When is a mastectomy the right choice?

Inevitably in certain situations mastectomy (removal of the whole breast) is the only treatment that will effectively treat a breast cancer depending upon your individual circumstance. In addition sometimes a patient may elect for mastectomy even when breast conservation is possible (e.g. in a situation where there is a significantly increased familial breast cancer risk). In these situations a patient may choose simple mastectomy (without reconstruction) or a mastectomy in combination with whole breast reconstruction.



If a patient chooses simple mastectomy Mr Hawkins will use an approach most likely to result in a mastectomy scar that is as easy to live with as possible and avoids excess skin which enables the easy use of a external prosthetic if required. However, increasingly breast reconstruction is being chosen by patients who opt for mastectomy as part of their treatment. Mr Hawkins provides a wide range of reconstructive techniques and is able to guide you through your choices..

Your options in Breast reconstruction

When considering breast reconstruction surgery it is important that you have all the information at your disposal to allow you to make the correct choice. Mr Hawkins is able to guide through your options in the full range of breast reconstruction techniques and is dual trained in breast cancer and reconstructive techniques to provide both aspects of your care personally.

Some of the issues that you may wish to discuss include;

• Immediate vs. Delayed Breast reconstruction.

Breast reconstruction can be performed either in an "immediate" setting (at the same time as a mastectomy is performed) or as a "delayed" procedure at a later time following a previous mastectomy. Either approach can have particular advantages depending upon the individual circumstance. Immediate breast reconstruction allows the original breast skin "envelope" to be used and may lead to better aesthetic outcomes, However, a delayed reconstruction may be the better alternative if there is an expectation of post mastectomy radiotherapy and also allows a patient to recover from their cancer treatments before embarking on their reconstructive journey at a time that suits them and fits in with their lifestyle.



• Skin Sparing & Nipple sparing mastectomy and immediate breast reconstruction. 

Skin sparing and nipple sparing mastectomy techniques are both techniques that are offered by Mr Hawkins and in the correct situation offer a safe and effective treatment when combined with immediate breast reconstruction. This allows your existing breast skin to be used as part of your breast reconstruction which improves the natural appearance of the reconstructed breast. 

• Implant based Breast reconstruction.

Mr Hawkins is an expert in the delivery of implant based breast reconstruction and uses advanced implant based techniques including Acellular Dermal Matrix (Strattice) and Lower pole dermal sling assisted reconstruction. These techniques allow optimal positioning of the implant and provide a more natural appearing breast reconstruction compared with traditional implant-based reconstructive surgery (where an implant is simply placed under the pectoral muscle leading to an unnatural appearing reconstruction, which often sits too high on the chest wall). Mr Hawkins introduced the use of Acellular Dermal Matrix in breast reconstruction to Great Western Hospital in Swindon and this was a major focus of his fellowship training.

• Flap Based (Autologous) Breast reconstruction.

Flap based reconstruction uses your own tissue to reconstruct the breast and can be particularly useful in breast reconstruction where radiotherapy treatment is expected. Mr Hawkins offers pedicled flap based reconstruction in the form of the Latissiumus Dorsi Flap where tissue is transferred from the back whilst still connected to its blood supply and can be performed with the use of a silicone implant if extra volume is required. He can also advise on the use of micro-surgical techniques (including DIEP flaps) that are offered in tertiary centres.

• Lipofilling or Fat transfer. 

Lipofilling is a restorative surgical procedure which involves transfer of fat cells from other areas of the body (usually the abdomen, buttocks and thighs) into the breast to correct deformity caused by previous breast surgery. It is a highly versatile treatment that can also be used in other areas of reconstructive and restorative breast surgery. 

• Nipple Areolar Reconstruction surgery. 

Nipple reconstructive surgery is often the "final step" on a woman's reconstructive journey and provides the finishing touch to a breast reconstruction where preservation of the nipple has not been possible. Mr Hawkins uses a number of different techniques including the use of local skin flaps or nipple sharing to produce a natural looking nipple on a reconstructed breast. This can often be done under local anaesthetic and can be combined with areolar tattoos to provide a natural appearing nipple reconstruction.

The other breast....

The other breast is an important consideration during breast reconstruction surgery for a range of reasons including concerns that you may have about developing disease in the healthy breast following a diagnosis of breast cancer. These issues are often complex and involve a number of considerations including your risk of developing a further breast cancer. It can be difficult to make decisions regarding a healthy breast in the midst of a breast cancer diagnosis and it is important that you make the choices that are right for you in the long-term. Mr Hawkins will be happy to address any concerns that you may have regarding your long-term breast health as part of your consultation.

In addition the other breast may require surgery to obtain symmetry following a breast reconstruction. As an dedicated oncoplastic breast specialist Mr. Hawkins performs a wide range of breast reduction, augmentation and uplift procedures which are an essential element of achieving the best outcomes following breast reconstruction surgery. These techniques are often the same as those employed in cosmetic breast surgery procedures (see cosmetic surgery section).