Breast reconstruction - patient information guide

Plastic surgeons are frequently involved in the primary reconstruction of the breast following a mastectomy – that is, following the whole or partial removal of the breast to help treat or prevent breast cancer.

1. Introduction

Reconstructive breast surgery is a multi-disciplinary treatment, coordinated with cancer surgeons and cancer specialists (known as oncologists).  Reconstructive surgery aims to rebuild the breast, either wholly or partially, to normalise the look of the breast and leave the patient with a symmetrical bust.  It also aims to improve the patient’s body image and self-esteem, helping the process of recovery on a physical, emotional and psychological level.

Current evidence suggests that breast reconstruction, either at the time of (immediate) or after (delayed) cancer treatment, has no adverse effect on the outcome of a patient’s cancer.  According to guidance from the National Institute of Clinical Excellence (NICE link), all patients should be offered immediate breast reconstruction following a mastectomy.

Breast reconstruction can be a complex procedure, often involving microsurgery techniques; it is therefore best carried out in specialist centres equipped with state-of-the-art facilities.  As patient awareness of breast reconstruction grows, there is likely to be increasing demand for this procedure – as a result, plastic surgeons are becoming common and integral parts of the multi-disciplinary teams treating breast cancer in the UK.

2. What causes breast cancer?

Breast cancer is the most common form of cancer affecting women in the UK, with 40,000 new cases diagnosed every year.  Cancer occurs when normal cells stop responding to the control systems used to co-ordinate the function of cells.  These rogue cells start to multiply abnormally, forming cancerous tumours.  The reason for this cell dysfunction is the subject of much research and debate, but is a combination of environmental, lifestyle and genetic factors.

The treatment of breast cancer is based on the elimination of these rogue cells, whether through surgical excision or by killing them with radiotherapy and chemotherapy.  The type of treatment a patient requires depends upon the type of breast cancer, and the extent to which the cells have spread within and beyond the breast.  Your breast surgeon will discuss the options available for you and will help guide your decision.  

3. What is a mastectomy?

About 40% of women diagnosed with breast cancer require or choose to undergo mastectomy, the surgical removal of the entire breast.  The breast is positioned between the skin of the chest and the chest wall muscles, and consists of milk ducts, glands, fat and some connective tissue holding all of these components together.  The glands produce milk, which runs via the ducts to the nipple.  As the nipple is connected to the entire breast and the cancer can involve the ducts, the nipple must usually be removed as part of the mastectomy.

Mastectomy is recommended for women with certain types of breast cancer.
The details should be discussed with your breast surgeon, but generally a mastectomy is recommended if:

  • cancer is present in two or more areas of the breast;
  • the breast has been previously treated with radiotherapy;
  • a large tumour is found in a small breast; and if
  • the tumour is likely to recur.

On discovering cancer within one breast, many women prefer to have that entire breast, or even both breasts, removed to minimise the chance of breast cancer in the future.

4. What surgery is available, and what techniques are involved?

Breast reconstruction involves recreating the breast to match the remaining natural breast as closely as possible.  The main aim is to recreate the breast shape and volume, either at the same time as the mastectomy, or at a later date.

One of the first choices confronting patients is whether to undergo immediate or delayed reconstruction. Immediate reconstruction is performed during the same operation as the mastectomy.  Delayed reconstruction occurs once a patient has fully recovered from a mastectomy (usually after several months).

The benefits of immediate reconstruction are:

  • Better cosmetic results
  • The skin of the breast can be preserved
  • Smaller breast scars
  • Only one anaesthetic and recovery period
  • Only one stay in hospital
  • No period of time without a breast

The benefits of delayed reconstruction are:

  • Staggered surgery, resulting in an easier and shorter recovery following each procedure
  • Time to consider whether reconstruction is right for you without delaying the cancer treatment
  • Less to deal with at once

The favoured technique amongst many plastic surgeons is to use a patient’s own tissue to reconstruct the breast.  In recent years, own tissue or autologous reconstructions have become more and more popular amongst patients. This tissue is usually taken from the abdomen or back, but sometimes from the buttocks or thighs.  For some patients, however, an implant-based reconstruction is more appropriate.

Finally, some women still opt not to have their breasts reconstructed at all.  Many women feel radically changed by their cancer experience, and some feel that a flat chest is an apt acknowledgement and expression of their post-cancer persona.  Others may opt to wear a prosthetic breast rather than undergo further surgery.

