Miss Rachel Bright-Thomas obtained a first in medical sciences at Cambridge University and then did her clinical training at Oxford University. Rachel spent the next 13 years in surgical training, largely in London teaching hospitals, before moving home to the West Midlands. On the clinical front she spent her penultimate year in training in 1 of only 9 National Oncoplastic Breast Fellowships, learning how to use plastic surgical techniques to complement and enhance the results of breast cancer surgery.An overview of the most common cosmetic conditions that are treated by Rachel Bright-Thomas are detailed below. For information about any additional conditions or treatments not featured within the site, please contact us for more information.
Breast Augmentation or ‘the boob job’ is an operation aimed to enhance the volume of your breasts. It is the most popular plastic surgery procedure, and almost 1% of women have had it done. It can also be done to lift a slightly droopy breast or combined with a mastopexy (breast lift) if the breast is very droopy and more volume is wanted. Most women seeking this surgery have always had smaller breasts and are self-conscious about the appearance. This can affect their choice of clothing, activities, relationships - even confidence at work. They are fed up of padded bras and want a bigger breast out of the bra too! In some women, volume has been lost after pregnancy or weight loss or one breast is a different size to the other (asymmetry) and breast augmentation can be a good option for these patients too.
Breast augmentation surgery can be done a number of ways. The extra volume comes from insertion of a silicone implant either under the breast gland or under the muscle beneath the breast gland. Silicone is extensively used in the medical as well as other industries and is entirely safe. Implants can be a round or teardrop shape. Miss Bright-Thomas has extensive experience of all the latest techniques and will be able to advise which technique is best for you, depending on the shape and amount of breast volume you have, and your desired volume and shape. Many surgeons are only familiar with one or two techniques, so it’s important to know, whoever you see, that they are suggesting the operation that is best for you rather than just the operation they are able to do.
Miss Bright-Thomas's patients are highly satisfied with their surgery. Her patients are more comfortable with their appearance after surgery, their confidence and self-esteem is better. They feel they can wear more revealing clothing and often personal and sexual relationships improve. It’s an operation Miss Bright-Thomas enjoys doing with predictably good results.
Before you proceed with this operation you will be given written information about breast implants in general and the procedure in specific for you and a minimum cooling off period of 2 weeks is mandatory to ensure that you are fully informed and have considered all your options before surgery. After surgery you will have at least 2 follow up appointments and more if required at no additional charge. You will be supported throughout your surgical pathway by our excellent breast care and cosmetic nurse specialist.
Breast reduction is an operation aimed to reduce the breast volume, while at the same time keeping or restoring a youthful appearance to the breast. Most patients are self-conscious about the size of their breasts, -this may affect their choice of clothing, work, activities and self-confidence in relationships. They may also get symptoms such as sweating and intertrigo (redness and soreness of skin) under the breast, back and neck ache, bad posture and grooving from bra straps. Some women also have one breast bigger than the other (asymmetry) which the operation can also address by taking more from one breast than the other.
Breast reduction surgery can be done a number of ways. Miss Bright-Thomas has extensive experience of all the latest techniques and will be able to advise which technique is best for you, depending on the amount of breast volume and skin laxity you have, the nipple position, and your desired breast size and shape. Many surgeons are only familiar with one or two techniques, so it's important to know, whoever you see, that they are suggesting the operation that is best for you rather than just the operation they are able to do.
Miss Bright-Thomas's patients are highly satisfied with their surgery. Her patients are more comfortable with their appearance after surgery, their confidence and self-esteem is better. They feel they can wear more revealing clothing and often personal and sexual relationships improve. It’s an operation Miss Bright-Thomas enjoys doing knowing that she gets predictably good results.
Breast reconstruction is surgery to make a new breast shape after removal of the breast (mastectomy) or removal of a significant amount of breast tissue (lumpectomy or wide local excision).
The main ways of making a new breast shape include:
• Using a tissue expander to expand your skin and then then replacing it with a fixed volume silicon breast implant. This is NOT suitable for women who have previously had radiotherapy to that area of skin.
• Removing just the breast tissue, but leaving the skin, and putting in an implant (a skin sparing mastectomy)
• Reconstruction with your own living tissue taken from another part of your body
• A combination of your own tissue and an implant
You will need to speak to Miss Bright-Thomas to find out which type of reconstruction is suitable for you.
Miss Bright-Thomas aims to create a breast similar in size and shape to your own breast. But a reconstructed breast won't be identical. When you are undressed you are likely to notice differences in symmetry and shape. After your reconstruction, you may need to have further surgery to create a nipple or change the shape of your other breast to match your reconstructed one.
When to have breast reconstruction
You can have reconstruction at the same time as your breast cancer surgery (immediate reconstruction) or some time later (delayed reconstruction). It is a very personal decision and you can choose what feels right for you.
