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Video

Voiceover:
52-year-old Janice came to the clinic to see if she could have a nipple reconstruction after breast cancer 13 years ago. She also has breast asymmetry and is looking for a solution.

Dr Christian:
Yeah, it doesn’t look amazing, does it, actually. I think we could improve on that.

Voiceover:
She’s been referred to see consultant Mr Farhardi to see what kind of reconstructive surgery is available.

Janice:
When I bend over, you can really see…

Mr Farhardi:
Yeah, the difference.

Janice:
This one is not really behaving like a breast anymore.

Mr Farhardi:
Yeah.

Janice:
It doesn’t feel nice, it’s really hard.

Mr Farhardi:
It’s hard, yeah, because the implant…

Janice:
Especially when I’m lying down.

Mr Farhardi:
The implant has become firm, and you can feel that the implant has a very thick capsule surrounding it. On your right side is the implant as well, and it’s not anymore sitting as it should, and opposite as well, your nipple is distorted. It has almost like a rectangular shape. On your left breast, the reconstructed one, I would exchange the implant and remove part of the capsule, to make it again soft. On your right breast, I would remove some amount of skin and reposition the nipple so that you would have symmetry.

Janice:
Thank you.

Mr Farhardi:
Nipple reconstruction has become very very realistic nowadays, especially as you can individualise the size and shape of, of the reconstructed nipple. And most women are very pleased with the result of a reconstructed nipple, and therefore I think you can achieve good results nowadays.

Voiceover:
Two weeks later, Janice is back for her operation. Mr Farhardi marks out the positioning of the new implants and nipples. The first task is to soften Janice’s reconstructed breast.

Mr Farhardi:
A capsule formation always happens, um, because of the implant, because it’s a reaction of the body to what’s foreign material, which gives the discomfort and pain, and obviously it has changed her breast shape. There are different grades of capsular contraction, they range from one to four in severity, and hers is a grade three. So this bit here, that’s the capsule, that’s her own tissue, and the thicker it becomes, the more, the more contracture it gives.

Voiceover:
Once the hard shell is released, the new implant can go in. To sort out the asymmetry, he moves on to the other breast, replacing the old implant and removing the excess skin.

Mr Farhardi:
I’m positioning the nipple into the new area, which we marked out before, so that’s, that’s starting to lift up the breast and the nipple into the new position. So that’s going to have in the end a more rounder look. I have removed part of the lower skin in order to do the breast lift, and we’re starting that as well, stitching them up together too. And the measurement which I have done from here to here is exactly the same one that’s going to be from, from uh, on the opposite side. That’s all part of the planning, so that at the end, the breasts will look similar. The right breast will always fall more to the side than the left one, because this breast here, this is a reconstructed breast, and this one here is her own breast, so this is kind of the natural way how her breast would fall when she lies down.

Voiceover:
With the breast symmetry now sorted, a new nipple can be created using a flap of Janice’s own tissue.

Mr Farhardi:
The one which I’m using at the moment, it’s called an arrow flap because that’s the shape of an arrow. So I’m just…I’m lifting up the skin pattern which I’ve marked, together with fat, just underneath it. It’s a very reliable technique, and gives you good projection. As you can see, it’s going to be bigger than this side, but I’m always creating a nipple about 50% larger than what I’m expecting, because it will shrink down by 50% anyway. So if you would, if I would be doing it too small, then obviously I’d end up with a flat nipple. The skin I used was good viable tissue, and therefore the final result should be quite pleasing.

Voiceover:
Now for the cherry on top of the cake—the area around Janice’s new nipple needs to be shaded, using a new tattooing technique to create an aureole.

Tattooist:
So what we’re going to be doing is we’re going to be bringing some of the natural colour of your aureole and placing it on where the reconstructed side is. That’s pretty good. What I’m trying to do here is I’m trying to find the perfect colour to match to your aureole…I would be inclined to go for this colour here.

Janice:
Yeah.

Tattooist:
Are you happy with that?

Janice:
Yeah.

Tattooist:
Perfect.

Voiceover:
Unlike normal tattoos that use ink, this procedure uses a more natural ingredient: iron oxide pigment. And although needles are used, the tattoo doesn’t go as deep as traditional tattooing, making it a semi-permanent procedure that can last up to six years, and meaning that the tattoo can be adapted at a later date to match changing skin tones. The tattooing aids the shrinking process, one of the main reasons for making the nipple construction twice as big.

Tattooist:
So here we are, we have a set! So, what do you think, Janice?

Janice:
I love it! I think it’s great.

Voiceover:
A few days later and Janice is back in the clinic to show off her new bosom to Dr Christian.

Dr Christian:
And you’ve actually had quite a bit of surgery, haven’t you? It wasn’t just a question of building a new nipple…

Janice:
No.

Dr Christian:
...but to get all the asymmetry corrected, you’ve had to have your implants removed, new ones put in…I mean, it’s been quite an ordeal, hasn’t it?

Janice:
It has, it took a while to get over it.

Dr Christian:
So are you happy now with everything?

Janice:
I’m really happy.

Dr Christian:
You are, really, honestly.

Janice:
Yeah, I love them.

Dr Christian:
Great! That’s all I want to hear. Do you feel now, happy, confident? This, this is it now, is this…

Janice:
I do. I’ve turned into a complete narcissist, and I keep gazing at myself adoringly in the mirror.

Dr Christian:
Really. Do you keep looking at your bosoms in the… Well, to put it politely, can I have a look at your breasts now, please? I’d love to see them.

Janice:
Of course.

Dr Christian:
Excellent, now, stand up, and have you got a bra on?

Janice:
Not…no.

Dr Christian:
Okay, I can see why you’re happy! That is a massive difference, isn’t it?

