# Breast Reconstruction: What No One Tells You

An episode of [Vain-ish](https://invisiblenetwork.ai/podcast/1824105551), 7 Oct 2026, 39 min.

Audio: https://enrichment.soundstack.com/4vjqq8/episode.flightcast.com/01M477DPC66H4DFZT7ANYFBV9K.mp3

Specialist plastic and reconstructive surgeon Dr Hamish Farrow joins Vain-ish for Boobie Month to discuss breast reconstruction - from cancer recovery to congenital conditions like Poland syndrome and tuberous breast deformity. Dr Hamish explains nipple-sparing and risk-reducing surgery, the DIEP flap technique, and how breast and plastic surgeons work together in the operating theatre. He also breaks down nipple reconstruction, inverted nipples, scars, and what reconstructed breasts can feel like. For Breast Cancer Awareness Month, consider this your reminder to prioritise your breast health and speak with a healthcare professional if you have any concerns or questions. This episode features personal experiences, professional perspectives and medical information for general informational and entertainment purposes only. It is not a recommendation or endorsement of any treatment or procedure. Please speak with an appropriately qualified health professional about your individual circumstances. Find us on Instagram: @vainishpodcast Hosts: @becjudd and @jessierobertsx Producer: Liza Altarejos Audio Imager: Chris Marsh Video Producer: Justin Hill Find more great podcasts at LiSTNR

## Transcript

[0:02] a listener production.
[0:05] I'm Bec Judd.
[0:06] And I'm Jess Roberts.
[0:07] And we're done with the smoke and mirrors.
[0:09] Fainish shares honest stories about what it takes to look amazing because we did not wake up like this.
[0:15] And you should know the stuff that we chat about on this podcast is based on our personal experiences.
[0:21] We're sharing it for your entertainment.
[0:23] It's definitely not medical advice.
[0:26] And we'll always be clear with you when something is a paid endorsement.
[0:29] Please always chat with your qualified healthcare team before making any decisions about your health.
[0:49] Hi guys, it's Bec Judd and Jess Roberts and welcome to Vanish.
[0:52] Welcome to Vanish.
[0:53] We've got a big booby month.
[0:55] We do.
[0:56] We're talking everything boobs.
[0:58] Yes, and we thought that we'd kick off with today's expert.
[1:02] He is a specialist plastic reconstructive surgeon.
[1:05] It is Dr. Hamish Farrow.
[1:08] Welcome to Vanish.
[1:09] Good to be here.
[1:10] Tell us about your qualifications.
[1:12] I'm a plastic surgeon, worked in both public and private for many years, and basically my practice purely revolves around breast, has done for the last 15, 20 years, something like that.
[1:22] So this is my bread and butter topic.
[1:24] This is where we go.
[1:25] So you're the guy to come and talk about all the things.
[1:28] I'm one of the guys.
[1:28] All the things.
[1:30] All gals.
[1:30] We always say guys, don't we?
[1:32] And there are gals.
[1:32] Some great gals doing amazing things in this space.
[1:36] So, Hamish, what is a breast reconstruction?
[1:40] Yeah.
[1:41] So mostly we talk about people that have had a cancer or a destructive process for some reason and you're basically trying to put them together again.
[1:50] So reconstruction actually covers the whole gambit of reshaping and removing breasts to fill things, but also starting from fresh.
[1:58] So if you consider someone who has a congenital deformity and one breast doesn't grow very well, we would call that a reconstruction too.
[2:05] Okay, yeah.
[2:06] So there's a couple of conditions to do that where the chest is a bit wiggly or...
[2:10] You don't develop a breast on one side.
[2:12] Sometimes they don't develop a pec muscle or a nipple and you can have a shortened arm and...
[2:19] short fingers with a little web in them, a condition called Poland's disease, and it's varied across how extreme that is.
[2:26] And then there's another condition called tuberous breast deformity.
[2:29] I've heard of that one.
[2:30] Yeah, where the breast has got a really small base to it and it often pops through the areola.
[2:34] So you get this sort of puffy areola, which looks like a little mushroom cloud coming out the end.
[2:40] And again, that's the extreme end of it.
[2:41] But we'd call that a reconstruction because you're not going from normal to better, you're going from...
[2:47] damaged to or not quite right to normal.
[2:51] I feel like when most people think of a breast reconstruction, they're thinking post-breast cancer in that scenario.
[2:57] And that's probably the bulk of them.
[2:59] Yeah.
[2:59] The other, did you say tuberous breast and there was another syndrome you mentioned?
[3:03] Hollins.
[3:03] Is that common?
[3:04] Like how many of these do you see?
[3:05] Yeah.
[3:06] I'd see half a dozen a year.
[3:09] But then again, I'm really right up the end of specialism.
[3:12] So I expect that most people would see a couple in five years, something like that.
[3:18] Okay, so it's not very common.
[3:19] And if they do have it, do they come to you at an early age?
[3:21] Like are they teenagers that do it or...?
[3:24] Well, it's an awareness thing and your work is fantastic just for making people think about it.
[3:28] But I will see people that have struggled for decades and never felt they could do anything about it.
[3:33] And then I'll see, we had an extraordinary situation of a 16-year-old girl whose one breast had grown with what's called pubertal hypertrophy where...
[3:43] All of a sudden it just goes whoosh.
[3:44] And this one was like a basketball and the other one was a completely normal breast.
[3:48] And this one you really almost couldn't find the nipple because the thing was so huge and she was ulcerating and she'd seen...
[3:54] Six people before she got to me.
[3:56] Wow.
[3:56] Because she had to get someone to take her seriously that this was really a problem.
[4:00] Yeah.
[4:01] And you do a reduction on that breast and bring her back to size and bring her back to shape and it takes two hours and she's changed.
[4:07] A changed woman.
[4:08] That's amazing.
[4:09] Wow, that is amazing.
[4:10] And do you see a lot in guys as well?