If you are having a mastectomy, Miss Bright-Thomas will discuss with you whether you want to have immediate breast reconstruction. She will advise you, taking into account
• The type and stage of your cancer
• Other treatments you are likely to need
• Your feelings and preferences
• Benefits of immediate reconstruction
Immediate Breast Reconstruction
An immediate reconstruction gives you a new breast straight away. The breast will be different to the one that was removed, but some women find that immediate reconstruction helps them cope more easily with their feelings about the loss of a breast.
You will have your new reconstructed breast when you wake up after your mastectomy or breast conserving surgery. You have fewer operations, so fewer anaesthetics.
Your finished breast may look better because the surgeon is usually able to use the breast skin already there.
Drawbacks of immediate reconstruction
You may not have as much time to decide on the type of reconstruction you want
If you are having radiotherapy after surgery for breast cancer, it may damage the reconstruction
Your doctor may advise you not to have implant reconstruction if you are having radiotherapy afterwards, but you may have a temporary implant during radiotherapy with a second reconstruction operation after the radio- therapy.
If you have complications of surgery, it may delay any chemotherapy you need. This is important. Reconstruction is major and complex surgery. Chemotherapy stops the body from being able to heal itself so well. So if you have any problems with wound healing after your reconstruction, you won’t be able to start chemotherapy until the problems have cleared up. Chemotherapy at this time would stop the wound healing and you could get a serious infection. There is good research evidence that chemotherapy works best if you start it within 3 months of your cancer surgery. And that may not be possible if things don’t go according to plan with the reconstruction.
Up to 70% of women prefer to get over the mastectomy and breast cancer treatment before they think about reconstruction. With delayed reconstruction:
• You have more time to look at your options and discuss them with Miss Bright-Thomas and possibly with other plastic surgeons as well.
• Your breast cancer treatment will be finished and won’t be affected by your reconstruction surgery
• You may have a larger scar on the reconstructed breast
Remember that if you are interested in immediate reconstruction (during mastectomy surgery) talk it over before- hand with Miss Bright-Thomas. She will tell you if it is advisable or not, and can talk through the pros and cons with you.
Who can have breast reconstruction
Breast reconstruction is possible for most women who have had their whole breast removed. Even if you
• Have had a radical mastectomy
• Have had radiotherapy
• Have large breasts
If you are well enough, you may have a breast reconstruction at any age. But reconstruction may be difficult in women who smoke, are very overweight, or who have illnesses that increase the risk of surgery. Miss Bright-Thomas will discuss this with you.
Reconstruction and conservative breast surgery
The appearance of the breast after conservative surgery plus radiotherapy is usually very good. Few women need reconstructive surgery when only part of their breast is removed. But for some women reconstruction of the remaining breast tissue during the initial operation is needed.
It is sometimes possible to get back the shape of the breast by remodelling the breast’s glandular tissue at the time of the original surgery (called oncoplastic breast surgery). Miss Bright-Thomas is trained in this and uses it as part of her normal surgical practice. Alternatively if a larger amount of breast tissue needs to be removed you may need a therapeutic mammoplasty (using a breast reduction technique to remove a breast cancer). Again Miss Bright-Thomas does this procedure regularly with very high patient satisfaction. Finally if you need a whole quarter or more of the breast removed it might be possible to fill the dent with a small area of living tissue. Miss Bright-Thomas usually uses tissue from your back to do this – called a latissimus dorsi flap. You will still need radio- therapy to the remaining breast tissue to reduce the risk of the cancer coming back.
Mastopexy or Breast Lift is an operation aimed to restore the youthful appearance of the breast. With age, after pregnancy and weight loss the breast tissue can stretch and become saggy, and the nipple position falls. Most patients seeking simple mastopexy, as opposed to reduction mastopexy (removing breast volume with the lift )or augmentation mastopexy (increasing breast volume with the lift with an implant), are happy with their breast volume within the bra, but self-conscious of the appearance out of the bra. They may also get symptoms such as sweating and intertrigo (redness and soreness of skin) under the breast.
Breast Lift surgery can be done a number of ways. Miss Bright-Thomas has extensive experience of all the latest techniques and will be able to advise which technique is best for you, depending on the amount of skin laxity you have, the nipple position and size, and your desired breast shape. Many surgeons are only familiar with one or two techniques, so it's important to know, whoever you see, that they are suggesting the operation that is best for you rather than just the operation they are able to do. For more details of the procedure, see ‘Breast Lift Information Leaflet’ below.
Miss Bright-Thomas' patients are highly satisfied with their surgery. Her patients are more comfortable with their appearance after surgery, their confidence and self-esteem is better. They feel they can wear more revealing clothing and often personal and sexual relationships improve. It's an operation Miss Bright-Thomas enjoys doing, knowing that she gets predictably good results.
Fat transfer to the breast is a minimally-invasive treatment aiming to restore volume that has been lost as a result of previous treatment for breast cancer (surgery and/or radiotherapy).
