NON CANCER SURGERY

Prior to removal of a breast lump, Michelle would need to be confident as to the nature of the lump (benign, “not sure” or malignant). Some women have a benign breast lump called a fibroadenoma which they will want removed. Michelle will discuss scar placement so that shape of the breast following surgery is cosmetically pleasing, with minimal deformity.

Some women will be dissatisfied with their breast implants and will request removal of the implants. They may be having pain if there is capsular contracture or have significant asymmetry. It is worth remembering that following the removal of an implant, the breast becomes much flatter as the skin will have been stretched. The nipple position is often lower following removal of your implants (“ptosis”). To correct this some women require a breast lift or mastopexy.

Removal of breast implants is undertaken under a general anaesthetic and may be a day case procedure or an overnight stay. The capsule around the implant is removed and sent for analysis. You will have a drain in place for a few days- you are able to go home with the drain.

Some women have extra breast tissue or fatty tissue in their armpit area, called “accessory breast tissue.” This tissue acts like normal breast tissue, meaning it can swell, feel full, or hurt before a period. It might also develop lumps or change during pregnancy.

If this is bothering you, Michelle can surgically remove this tissue. You will be left with a scar in your armpit.

Michelle may recommend you have a Total Duct Excision if you are experiencing bothersome nipple discharge, or if the discharge is blood stained or clear in colour. Patients who have inverted nipples or chronic infection beneath the nipples affecting the ducts may also elect to have this operation.

This procedure is usually performed as a day case operation, and involves removing all of the milk ducts which open on to the surface of the nipple. There are approximately 12-15 ducts opening onto the surface of the nipple and some diseases will affect all of the breast ducts.

The operation is performed under a general anaesthetic. A small incision around the areola (the line between the brown area of the nipple and the remaining skin of the breast) is made and all of the ducts are removed and sent for pathological assessment. The wound is closed with absorbable sutures.

Approximately 1 in 3 patients after removal of the ducts from the nipple will have lost sensation to the nipple (numbness). This is more common in women who have had the procedure performed for infection. The symptom of nipple discharge will rarely recur. However, if the operation is performed for eversion (perhaps to correct an inverted nipple) about 10% of these patients will have recurrence of the inversion. Infection of the duct is common in smokers and continuation of smoking can contribute to recurrence of the problem.

Breastfeeding is not possible after total duct excision. There are no concerns if a patient becomes pregnant post operatively. The breasts may feel slightly engorged but they will settle after delivery of the baby.

Complications

Bleeding and bruising can occur post operatively. However, it is uncommon for patients to be returned to the operating theatre to drain a haematoma. Antibiotics will be given during the procedure and postoperatively to reduce the risk of infection. However, despite this a small number of women will get an infection postoperatively. The probability of this occurring is more common if the procedure is being performed for chronic nipple infection.

Occasionally, patients can develop a seroma after the surgery. This is natural fluid secreted by the breast tissue in the cavity where the surgery has been performed and occasionally a needle and syringe will be required to aspirate the fluid postoperatively.

There is always a very small chance you might lose some of skin over the nipple with nipple surgery as the blood supply to the nipple can be damaged at the time of surgery which can lead to loss of the nipple. A small scab will occasionally develop over the surface of the nipple and once it separates off the skin, new skin will grow under this.

Breast Augmentation or ‘the boob job’ is an operation aimed to enhance the volume of the breasts. It the most popular plastic surgery procedure, and almost 1% of women have had it done. It can also be done to lift a slightly droopy breast or combined with a mastopexy (breast lift) if the breast is very droopy and more volume is wanted. Most women seeking this surgery have always had smaller breasts and are self-conscious about the appearance. This can affect their choice of clothing, activities, relationships – even confidence at work. They are fed up of padded bras and want a bigger breast out of the bra too! In some women, volume has been lost after pregnancy or weight loss or one breast is a different size to the other (asymmetry) and breast augmentation can be a good option for these patients too. Do not be tempted to enlarge the breasts ‘naturally’ with breast enhancement pills. These contain phytoestrogens which have not been properly tested – many patients gain weight, there is a risk of deep vein thrombosis and possible risk of cancer.

Breast augmentation surgery can be done a number of ways. The extra volume comes from insertion of a silicone implant either under the breast gland or under the muscle beneath the breast gland. Silicone is extensively used in the medical as well as other industries and is thought to be entirely safe. Implants can be a round or teardrop shape. Miss Mullan has extensive experience of all the latest techniques and will be able to advise which technique is best for you, depending on the shape and amount of breast volume you have, and your desired volume and shape. Many surgeons are only familiar with one or two techniques, so its important to know, whoever you see, that they are suggesting the operation that is best for you rather than just the operation they are able to do.

Miss Mullan’s patients are highly satisfied with their surgery. Her patients are more comfortable with their appearance after surgery, their confidence and self-esteem is better. They feel they can wear more revealing clothing and often personal and sexual relationships improve. Its an operation Miss Mullan enjoys doing knowing predictably good results.

Breast reduction is an operation aimed to reduce the breast volume, while at the same time keeping or restoring a youthful appearance to the breast. Most patients are self-conscious about the size of their breasts, -this may affect their choice of clothing, work, activities and self-confidence in relationships. They may also get symptoms such as sweating and intertrigo (redness and maceration of skin) under the breast, back and neck ache, bad posture and grooving from bra straps. Some women also have one breast bigger than the other (asymmetry) which the operation can also address by taking more from one breast than the other.

Breast reduction surgery can be done a number of ways. Miss Mullan has extensive experience of all the latest techniques and will be able to advise which technique is best for you, depending on the amount of breast volume and skin laxity you have, the nipple position, and your desired breast size and shape. Many surgeons are only familiar with one or two techniques, so its important to know, whoever you see, that they are suggesting the operation that is best for you rather than just the operation they are able to do.

Miss Mullan’s patients are highly satisfied with their surgery. Her patients are more comfortable with their appearance after surgery, their confidence and self-esteem is better. They feel they can wear more revealing clothing and often personal and sexual relationships improve. Its an operation Miss Mullan enjoys doing knowing predictably good results.

Mastopexy or Breast Lift is an operation aimed to restore the youthful appearance of the breast. With age, after pregnancy and weight loss the breast tissue can stretch and become saggy, and the nipple position falls. Most patients seeking simple mastopexy, as opposed to reduction mastopexy (removing breast volume with the lift )or augmentation mastopexy (increasing breast volume with the lift with an implant), are happy with their breast volume within the bra, but self-conscious of the appearance out of the bra. They may also get symptoms such as sweating and intertrigo (redness and maceration of skin) under the breast.

Breast Lift surgery can be done a number of ways. Miss Mullan extensive experience of all the latest techniques and will be able to advise which technique is best for you, depending on the amount of skin laxity you have, the nipple position and size, and your desired breast shape. Many surgeons are only familiar with one or two techniques, so its important to know, whoever you see, that they are suggesting the operation that is best for you rather than just the operation they are able to do. For more details of the procedure, see ‘Breast Lift Information Leaflet’ below.

Miss Mullans’s patients are highly satisfied with their surgery. Her patients are more comfortable with their appearance after surgery, their confidence and self-esteem is better. They feel they can wear more revealing clothing and often personal and sexual relationships improve. Its an operation Miss Mullan enjoys doing knowing predictably good results.