[4:14] Well, I try not to in my practice.
[4:17] But certainly men have... Pollens affects a man probably more than it affects a woman because you're staring at their pec muscle.
[4:24] So if you don't have a pec muscle or some of the pec muscle's gone, it's hard to wear nothing or a T-shirt.
[4:30] And these guys are often...
[4:32] More affected if they're self-aware and they build their muscles up and you can see the defect more clearly.
[4:36] So we'll see that with them.
[4:40] But it's more about muscle and chest wall with them rather than breast, obviously.
[4:44] Yeah.
[4:45] And they're, as a group, more commonly introspective about how they fit into society and how they fit socially and so forth.
[4:52] Women are used to hiding most of their breasts socially.
[4:55] Yeah.
[4:55] and men are used to having their shirts off and it's a little bit more in your face for the guys, I think.
[5:01] So I've done a series of men over the years, but my clientele is 99.5% females.
[5:08] Let's talk about the scenario where it's breast cancer and mastectomy.
[5:13] When someone is told they need a mastectomy, when does the conversation about reconstruction usually start?
[5:18] Okay, so this has changed over my career.
[5:20] When I started, we had about an 8% immediate reconstruction rate.
[5:25] In other words, people would have a diagnosis that'd get introduced to us, you'd offer them a reconstruction, and the breast surgeons were comfortable that that wasn't going to make the final outcome worse because the history has been that they've all said, let's deal with your cancer, it's terrible, nasty, and if you survive two years and you're doing well, then you can consider fixing your breast, and it's...
[5:45] done a full circle.
[5:46] So they recognize that reconstruction doesn't change your long-term outcome, doesn't change your survival.
[5:51] It makes your surveillance a little different, but not less effective.
[5:54] So all of a sudden they go, okay, so it's actually not a bad thing for you to consider and keeps you dignified and complete.
[6:01] And also one surgery, hopefully, rather than two.
[6:04] Yeah.
[6:05] And so then the breast surgeon who's doing the mastectomy needs to be able to make room in their day for you to take up some of their operating time because otherwise they do a mastectomy and do the next one and do the next one.
[6:17] If you come in and I spend seven hours doing a reconstruction, which I can do, Mm-hmm.
[6:22] That blows their day.
[6:24] So you need a breast surgeon who's willing to say, I'm willing to give and take to make this better for my patients.
[6:29] And you need a plastic surgeon who's willing to say, I'm willing to come and make their work.
[6:33] So who goes in first?
[6:34] They go in first, then you go, then they finish?
[6:36] They make the whole thing.
[6:38] Yeah.
[6:38] And we feel it.
[6:39] You feel it.
[6:40] And then do they have to come back in at the end?
[6:41] Like you know how you said sometimes it can take seven hours and they need to make time in their day.
[6:45] Do they need to come back after the seven hours?
[6:47] No.
[6:47] Okay.
[6:48] So, for example, last Thursday we had one breast surgeon did a mastectomy in one theatre.
[6:53] A plastic surgeon went in to do the reconstruction and then she came across to my theatre and did a mastectomy and I finished off.
[6:59] Yeah.
[6:59] So the breast surgeon doesn't come back.
[7:02] They don't need to come back.
[7:03] Once they've done what they've done.
[7:04] Yep.
[7:05] We let them finish and then we deal.
[7:08] Okay, you do the reconstruction.
[7:09] So just to finish that, what happened at the Austin during my time there, we went from an 8% to a 66% on day of surgery reconstruction.
[7:17] Phenomenal change.
[7:18] Really?
[7:19] And that's, yeah, it's great.
[7:20] I do feel like when you are going through cancer and then you have to have everything removed, you're going to have everything removed.
[7:27] And then having that whole mental, just that whole like you've just lost your kind of womanhood.
[7:32] And then, you know, the most important thing when you're healing from cancer is your mental health.
[7:37] So it's like to have that put back in again, just to kind of for your mental health to help the recovery.
[7:42] I feel like that's like super important in a way.
[7:44] Or at the very least to have the choice.
[7:46] So not everyone's ready for that.
[7:49] It's like one more thing.
[7:50] No, I don't want to deal with that now.
[7:51] Yeah.
[7:52] Yeah.
[7:52] So the discussion should be at the time of the diagnosis and the plans for what you're going to do about the disease.
[7:57] And if you can have that discussion and you can choose to either action it or not action it, that's the way to go.
[8:03] And then you need a team that works well enough together to make it timely and effective within a reasonable timeframe.
[8:10] And the public hospital systems are great at this.
[8:14] They have multidisciplinary teams and so forth.
[8:16] And in private, it's a little bit more difficult.
[8:17] So you get surgeons who are good at having a link with a plastic surgeon.
[8:22] Yeah.
[8:23] Yeah.
[8:23] So there's certain people that you work really well with and, yeah.
[8:26] So each of us have four.
[8:27] Just like in life with everything.
[8:29] Yeah, exactly.
[8:29] You have your team.
[8:30] Your netball team.
[8:31] Yeah.
[8:32] Surgery team.
[8:32] Your healthcare team.
[8:33] Like you've got your team.
[8:34] Yeah.
[8:35] Your facial beauty team.
[8:36] Yes, exactly.
[8:38] Okay.
[8:39] So...
[8:40] Why might someone choose to have it immediately or decide to wait?
[8:44] Like what are the main reasons someone would wait?
[8:46] Is it more just like overwhelm?
[8:49] Probably.
[8:49] And there's also a couple of situations where you don't know how nasty the disease is, to put it like that, and they're coping with other things.
[8:58] So in a well person who doesn't have something else that's going to obliterate the next few months and they have the wherewithal to be able to consider it, doing it at the time means you can keep most of the skin.
[9:09] So, again, mastectomy has changed.
[9:11] We used to take the nipple, we used to take skin, we used to take muscle because they figured the more stuff around the breast that they could get rid of, the less likely they were to leave cells behind.
