2nd November 2006

Doctors made me a new breast... from my bottom!

By ANGELA BROOKS

 Better than before: Chrystele is pleased with her new look

More than 15,000 women a year have a mastectomy for breast cancer and most of these will have breast reconstruction. One of the latest advances is the IGAP where excess fat from the bottam is used to create a more 'natural breast'.

Here Chrystele Ganivet, 34, a support manager for an IT company who lives with her husband Neil in Haywards Heath, West Sussex, tells ANGELA BROOKS about her IGAP, while her surgeon explains the procedure:

The patient

Two years ago, my husband knocked my right breast when we were pushed in a crowd. It really hurt, and when I checked it at home I found a hard lump about the size of an egg yolk.

I went to my GP the following day. He said that, at 32, I was probably too young for breast cancer, but referred me to a consultant.

Over the next fortnight I had several scans, a mammogram and a needle biopsy. I was shocked to be diagnosed with Grade III breast cancer, the most aggressive form of the disease.

I'd never known anyone with cancer, and to make it worse, the surgeon said he only rated my survival chances at 70 per cent.

I was referred to oncologist Professor Elaine Smith at the Royal Marsden Hospital, London. She was very reassuring and refused to predict my survival chances because she said every breast cancer is different and each patient responds differently to treatment.

During the next four months I had two sorts of chemotherapy to shrink the tumour so that I could have a lumpectomy instead of a mastectomy, in which the whole breast is removed. Although the second course shrank it slightly, it wasn't enough.

I was devastated when Professor Smith told me I'd have to have a mastectomy — not just because of how it would look but also because the cancer might have spread. She arranged for me to see the hospital's plastic surgeon to discuss breast reconstruction.

Some women can have breast reconstruction at the time of the mastectomy, but mine had to be held off for eight months because my lymph nodes were to be removed to see if the cancer had spread. Then I was to have radiotherapy.

I did consider not having breast reconstruction, but my breasts are such an important part of my sexuality - I didn't want to lose that.

The best news was being told that my lymph nodes were cancer-free, but I still had radiotherapy to zap any stray cancer cells.

A few months later, I was referred to Elaine Sassoon, a plastic surgeon in Norwich. She was carrying out IGAP - an operation where tissue from your bottom is used to create a new breast.

I saw her in October last year. She explained there are several options with reconstruction: a silicone implant was the simplest, or surplus tissue could be taken from parts of the body to create the breast. I was told the IGAP suited my body shape.

I preferred the idea of having my own tissue to that of an implant. And I was told implants have to be changed periodically - which would mean another operation in 15 years.

I was admitted to hospital for the operation in November 2005. Two surgeons carried it out.

I lay on my side. One surgeon took the tissue (the flap) from just above and below the crease where the bottom joins the legs; the other cut out the mastectomy scar and found the blood vessels to which to connect the flap. The flap was then tailored to the right shape and stitched into place.

For the first two days after the operation, nurses checked the blood supply to the flap every half hour by holding an ultrasound wand over my breast. This is critical - if a clot develops where the vessels are joined, I could have needed emergency surgery.

My bottom was painful straight after the operation. Sitting in the car going home from hospital a week later was uncomfortable, too.

At night in bed, I slept on my side, and I sat in an ergonomic chair - the sort people with bad backs kneel on. But just a few weeks after surgery the discomfort had gone. From the start, my bottom looked fine. Now you can hardly notice a scar.

I was told not to do any physical exercise for six to eight weeks because of the wounds. But five weeks after surgery I went skiing - I am very sporty and couldn't bear to miss the holiday. I could feel my skin pulling on the wound in my bottom so I had to be really careful.

I was amazed how good my reconstructed breast looked when I saw it a few days after the surgery. It wasn't a perfect match, but it was a lovely shape - even slightly nicer than my other breast. I had no bruising but it felt tender for over a month.

Last month Miss Sassoon created a nipple for my reconstructed breast by taking a small wedge of tissue from the other nipple under local anaesthetic. This scar is still visible on my unaffected breast, but on my reconstructed breast the graft looks excellent because the texture and colour is the same.

She also did a little liposuction on my left thigh and injected this into my normal breast, padding it out to match my reconstructed one. (You can't tell where this fat was taken now because my body has adjusted.)

When the fat was taken from my bottom it initially looked lopsided but now, ten months later, it is symmetrical. Now I feel that I'm not just back to normal - I'm a stronger person.

THE SURGEON

Elaine Sassoon is a consultant plastic surgeon at Norfolk And Norwich University Hospital. She says: THERE are numerous operations on offer for breast reconstruction. A prosthetic implant may be ideal for slim patients with small to medium-sized breasts as they don't have surplus fat to use in breast reconstruction.

For others, alternative procedures include having surplus fat (flaps) redistributed from one part of the body to form a new breast.

Some patients are happier with this more natural route. But these are big operations with lengthy surgery and longer recovery periods.

Some women have breast reconstruction at the same time as their mastectomy. But for those who need post-operative radiotherapy, reconstruction is postponed because tackling the cancer takes priority and also radiotherapy could damage the new tissues.

For the IGAP we take a segment of skin, tissue and vessels - the flap - from the lower part of the bottom on one side, join these vessels to blood supply in the chest and then create the breast from this tissue mound.

The scar in the bottom falls in the bottom crease so it will be fairly inconspicuous, and we don't take any muscle so there's no loss of strength in the area from which we've borrowed.

In theatre the patient is placed on her side. One surgeon harvests the tissue flap from the bottom - this will be similar in shape to a large chicken breast. The other surgeon either does the mastectomy or, in a situation like Chrystele's where the reconstruction was postponed, they will cut out the mastectomy scar.

Chrystele's scar ran horizontally across the middle of her breast, but where this is will depend on the tumour. The latter surgeon will then find and prepare blood vessels to use in joining the flap.

Once we have this flap, we stitch the tiny vessels in the chest we've prepared to the vessels in the flap. When we're sure the flap is getting a good blood supply we can start tucking and pleating the tissue to fashion the new breast.

Every breast and flap is different, so precisely what we need to do will vary between patients. Essentially we are manipulating and moulding this transferred tissue to create a new breast similar to the other one.

When we are happy with the shape, we close up with under-the-skin stitches, which gives the best cosmetic result. In Crystele's case, these are now fine lines and fading well.

Patients are monitored every half hour over the next 48 hours to check the new breast has a good blood supply. If the breast goes cold or white, one of the joined vessels is blocked. This could mean emergency surgery to repair the problem.

Patients stay in hospital for a week and will initially be on a high protein diet. They have only light dressings - no bandages - so that we can check the blood supply. The dressings will be removed before the patient is discharged.

Patients will probably feel very tired for the first month, just like after any big operation.

IGAP reconstruction costs about £4,500 on the NHS and £10,000 privately. See www.optionsfor breastreconstruction.com.

3 people have commented on this story so far

This story features two very remarkable women, but unfortunately the article cannot cover all of the other fantastic people who has helped Chrystele on this journey. To correct one point, the oncologist was Professor Ian Smith from the Royal Marsden and was the first person to instil hope in Chrystele.

Elaine Sassoon, the plastic surgeon is one of the most dedicated people I have ever met. She used her own time to research this operation in France, USA and Scotland. She has since taught others so that it is now becoming a standard technique.

Chrystele, as you may have gathered is my wife. A person who has inspired and helped a lot of people with her openness and frankness throughout her illness and beyond. I am exceptionally proud of her.

- Neil, Haywards Heath

What a great idea, we need more of these stories please.

- Joan, Johnstone, Scotland

What an amazing story!

- Vicky, Staffs

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Last modified: 04/24/06