Manuela (not her real name), did not miss her date with the beach every summer. He didn’t let cancer take that away from him too. But this year he returned to toples calmly. He hadn’t been able to do it since he had a mastectomy. Plastic surgery reconstruction was the first step, but she could not say goodbye to breast cancer until she arrived at the consultation of Fátima Carrasco, a beautician specializing in nipple and areola micropigmentation. “They come with a lot on their back, with scars on their chest, but more on their soul and this final part is a lot for them, it means that they have overcome it,” he explains.
“Many have the reconstruction done, but without micropigmentation the process does not end, there are cases in which they stay that way because they stop going to consultations or see doctors, but this last process turns their lives around, they look in the mirror again, to regain their self-esteem ”, explains Marta Marañón, a nurse from the plastic surgery area of the Burgos University Hospital, HUBU. She and her partner Soraya Hernáiz have insisted that HUBU regain this service after two years.
“Between the retirement of the nurses who did it before, and the Covid, we have not done this technique for two years and now, thanks to the nurses having spent time training, we can start it up again,” explains the boss. of Plastic Surgery of the HUBU, Miguel Estefanía. It recognizes that it is an important final process for patients to regain self-esteem. «It is a long process that they have been behind, in our service they can spend a year and a half from the first consultation to the last, in addition to the time they spend in the specific treatment against the tumor, and with this technique they recover aesthetics, sexual and psychologically ”, explains the surgeon.
The effort of the two HUBU nurses is to ensure that the service is no longer blank. “We have trained on our own, we have rotated at the Ramón y Cajal Hospital, which is the pioneer unit in this technique, and we have developed a protocol for all the services involved,” explains Soraya Hernáiz. They highlight the will to “continuity and team building so as not to suffer this two-year break due to the retirement of colleagues and having to train”, they explain. The team is completed by Noelia Cortezón, General Surgery nurse, and Ana Isabel Casado, Dermatology nurse.
The nipple-areola micropigmentation technique in mastectomized women has been in the portfolio of the National Health System since 2018. It is a service that is not provided in all public hospitals, although in the Burgos hospital it has been applied since 2000, first in the operating room by the surgeon until a group of nurses was empowered. In view of the fear of the operating room, since 2013 the technique was enabled in consultation until 2019. The formation of the quarry will prevent a stoppage in this service that can also be applied privately. It is an aesthetic and tattoo technique but “it is not a tattoo,” the nurses remarked. The esthetician Fatima Carrasco also does it in Burgos, who has ten years of experience in this task and to whom cases are derived from the Spanish Association Against Cancer of Burgos cases that she carries out on a voluntary basis. Although the Psychosocial Team of the Burgos entity recognizes that “it is a process from which we are more detached, we assume more cases of guidance and support at the beginning with the diagnosis of the disease.”
Much more than a tattoo
The process to look in the mirror again is long. The first part, breast reconstruction after mastectomy, is one of the most common operations in the Plastic Surgery service. They can be of two types: immediate, it is done at the same time the affected part is removed, or delayed, which is done a second time when the mastectomy has healed. At HUBU, two immediate rebuilds can be made a week and, depending on the waiting list, deferred rebuilds are scheduled with a minimum of one weekly.
Three months after the last surgery, nipple and areola reconstruction can be performed. There are three sessions, something in which the HUBU protocol and Fátima Carrasco’s consultation coincide. Difficulties vary if an intervention has been made on one breast, «where there is a reference to what they have», or both have been reconstructed «it is more difficult because they do not remember what it was like then we value how to do it with them and in the tone we take the lip mucosa that gives us pink tones or brown tones ”, explains Carrasco. 3D reconstruction is also performed, which is sometimes facilitated by the surgical operation and in others it is recreated with shading and perspective.
It differs from tattoos in that it is not an ink injection into the dermis, but pigments of pink and brown tones are injected into the epidermis. He agrees that dermographs and needles are used. But the pigments are organic “they are compatible with the health process carried out by the patient and do not contain metals”, details Fátima Carrasco. “It is not a painful technique, we want them to avoid entering the operating room, which is something they do not want,” explains Hernaiz. “When they arrive they tell us about the battles they have fought until they win the war, their intention is to put an end to this stage of their life,” sums up Marta Marañón. It is much more than a tattoo, they are signs of a survivor who smiles back to life looking in the mirror.
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