[9:21] And it's swung again to a much more preserving process where the pec muscle virtually never gets taken.
[9:27] Most of the skin of the breast is left and quite often the nipple is left.
[9:32] Really?
[9:32] Yeah.
[9:32] Because most people, sorry, not most people, I'm just thinking in my… Algorithm.
[9:37] No, but also in my circle of friends and family, when you talk about mastectomy, you think everything goes.
[9:44] It's gone.
[9:45] Yeah, I would just assume that the nipple's gone and when you've had conversations about it,
[9:50] just us as lay people going, okay, so the nipple goes, you tattoo it back on, do you think someone could get rib cartilage and like craft one?
[9:58] Yeah, so for you to say that a lot of that, in what percentage can the nipple be saved?
[10:02] Or do you say that it's preserved?
[10:05] It's increasing, but it's about how small...
[10:08] the tumour is and how far away from the nipple is.
[10:10] If it's close to the nipple and they don't figure they've got a reasonable boundary, the nipple goes.
[10:13] Yeah.
[10:14] And it's a low threshold for taking it if it's in risk.
[10:18] Oh, yeah.
[10:19] Gosh, yeah.
[10:19] Take it.
[10:20] Yeah.
[10:20] Yeah.
[10:21] All the prophylactic girls, all the girls who have genetic risk of BRCA, BRCA, yeah.
[10:26] They will almost always keep their nipples unless their nipples are in no good shape and it's not worth keeping them.
[10:32] Yeah.
[10:32] But –
[10:33] You can do a reconstruction and people can't tell.
[10:37] So do you actually have people come in and go that have their BRCA gene and haven't got diagnosed with cancer yet?
[10:44] Do they come in and go, let's just get rid of everything?
[10:47] Absolutely.
[10:47] Really?
[10:48] And keep the nipple.
[10:49] Yeah.
[10:49] Yeah.
[10:50] And you use, you know, we do them in their 20s.
[10:54] Yeah.
[10:55] It's an elective defense decision.
[10:58] Yeah.
[10:59] And, yeah, it's powerful.
[11:00] So there's a whole lot of support groups and, you know, genetic counseling goes into this and then they can work out basically on your family's history when your risk will really start to grow.
[11:09] And people say, well, I'm going to have –
[11:11] this, this, this, and this part of my life, like have kids and breastfeed and so forth, and then I'm going to do it.
[11:17] Or I want to be, you know, maybe 10 years before my most common relative and their cancer date, you go before that.
[11:25] As a general ballpark, I'm not the person to guide that decision, but they will come in and say, I just don't want to go there.
[11:31] I saw what my mom did and I'll do it in my mid-20s.
[11:34] Yeah.
[11:36] And I've just taken away the risk because essentially the more of the breast you take away, the more of the risk you take away.
[11:41] Yeah.
[11:42] So a mastectomy will confer, you know, 96%, 98% risk reduction.
[11:48] And if your BRCA risk is, say, 70% population lifetime,
[11:52] you take 98% of that away, you're down at two and three.
[11:56] And population is about 13.
[11:58] Yeah, so you're less than the normal population.
[12:00] You're five times better than the population.
[12:01] Yeah, wow.
[12:02] So when a mastectomy is happening, what is left?
[12:05] Like what are you seeing?
[12:07] Just, for example, in the context of a 25-year-old with BRCA gene and she wants them removed.
[12:14] After the breast tissue's been removed, how does the patient present to you when you go into theatre?
[12:18] What does it look like?
[12:19] Yeah, if you think of the breast as an organ in a bag of skin and the connection of the organ to the outside world is the nipple, so the nipple's like just the exit valve for milk.
[12:29] you can take the stuff out of the bag and just be left with the skin bag.
[12:33] And so the skin is maybe, I don't know, half a centimeter to a centimeter thick and it's just a floppy bag that's empty.
[12:41] And if you've taken the nipple, you've got a circle hole where the nipple used to be.
[12:45] And then you need to think of how you're going to fill that and it's a matter of what's available.
[12:50] So we talk about using implants.
[12:52] We talk about using their body parts if they've got them to.
[12:57] You want that trade if you're going to steal bits of tissue for that to be a good trade for the patient, not a damaging trade.
[13:04] So you end up with a positive.
[13:06] And the classic operation is to take lower belly in someone who's had three kids and they've got a roly-poly lower belly and you go…
[13:12] I can give you a flat tummy and I can give you a warm, soft breast made of you, which will gain weight with you, lose weight with you.
[13:18] Yeah.
[13:18] It's a big operation and a big undertaking.
[13:20] Yeah.
[13:21] But you can just become as close to what you used to be.
[13:25] Yeah.
[13:25] Afterwards, but your cancer's gone.
[13:27] Yeah.
[13:28] That fat, do you harvest the fat and then inject it back in as a fat transfer?
[13:31] No, no.
[13:32] Or are you just taking it in like, for want of a better word, a chunk?
[13:35] Yeah, you take a chunk.
[13:35] So I use allergies a lot of the time and...
[13:39] Teddy bear blanket.
[13:40] Teddy bear blanket.
[13:41] Doona.
[13:41] Well done.
[13:42] Doona.
[13:42] So this is the vacuum cleaner and you unplug the vacuum cleaner and you take the vacuum cleaner from the belly and you take it up to the breast room and you plug it in again and it should run just fine in that room.
[13:55] Mm.
[13:55] So the challenge with that is you need a block of tissue that's big enough to fill the breast, that's soft enough and the shape's reasonable to make a breast shape.
[14:04] And you need to have one main vessel that you can unplug that will actually keep that whole thing alive, a bit like a sprinkler system for a garden.
[14:11] It needs to have enough blood vessels in it.
[14:13] And then do you have to attach those blood vessels?
[14:16] So you do a bit of vascular surgery.
[14:18] Microsurgery.
