Wednesday 22 November 2017

Breast Reconstruction - Know Your Options

Losing a breast is, for many women, one of the most traumatising aspects of breast cancer. Mastectomy patients often report feeling less feminine, which can lead to a loss of confidence and sexual well-being.

However, advancements in breast reconstruction techniques mean there are a variety of options for women who want to restore their figures.
Ocean Clinic Marbella specialises in breast surgery, including enhancement, reduction, and reconstruction. Read on to discover the treatment options available or book a consultation for personalised advice.  
Not about vanity
The decision to have breast reconstruction is a highly individual one; lots of women do decide to “go flat” and avoid further surgery. For others, breast reconstruction is an important part of their treatment and recovery.
Opting for reconstruction can minimise the psychological impact associated with losing a breast, especially if performed immediately after mastectomy. One study, which compared patients who had undergone breast reconstruction with those who had a mastectomy without reconstruction, found they were significantly more satisfied with their appearance and fared better psychosocially and sexually. Furthermore, they functioned better physically, experiencing less pain and fewer limitations.



Reconstruction without implants

In some cases it is possible to reconstruct a breast exclusively with a patient’s own tissue. Known as “autologous flap” surgery, it involves taking a section of skin, fat and sometimes muscle, from elsewhere on the body and transplanting it to the breast.

So-called “flaps” can be taken from the tummy, buttocks, upper back, inner thigh or upper hip. They can be cut completely free or left partially attached to the blood supply (pedicled) and moved up to the chest from within the body. With “free flap” reconstruction, the blood supply is re-established using microvascular surgery techniques.

The most popular autologous flap method uses the tummy as a donor site. This method has the unintentional benefit of providing patients with a tummy tuck at the same time, due to the relocation of abdominal tissue and subsequent skin tightening.

It can be performed either as free or pedicled, but free flap (DIEP flap) is preferred because it means the rectus abdominis muscle can be spared, helping to preserve abdominal strength.

The reconstructed breast can be further filled and shaped through fat transfer, which involves removing fat from another part of the body via micro liposuction and reinjecting it. Like the transplanted abdominal tissue, the fat regains a blood supply and becomes permanent.  

Providing a patient has enough donor fat and tissue on their body, autologous flap surgery can offer an all-natural way to restore the shape and size of their breast. The tissue ages naturally and changes volume corresponding to the patient’s overall body weight. While the patient will be left with scars on the donor site, when the flap is taken from the abdomen, these scars are well concealed below the bikini line.



Reconstruction with implants
If a skin-sparing mastectomy or lumpectomy is performed, where much of the breast skin is preserved, an implant can be immediately implanted under the pectoralis muscle. If the mastectomy leaves the skin too tight, a two-stage implant process is necessary.  

Firstly, a tissue expander (essentially a silicone pouch) will be put in and slightly expanded with saline solution. Over a period of several weeks, the expander is expanded via the injection of additional saline solution. This gradually stretches the skin and creates a pocket for the implant.

A new type of expander called AeroForm uses carbon dioxide instead of saline solution. It is needle-free and is expanded by the patient, at home, using a wireless, handheld dosage controller.

When the breast tissue expands to the desired size, the expander is replaced with a permanent implant. The benefit of using implants over autologous flap is that scarring is restricted to the breast itself and the procedure does not rely on the patient having sufficient donor tissue. It is therefore the best option for thinner individuals.


Timing for a breast reconstruction

The best outcomes can be achieved when breast reconstruction is carried at the same time as mastectomy or lumpectomy. Not only does it reduce the number of times a patient must undergo surgery and minimise scarring, deciding on immediate reconstructions enables patients to opt for a skin-sparing surgery.

Most women are eligible for skin-sparing mastectomies (unless the tumour cells are close to the skin). During skin-sparing mastectomy, the surgeon removes only the skin of the nipple, areola, and the original biopsy scar. Then the surgeon removes the breast tissue through the small opening that is created. The remaining pouch of skin provides the best shape and form to accommodate an implant or autologous flap. It enables patients to get the most realistic and pleasing results from breast reconstruction.
If a patient does not opt for immediate reconstruction, a skin-sparing mastectomy is not usually performed. The surgeon will most likely remove as much skin as is required to make the scar and the surface of the chest flat.
If a patient decides to wait and have reconstructive surgery later, they may still choose between an implant or autologous flap. The incision will be made along the scar of the previous mastectomy. In the case of implants, an expander will be used first, which does require the patient to have two operations.