5. Implant-based reconstruction

When a breast is reconstructed using an implant alone a silicone implant is inserted under the skin and muscle of the chest to replace the breast volume that has been removed at the time of mastectomy.  This is quite a simple operation that does not involve incisions elsewhere on the body.  Sometimes an adjustable implant called an expander-prosthesis can be used, this is adjusted by injections of saline which can be done in the outpatient clinic in the weeks after the operation.

Implant based breast reconstruction

In implant-based reconstruction a silicone implant is inserted behind the chest wall muscles.  Sometimes an inflatable tissue expander-prosthesis is used to stretch the overlying tissues and allow adjustability after the operation.

Implant-based reconstruction is usually advised for patients who are not suitable for autologous reconstruction.  This might be because they have no spare tissue to use, they are not medically fit for a larger operation, or they simply do not want a big operation involving incisions and scars elsewhere on the body.  It is best for patients with relatively small breasts that do not droop at all.  It can be difficult to get a natural breast shape with an implant alone so can be effective if both breasts are being removed.

The main disadvantage of implant-based breast reconstruction is that it is impossible to create a breast with a natural shape and feel.  No skin is replaced so it cannot be used where there is a need for skin replacement.  Most patients having an implant-based reconstruction will require adjustment of the opposite breast to improve the shape and size match.  Whilst the breasts can look a reasonable match whilst dressed they will usually be different shapes when undressed.  Many patients who have implant-based reconstruction will need to have further operations in the future to adjust or exchange their implant.  Implants are prone to hardening, deflation, visible folds and creases, and do not give good results in patients who have radiotherapy.

6. Latissimus Dorsi flap reconstruction

One type of flap transfer for breast reconstruction uses the latissimus dorsi muscle from the back along with an overlying patch of skin.  This muscle’s blood supply makes it extremely useful for breast reconstruction, as it gets its main blood supply from vessels emerging from the armpit. In this procedure, the muscle is transferred to the breast area by swinging it around the ribcage so that it lies at the front of the body.  Using this procedure skin removed at the time of mastectomy is replaced along with some volume.  Some patients will also need an implant to further augment the volume, but it is sometimes possible to remove enough fat from the back attached to the flap to replace the missing breast volume without an implant.  This is called an autologous latissimus dorsi reconstruction.

Latissimus dorsi

In latissimus dorsi breast reconstruction a flap consisting of the latissimus dorsi muscle along with a patch of overlying skin is taken from the back and rotated around to the front in order to recreate the breast.  An implant is sometimes need beneath the flap.

 

Latissimus dorsi

This shows the expected result of a delayed latissimus dorsi breast reconstruction.  The flap has replaced the skin that was removed at the time of the mastectomy.  The volume is replaced either with just the muscle and fat of the back, but if this is insufficient an implant is also used.  The second picture shows the final result after nipple areola reconstruction.

 

Latissimus dorsi

In immediate breast reconstruction it is often
possible to preserve most of the breast skin.
In this case only a small disc of skin including
the nipple areola has been removed at the
mastectomy.  This skin disc and the breast
volume has been replaced using a flap.
A nipple areola reconstruction has also
been done.

A latissimus dorsi flap reconstruction is a larger operation that using an implant alone, but will usually give a more natural result, particularly if an implant is not needed. It is a very durable and reliable flap.  It does result in quite a large scar on the back, but this can usually be positioned to be concealed by most clothing and underwear.  Losing the muscle from the back does not seem to cause any restriction of shoulder movement or strength in most patients.  Latissimus dorsi flap reconstruction is most suitable for patients who do not need much skin replacement and whose abdomen is not suitable for flap transfer.  It can be ideal for relatively heavily built patents who have small to medium sized breasts.

7. Abdominal flap reconstruction

The skin and fat of the lower abdomen is often the ideal tissue for breast reconstruction.  A large amount of skin and volume can be replaced in order to achieve a very natural look and feel.  Removal of excess skin and fat can often be a welcome bonus for the patient, resulting in a “tummy tuck”.  When first described the operation involved tunnelling the lower abdominal flap with the underlying rectus abdominis muscles beneath the upper abdomen to the chest – a pedicled TRAM flap.  Whilst this technique is still sometimes used most surgeons find that transferring this tissue as a free flap is more reliable.  Free flap reconstruction involves the transfer of living tissue from one part of the body to another, along with the blood vessel that keeps it alive.  Free flaps are entirely disconnected from their original blood supply and are reconnected using microsurgery in the recipient site.  This procedure involves hooking up all the tiny blood vessels of the flap with those in the new site, and is carried out with use of a microscope, hence the name ‘microsurgery’.