[14:18] Yeah, yeah, yeah.
[14:19] Wow, that's cool.
[14:20] Very small fingers.
[14:21] No, they're not really fat fingers.
[14:24] Yeah, you unplug and there's a...
[14:27] There's a whole series of techniques to that.
[14:29] We used to take muscle with it.
[14:30] We don't take muscle anymore.
[14:32] You open the muscle and you peel the vessels through and you end up with a block of fat with skin over the top of it from wherever you've taken it from and then a little pipe with an artery and a vein going into it.
[14:43] And then we go through the ribs or take a rib out, go in just in front of the heart and find the vessel running down there, bring it out, sew it on.
[14:52] Oh!
[14:53] Wow.
[14:54] It's great fun.
[14:55] This is amazing.
[14:56] This is – you are doing – Can we scrub in?
[14:59] Yeah.
[15:00] This is incredible work.
[15:02] And to have – to be able to do this for a woman who's having such a hard time and to have this option is just incredible.
[15:12] How does it feel?
[15:13] I have this discussion with my staff a lot because –
[15:18] The financial reward for doing a lift and implants is four times as much or three times as much as doing one of these.
[15:25] And these take four times as long and the follow-up is emotional and deep and so forth.
[15:32] It's wonderful.
[15:33] It's a great job to do.
[15:34] That's why you do it, right?
[15:35] Oh, yeah.
[15:36] It's fantastic.
[15:37] Yeah.
[15:37] So in the cancer game…
[15:39] The cancer and its disease is ugly and tough and difficult and we're the happy bear.
[15:46] Yeah.
[15:47] You're like, here's your new boobs.
[15:49] Yeah, yeah.
[15:50] Yeah, yeah.
[15:52] That's so cool.
[15:53] Leaving, this could sound just so silly,
[15:57] When it comes to breast cancer, is it found in breast tissue and not the glands?
[16:02] The glands are breast tissue.
[16:04] Oh, they are.
[16:04] Okay.
[16:05] The memory glands.
[16:06] Jess, there's no silly questions.
[16:08] Yeah, because I've always thought there's the tissue that gives you the voluptuous and then there's the glands.
[16:13] So is the tissue the glands?
[16:16] Well, so tissue is everything.
[16:18] So skin, fat, breast gland.
[16:21] But your breast is made of glandular tissue laced up with fat.
[16:25] So there's fat around it.
[16:26] And if you get really thin or you have really thick, lumpy breast, your breast will feel different to someone who's a little more plump and has a bit more fat in there.
[16:35] But essentially it's a skin bag with a gland sitting inside it.
[16:40] like a pimple in a cruel kind of way that comes through to the nipple where the duct of that gland comes out to finally deliver the milk.
[16:48] Right.
[16:49] And so when you are preserving the nipple and you've got all the glands around it, how do you keep that nipple alive?
[16:57] Yeah, so the nipple has to stay connected to something to keep it alive.
[17:01] Yeah.
[17:01] The gland provides its ducts to the nipple.
[17:04] You cut them below the nipple.
[17:06] So you're left with the skin of the nipple and the bump of the nipple, but nothing connecting to the depth of the gland.
[17:12] And you have to leave the nipple then connected to the skin around it to keep it alive.
[17:17] It loses its feeling.
[17:18] Yeah.
[17:19] So there's a vascular supply from the skin?
[17:21] Is that what you mean?
[17:21] Yeah.
[17:22] Yeah, okay.
[17:22] And one of the challenges with this is when you do a mastectomy, if the skin is...
[17:28] particularly thin or it's had scars before or they're a smoker or it's just a tough operation to do, you can damage the skin of the mastectomy at the time.
[17:38] So you take out the gland and the skin that's left behind isn't healthy enough to cope with the next stress.
[17:44] And sometimes you end up with challenges in terms of getting a nice shape.
[17:48] So-
[17:48] So the more skin that's left behind, the prettier the thing is generally, but that skin has to be healthy.
[17:54] So the nipple itself is kind of the last thing in the supply chain.
[17:59] It's coming from the side wall of the chest, and you've got this thin bag of skin that's left behind.
[18:03] The last thing is the nipple.
[18:05] So if you're going to get a problem with blood supply,
[18:07] at the end of an operation, it's off on the nipple.
[18:09] Yeah.
[18:10] So we carefully look for good surgeons, breast surgeons, who will leave the nipple alive and healthy as best we can.
[18:16] And it's a game because the less tissue you take away around the nipple, the healthier the nipple will be.
[18:21] But if you haven't taken away all the cancer, you haven't made the job effective.
[18:24] Yes, 100%.
[18:25] Yeah.
[18:27] What happens when the nipple's gone?
[18:29] Can you reconstruct a nipple or do you just kind of flatten off the skin and then you tattoo it on?
[18:36] What are the options?
[18:36] Yeah, so there's sort of three.
[18:39] People have no nipple.
[18:41] And to have no nipple and be comfortable with that tends to either imply that they don't care, that's not their thing, or it's more common if you've done both sides because if you have both sides gone, your social presentation on a cold day is the same on both sides.
[18:55] If you've got one side that's a decent nipple and one's flat, that's a bit more likely to get in the way.
[19:01] So we would reconstruct unilateral nipple
[19:04] Breast reconstruction probably 70% of the time.
[19:06] In the bilateral, it's probably about 40% in my experience.
[19:10] And the way you do that, if you've actually got one nipple that's normal and surviving on the other side, you can take half of that, make that a little bit smaller and make the other one from a shared content.
[19:22] They're the most natural looking.
[19:23] You need a decent nipple on the side that you've kept.
[19:26] Could you make the – okay, I needed a little –
[19:30] human biology lesson, anatomy lesson, you've got the areola and then the nipple.
[19:35] The nipple's the protruding part.
[19:36] Correct.
[19:37] How do you make that smaller?
[19:38] Is that what you're talking about?
