Volume Replacement Breast Surgery

This type of surgery may be suitable for someone who has a breast cancer (tumour) and wishes to conserve (keep the breast) therefore mastectomy (removal of the breast) may be avoided. 

Whenever breast conservation surgery is performed the surgeon must also remove an extra rim of normal healthy tissue surrounding the tumour to ensure a clear excision margin. If this margin is not achieved, then further surgery may be required.

AIM

The aim of volume replacement surgery is to allow larger tumours to be removed and the tissue to be replaced to restore the shape and size of the breast with a good cosmetic outcome.

TYPE OF SURGERY

Most women have spare tissue on the chest wall and under the arms so this tissue can be used to fill the space where the tumour has been removed. 

There are several types of volume replacement surgery which involves moving tissue from the chest wall or under your arm  depending upon where the tumour is located. Your surgeon /breast care nurse will discuss the options that are best suited to your needs . The types of surgery  are as listed below: –

LICAP

Lateral Intercostal Artery Perforator Flap Reconstruction.

Suitable for patients whose tumour is situated in the outer part of the breast

MICAP

Medial Intercostal Artery Perforator Flap Reconstruction.

Suitable for patients whose tumour is situated in the inner part of the breast.

THORACIC/ABDOMINAL ADVANCEMENT Flap Reconstruction

Suitable for patients whose tumour is situated in the lower or outer part of the breast.

THE OPERATION

The operation will be carried out under a general anaesthetic and will take approximately two to three hours to perform. All patients who smoke will be advised to stop smoking prior to the operation to reduce the risk of post-operative complications.

On the day of the operation, your surgeon will draw on you to help plan the surgery he/she may need to use a special instrument called a doppler to assess the blood supply to the flap of breast tissue which will be moved to fill the space where the tumour has been removed. This is to ensure that a good blood supply is maintained and the tissue stays healthy. 

SCARS

Your surgeon will talk in more detail about the scars and have photographs / drawings available for you to view.  Usually the scars for the LICAP  are situated in the upper outer part of the breast towards the chest wall and  for the MICAP and THORACIC /ABDOMINAL ADVANCEMENT FLAP the scars are usually situated under the breast  or at the outer edge of the breast. All scars are red and raised initially and begin to settle over a 12-month period. The scars are well hidden in a bra.

With your consent, your surgeon will most likely ask to take photographs before and after the surgery.

HOSPITAL STAY AND AFTERCARE

This surgery is usually a day case procedure, but you may require one overnight stay in hospital depending upon your recovery.

An appointment will be made for you to return to clinic to see your Consultant or breast Ccare nurse to have your wound assessed, you may have to attend the clinic for further dressings. Your wound should be kept covered by dressings until your Consultant or breast care nurse is happy with your wound. The stitches will be dissolvable. 

It is unlikely that you will require a wound drain however your surgeon may decide to use one.

This involves a small plastic tube being inserted into the operation site during surgery and attached to a drainage bottle. Your surgeon may want this to remain for several days after your operation. You will be allowed to go home with the drain in place but will have to return to see your breast care nurse to assess the drainage volumes, then to have it removed.   

A comfortable bra can be worn after surgery, underwire bras should be avoided until your wound is well healed. Please speak to your breast care nurse before wearing an underwire bra.

Heavy lifting and strenuous exercises should be avoided for at least six weeks.

Driving should be avoided until your wound has healed and you can comfortably wear a seat belt and perform an emergency stop if required.

Any other specific instructions will be explained to you before you leave hospital or by your Breast Care Nurse.

BENEFITS OF SURGERY

All surgery involves risks and benefits, it is very important that your surgeon discusses this with you so that you can make the right choice for you.   

The most important benefit of surgery is that the cancer is removed from the breast.

By using this type of surgery, the cancer (even some larger tumours) can be successfully removed without the need to perform a mastectomy; therefore you will not need to lose your breast. 

RISKS AND COMPLICATIONS OF SURGERY 

Most patients will only experience a few of these but it is important that you are aware of any potential problems.

BLEEDING 

Bleeding may occur after the surgery (usually within the first 12 hours) A very small amount of bleeding is not uncommon but anything more may mean another short operation to stop the bleeding.  

BRUISING 

Bruising is common after surgery and usually settles after a few weeks.

PAIN

Pain may be experienced after any operation especially when it involves breast tissue being moved around however it is not usually described as severe. You will be offered painkillers both in hospital and to take home. You may experience tightness on the chest wall where the flap has been taken from. This should settle within 2-3 weeks. 

INFECTION

Infections are rare after breast surgery but can occur so as a precaution you may be given antibiotics during the operation to reduce the risk of infection. If the wound becomes infected after surgery, you may require a course of antibiotics. The risk of infection is higher in patients who smoke or those who are diabetic or obese.

ASYMMETRY (unequal size and shape)

There may be a difference in the size and shape of your breasts, this will adjust with time as your wounds heal and any swelling settles. However, if this is very noticeable further surgery may be performed at a later date to address this.  

FURTHER SURGERY

In approximately 5 to 10 percent of patients further surgery is required to ensure the cancer has been completely removed.  Your surgeon will discuss this with you if required. 

RADIOTHERAPY CHANGES

When patients have breast conservation surgery, radiotherapy treatment is usually recommended after the surgery., This can lead to shrinkage of the breast tissue which can make the breasts appear different to one another. This is often not noticeable when wearing a bra, but if this is causing you concern please speak to your surgeon or breast care nurse about any options available to you.  

SEROMA

This is a fluid collection under the scar area which frequently occurs after surgery. This is not harmful and can just settle on its own but occasionally the seroma can cause some discomfort and can be drained by your breast care nurse.

WOUND AND SHOULDER STIFFNESS 

Your wound may feel quite tight after the surgery, this will relax over the coming weeks, but you should keep your shoulder supple and perform the post-operative exercises advised by your breast care nurse or physiotherapist. 

WOUND BREAKDOWN

This is when the wound can open and lead to a delay in the wound healing requiring dressings to be used to aid the healing.

LOSS OF SENSATION

Some patients can experience changes in sensation in the tissue around the scar which can sometimes extend towards the nipple, this can be either numbness or hypersensitivity. It usually settles within a few months.  

FLAP LOSS/FAILURE

There is a 1 to 2 percent risk of loss of blood supply to the flap resulting in further surgery being required. 

FAT NECROSIS

This can occur any time after the operation. It is when a firm lump is felt in the breast resulting from inadequate blood supply to the fatty tissue in the flap or breast tissue. This is not cancerous but may require an ultrasound scan (and possible biopsy) to confirm the diagnosis.  

GENERAL ADVICE

This information sheet should be read in conjunction with the Queen Elizabeth Hospital, Green Book patient information file.

If you have any further questions, please contact your breast care nurse or an appointment can be made or you to discuss this further with your consultant breast surgeon. 

DATA PROTECTION

Any personal information is kept confidential.  There may be occasions where your information needs to be shared with other care professionals to ensure you receive the best care possible.

In order to assist us to improve the services available, your information may be used for clinical audit, research, teaching and anonymised for National NHS Reviews and Statistics.  

Further information is available via Gateshead Health NHS Foundation Trust website or by contacting the Data Protection Officer by telephone on 0191 445 8418 or by email ghnt.ig.team@nhs.net.