I've got my curves back after a mastectomy… thanks to a pigskin breast patch
11:13 GMT, 5 June 2012
Breast reconstruction after a mastectomy often involves two operations. Sarah Turnbull, 40, a postgraduate student who lives with her husband and their two children near Leeds, had a pioneering all-in-one procedure, as she tells ANGELA BROOKS.
When I was diagnosed with breast cancer in 2009 at the age of 37, my priority was having the disease dealt with.
I had to undergo a mastectomy in my left breast and had no hair after the chemotherapy — it was a horrible time.
I’d been warned that cancer could develop in my right breast, and had to go for twice-yearly check-ups.
Cancer survivor: Sarah Turnbull is feeling herself again after having pioneering breast reconstruction surgery
In September 2010, a mammogram found a lump in my right breast. Luckily after tests, my surgeon, Rick Linforth, gave me the all-clear — this time the lump was benign.
I was so happy, but I knew then and there I wanted that breast off, too — I just couldn’t face any more scares.
Mr Linforth was supportive and explained the options. He said he would be able to remove all the tissue from my breast through an incision he would make around my nipple, and then put in a silicone implant.
The implant is too heavy to be supported by the skin alone, and needs extra internal support.
So normally what they have to do is to fit something called an expander under the muscle in your chest.
This is a temporary, inflatable implant. For three months, you have to go back regularly to have saline injected into the expander — a bit like slowly filling an empty balloon with water — to stretch the muscle.
Once it has been stretched sufficiently, they replace the expander with a permanent silicone implant in a second operation.
Reconstruction: A graft made of pigskin helps to bolster existing muscle, so its strong enough to support a proper silicone implant straight away
Mr Linforth explained that all breast implants need this sort of internal support, as even small ones are heavy and otherwise they would stretch out the skin, making the breast droopy.
He said he could short-circuit this process by using a new graft made of pigskin. It helps to bolster your existing muscle, so it’s strong enough to support the implant, and they can put in the proper silicone implant straight away. It’s all done in one procedure and you’re spared the months of having the muscle stretched.
He said I could have my left breast reconstructed at the same time, but for this he wouldn’t be able to use pigskin. A lot of the skin had been taken when I’d had the mastectomy and you need to attach the pigskin to your own skin. So on this breast I would need to have the normal expander procedure.
I put my faith in him and knew immediately it was what I wanted, but I held off for almost a year — simply because the radiotherapy I’d had on my left side makes the skin less elastic.
I was admitted to Bradford Royal Infirmary for both breast reconstructions last September and came out of surgery four-and-a-half hours later with gauze dressings over each breast and a drain to take off excess fluid coming from each breast. I was worried at first because my breasts didn’t look symmetrical. But a week or so later, everything had settled and they matched very well. In fact, I’m probably slightly bigger than I was.
My breasts are also more pert — after having two children, they were like floppy chicken fillets, but now they are a good shape.
I’m so pleased with the surgery and just want to enjoy my life and my family.
Rick Linforth is an onco-plastic surgeon at Bradford Royal Infirmary. He says:
Some 45,000 women are diagnosed with breast cancer every year in the UK, and approximately 16,000 undergo mastectomy.
You can get a great result with a tummy-tuck breast reconstruction — where we take excess tissue from the tummy to reconstruct the breast — but it’s certainly not for everyone.
Some women, like Sarah, are slim and athletic and don’t have spare fat we can take. The tummy tuck surgery is also far lengthier with a longer recovery time and women are left with a second scar at the site the tissue was taken from. So breast implants will be the first choice for some women.
However, the major problem we’ve had with a mastectomy is that the pectoralis muscle in the chest that’s used to hold in the implant isn’t big enough to cover the whole of the implant.
So, traditionally, we’ve overcome this shortage by putting an expander under the muscle after mastectomy. Then, every two weeks the patient returns to the clinic to have more saline put into the expander. It’s not painful, but it’s like having a blood test every couple of weeks.
Then, about three months later they can have the expander removed and have a second operation to swap it for the silicone implant.
The advantage of the Strattice pigskin is that we instantly have the extra internal tissue we need, so we can do an immediate implant-based reconstruction.
Women wake up from a mastectomy with a finished bust, so the impact of the loss of their own breast is lessened.
Pigskin is fairly similar to human tissue, and we strip all the pig cells out of it so the body doesn’t recognise it as foreign.
This means that within three months the patient’s blood vessels will be growing into it.
The human body continually breaks down and makes new tissue, so within two or three years it will completely break down the pigskin and have started transforming it into its own tissue. First, I make an incision around the nipple and remove all the breast tissue through this.
That done, we can see the pectoralis muscle and, by cutting along the lower edge of this and just slightly up the middle, which is a fairly bloodless area, this muscle becomes loose.
I then take the thin, stretchy piece of pigskin and stitch it to the tissue the muscle is attached to. This forms the bottom of a ‘hammock’ for the implant.
Next, I put in the implant and stitch the pigskin and muscle round the sides of the implant.
Finally, I close the nipple opening. Women can keep their nipple, but there is a slightly increased risk of cancer recurrence if they do.
If they don’t, they will just have the breast mound, but we can fashion a nipple from tissue and the colour can be tattooed on at a later date — many people say they can’t tell the difference.
Patients leave surgery with a gauze dressing over the scar and they will have a small drain coming out of the breast to collect excess fluids from the breast.
There will be some bruising and swelling, but the breast will pretty much look how it’s going to look immediately after surgery.
The pigskin graft can be used only when the reconstruction is being done at the same time as a mastectomy.
Women who have previously had a mastectomy and lost most of the skin on their breast — as Sarah had with her left breast — cannot have it.
Pigskin is expensive. The piece we need, which is 16cm by 8cm, costs 1,900, but the procedure costs no more to the health service than expander reconstruction because we save on the second operation and the five clinic appointments patients would need to top up the expander.
Mastectomy with immediate pigskin reconstruction costs the NHS 4,500. Privately, it costs approximately 10,000.