[19:39] You take from that and then you... Yeah.
[19:42] I've got some to give.
[19:43] I don't know.
[19:44] My mum does.
[19:44] She can stack 10...
[19:45] Yes, that is my mum.
[19:46] I don't know.
[19:47] It must be booming.
[19:48] Mum goes...
[19:50] They talk about kangaroo teeth.
[19:51] Yeah, yeah.
[19:51] It's like a thumb.
[19:52] Yeah, mine used to put like CDs as a CD stacker.
[19:56] I don't get any plus.
[19:57] So how do you do that?
[19:59] You can do it several ways.
[19:59] You can just simply take the top off and then move that over and that top will actually heal up pretty well, surprisingly.
[20:07] Because it's got obviously blood supply and stuff in it so you can kind of attach it.
[20:12] I reduce nipples for people with various cosmetic surgery because I say your nipple's disproportionate to your boob.
[20:18] We should make your nipple point less and you'll find it easy to wear a T-shirt.
[20:22] Yeah.
[20:23] Especially if you have implants for the first time and you've got great big nipples, then suddenly your nipples are out.
[20:28] Walk in five minutes before you two.
[20:30] But I launch that with people and they look at me shocked and then they come back the next week and go, yes, yes, I want it.
[20:36] Yeah, yeah.
[20:36] But the first time they go, don't touch my nipples.
[20:38] Yeah, yeah.
[20:39] So that's one.
[20:40] So, yeah, and that's a cut and a graft.
[20:43] And you can actually take a big nipple and do sort of like a V cut, like taking out the top and then you close the two.
[20:51] Yep.
[20:51] What's remaining.
[20:52] Anyway, so that's one.
[20:54] Number two is you would take –
[20:56] On the side that had no nipple, you take two bits of tissue and you lift them up like a yin and a yang to make a bump.
[21:02] Make a bump, yeah.
[21:03] And where they've come from, you close, and then you would either tattoo or graft onto that.
[21:08] Yeah.
[21:10] And historically, they've tried to take skin grafts from places that are likely to pigment.
[21:14] And so when you put the skin on to make the areola, it has a natural color to it.
[21:19] And one of the...
[21:20] Sounds fiddly.
[21:21] Sounds fiddly.
[21:22] Well, it's fiddly, but they also used to take it from labia.
[21:24] I was going to say, they would have taken it from a fanny.
[21:27] Is it the same tissue?
[21:28] Is a nipple the same as a labia?
[21:29] Hell no.
[21:30] No.
[21:30] I was just going to say, you're lost.
[21:33] What is it?
[21:33] Your lips are the same skin as your butthole.
[21:35] Yeah.
[21:36] And your, I won't like this, inside my mouth.
[21:40] What is it?
[21:40] Mucosa.
[21:41] Mucosa.
[21:41] Yeah, that.
[21:42] So you're actually after the pigmentation for this, but you end up injured in a place, another injured.
[21:47] So we more commonly tattoo.
[21:49] Yeah, me too.
[21:50] And how do you get the bump then?
[21:52] Yeah.
[21:52] So the bumps made by bringing the two bits of tissue together.
[21:55] Yeah.
[21:55] So you'd stitch them in a protruding way.
[21:58] And then third of all is people just have a flat tattoo and you can have a flat tattoo which is done in a way to give it a sense of a 3D sort of look.
[22:06] And contour it.
[22:07] Yeah, it's nice.
[22:08] And shadow it.
[22:09] And then there is these fantastic little silicon stick-on nipples and they look really good.
[22:15] Oh, yeah, Kim Kardashian.
[22:16] Did the bra.
[22:16] Yeah, yeah, yeah.
[22:18] You can have a third one.
[22:19] Next year we're saying ear cartilage, rib cartilage.
[22:23] Yeah, the problem with making a bump is that they all tend to flatten.
[22:26] So whatever you make, you're probably going to lose 50% of it over the first six months and people flatten away completely and then you're grinding up rib cartilage or ear cartilage or even a bit of big toe or something like that to stick in there.
[22:39] And they're all kind of not wonderful.
[22:41] We used to use coral from South Pacific.
[22:45] Don't say Great Barrier Reef.
[22:47] No, no, no.
[22:49] So speaking of nipples...
[22:51] Yeah, let's speak about nipples.
[22:52] Yeah, let's just get to our nipples.
[22:54] If you've got an inverted nipple, can you reverse it?
[22:56] Like, can you fix – do you do a lot of that work as well?
[22:59] Do a bit of that, yeah.
[22:59] Yeah.
[23:00] How do you do that?
[23:00] And can you make it look like a normal nipple if you've got inverted nipples?
[23:03] Yes, you can.
[23:04] Depends what you have.
[23:05] So some people have a normal nipple just pulled in, and basically one of the structures coming from the back of the breast to the nipple is too tight, and it's sort of pulled it in.
[23:14] Okay.
[23:14] Like a dimple.
[23:15] Okay.
[23:16] Yeah.
[23:16] And you will have to divide that if it's really strong to get the nipple to pop out.
[23:20] Now, if you have someone who's 22 and they haven't had kids and so forth, having a nipple that pops out with no feeling and no connections anymore is like, okay, it's pretty, but it doesn't work.
[23:32] So if you've got a nipple that comes out occasionally and doesn't come in, then probably it's an elastic thing that it's been pulled in by an elastic.
[23:39] And so what you can do is evert that nipple under local anesthetic stitch and pull it out.
[23:43] And then I put a stud across it.
[23:44] Okay.
[23:45] And you leave the stud there for long enough to let that elasticity sort of fade.
[23:49] When that doesn't work because it's just too tight and you have to divide, the more you divide, the more numb you get, the more less likely you are to be able to breastfeed.
[23:57] But those girls generally haven't seen the nipple, so anything's better than nothing.
[24:01] Nothing, yeah.
[24:02] And that's a little surgical procedure.
