Mastectomy & Immediate Breast Reconstruction

Banana Roll Excision

Body

What is a Banana Roll excision?

A Banana Roll excision is surgery to remove extra skin and fat from the crease under the buttocks (gluteal fold). The aim is to elevate and tighten the posterior thigh, as well as symmetrise the level of the buttock creases. Liposuction can also be used to remove any excess fat from the posterior thighs, hips, back and buttocks. Banana roll excision is commonly required in asymmetry of the gluteal fold where patients have had previous liposuction that has weakened the support of the buttock and allowed it to drop into an abnormal position with a double crease.

What does the surgery involve?

An incision is placed in the gluteal fold under the buttocks and the fold is elevated into a new position.

Banana Roll excision surgery is usually carried out under general anaesthetic (you will be fully unconscious) and take between 2 to 3 hours to perform. You are likely to stay in the hospital for one night.

What are the risks and side effects of surgery?

Having Banana Roll excision surgery should be a very positive experience. Complications are infrequent and usually minor. However, no surgery is without risk, and it is important that you are aware of the possible complications. All the risks will be discussed in detail with you at your consultation. However, if you have further questions or concerns, please do not hesitate to discuss them with me. Decisions about any surgery should never be rushed.

Scars

Scars tend to settle remarkably well. However, some people heal with thickened scars, and this can make them more noticeable.

Bruising and swelling

Bruising and swelling is very common and may take approximately 3 weeks to settle.

Haematoma

This is clotted blood that collects under the skin. If a haematoma develops, it is likely to do so within 4 to 6 hours post-surgery. Any increase in swelling or pain should be reported immediately so that treatment can be given. Sometimes patients need to have this collection of blood removed with another short operation. This does not normally delay your recovery or change the cosmetic result.

Infection

This is rare but you may require antibiotics if there are any concerns.

Asymmetry

Occasionally patients develop asymmetry where one gluteal fold remains lower than the other. If this is noticeable then it may need to be adjusted further.

Numbness, reduced sensation or oversensitivity

A reduction in sensation occurs in most patients around the upper thigh and buttocks. This is usually temporary, but occasionally these changes can remain to some degree.

Wound healing problems

These healing difficulties can range from minor problems, such as small scabs or areas of wound separation, to major issues, such as skin loss. Although very rare, this situation may require a skin graft to close the wound, meaning more surgery.

Patients who have diabetes, smoke, are obese or elderly are at an increased risk of delayed healing.

Seroma

This is a collection of clear fluid under the skin, which sits in a pocket. This normally reabsorbs spontaneously over the course of a couple of weeks, although it can be drained with a needle if it feels tight. Vary rarely a surgical procedure may be required if it does not reabsorb.

Dog-ears

These are prominences of soft tissue found where the scar stops. In most cases these settle over the course of 3 months. However a small local anaesthetic procedure may be required to remove any excess that remains.

DVT/PE

Following any surgical procedure it is possible to develop a blood clot in your legs, which could potentially break off and travel to your lungs. If the blood clot is large enough, it could prove fatal.

The overall risk for cosmetic surgery is less than 1%, but to reduce any risks of a DVT/PE, you will be provided with special stockings to wear in bed together with a blood thinning injection, if you are not mobile or have previously had a DVT or PE.

What happens after the operation?

The scar will initially feel tight and under tension, but it will relax over the course of approximately one week. I recommend that you lie on your side or stand as much as possible and avoid sitting for too long, or bending your knees to your chest, as this puts tension on the scar.

The incisions are closed with dissolvable sutures that do not require removal. They are often hidden under the skin, so you will not see them and will dissolve naturally over a period of approximately 4 weeks, when the incisions are strong enough to support themselves.

I use transparent glue and tape dressings (Prineo®), which are waterproof and can be peeled off approximately 2 to 3 weeks after surgery, when they start to lift at the corners.

You can shower as soon as you like after surgery and do not require any dressing changes.

Before you are discharged from Hospital you will be given a follow up appointment to see the nurse after one week post-operatively to check your incisions. I normally see you in clinic approximately 2 weeks following your procedure.

You will not be able to drive yourself home from Hospital and, ideally, you should have someone to stay with you for the first few days to assist you. If you have any concerns during this period, please contact the clinic for advice.

What is the estimated time for recovery, absence from work and return to usual activities?

When you return home, you should take it easy for the first week or so. Most people take around 2 to 3 weeks off from work. You should be able to drive from 2 weeks, commence gentle exercise at around 4 weeks and return to sit ups and normal activities at around 6 weeks.

I hope you find this information useful. If you have any questions or require a little more information then please do not hesitate to contact me.

Anne Dancey
Plastic and Reconstructive Surgeon FRCS(Plast), MBChB(Hons), MMedSci(Hons) and MCh(PASP)