Abdominal flap

This illustrates a breast reconstruction using a free lower abdominal flap.  A large flap of skin and fat from the lower abdomen is raised along with the blood vessels that keep it alive.  In this case a small portion of muscle has also been taken (TRAM flap).  In some cases it is possible to take the blood vessels without taking any muscle (DIEP flap).  The flap is transferred to the chest to replace the missing skin and volume.  The blood vessels of the flap are joined microsurgically to blood vessels in the chest to restore the blood supply to the flap.

In free flap breast reconstruction, skin, fat and sometimes muscle from one part of the body is transferred to the breast area.  During this process, the skin and fat is completely removed from the original area and reconnected in the recipient site.  Blood vessels from the armpit, or near the breastbone, are used to create a new blood supply for the transferred tissue.  There are several variants of lower abdominal free flap transfer depending on which blood vessels are used and whether any muscle is transferred, these are:

Types of lower abdominal free flaps
Free TRAM flap - In this operation a small piece of muscle is taken along with the blood vessels, skin and fat
Free DIEP flap – this variant uses the same blood vessels as the TRAM flap, but they are carefully dissected out from the muscle when the flap is raised and DIEP flap contains no muscle
Free SIEA flap – In this operation some of the more superficial blood vessels on the tummy are used and no muscle is dissected or transferred

Each of these flaps can achieve the same thing in terms of the eventual reconstruction, but the DIEP and SIEA involve less or no interference with the function of the tummy muscles.  Some surgeons have a particular preference and experience with one or other variant.  Sometimes the exact flap used is decided during the operation so it is not possible for the patient to pick one technique that will definitely be used.  The patient has to rely on the surgeon to use the most reliable technique in the circumstances.

Whilst abdominal flap reconstruction can give excellent results it must be recognised that this is a major procedure.  Patients spend up to a week in hospital and will undergo a recovery period lasting several weeks.  There will be scars on the breast and a large scar across the abdomen as well as around the umbilicus.  There may be some difficulty sitting up from lying down initially if the abdominal muscles are dissected, but in the long term most patients notice no real problems.  All breast reconstruction is a process and many patients will need further procedures to adjust their reconstruction.  These are usually minor procedures such as liposuction to reduce the size of the flap, scar revisions, lipofilling or nipple reconstruction.  That said, autologous reconstruction is durable and once a satisfactory result is achieved it tends to be static and permanent.

8. Other Flaps

Where the abdomen is unavailable or unsuitable flaps can be taken from the buttocks or upper inner thighs.  These flaps are much less commonly used and not all breast reconstruction centres will offer these techniques so you might have to travel to see a suitable expert if this is the best option for you.  Buttock flaps are based on one or other of the blood vessels emerging from the buttock muscles, the flaps are known as SGAP flaps or IGAP flaps.  Flaps from the upper inner thighs are known as TUG flaps.  In general these other flaps are used in patients who want autologous reconstruction and who are very slim  or have had previous abdominal surgery.

Flaps containing muscle are named after the muscle

Flap type
TRAMTransverse rectus abdominis muscle from the abdomen
Latissimus dorsiLatissimus dorsi muscle from the back
TUGTransverse upper gracilis muscle from the upper inner thigh

Perforator flaps only contain skin and fat and are named after their artery

Flap type
 
DIEPDeep inferior epigastric perforator from the abdomen
SIEASuperficial inferior epigastric artery from the abdomen
IGAP
Inferior gluteal artery perforator from buttock crease
SGAP
Superior gluteal artery perforator from the upper buttock

9. What should I expect as a patient?

All patients considering breast reconstruction should have the opportunity to  have a consultation with a plastic surgeon who has an interest in breast reconstruction in order to discuss their options.  At this consultation all your options will be explored and discussed.  In some patients there is really only one type of procedure that can be recommended, but some patients will have a choice to make.  Consideration is given to how much skin and volume needs to be replaced, how much is available in the various flap donor sites, the general fitness of the patient, their preferences in terms of outcome and donor scarring, possible interference with other treatments and whether the other breast can be matched or if it needs to be adjusted.