[24:05] Do you know what girls are doing if they've got inverted nipples?
[24:08] What?
[24:08] It's a trend.
[24:09] They get both their nipples pierced.
[24:12] Yeah.
[24:12] Yeah, and so I'll get the nipples pierced and then over time it will cause like a bit of scar tissue when they do...
[24:18] Holds it up.
[24:19] Yeah, when they do take it out in 10 years' time and then the nipple isn't as inverted as it used to be.
[24:26] So we do that in the rooms.
[24:27] Oh, okay.
[24:28] Yeah, that's the stud.
[24:29] Yeah.
[24:29] I know a few friends that have got that for that reason.
[24:40] So, Hamish, how close can reconstruction come to looking like a natural breast?
[24:44] How does it feel to touch?
[24:47] And then how does it feel in terms of sensation for the patient?
[24:50] Okay, can I go back a little bit?
[24:52] Yeah.
[24:52] So the methods of making new breasts, if you're going to use your own tissue and that own tissue is healthy, then it should be warm, soft, feel like you're pushing your tummy, same sort of feel as that.
[25:02] And it's often a little bit firmer than a natural breast because it's more sort of, I don't know, present skin.
[25:08] Not always, it can be just as soft.
[25:10] So that can feel and look like a normal breast.
[25:13] Mm-hmm.
[25:14] From the patient's point of view, if you've had a mastectomy, you lose all of the feeling from the base of the breast going forward.
[25:20] So all of the skin goes, the nipple goes, and then the regrowth of that sensation kind of relates to your age and how thick the skin is left behind and luck, I suppose.
[25:32] So some people can get feeling all the way back into their nipples.
[25:35] Wow.
[25:36] But it doesn't happen very often.
[25:37] Most people have a numb nipple because that's just too far for that sensation to come to.
[25:42] But when you are pushed on that breast, you feel it against your chest wall too.
[25:46] So people learn to associate that sort of touch as being to their breast because their chest wall moves and their skin around their armpit moves and so forth.
[25:57] But if you bit, you know, if had an insect bite them on the breast, they wouldn't know.
[26:00] And one of the risks after reconstruction is burning yourself.
[26:03] People hold a cup of tea on their boob.
[26:04] Yeah.
[26:04] Yeah.
[26:05] And they get a blister because they didn't know it was cooking.
[26:08] Yeah, right.
[26:09] Yeah, interesting.
[26:10] But with implants, if you have an implant under a mastectomy flap, there's not a lot of doona, and so the warmth of that skin isn't enough to warm up your implant.
[26:19] Your implant will be at room temperature.
[26:21] So this table is at room temperature.
[26:23] It's cooler than if you put your finger in your mouth, you're 37 in there.
[26:27] This is 22.
[26:28] Me just like.
[26:29] Yeah.
[26:30] But I've got a bra.
[26:31] It's like my fib.
[26:33] So they're often cold and they're often firmer than a natural breast.
[26:36] And so if you are making one breast and you are using implants, you're going to have a more firm, upward-pointing, cooler breast than your natural.
[26:46] And so ideally you try and do something where there's a bit of the same process happening on both sides.
[26:50] Okay, so it's very individual based on what you need.
[26:53] So you do have patients that come in if they've got, when someone has breast cancer, they'll have it on usually one side.
[26:59] They will choose to take both breasts to make it symmetrical.
[27:04] Yeah.
[27:04] Yeah.
[27:05] And especially the prophylactic girls, like where they don't have disease at all.
[27:10] There's no point just taking one.
[27:11] Yeah, take them both.
[27:13] But in the disease scenario, if you can make a breast that's good,
[27:19] with one side, like you have enough tummy to make one but not enough to make two, and the other side doesn't have any disease, it doesn't make great sense to take the other one off apart from risk reduction.
[27:27] But usually if you've had cancer on one side, the risk of that going on for your life is going to be your biggest risk in life.
[27:33] Anyway, taking off something that's normal doesn't necessarily improve with that.
[27:37] But they're detailed discussions to have with a breast surgeon.
[27:39] Yeah.
[27:40] And it's individualized again.
[27:42] But, yeah, I get quite a few people who say,
[27:45] I want the best aesthetic and functional outcome.
[27:48] I'm going to do both sides because that will give me symmetry.
[27:51] Yeah.
[27:52] And that's – I understand that.
[27:53] Yeah.
[27:54] With a mastectomy, talk to us about the scars –
[27:57] Are they kind of standard or does it depend on where the cancer is with the patient?
[28:03] What do they look like, a mastectomy?
[28:05] Yeah.
[28:05] They do depend on where the tumour is and they depend on the familiarity of the surgeon to make an access to get that out with sensitivity to femininity and clothes and natural.
[28:18] Mm-hmm.
[28:18] The people that I work with will have patients have reconstructions frequently.
[28:22] So they're very switched on to looking after the hole being, not just the cancer.
[28:27] Yeah.
[28:28] So nothing tends to go above the nipple.
[28:30] So everything's a nipple or below.
[28:31] So even if the cancer's above the nipple, they can access from below.
[28:35] Yeah, yeah.
[28:35] Cool.
[28:35] But you need a big enough hole to get in to do that.
[28:38] We've done them through crease lines.
[28:40] We've done them over the nipple and out to the side.
[28:42] We've done them through...
[28:44] smaller holes, but you try and leave the cleavage alone and you try and leave the upper breast alone.
[28:49] It infuriates me when you see someone who's had a port put in to give them chemo and they've put it in a very visible place.
[28:56] You think it's just...
[28:57] There are other ways of doing that which is more sensitive.
[29:01] The scar...
[29:03] It tends to be something you'll see when you've got your gear right off.
[29:06] But socially, you shouldn't have a scar.
[29:08] Okay.
[29:09] Interesting.
[29:09] Yeah.
[29:10] So, Hamish, do you have a favourite type of breast reconstruction to do?
