My breast was rebuilt by a robot: After Colette”s mastectomy, a pioneering technique restored her confidence
More than 18,000 women have a mastectomy every year in England alone.
Colette Hatley, 51, a payroll administrator from Ipswich, was the first in the country to undergo robot-assisted breast reconstruction.
“They give you a tummy tuck and use that removed tissue to tailor a new breast for you,” said Colette Hatley on DIEP flap reconstruction
Five years ago, at 47, I was diagnosed with breast cancer.
I’d gone to my GP after noticing puckering around the nipple of my right breast a couple of weeks earlier, and was referred for a mammogram and needle biopsy.
I’d done such a good job convincing myself it was nothing that I felt stunned when I got the results two weeks later.
What I found particulalrly difficult was being told I’d have to lose my breast.
Lumpectomy was ruled out because they’d found more than one lump, so mastectomy offered the best chance of completely clearing the cancer.
I was told I could either have a mastectomy with no breast reconstruction, or breast reconstruction with an implant, carried out at the same time as the mastectomy.
For the latter, doctors said they would insert a saline expander implant, which would be regularly topped up, to stretch the skin in order to allow for some droop when the silicone implant is put in later.
I have private insurance through work, so had this carried out at the Ipswich Nuffield at the end of July 2007 — but it was a disaster.
The saline implant had a faulty valve, so every time I went to have it topped up, the water would leak out and my T-shirt would be sopping by the time I got home.
Unfortunately, this had to take a back seat. Cancer had been found in my lymph nodes so this had to be the priority — chemotherapy then five weeks of intense radiotherapy.
This was completed in March 2008, so two months later my surgeon booked me in to swop the leaky saline expander for the silicone implant.
But my skin had been so damaged by radiotherapy it wouldn’t heal properly and I had a weeping wound.
On December 23 I was changing my clothes and found a hole in my breast, the size of a 2p, where the nipple would be.
It was absolute panic stations. We shot back to hospital and I was scheduled for surgery to have everything removed a few weeks later.
“It”s been almost two years since this operation and the scars are fading well,” said Colette
After that operation, I wasn’t just flat-chested on my right side, I was almost concave as they had to remove all the radiated tissue.
It was at a subsequent check-up that a new female surgeon asked if I’d considered having a DIEP flap reconstruction where they give you a tummy tuck and use that removed tissue to tailor a new breast for you.
I’d been told about this initially and it had sounded horrendous. But the surgeon said it would heal well this time because they had now removed all the radiated breast tissue.
She referred me to plastic surgeon Venkat Ramakrishnan, at St Andrew’s Centre, Chelmsford.
At my first appointment in April 2009, this time on the NHS, he explained how it works.
He would make a hip-to-hip incision, take out a large segment of tissue with blood vessels which they plug into your chest and fashion into a breast, then stitch your tummy so you get a tummy tuck, too.
My daughter Charlotte, 24, and Lee, my partner, were against it; they felt I’d been through enough. But I wanted to go ahead, so Mr Ramakrishnan put me on the waiting list and I had the procedure in April 2010.
It was then that I was asked if I minded if they did the stitching to join the blood vessels robotically.
Apparently, few surgeons can match the skill of a robot at this. I wanted it done, so said yes, and came out from surgery with a light dressing over my breast. I was kept very warm to make sure the newly connected blood supply to the breast was getting through.
It’s been almost two years since this operation and the scars are fading well. This year I went back to St Andrew’s for a breast reduction on my healthy breast so now I’ve got symmetrical boobs.
I can do all the normal things you don’t think twice about when you’re healthy, such as going to the gym and swimming. It’s been a rollercoaster, but looking back, my only regret is that I didn’t go for this in the first place.
Venkat Ramakrishnan is a plastic surgeon at St Andrew’s Centre for Plastic Surgery at Broomfield Hospital, Chelmsford.
The DIEP reconstruction procedure, using tissue from a tummy tuck to fashion a new breast for breast cancer patients who have had a mastectomy, was pioneered in the U.S. in 1992, and was first carried out in the UK in 2000.
Robots are now commonly used in some hospitals for prostate and kidney surgery, but we’re the first in the country to use it in breast reconstruction.
We use robots to join the blood vessels in complex breast reconstruction, which is the most challenging part of this sort of microsurgery.
These vessels are just 2mm in diameter, and if you get the tiniest overlap, the vein will block and the patient has to be taken back to surgery.
The robot arms have wrists and you can manoeuvre them perfectly in a tiny and deep space, which is what we’re doing in joining these blood vessels. The operation takes around four and a half hours.
Colette had what’s known as a delayed DIEP reconstruction. Our first step in theatre was to take a large oval-shaped segment of skin and fat from hip to hip.
We remove this tissue and stitch the top of the oval to the bottom of it.
Then we stitch the surrounding skin left on the stomach to the belly button, leaving a smiley face scar. We now weigh the tummy tissue we’ve taken.
At the time of mastectomy, the removed breast is weighed when it goes for testing, and to get the best match we want the new breast to be the same weight.
There is usually more tummy tissue than we need for the breast, so invariably this is trimmed.
Another surgeon will have opened the breast along the original mastectomy line and we now mould the tummy tissue into a cone or dome, then put a couple of stitches in it to hold it in shape and stitch this into place.
Then we make a 4cm to 6cm incision in the armpit where we look for a suitable artery and vein. With that located, we tunnel a channel from the chest through to the armpit and feed the blood vessels from the new breast though to the armpit.
It’s at this stage the robot is wheeled in to join these blood vessels, putting about 12 microscopic stitches with material thinner than a fine hair through each of them.
We close the incision in the armpit and the chest, and the patient is taken to a ward where they are carefully monitored for three days.
Nurses continually check the breast to make sure it’s both warm and a healthy colour. If it were to go very pale or blue, this would mean a vein was blocked and the patient would have to be taken back to theatre.
A DIEP flap is the gold standard for breast reconstruction.
The great beauty of this procedure is that it will age and droop more naturally, and if the patient loses weight, the breast will change shape naturally with it.
Robot-assisted DIEP flap reconstruction is not yet available privately. It costs approximately 7,500 on the NHS.