AIBU to expect reconstruction on the NHS

[Welshmaenad]

Probably v outing but never mind.

Last summer I developed a large, rapidly growing breast abscess (it was about the size of an apple under my areola). I was referred to breast clinic and sent for an ultrasound. Ultrasound operator confirmed it was a sealed abscess "full of gunk" and then decided to biopsy it despite no request from the consultant to do so. Consultant then saw me before I left, aware of biopsy. No antibiotic cover offered (have since discovered this is best practice guidelines).

Over the next few days I became very unwell, fever, rifles, vomiting, breast hugely swollen and red/sore, pus leaking from biopsy site which expanded and started going black. On gp advice I presented at a&e. Another ultrasound confirmed biopsy had ruptured abscess and contents had dispersed through my breast tissue. I was admitted.

Following day I had extensive surgery to remove necrotic tissue. The day after that I was taken back to theatre as there was more necrotic tissue, I was then isolated and informed I had necrotising fasciitis. I spent three further days in hospital, then discharged in oral antibiotics, district nurses daily to repack wound. They ended up removing g about 50% of my breast tissue. I was unable to work for four months.

Seven months in and wound us still 2" deep and being packed though I am now in work. Aftercare has not been great from the hospital side - GP surgery nurses have been fab though. Yesterday I was in clinic and saw a registrar, I asked about reconstruction (was told by surgical team at the time this would be done). He "doesn't see there will be a need for it and it looks ok". It is not ok. One breast is about 3 cup sizes smaller than the other, hangs in a sad triangle, folds itself in half if I put an underwire bra on and doesn't fill the cup, half the nipple is gone, a great puckering scar has formed. It looks like an anus. I have a boob anus.

AIBU to expect them to at least try to make it look normal? I'm being made to feel I should be grateful they saved my life. My life would not have been in danger if they hadn't burst the bloody thing. I could have it drained via needle aspiration with no surgery at all. Several people have suggested I sue for med neg. what would you do in my position?

You absolutely are not being unreasonable, thats awful and reconstruction definately shouldnt have to be paid for by you.
I was told I could qualify for a boob job on the NHS as being underweight due to anorexia in my teens meant my breasts hadnt developed properly, they werent disformed, uncomfortable or inpracticle just small.

Bloody hell.

upsideup thats great but its in stark contrast to what people have been told on the skin removal surgery thread.

A poster has been told she doesnt qualify for that surgery despite losing 20 stone and her folds of skin having the possibility of becoming infected.

OP, I just wanted to say how sorry I am you've had to go through this. I had an abscess two years ago which resulted in 6 months of daily visits to the nurse for packing and 4 operations to drain it and repair the damage it had done to my insides in stages over the course of 14 months.

Abscesses are absolutely horrific things to deal with physically and mentally, you have my total empathy, thinking of you and hope you heal quickly and get the reconstruction you need

HelenaDove

Thats what I was suggesting. That its insane to think someone who medically needs reconstruction and has be left in pain and uncomfortable due to surgery/illness/lifestyle wouldnt qualify but yet I and other people to which the surgery would be purely cosmetic do.

YY upside Im sorry to hear about your struggles with anorexia

I would most definitely sue and demand a reconstruction, you poor thing! Best of luck

Have you been discharged from the clinic or do you have a further follow up appointment? If the latter is the case, I'd request to see the consultant, as they'd be the one/s doing reconstructive work or referring you for a second opinion, and take it from there.

NC here.
I have the BRCA gene mutation (Breast cancer gene) and although I had my genetic counselling, BRCA gene test, psychological assessment and baseline mammograms etc on the NHS, I struggled to obtain the mastectomy and reconstruction on the NHS to finish it all off. I have a lifetime chance of breast cancer of 87%.

I was never told that I couldn't have the mastectomy on the NHS but I would be on the waiting list and that women with a diagnosis of breast cancer would always be first on the surgery list. This I completely understood and in no way would I ever argue or disagree with that decision. I was on the list for 8 months until I decided that I would pay to go private.

Luckily, I had come into enough money to do it. I had a brilliant consultant, the same one I always saw on the NHS. She operated on me within 5 days of my decision. I now have less than 12% chance of breast cancer which is actually less than the general population.

The point I'm trying to make is that, you may need to get a referral back to a breast consultant and ask specifically why you don't meet the criteria for reconstruction, because I bet you do. The registrar with their inexperienced opinion, was probably trying to put you off. I had plenty of these conversations, specially prior to my genetic testing. Tenacity got me to the genetic testing stage but every registrar I saw on my journey dismissed me.

Get referred to a breast consultant (mine was female and I insisted on a NHS referral to her as she was in a different PCT). Your GP should support you in this. Insist on a discussion as to why you don't meet the criteria.

As an aside, It annoys me beyond reasonable thought when I read about TIF's getting breast recon on the NHS. How many breast mutated gene patients are they ahead of?

Excellent post by Gincision. That would be my route.

Bloody hell OP, you poor thing! I too have had a massive breast abscess, it was syringed and syringed a second time with a drain put in for a week. I had iv antibiotics for 5 days and then a course for 10 days on discharge.

My breast is fine, no damage at all and even though supply of breastmilk was affected last time, currently breastfeeding my second child with no issues at all.

Please persue this!

Would this happen to the Queen or similar? No, it bloody wouldn't! The treatment dished out here was woeful and the attitude of that registrar dismissive and arrogant. You should defo get the surgery and, in my opinion, sue. Sorry you have had to go through this.

I really appreciate all your replies, I was a convert last night with the kids so will read properly this evening.

Just to clarify, at no point was it drained with a needle, ultrasound lady tried (my go had tried also) and said she got very little as it was so thick and would need a larger diameter needle.

I did ask the breast consultant about reconstruction last autumn, obviously I realise nothing can happen till I'm healed but wanted more information on the process, he also was very dismissive, said he wasn't sure it would be needed and refused to give information about it saying it needed to heal first anyway.

At a concert! No conversion took place!

Didn’t see the thread last night, but seems like you got loads of great advice.

I’d also be concerned about the length of time the wound has taken to heal. Are you on steroids or anything else that would slow the healing process? Is it being packed with an algenate wound dressing, or only gauze?

I am diabetic, which obviously doesn't help.

I started on alginate ribbon, was changed in January to silver alginate (aquacel ag) and on the advice of a tissue viability nurse I spoke to in work, recently bought some Probtosan irrigation fluid. Hopefully it will all help, I'm not sure what other solutions can be offered.

Sorry this has happened to you you have had the opinion of a registrar you need an opinion from a consultant and you are also entitled to a second opinion so you could get referred to plastics for this. I would wait until it is all well healed and settled first. I hope it all works out for you.

That all sounds good - you must be exhausted having to stay on top of it. Keep going!