Breast Surgery Q&A: Miss Alexandra Molina

Q1. What surgery do you find most rewarding?

A. It's a difficult question to answer because I enjoy my job immensely. I'd say I have two favorite operations, the first of which is breast reduction. Breast reduction is often viewed as a cosmetic procedure, but in fact, it's a very functional operation for many women and indeed, can be life changing. Symptoms such as back pain and neck pain, bra straps digging in and rashes under the breast can disappear overnight for these ladies.

The other operation I perform regularly, which I really enjoy is breast reconstruction after cancer. What I really like these days is that actually I can combine my two favorite operations. For ladies who've always wanted smaller breasts and are unfortunately faced with breast cancer, we can now often offer reduction of the other breast at the same time as reconstructing the breast affected by cancer, and this is incredibly rewarding for myself as a surgeon and shortens the patient journey through their breast reconstruction.  

Q2. Why does DIEP flap surgery take so long? 

A. Now, first of all, that's something we're working on here at The McIndoe Centre. Most of us do reconstructions as a two-consultant team, which improves efficiency and therefore, means the anaesthetic for the patient is shorter. However, it is a complex operation with a number of steps, and I describe it to patients like a transplant, but instead of transplanting an organ like a kidney, we're transplanting skin and fat from the abdomen to make a new breast. We join the blood vessels together under the microscope, and this is quite a fiddly stage of the operation, but for patients who are worried about the length of surgery meaning it's serious, I usually say that this is mostly surface surgery and we're not going near to many of the vital organs of the body so actually, in terms of serious risks, DIEP surgery is very safe. 

Q3. Who is suitable for breast reconstruction using their own tissue?

A. First of all, these operations are relatively long, so patients need to be fit and well enough to withstand a relatively long anaesthetic. However, we do not have age cutoffs as such, personally, my oldest patient has been 76, but I know colleagues have done patients approaching their 80th birthday. It depends on the patient's wishes for their reconstruction and their general health status. However, we do have some limitations and do not offer complex breast reconstruction surgery to patients with a body mass index over 35 or patients who are smokers.