Breast enhancement with Fat Transfer involves removing pockets of fat from other areas of your body (such as the legs or abdomen) and transferring the fat into the breast area to increase volume and shape in a subtle, natural-looking way.
Am I Suitable for Breast Fat Transfer?
Fat Transfer is not recommended if you:
• Want a significant increase in breast size.
• Don't have enough fat to transfer.
• Require an uplift.
• Are considering having children within the next year.
You will need to have enough fat to transfer for treatment, meaning it is not always suitable for those with low body mass, and we advise all patients to be cautious with their expectations. Breast Fat Transfer will hopefully improve shape and definition but will not provide a substantial increase in breast size.
Before going ahead with fat transfer you will always require a full consultation with Miss Bright-Thomas who will advise on your suitability.
The Fat Transfer Procedure
A Fat Transfer procedure begins with the use of an advanced, minimally-invasive liposuction treatment to extract fat from your chosen area(s). This is usually performed under a short general anaesthetic and will require only tiny incisions.
The extracted fat is then refined before it is carefully injected in layers into the breasts to create volume and definition. As both parts of a fat transfer are minimally-invasive, no hospital stay is usually required making recovery and downtime far less than traditional breast implant surgery.
If you are unsuitable for an Breast enhancement procedure with Fat Transfer, Miss Bright-Thomas may still be able to offer you a different procedure to improve your breast symmetry.
The Breast Fat Transfer Results
A subtle fullness is restored to the breasts. As implants are not used the final results are soft and natural-looking. However, not all of the fat may survive and sometimes the volume injected will reduce over the following 3 months. Occasionally small areas of the fat can become hard and lumpy due to inadequate blood supply (a condition called fat necrosis). This may require further investigation with breast imaging and sometimes core biopsy to exclude a local recurrence of your previous breast cancer.
Downtime is minimal. However, because there may be some bruising and swelling, it is best to wait one to two weeks before you hit the gym or do any rigorous physical activity.
After breast reconstruction, you can decide if you'd like to have your nipple reconstructed, too. Some women do and some don't -- the choice is up to you. You have time to make that decision. Nipple reconstruction is done after the reconstructed breast has had time to heal -- at least 3 or 4 months after reconstruction surgery. But you can take longer to decide if you'd like.
The nipple may be reconstructed from the surrounding skin at the site desired for nipple placement. Miss Bright-Thomas makes small incisions and then elevates the tissue into position, forming and shaping it into a living tissue projection that mimics the natural nipple. Older techniques, which used donor tissue from the genital region or elsewhere, have become less favoured over time.
Before nipple reconstruction surgery:
Nipple reconstruction surgery is usually done as outpatient surgery, which means that you don't stay overnight in the hospital.
Miss Bright-Thomas will draw markings on your breast to show where the incisions will be made. Usually this is done with a felt-tip marker. You’ll probably be standing up while this happens.
Nipple reconstruction is generally done under local anaesthetic. This means that Miss Bright-Thomas will use a needle to inject numbing medication into the area where the reconstructed nipple will be. If you have local anaesthetic, you will be awake during the procedure.
Skin to create the new nipple is usually taken right from the site where the new nipple will be located. This has become the favoured approach. Another potential source is the opposite nipple, if this is large enough to share. Make sure you’re clear about how the reconstruction is being done and why, especially if a graft from the opposite nipple is recommended.
During nipple reconstruction surgery:
Typically, a small incision is made at the site where the nipple will be made. The skin is formed into a nipple shape and small sutures (stitches) are used to secure the form. The new nipple and surrounding areola can be tattooed about 3 months after surgery.
Once the nipple is sewn into place, a nipple shield (a protective covering shaped like a tiny hat with a wide flat brim) is filled with antibacterial ointment and taped over the reconstructed nipple to protect it.
The length of nipple reconstruction surgery can range from 30 minutes to an hour or so. Tattooing, which happens about 3 months after the nipple reconstruction surgery, usually takes 30 to 40 minutes and is done under local anaesthetic in the outpatient clinic by our breast care nurse specialist.
After nipple reconstruction surgery:
If you've had local anaesthesia, you'll be able to go home after the nipple shield is in place. If you've had general anaesthesia, you'll be moved to a recovery room after surgery, where hospital staff members will monitor you. Once you're awake and Miss Bright-Thomas has checked your heart rate, body temperature, and blood pressure, you'll be allowed to go home. No matter which type of anaesthesia you have, make sure you arrange for someone else to drive you home.
Miss Bright-Thomas will give you specific instructions to follow for your recovery.
The nipple shield is usually left on for about 3 days. After it's removed you can shower. Your reconstructed nipple will probably look pointed and somewhat larger than your other nipple. After the stitches are removed -- usually after 2 weeks -- the nipple will begin to flatten out and look more like your other nipple.
The reconstructed nipple can be tender for a week or so. Ask Miss Bright-Thomas for medicines you can take to ease any pain you may have.