[29:15] Absolutely.
[29:16] So if you use the belly and we don't take the muscle, the flap's called a DEEP or D-I-E-P, and it's deep inferior epigastric perforator.
[29:25] They just name these things by the vessels that are involved, and it's really weird and strange sort of name because that gives you a tummy tuck and a breast.
[29:33] And yes, it may be a six or eight-hour operation, but if it all works well...
[29:38] hard to tell which one's actually the reconstructed one.
[29:40] So I've had numerous patients have mammograms and the mammographer wants to mammogram the deer.
[29:46] And she goes, it's not a breast, it's a reconstruction.
[29:48] She goes, no, no, sweetheart, you don't know what you're talking about.
[29:50] She goes, it's my breast, I know what I'm talking about.
[29:52] Yeah.
[29:53] Wow.
[29:54] How many of those would you do a week?
[29:56] Because that sounds intense, six to eight hours.
[29:59] Yeah, there's a bit of kudos amongst the surgeons.
[30:02] They go, I've done five.
[30:03] Yeah, yeah.
[30:04] What?
[30:04] You do five of those a week?
[30:06] No.
[30:06] You have done?
[30:07] Really?
[30:07] What?
[30:08] Yeah.
[30:09] Holy shit.
[30:09] Are you tired?
[30:10] You might do two on one.
[30:11] Yeah.
[30:11] So to one patient, you do two.
[30:13] That's the eight hours.
[30:14] Yeah.
[30:14] The single's about six hours.
[30:16] Yeah, you can be exhausted.
[30:17] And some of the guys doing this frequently, I mean, I've probably done 2,000 now.
[30:21] Wow.
[30:23] You can be just shattered by the end of a four-day.
[30:26] But you do them because the time, you know, you don't have a lot of choice to say, I'll book them for July because that's not how it happens.
[30:34] No, it needs to be done.
[30:35] Yeah.
[30:37] But you enjoy it.
[30:38] It's fantastic.
[30:39] Yeah.
[30:39] Just seeing like, you know, the result.
[30:41] Yeah.
[30:41] It can be restorative.
[30:42] And any reconstruction is never as good as a natural, but it doesn't have the risk of the natural.
[30:48] So, you know, when I see people and they say, I'm having a reconstruction, so the girls with BRCA, and they go, I want to be risk-free, and I go, you're going to have a loss of quality with this process.
[30:57] So you'll lose feeling, you might lose warmth, you might lose that ability to freely wear whatever bra or whatever you like.
[31:05] And for some people it's an improvement because their shape isn't great before they start.
[31:08] But for most people...
[31:10] they don't get that it's not like putting an implant in a natural breast where you get a prettier natural breast.
[31:15] This is a very different process.
[31:17] You are cool and you are thin covers.
[31:19] You can feel your implant much more easily.
[31:21] You can get great aesthetic results, but it's still a change.
[31:24] Yeah.
[31:25] And so it's not something you jump into lightly.
[31:27] No.
[31:27] And it's a good discussion to have.
[31:29] I love that there's so many different ways to now do reconstruction because I just always thought that –
[31:35] You take everything out, the nipple, everything, and then you get it tattooed on.
[31:39] So it's really good to hear that, you know.
[31:42] Sometimes it can be preserved.
[31:43] Yeah.
[31:44] Yeah.
[31:45] And tummy tuck and a great set of teeth after, great.
[31:50] It's getting more common.
[31:51] We're down to one in seven women now.
[31:53] It was one in eight and it's dropping to – younger women are getting cancer.
[31:57] One in seven for breast cancer.
[31:59] One in seven.
[32:00] One in seven.
[32:00] I don't know what it is, but I've been targeted heavily the last couple of weeks.
[32:04] And there was a woman in the States.
[32:06] She's 28 with three kids and she's just been diagnosed with stage three breast cancer.
[32:11] And it's not even in her family and just devastated.
[32:15] What is going on?
[32:16] Yeah.
[32:17] And then there's been other people that have – in their 20s.
[32:20] I've had a 22-year-old.
[32:22] Wow.
[32:23] 22.
[32:23] That's crazy.
[32:26] And then, you know, we can't get mammograms or it's, you know, not covered by Medicare unless you're over a certain age.
[32:33] Like I know I've had to go in for a few mammograms myself and they're like, oh, yeah, this is the cost.
[32:39] And I'm like, okay, well, I don't, unless you tick these boxes and it's, I think Medicare will pay for it, which one time I did tick the boxes and Medicare did pay for it.
[32:48] But not the other time.
[32:49] I remember you telling me it was like a $700 bill or something.
[32:52] Yeah, a $700 bill.
[32:52] And like, oh, can you come back in six months and we'll do another ultrasound?
[32:54] I'm like, if we're sus on this, can we just get it out?
[32:57] Like it's just – It's scary.
[32:59] Yeah, and I was like only 30 or 29 at the time.
[33:02] And you're very fragile.
[33:03] Yeah.
[33:04] And vulnerable.
[33:04] Yeah.
[33:05] So mammograms are a great screening for under 50.
[33:09] Yeah, what's the best screening for under 50?
[33:11] Yeah.
[33:12] Well, it's probably an ultrasound is the most common.
[33:14] And then things like an MRI will look through your breast regardless of its density.
[33:19] So pre-menopause, your breast is driven by estrogen and it's thick and it's dense.
[33:26] And then after menopause, when the estrogen drops off, it goes more fatty and you can see through it more clearly with mammograms.
[33:32] So I tend to use mammograms.
[33:34] They use it where they need to across all ages, but predominantly it's over 50s.
[33:39] And then Medicare will kick in and it'll be breast screening.
[33:41] Right, okay.
[33:43] But, you know, 45 onwards, something like that.
[33:45] Otherwise, yeah, you pay for it.
[33:47] Do you have any thoughts on the numbers just becoming more prevalent?