Once the decision to proceed has been made you will have a preadmission assessment and clinical photographs.  All breast reconstructions are done under general anaesthesia.  When you come round you will have some dressings and drains.  Various techniques are used to make the process as painless as possible.  With free flap breast reconstruction you will have a period of careful monitoring for the first day or so after the operation, but will then be allowed to get up and about.

Once you go home from hospital you will feel very tired initially, and would be advised to have someone around to help you.  After the first week you should be starting to look after yourself and begin to resume normal activities.  The recovery period varies depending on which of the operations you have had done.  A few weeks after the operation you will be seen again in clinic to check how you are doing and make sure all your wounds are healing well.  You will then be seen a few months later to assess the outcome.

Surgical adjustments are often needed following breast reconstruction, and it may be necessary for patients to undergo one or two smaller procedures, aimed at slightly altering the shape of the breast or creating a nipple and areola.

10. What complications can occur?

With any operation there are some risks, steps are always taken to minimise these risks.  The most frequent complication is delayed wound healing.  This risk is greatest in some of the larger flap operations where the incisions are longer.  If there is a wound problem it is usually minor, but more major wound healing problems can occur such as infection, skin loss, wound separation and possible reoperation.  Very occasionally, soon after the surgery, bleeding may occur this may necessitate a return to theatre to stop the bleeding.  Sometimes patients can collect fluid beneath the operation site, this may need to be drained off in clinic.  If an implant is used there are some specific complications that can happen.  In some abdominal flap surgery there is a risk of abdominal muscle weakness or perhaps even a bulge or hernia. There is a slight risk of blood clots after the operation occurring in the legs or lungs, steps will be taken before during and after the operation to minimise this risk.  In flap surgery there is a risk that the circulation to the flap may cease, if this occurs it is usually in the first day or so.  You will be monitored carefully to spot this, but if it occurs you will need to go back to the operating room to remedy the problem.  The microsurgery may need to be redone, if so circulation will usually be restored.  However there is a slight risk that it cannot and the flap is lost.  The relative risk of these various complications varies between operations and the likelihood of them happening in your operation will be discussed with you.  There is not much that you can do to minimise any of these risks, but in delayed reconstruction patients may be advised to try to lose weight before the operation, all patients should stop smoking prior to surgery.

11. Where can I go for more information?

Download the BAPRAS Guide to Breast Reconstruction

Breakthrough Breast Cancer

Breast Cancer Care

Breast Cancer Support Board

Macmillan Cancer Support - Breast cancer

Cancer Research UK- Breast cancer

Hereditary Breast Cancer Helpline - 01629 813000 (24 hour helpline)
Email: canhelp@btopenworld.com

Irish Cancer Society

Look Good...Feel Better

Options for Breast Reconstruction

The Boudica Within: The extraordinary journey of women after breast cancer and reconstruction by Elaine Sassoon published by The Erskine Press, 2007 ISBN 978-1-85297-097-0

Department of Health - Guide to breast screening

Department of Health - Be breast aware

My New Breast- A BBC documentary profiling the work of plastic surgeons at the Canniesburn unit in Glasgow