Janice:
Yeah, they’re great.

Dr Christian:
What a good job, I have to say. I mean, you know not being rude about it before, but it was a bit of a mess before, compared to now, isn’t it.

Janice:
Yeah, you’re telling me.

Dr Christian:
I mean, they’re a good size for you and your figure, they’re balanced, they’re pretty equal in size, and the nipples are great, actually. They’re there, for a start, you’ve got two…

Janice:
I know!

Dr Christian:
Which is another change. And I mean, the scarring, the old scarring is just not really noticeable at all, isn’t it?

Janice:
That’s right, and it draws the eye away from it. And it was a very good reconstruction before, but now I think it’s great. You can hardly tell.

Dr Christian:
Do you feel now a big sigh of relief, this is the end of the story?

Janice:
Yeah, I do.

Dr Christian:
You do.

Janice:
I do. It has been a really emotional experience, really.

Dr Christian:
And you’re pleased, you’re happy with what you’ve got.

Janice:
I’m very happy.

Dr Christian:
Well, in that case I am too.

Read the video transcript

Janice came to the clinic to talk about her breasts. Janice had a mastectomy and subsequent breast reconstruction in 1996 as part of her fight against breast cancer. At the time Janice opted out of having a new nipple constructed as it would have been made using tissue from her vulva or anus. Furthermore the reconstructive surgery left Janice’s breasts particularly assymetric. After discussion with Dr Christian she decided to under go further surgery to correct the asymmetry with new implants, as well as having a new nipple constructed out of her breast tissue. The process was completed with a tattooist applying colour to the nipple area to create an areola.

Patient Name: Janice Day
Condition: No nipple post-mastectomy and breast assymetry
Specialist: Mr Jian Farhardi
Tattoist: Kelly Forshaw
Clinic: The Cadogan Clinic, 120 Sloane Street London
Length of procedure: Approx 3 hours

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Comments and Questions

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I am about to have double mastectomy with reconstruction next week. I am glad I saw this as at least it shows things can go wrong...but can be fixed!





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I had a double matectomy with immediate reconstruction august last year. I watched the video0 before hand also, and it did help me 1 year on and all is well Mr. Farhadi is an amazing surgeon good luck

my breast reconstruction surgery following breast cancer is horrendous and has caused me major distress and depression. i am now awaiting my third reconstruction, but, quite frankly i donthold much hope. please can anyonehelp me?





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Hello Helen, Stay Strong, although I know how you feel having suffered problems with my breasts which left me feeling depressed. I had reconstruction surgery a couple of weeks ago with Mr Jian Farhadi (whom I saw on this site). He has excelled my expections and has really made me feel complete once again. If you can, have a consultation with him as you do not want to be in the same postion yet again post surgery. I wish you all the best and hope what ever you decide to do works out for you. Take care.

please don't give up hope i'm 5 1/2 years down the line since being diagnosed and after having double mastectomy and diep reconstruction i've just had one nipple reconstructed and it's amazing it's all been done by an amazing team of nhs surgeons if i can do anything to help you i promise you i will

hi i am helen ,, i had three children , i've breast feed my first too children & bottle feed the last child , since i was 14 yr old i was a 32 E bra , now i am 36 yr old i am a 40 K , I've been to my doctors they said i've got lost weight of course i am trying , i evening look into private , now they are starting to get me down





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I have had 2 LD reconstuctions after suffering BC twice, 4 years apart. Left side mastectomy with immediate reconstruction in Feb 2005 and the same procedure on the right side in Jan 2009. I have also had both nipples reconstructed with tattooing. My plastic surgeon throughout was Mr Miles Dickson who is fantastic at both what he does and his sensitivity to patients. I can't thank him enough. Without him, I know I'd have closed my eyes everytime I was naked.





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tying to decide whether to ask my surgeon if he could do a nipple reconstruction for me when i go in for the saline bag that was put in to stretch the skin is replaced with the silicone one. after watching the video with its awesome results,i think i will.would be happy if my reconstruction could end up looking like that





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I would do anything to have her breast even when she had only one nipple. it was still nice and firm unlike mine. To be honest the surgeon did a fantastic job and her breast looked amazing but i still would of swapped breast with hers even with the one nipple.





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I found this video of this nipple procedure really helpful. Like the lady in the video, I have had a reconstruction with implant after a mastectomy in 2008. My implant has capsulated too and I do not have a nipple. It is also not symetrical. Thinking of having this same procedure privately as I do not think my original NHS plastic surgeon would be very sympathetic if I asked her to redo it.





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I had a latissimus dorsi reconstruction after breast cancer in March 2010 and 3 weeks ago had a nipple reconstruction. I am now waiting for the tattoo. I have called the new nipple 'awesome', because it is!! It was good to see how it was done on the video. Many many thanks to my plastic surgeon Mr Miles Dickson for giving me back my body. Sally





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Hi, I had my nipple reconstruction two weeks ago. How long we're you told to keep the sponge doughnut type dressing on?

Hello Karen, I was told to keep the dressing on for about a week. I didn't wear any tight fitting clothes for about 3 weeks though...just in case. I had the nipple tattoo which was slightly lighter than the real one, but I have now had a huge bird of paradise tattoo on the scar areas. The wings 'cup' the reconstruction and the tail feathers flow down my back covering the scar on my back. Any minor changes in shape and size have now been masked by the tattoo which is so pretty. Just a thought for anyone who is not happy with their reconstruction. This is my first tattoo and I'm 61 so don't think that tattoos are just for the young.

What about this nipple procedure on and irradiated breast??





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Try out this amazing specialist www.defineinc.co.uk





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It looks like no one else has asked this question, so please fill in the rest of your details below.





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