This month’s Nuffield Health advice column focusses on congenital breast problems, including the signs to look out for and ways to alleviate the problem
Ms Elena Prousskaia is a Consultant Plastic Surgeon at Nuffield Health Bristol Hospital, The Chesterfield, who performs breast reconstruction surgery for breast cancer patients, but also for women with forms of congenital breast pathology. Elena is keen to raise awareness of this latter group of patients who are born with breast anomalies, and tell us about the treatments that are available to correct these conditions.
Elena, why did you decide to tell us about this particular problem?
Elena: There is already a lot of public awareness about breast reconstruction for breast cancer patients. In my role as a patron of the breast cancer charity Keeping Abreast, I often deliver talks for patients who are looking at reconstruction following a mastectomy. However, when I see patients in my clinic, I realise just how little information is available about other breast deformities, which can actually be resolved very successfully.
I often have consultations with young girls who come with their parents after researching online to find a surgeon who specialises in breast asymmetry or the correction of a condition known as ‘tuberous breast’. Many of them tell me the difficulty they have experienced in simply finding a specialist for this particular problem, and information online can sometimes be controversial, as well as being confusing for the patients.
It must be very difficult for a young girl to discover that there is something wrong with her body. Would it be fair to say that when they come to you they are quite upset?
Elena: Most of them tell me very similar stories, about how they started to realise in their early teens that their bodies may be different to those of other girls, and how it affected their confidence. Unfortunately, some of them do not feel they can share how they feel with their parents or friends, and they may not have a partner to confide in as they feel uncomfortable being undressed, or going to the beach. Their quality of life and personal happiness can be severely affected.
What is the most common form of congenital breast pathology that you see in your clinic?
Elena: The two that I see most frequently are breast asymmetry and tuberous breasts.
Congenital breast asymmetry is the term given when a girl has developed two breasts of different size and shape. Tuberous, or tubular, breasts are when the breasts have developed in an incorrect shape, with a very narrow base and excessively large areola. It is called “tuberous” because it is similar in shape to a tube, instead of the normal teardrop breast shape.
Is the surgery required to correct this type of problem complicated? How many operations might these patients need to restore their breasts to a more “normal” shape?
Elena: Asymmetrical breasts can be corrected with a single operation. I always explain to the patient that the most important thing is to make them equal in terms of volume of breast tissue and skin. Once I have created a good match, the shape can be improved with breast tissue remodelling techniques or implants of the same size, and it can all be done in one operation.
With tuberous breasts it can be slightly more complex as the breast tissue and skin are sometimes severely constricted from the inside. In most cases I manage to release this hard tissue from inside and correct the volume with implants in one stage. Areola reduction is done on the same day.
However, in some instances, I also need to insert “tissue expanders”, which work like a balloon to stretch the skin and breast tissue with regular inflation sessions where I add around 55cc of volume each time, by gently stretching the tissue. This will sometimes be done over the course of a few months.
Once a desired size of skin pocket is reached, I proceed with the second stage whereby I exchange the tissue expander for the breast implant, and perform further breast tissue remodelling to give the patient their desired shape and volume. These cases can be quite challenging, but ultimately also satisfying to see the change.
Public opinion about plastic surgery nowadays is that it is mostly about vanity. When these patients come back to see you for follow-up appointments, what do they tell you about the difference this surgery has made to their life?
Elena: Before surgery, both the patient and their family can be quite anxious regarding the whole situation.
After surgery, the patients have an air of confidence about them that they lacked before, which is very similar to what I see in patients after reconstructive surgery for breast cancer. As a surgeon I find this part of my work very rewarding.
At Nuffield Health Bristol Hospital, The Chesterfield, we work with professionals in all areas of Plastic and Cosmetic Surgery, and believe in giving our patients the individual attention they need and deserve throughout their treatment journey.
Consultant plastic, cosmetic and reconstructive surgeon, Ms Elena Prousskaia
To achieve the best results from any type of plastic surgery, it is important to do your research first. Here are some tips for what to ask before surgery:
- Who will I see at my consultation?
This should be your surgeon. After your consultation, you should also have a ‘cooling off’ period before your operation of at least two weeks to ensure you really have time to think through your decision.
- What are the surgeon’s qualifications?
Check your surgeon is on the GMC specialist register for plastic surgery in the UK. If your surgeon has a further qualification in plastic surgery you will see FRCS (Plast) after their name. Ideally surgeons will belong to one of the professional organisations: the British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS) or the British Association of Aesthetic Plastic Surgeons (BAAPS). Your anaesthetist should also be listed on the GMC specialist register.
- Is the surgeon and the hospital fully insured in case anything goes wrong?
All Nuffield Health surgeons are fully insured, as are Nuffield Health hospitals. Any necessary revision surgery should be free. If you have surgery at Nuffield Health, post-surgery complications will be treated free of charge, without a specific time limit.
- What is the surgeon’s experience in performing my procedure?
Your surgeon should specialise in the type of surgery you are interested in, and perform your specific operation at least once a month. They should also be able to describe back to you what you have asked for, and tell you what they can’t achieve as well as what they can. Be wary of surgeons who say they have never had a complication.
- Can I see before and after photographs?
Not all patients want to be featured on websites, but most surgeons will have photographs of patients. However, ensure they are the surgeon’s actual patients. You may also be able to speak to previous patients about their experience.
- Where will I have my procedure?
This should be the hospital or clinic you are seen in. Having surgery close to home makes follow-up care more convenient. Anywhere you have surgery should be registered with the health regulator, the Care Quality Commission.
- What will my recovery be like?
Ask about the typical recovery period, so you can plan time off work and childcare, if needed. Ask about bruising, swelling, and any specialist garments you need. Find out if they are supplied by the hospital or if you should bring them with you.
- How much will my surgery cost?
Ask if everything is included in the price, including your Consultant and anaesthetist’s charges, medications, dressings, and after-care.
Nuffield Health is the UK’s largest not-for-profit healthcare provider, which means that all of its profits are reinvested into better facilities for the patients. For more information about the full range of cosmetic and plastic surgery available at Nuffield Health Bristol Hospital, The Chesterfield, visit nuffieldhealth.com or call the enquiries team on 0117 911 5339 to book an appointment.