Conditions that develop later in life due to accident or infection.
Lazy eye.
A preinvasive cancer involving the surface layer of the anus.
Before birth.
Rare and dangerous lesions that occur in the scalp, head and neck region. Often triggered by puberty, there is often a visible swelling in the skin which is blue in colour.
This is surgery to fuse a joint.
The procedure whereby liquid contents of a swelling can be removed with a needle.
Reconstruction of the ear using the patient’s own tissue.
This is the most common form of skin cancer. It grows locally and does not spread elsewhere in the body. It is usually cured by simple removal.
A colloquial term for prominent ears.
A condition caused by infection of by a reduced blood supply to the facial nerve.
A benign condition is one that is not usually serious or harmful.
When clefts occur on both sides of the mouth.
Microtia affecting both ears.
A biopsy is a medical test involving the removal of cells or tissues for examination.
A new surgical technique often used in the treatment of hemifacial microsomia. Developed from limb lengthening operations first described in Russia, this technique is based on the principle of pushing small pins into bone, and moving these pins apart by a connecting bar which incorporates a screw thread. As the pins are gradually stretched apart, the bone and surrounding soft tissue is also stretched.
The group of nerves located behind the collar bone which control feeling and movements in the arm.
An artificial implant that is under the skin.
The smallest blood vessels in the deep layer of skin.
Another term for a haemangioma or strawberry mark.
A condition caused by mechanical interference with the median nerve in the wrist. This large nerve provides feeling to the thumb, index and middle fingers and half of the ring finger. It also provides power to the small muscles at the base of the thumb. The median nerve enters the hand from the forearm, passing beneath a tough ligament (known as the carpal ligament) that runs across the wrist. This nerve can become squeezed, either because the contents of the tunnel beneath the ligament swell, or because the size of the tunnel decreases. This squeezing of the nerve causes tingling in the fingers, often accompanied by numbness. These sensations are usually worse at night, and often wake a patient from sleep. Pain can occur later on in the condition and can be felt in the hand, forearm or even in the upper arm and shoulder.
An acquired shriveling of the outer ear common in boxers and rugby players.
Another term for a haemangioma or strawberry mark.
Abnormal cells in the cervix that only involve the surface layer of the cervix.
The neck of the uterus or womb.
Saromas arising from cartilage
Split or separation.
Where the lip components fail to fuse and are split or separated.
A specialist nurse that works as part of the cleft lip and palate team.
Where the palate is split or separated. This occurs when the main components of the palate – the two palatal shelves in the roof of the mouth – fail to fuse properly.
A clinical expert in the delivery of evidence-based nursing interventions usually in one specific area of clinical practice.
Medical practitioner who specialises in cancer and its treatment.
Nose reshaping operation carried out from inside the nostrils.
The central piece at the bottom of the nose that divides the nostrils.
A whole side-cleft running up to the nose from the lip.
A complete cleft of the palate extends to the hard palate, the bony part at the front of the mouth.
A graft consisting of skin and other underlying tissues such as fat and cartilage.
The cartilage bowl of the ear.
Conditions present at birth.
A congenital condition in which the ear takes on a cup shape due to shortening of the outer circumference of the ear.
A situation where tissues or scars shorten and cause deformity.
A bone distraction procedure whereby a cut is made in the bone which is to be stretched. Pins are passed through the skin and into the bone on either side of the cut. These pins are then connected together by a distractor. In most cases, the distractor is opened by approximately one to two millimetres each day through the turning of a small screw. An average distraction length is likely to be in the region of two to two and half centimetres, which will probably take about three weeks to achieve. At the end of the period of distraction, the distractor is left in position for six to eight weeks while new bone fills the gaps which have been created. A second small operation is then required to remove the distractor.
Is the term used to describe a number of conditions which, like craniosynostosis, involve the overgrowth and undergrowth of the structures of the head and face.
A condition caused by the premature closure of the gaps between the bones of the cranium.
Cryptotia means ‘buried ear’. This is a relatively rare deformation in which the groove behind the ear is not fully formed. This is aesthetically displeasing and can cause difficulties in wearing glasses. This condition can occasionally be corrected using splints but more commonly is corrected surgically around the age of 5.
A colloquial term for constricted ears.
Cysts associated with the skin are very common. They appear as rubbery or firm lumps just beneath the skin and attached to it. Often a tendency to get cysts is inherited. If they grow large they can become unsightly, they can become infected.
Concerning the act of defaecation.
Flat head syndrome in newborn babies. This is asymmetry in a baby’s head caused by the positioning of the head during extended time spent in a neonatal unit, the birth process, the position in the womb, and most often, the infant's preferred sleeping position.
Deep layer of skin.
