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
*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
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
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
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 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
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
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