Breast reconstruction and radiotherapy
Radiotherapy can reduce the likelihood of a successful breast reconstruction. This is because radiation kills normal tissue as well as cancerous tissue. It is therefore recommended to delay reconstruction until after treatment has been completed.
Radiated skin is hard to stretch and often becomes discolured. In addition, because radiation therapy significantly increases the risk of capsular contracture (the formation of excessive scar tissue around an implant) delayed autologous flap reconstruction is recommended over reconstruction with implants.
The good news is that, whatever a patient’s treatment plan, reconstruction is almost always an option. And although immediate reconstruction is preferable from a surgical point of view, breast reconstruction can be carried out months or even years after surgery. This means patients can take as much time as they need to recover, whether that’s physically or mentally.
Achieving the best aesthetic result possible
Achieving symmetry between a patient’s breasts is a key goal. To this end, a reconstruction can be carried out in combination with surgery on the remaining breast to ensure they are as close in size and shape as possible.
If the mastectomy has included the removal of the nipple, this can be reconstructed three to four months after surgery. This can be done by creating small flaps at the site where the nipple would have been and forming them into a nipple mound.

Micropigmentation tattoo is then used to simulate the natural colours. Alternatively, micropigmentation alone can used, with colour skillfully applied to give the appearance of a three-dimensional nipple.
While your new breast will never look or feel 100% like your old breast, breast reconstruction surgery can help you feel like your “old self” again, making you more confident to be intimate, on the beach or in the changing rooms.

If you are facing the prospect of mastectomy or have already undergone breast removal and would like to discuss your options for reconstruction contact Ocean Clinic Marbella.

Friday 3 November 2017

Do You Have A “Mathematically Beautiful” Face? (And How to Get One If You Don’t)

It’s often said that beauty lies in the eye of the beholder, however scientists have long been fascinated by trying to identify formulas for attractiveness.


On this blog, we have previously looked at the measurements hailed as “perfect” for noses, lips and buttocks - now we can reveal what science says about face shape.


The recent study, conducted by researchers at the Temple University School of Medicine in Philadelphia and published in Aesthetic Surgery Journal, aims to provide a guide for plastic surgeons to ideal mid-face proportions.


The study involved analysing photographs of 55 women with idealised facial proportions - the images were selected from a stock photography website after running a search for “beautiful young woman not smiling”.


Some 13 facial measurements were taken, but only eight were found to be statistically significant in terms of attractiveness. The researchers recorded the average measurements from the women’s faces (see below).


The most important measurements were:


  • The distance between the eyes (59.2mm)
  • Eye diameter (11.5mm)
  • Nose length (43.6mm)
  • Distance from the inside of the eye to top lip (53.8mm)
  • Width from cheekbone to inside of the eye (13.1mm)
  • Diagonal of cheekbone to chin (98.9mm)
  • Distance from cheekbone to hairline (86.9mm)
  • Distance from cheekbone to chin (83.5mm)



The overall conclusion from the study was that a heart-shaped face, with broad cheekbones and a narrow chin, was the most attractive. This face shape can be seen on celebrities like Reese Witherspoon, Jennifer Love Hewitt and Eva Longoria.
Writing in the journal, lead author Dr Gary Linkov, says: “The notion of ‘mathematical beauty’ implies the existence of ideal facial contours, dimensions, and ratios that, when present, create a harmonious, balanced, and attractive face.
“A heart-shaped mid-face is the quintessential symbol of youth and remains the overarching goal of mid-facial rejuvenation. However, few objective criteria exist to describe mid-facial position, whether in the ideal or aged state. We felt that these parameters might be useful to clinicians looking to find means of quantifying ageing changes, as well as postoperative improvements.”
Although some measurements recorded in the study - such as the distance between the eyes - cannot be cosmetically altered, others can be manipulated with injectable filler or fat transfer.
Cheeks, in particular, lose volume with age. This can be restored with fat or filler in order to give a fuller, more youthful looking face. One finding of the study was that cheekbones should be as wide as eyebrows for maximum attractiveness - augmenting the volume in the cheeks can help to achieve this appearance.
Ocean Clinic’s Head Surgeon Dr. Kai Kaye says: “Enhanced volume added to key areas of the face such as the cheeks and lips can make you look younger and more beautiful. However, if you don’t want a cosmetic procedure, contouring with makeup can help create the illusion of the desireable heart-shaped face.”

Meanwhile, women who have experienced facial skin sagging, resulting in jowls that have altered the lower proportions of their face, can have their jawline restored through a mini facelift.

To find out how your facial proportions could be enhanced, contact Ocean Clinic Marbella for a free consultation.