A healthy part of the body where skin is removed as part of a skin graft or flap procedure.
Bridge of the nose.
This affects the layer of gristle which lies beneath the skin on the palm of the hand, fastening the skin to bone, enabling us to clutch and grip. The disease first makes its appearance as a small lump in the pit of the palm. Over time, this lump may form a cord of tissue that runs from the palm to the finger. After a while, this cord begins to shrink, drawing the finger into a clawed position.
A treatment for arteriovenous malformations (AVM) with onyx. Designed to stop the blood-flow to the lesions.
A cut made in the posterior wall of the vagina during childbirth.
Surgical removal.
An operation to remove a diseased part of the body.
A balloon-like device inserted under the skin near the area to be repaired, which is then gradually filled with salt water, causing the skin to stretch and grow.
A procedure whereby the face is deliberately split vertically along the line of the nasal bridge during monobloc advancement, in order to bring the eyes closer together, expand the upper jaw and rotate the two halves of the face into a more normal position.
This refers to a paralysis of part of the face caused by a dysfunction of the facial nerve. The facial nerve controls the facial muscles, especially those around the eyes and mouth – for example, the muscles that lift the eyebrows, close the eyelids and raise the corners of the mouth to shape a smile. It is in these areas that patients with facial palsy most commonly experience problems.
When developing tissues fail to join up properly.
Between the tissues of the body are layers of connective tissue that separate them. These layers are known as fascia.
A flap including the fascia along with its blood supply.
Transfer of a living piece of tissue from one part of the body to another, along with the blood vessels that keep it alive. Unlike a skin graft, flaps carry with them their own blood supply. Flap surgery can restore form and function to areas of the body that have lost skin, fat, muscle movement, and/or skeletal support.
Flap reconstruction involves the transfer of a living piece of tissue from one part of the body to another, along with the blood vessel that keeps it alive. Unlike a skin graft, flaps carry with them their own blood supply. Flap surgery can restore form and function to areas of the body that have lost skin, fat, muscle movement, and/or skeletal support. There are two main types of flap. These are local flap and regional flap.
Flap reconstruction involves the transfer of a living piece of tissue from one part of the body to another, along with the blood vessel that keeps it alive. Unlike a skin graft, flaps carry with them their own blood supply. Flap surgery can restore form and function to areas of the body that have lost skin, fat, muscle movement, and/or skeletal support. There are two main types of flap. These are local flap and regional flap.
Asymmetry in a baby’s caused by the positioning of the baby’s head during extended time spent in a neonatal unit, the birth process, the position in the womb, and most often, the infant's preferred sleeping position.
Free flap reconstruction involves the transfer of living tissue from one part of the body to another, along with the blood vessels that keep it alive. Unlike other flap transfers, free flaps are entirely disconnected from their original blood supply and are reconnected using microsurgery in the recipient site. This procedure involves hooking up the tiny blood vessels of the flap with those in the new site, and is carried out with use of an operating microscope.
A graft consisting of all layers of the skin.
Ganglions are the most common type of swelling in the hand. They contain a thick clear liquid called synovial fluid. Although ganglions can arise from any joint or tendon tunnel, there are four common locations in the hand and wrist - in the middle of the back of the wrist; on the front of the wrist at the base of the thumb; at the base of a finger, and on the back of a finger end-joint. Ganglions occur when synovial fluid leaks out of a joint or tendon tunnel and forms a swelling under the skin, although the cause of these leaks is not known. In some cases ganglions are painful, in others they are not.
A clinical geneticist arranges tests and advises patients and families who suffer from inherited conditions.
The term used to describe any surgery to the chin which does not involve the tooth-bearing part of the lower jaw. These procedures may be used to move the chin forwards, backwards, upwards or downwards, and are usually done via an incision made inside the mouth where the lower lip joins the lower gum. The bone of the chin is cut horizontally below the level of the tooth roots, and is then moved into its new position and fixed there with wires or titanium screws. These remain in place and do not need to be removed. The incision is then closed with dissolving stitches.
The lower urinary and reproductive tract.
A drug used to treat GIST sarcomas.
A skin graft involves taking a healthy patch of skin from one area of the body, known as the donor site, and using it to cover another area where skin is missing or damaged. The piece of skin that is moved is entirely disconnected, and requires blood vessels to grow into it when placed in the recipient site.
Concerning cancers arising from the female genital tract.
Medical practitioner who deals with the health of the female reproductive system.
A benign overgrowth of blood vessels on the skin that appears as a soft, raised swelling. They are typically crimson red in colour with a slightly dimpled surface. They appear just after birth, largely around the head and neck but can appear anywhere on the body. Colloquially known as strawberry marks or birthmarks and medically also referred to as strawberry naevi, strawberry haemangiomas, capillary haemangiomas and cavernous haemangiomas.