[33:52] I've mine in seven now.
[33:53] Yeah, I know.
[33:53] Do you have any?
[33:54] Yeah.
[33:55] I mean, what is the research saying?
[33:57] Or it's not there yet, can't explain it.
[33:59] And it's younger women too.
[34:01] Is it more aggressive types of breast cancer?
[34:04] No, I don't know that that's the scenario.
[34:06] But again, I'm not absolutely the expert here.
[34:10] But my gut feeling is that we have much more exposure to toxins.
[34:14] So we all have our phones on, microplastics.
[34:17] You know, we stand in front of big televisions and there's radiation coming out of them the whole time.
[34:21] Computers.
[34:22] I keep turning the screens off at the hospitals because they sit there advertising its brand name on the front.
[34:27] And you think we just don't, we've got rid of whiteboards and we've got rid of...
[34:31] clear signage and now it's all electronic, but there's radiation coming from that the whole time.
[34:35] So if you assume we live in a life where there's so much going through the atmosphere and the food and so forth, you've got to assume that's going to make a difference.
[34:45] I pulled the pin on a project.
[34:47] It was going to be quite financially lucrative.
[34:50] I was designing a product, a beverage, and I wanted it to be as natural as possible and
[34:56] And then I went in to the food lab and I will tell you, the food scientists were so incredibly intelligent.
[35:04] What they could do was amazing.
[35:06] They're very, very smart people.
[35:09] But what they'd done to the concept to get it at a certain price, to be able to put it on a shelf and sell it at a certain price,
[35:16] had completely bastardised everything.
[35:18] Like I wanted to put lime in it, fresh lime.
[35:20] You don't get fresh lime.
[35:21] I had four versions of different lime flavours.
[35:24] That weren't even made from lime.
[35:25] That were made in a lab that had nothing to do with lime.
[35:28] I think it was like a sugar syrup with a fake lime.
[35:32] I pulled the pin.
[35:32] I pulled the pin.
[35:33] I was like, no, I'm not putting my name to this.
[35:35] I'm not.
[35:36] I'm not.
[35:36] selling this.
[35:37] This is shit.
[35:38] And even the other day I was in a supermarket walking down the aisle, just trying to get my kids something after school because I was going straight to pick them up from school and sport.
[35:45] And I realized I didn't have any food and just trying to pull stuff off the shelves and looking what was in it, preservatives, emulsifiers, all this stuff.
[35:52] I just want plain food, just normal food.
[35:56] Go to the organic veggie section, babe.
[35:58] Yeah, well, this shop didn't have an organic section.
[36:01] Yes.
[36:01] But, yeah, it's hard.
[36:03] Yeah.
[36:03] Yeah.
[36:04] Skin product, fragrance, makeup.
[36:06] I feel like we just need to go on an island and live off the land there.
[36:09] Live off the land.
[36:10] Yeah.
[36:10] You know, fish has got mercury in it these days, so, you know, who knows?
[36:14] Give me spots on the apples.
[36:15] Yeah.
[36:16] Yeah.
[36:17] What about the barramundi?
[36:18] Apparently any piece of barramundi you buy in a restaurant in Australia comes from a farm.
[36:22] So unless you go up north and catch it yourself...
[36:25] I know.
[36:26] It's from a farm.
[36:26] I'm basically vegetarian half the time because I freak out.
[36:29] I literally freak out about everything.
[36:32] I was in Japan back in 2019 and I just read this one little article that's saying from Fukushima.
[36:41] And I'm not eating any vegetables and I'm not eating any fish because it's all got radiation.
[36:47] Run off from Fukushima.
[36:48] And I'm literally freaking out.
[36:50] And I was like, what are you going to eat?
[36:51] I'm like, hot chips that are bagged up from like 7-Eleven in Japan.
[36:55] That's really good stuff.
[36:56] Oh, they do.
[36:57] Yeah.
[36:58] I was sitting there going.
[36:59] Lawson's.
[36:59] Yeah, yeah.
[36:59] I'm like, banana milk, but where's the milk from?
[37:01] And where's the banana from?
[37:02] Is it a real banana?
[37:03] Or is it one of four different banana flavours that they got to choose?
[37:06] I didn't eat for two weeks in Japan because I'm literally like, that doesn't get radiation.
[37:11] I was a nightmare.
[37:12] I've come a long way since then.
[37:14] This world we live in.
[37:15] I know.
[37:16] We digress.
[37:17] So lastly, before you go, what is the biggest misconception when it comes to breast reconstruction?
[37:23] That...
[37:24] The nipple always goes.
[37:25] The nipple always goes.
[37:26] And it doesn't.
[37:27] That it has to be a wounding procedure that you will end up a lesser version of yourself.
[37:33] You don't need to.
[37:34] It's an important part of your process, but it can actually be the rebuilding part.
[37:38] It's worth the energy.
[37:40] That's good.
[37:41] Rebuild.
[37:42] Rebuild.
[37:43] Like that reframe in the mind.
[37:45] Yeah.
[37:45] Well, it's an intrinsic part of how people feel.
[37:48] You talk about that whole sense of being complete.
[37:52] I really see this as a way of just having one smaller injury in one area because you're dealing with a whole lot of shit elsewhere.
[37:58] Can I say that?
[37:59] Yeah.
[37:59] Shit, yeah.
[38:02] And this can just make how you see yourself, how you relate to your family, how you relate to other people, just a little under the radar.
[38:09] You can maintain a bit of self in that.
[38:12] Yeah.
[38:13] Yeah.
[38:13] And it's important.
[38:15] I agree.
[38:16] Love it.
[38:17] Well, thank you so much.
[38:18] We love having you on Vanish.
[38:20] And we're going to see you for another topic very soon.
[38:24] So thank you for joining us, Dr. Hamish Farrow, and we'll see you again for another chat.
[38:28] Perfect.
[38:28] Bye for now.
[38:34] Pain

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