renowned American doctor Bob Allen, used fat taken from a woman's buttock to reconstruct the breast that was removed years ago during cancer treatment.

Now, following yesterday's successful teaching case, the procedure could be offered to many more breast cancer patients across the region.

The delicate microsurgical operation involves tissue to be used for reconstruction being taken from the bottom of the patient's buttock. Previously it has been taken from the stomach or the top of the buttock.

The new technique will mean that the resulting scar will be well hidden and help maintain a patient's body shape - reducing the trauma for women facing what can be distressing treatment.

The hospital is already one of very few in the country to use the Perforator Flaps techniques - pioneered by Dr Allen in the USA in 1992 - which uses the patient's own tissue to rebuild the breast without sacrificing muscle.

Dr Allen has taken the procedure one step forward and since March he has performed the buttock lift technique, to give women more choice and limit the physical and emotional impact of breast reconstruction surgery.

Dr Allen was invited to Norfolk by consultant plastic surgeon Elaine Sassoon, who has performed the pioneering surgery on 70 local patients since visiting him in America four years ago to learn more about his techniques.

She hopes that the procedure could now be opened out to more women at the Norfolk and Norwich University Hospital as well as encouraging more surgeons nationwide to adopt it.

“It was just great in the theatre today because now I am quite happy to go in and do the other breast for this lady in a few months' time. I am going to be able to do this procedure here now,” she said.

“A lot of patients previously didn't want their buttocks used, but now we can do it and they won't be able to see the scarring.”

Dr Allen performed the operation with a team of surgeons and support staff and it was relayed by video into another room, allowing trainee surgeons and doctors from other hospitals to watch.

He also gave a lecture to staff at the hospital detailing the new technique and the advantages of using fat, rather than muscle, for reconstruction.

Yesterday's patient was in her late 40s and had had a double mastectomy some years ago following breast cancer.

Dr Allen said her options were somewhat limited because she was very athletic and did not have enough tissue in her stomach.

However, rather than leaving a prominent scar and possible change of shape of one of her buttocks, she was recovering this morning with evidence of the procedure camouflaged by the natural crease of her body.

“Elaine said she had a difficult case and they were considering raising money for the patient to be sent to me in the USA and I said I would be happy to come over to demonstrate the development myself. Now this can be part of what this hospital has to offer,” said Dr Allen.

“You are able to create a natural breast. They have less pain with these techniques than with others and now you can hide the scar with this development and not affect the contour of the body. It is a wonderful hospital here. They have a great team and they obviously want to increase the options available to women, which is fantastic.”

The operation, which takes between four and six hours and costs about £5000, sees anything from a few grams to 1kg of fat taken from the buttock depending on the size of the patient.

The tissue is removed teasing out the main blood vessels from the muscle. While another team works on the breast area of the patient, the surgeons shape the removed fat to fit with the natural shape of the woman's breasts. It is then reattached, along with some of the skin from the buttock, using minuscule blood vessels, less than a millimetre in diameter, to enable the blood to begin pumping through the transplanted tissue.

Dr Allen said yesterday's patient had previously been extremely active and participated in tennis coaching and other sports, but had felt unable to enjoy such things following her original mastectomy.

“If we can get her back to doing all the activities she used to do then it will have a big impact on her quality of life,” he said.

“Breast cancer affects many women and there are still a lot who end up losing a breast because of it. The subject of breast reconstruction is complex because we need to make the woman feel whole again, the breast is about how a woman feels about herself, about femininity and sexuality.

“It is more of a psychological reconstruction and if a woman has a mastectomy and they wear a prosthesis in her clothes it affects her whole lifestyle and if they can have reconstruction with their own tissue then eventually I believe they can feel whole again. The new breast is warm, it feels like your own body and it grows with you.”

The procedure also gives surgeons more options if there is not enough excess tissue around the stomach area - without having to possibly disfigure patients' buttocks.

Dr Allen said the majority of hospitals in England still used muscle from the buttocks, stomach or back for reconstructive surgery, which was more painful and had greater implications for the patient.

“If women now have a choice to save the muscle and still have reconstructive surgery then I believe they would choose that.”