Major injuries that have been sustained to the hand. This could range from burns and skin loss to loss of digits.
Bony palate at the front of the month.
A congenital condition involving underdevelopment of the face.
The human papilloma virus.
Defect of the urethra in baby boys.
Slight notch in the lip.
This involves either realignment of bones or ligament reconstruction using a tendon; suitable only for a minority of patients who have an unstable joint but little damage to the surfaces of the joints.
The external lips of the vagina.
The outer lips of the vagina.
The inner lips of the vagina.
A surgical procedure to reshape the inner lips of the vagina.
Operations to move the facial bones forward.
Sarcomas that grow out of smooth muscle.
A lesion is a medical name for a skin blemish of some sort. Skin lesions include moles, warts, cysts and lipomas.
A muscle in the middle of the eyelid.
Lipomas are fatty lumps under the skin. They usually grow slowly as painless swellings.
Uses a piece of skin and underlying tissue that lie near to the wound. The flap remains attached at one end so that it continues to be nourished by its original blood supply and is repositioned over the wounded area.
Local removal of a lesion with a cuff of normal tissue.
A colloquial term for constricted ears.
A clear fluid carried through a network of channels in the body known as the lymphatic system.
These are organs consisting of many types of cells, and are part of the lymphatic system. Lymph nodes are found all through the body, and act as filters or traps for foreign particles. They contain white blood cells and are important in the proper functioning of the immune system.
A vascular malformation. These involve the lymph system and are present at birth or develop up until the age of two. The do not shrink or fade. They vary from small blister-like marks on the skin to large swellings in the neck, limbs or face.
A network of channels in the body that carry a clear fluid called lymph.
Melanoma is the type of cancer that arises in pigment cells within the skin. It is less common than the other sorts, but can be more serious. The majority of patients are still cured by simple removal, but melanoma can come back after removal and spread elsewhere in the body. Over the past few decades, the incidence of melanoma has risen steadily throughout the world.
Facial surgery to correct abnormalities of the jaw.
Medical practitioner who specialises in cancer and its treatment.
Surgery carried out with use of a microscope.
Surgery carried out with use of a microscope.
Translated from the Greek, means ‘little ear’. It is the medical word used to describe a small or absent ear in newborn babies.
A technique to remove a skin cancer with a narrow margin. The edges are then mapped and carefully checked to ensure complete removal of the tumour. If the excision is incomplete the involved margin is re-excised. This process is repeated until the excision is confirmed to be complete at all the edges.
A mole is a clump of pigment cells in the skin. Moles usually appear as flat brown marks during childhood and early adult life. They gradually change as time goes by often becoming more raised and paler, some go away completely. Moles assume a wide variety of sizes and appearances, some grow hair, and some are rough on the surface.
A LeFort III type osteotomy which extends into the skull to move the forehead region forward at the same time.
The mound anterior to the vagina.
This is a team made up of specialists working together to make sure that the best possible treatment is given
The medical name for capillary malformations.
Basal cell cancer and squamous cell cancer are two types of non-melanoma skin cancer.
The cartilage that makes up the tip-support to the nose needs to be partly removed or reshaped. This is done through the nostril, or by making a small cut in the bit (columella) between the nostrils.
A dental specialist that treats dental displacement or facial growth abnormalities on an aesthetic or reconstructive basis.
Surgeons that carry out procedures concerning the musculoskeletal system.
This is the degeneration of a joint through wear and tear. It can cause aching, especially between thumb and the side of the index finger. The pain may lead to a sense of weakness when you pinch or grip. The base of the thumb may become swollen and may crunch audibly during certain movements. It may also become misshapen. It is this pain and disability that often encourages people to seek surgical interventions.
Sarcomas arising from bone.
Is the term used to describe the surgical correction of prominent ears.
A surgeon who diagnoses and treats conditions affecting the urinary tract and genital tract in children.
A medical specialist that deals with the illnesses and treatment of infants, children and adolescents.
The two parts of the roof of the mouth that form the palate.
When the cleft is partial, it affects only the soft palate at the back of the mouth.
Medical practitioner who diagnoses diseases via tissue or cell samples or via autopsy.
That portion of the external pelvic organs that includes the urinary tract, the genital tract and anus.
A professional who treats and manages patient with musculoskeletal problems using exercises and other forms of physical therapy.
The colloquial name for capillary malformations.
Surgical procedure whereby the vagina is separated from the rectum and the muscles pulled together to tighten the vaginal structures.
These affect people who are immobilised through sickness or disability. The sores themselves occur when skin overlying a bony prominence breaks down following prolonged contact with a surface, such as a mattress or a wheelchair seat.
A sarcoma affecting bone.
The problem is often inherited, and is caused by a lack of the usual cartilage folds in the ear.
Shaping and fitting a false ear to the side of the head.
Someone who fits a prosthesis.
Professionals who are concerned using psychological findings to help people live healthy and productive lives and resolve mental health problems.
Medical practitioner who uses radiation to treat disease, usually cancer.
Radiation treatment used to treat disease, usually Cancer.
An area of the body where skin is missing or damaged and to where tissue is transferred.
The lower part of the large bowel above the anus.
Uses a section of tissue that is attached by a specific blood vessel. When the flap is lifted, it needs only a very narrow attachment to the original site to receive its nourishing blood supply from the artery and vein.
Nose reshaping.
An acquired condition characterised by the deterioration of the skin and soft tissue of one half of the face (usually the left side). More common in females than males, this deterioration causes initial changes in the tissues above the upper jaw, or between the nose and the upper corner of the lip. It then progresses to the mouth, the area surrounding the eye, the brow, the ear and the neck. It may also affect the tongue, the soft palate, and the gums. The eye and cheek of the affected side may become sunken, and facial hair may turn white and fall out.
A cancer of the body’s connective tissues, such as bone, muscle, cartilage and fat.
The outer groove of the ear.
The central structure of the nose.
A skin graft involves taking a healthy patch of skin from one area of the body, known as the donor site, and using it to cover another area where skin is missing or damaged. The piece of skin that is moved is entirely disconnected, and requires blood vessels to grow into it when placed in the recipient site.
The soft, flexible portion of the Palate at the back of the mouth that is concerned with speech.
The role of a speech and language therapist is to assess and treat speech, language and communication problems in people of all ages to enable them to communicate to the best of their ability.
A muscular constriction at the entrance or exit to a cavity or body organ.
The use of splints or other external devices to correct deformity, maintain position and support structures.
A graft that uses only the layers of skin closest to the surface.
A bar of cartilage in the upper part of the ear causing an extra crease.
Another term for a haemangioma or strawberry mark.
Another term for a haemangioma or strawberry mark.
A thick, clear liquid that lubricates a joint or tendon. This fluid accumulates within a ganglion.
Where muscle is moved from the temple to the eyelids to restore strength is area and counter the effects of paralysis.
The major bone in the lower leg.
Tissue expansion is a procedure that enables the body to ‘grow’ extra skin by stretching surrounding tissue. A balloon-like device called an expander is inserted under the skin near the area to be repaired, and is then gradually filled with salt water, causing the skin to stretch and grow.
This involves the transfer of digits from the foot to the hand undertaken with use of a microscope. The absence of a finger does not usually have much effect on either the function or the appearance of the hand, but when the missing digit is a thumb, or when many digits are missing, surgery may be needed.
A tough ligament that runs across the wrist.
This involves the complete removal of the trapezium bone; recommended if the joint above or below this bone are affected by arthritis. Some surgeons fill the gap left by the bone, or the deficit with adjacent tissue.
This is performed if there are concerns that the thumb appears too slack to sit securely in the new joint created by the removal of the bone.
The main joint at the base of the thumb. This joint carries a lot of force when the thumb is used, yet allows for a complex range of movements, including rotation.
Trauma refers to any serious, body-altering injury sustained through accident or impact. Trauma injuries vary in type and severity, but most commonly involve burns, lacerations, fractures and crush. Plastic surgeons have always been involved in the treatment of trauma.
An inherited congenital condition with a genetic cause. It affects both sides of the face and is associated with alteration of the position of the eyes, deafness, underdeveloped low-set ears, and underdevelopment of the mid and lower face.
Microtia affecting one ear.
This refers to all structures from the fingertips to the neck, and also encompasses the group of nerves located behind the collar bone which control feeling in the arm.
The tube through which urine is passed.
‘Pee-hole’
Constriction or blockage of the vagina.
These cover a broad spectrum of skin lesions present at birth of shortly after birth.
One of the types of vascular anomalies. They are present at birth. They grow proportionately to a baby and are classified according to the dominant blood vessel type they contain.
The external female genitalia.
Changes that can occur in the skin that covers the vulva. If left untreated, it can develop into vulval cancer.
A wart is a rough patch of skin. The most common type is caused by a wart virus infection. There other types of wart with other causes.
This means not only removing a tumour but cutting out a fair amount of surrounding tissue also.
Procedure whereby the wound is cleared of dead or damaged soft tissue and bone.
A procedure to convert a straight incision or scar into a zigzag. This is used throughout plastic surgery in a number of situations such as to release a contracture, reposition features, deepen a web, and improve the appearance of a scar.