Breast Reconstruction radio interview with Katia Sindali

So October is breast cancer awareness month, and today being the eighteenth of October, it is wear it pink day today. And I'm very pleased to welcome my next guest who is a consultant plastic reconstructive surgeon called doctor Katya Senali. Doctor Katia, welcome to Ashdown Radio. Thank you very much, Peter. Good to meet you today. Could I start by just asking a bit about your professional journey in becoming firstly a doctor and then becoming a surgeon in the area of your expertise, and what attracted you to do that? Of course. So I've been very interested in becoming a doctor ever since I can remember really. My father is also a surgeon, so he inspired me in my childhood. And my interest in plastic and reconstructive surgery started when I was a teenager. I saw a TV program on the Medecins Sans Frontieres, where a team of doctors were going abroad, reconstructing the face of children who had terrible infections. And, at that point, I thought that's really what I wanted to do. So I started my medical school at King's College London in two thousand, and I've been now a consultant for just over two years. It was a very long journey. But when you first started on your medical career, you knew where you wanted to get to in terms of plastic surgery? Yes, I was already absolutely decided on plastic and reconstructive surgery, yes. Looking at your CV, impressive. So just talk us through where you've worked? So I've worked in many different places. I started my medical school at Guy's and Guy's and Thomas'. I was a foundation doctor for two years after that. I worked in Ashford. I worked in one of the main some of the main London hospitals. Then I was a junior surgeon, again, in Ashford, Canterbury, St. George's Hospital, Wexham Park, East Grinstead. I did a lot of my training as well. I started my higher surgical training in two thousand fourteen. That took just a little bit over six years. And towards the end of my training, I was really interested in microsurgical breast reconstruction, which means using the patient's own tissue for reconstruction. So I did an intensive period of two of two years of fellowships, specialising in this, and that's what I do most of the time today. And we'll talk about that in just a moment. But before we do so, let's just talk about breast cancer, because obviously today is Wear It Pink Day, and it's the pinnacle of October of breast awareness. So just talk me through about the importance and issues around breast cancer. So breast cancer is the commonest cancer in the UK. It's important to know that one in seven women will be diagnosed with breast cancer in their lifetime. Every year fifty five thousand women are diagnosed with it. And four hundred men, it does not just include women. And so, the important message here is, of course, self self examination and prevention is key here. So women should self examine on a monthly basis. So premenopausal women should examine, just after their periods every month, and postmenopausal women about the same time each month to try and detect and prevent breast cancer. What are they looking for? So any lumps, bumps, any change in their breast tissue, any change to the nipple itself, any nipple discharge, all of that should alert to seek help to their GP. And are they looking for abnormalities that are near the skin, or we're looking things much deeper down? So it can be either. Sometimes the cancer can be located very close to the skin, sometimes it can be much deeper in the breast tissue, but it's not always palpable with examination, so a mammogram is key here, and women in this country aged fifty to seventy one will be offered a breast screening, which is called a mammogram every three years. And would I be writing saying that pain doesn't necessarily go alongside it? Absolutely you could have this and feel absolutely fine? The majority of the time there is no pain. What about men? You mentioned four hundred men with breast cancer, what should men be doing? So it's very similar, so they would also feel a lump change in their tissue around their chest, and for men it's also important, maybe not quite on a monthly basis, but to regularly have a look at their chest. So the work that you do, you get involved, so presumably for somebody with breast cancer, there is a team that's involved with diagnosing, removing, and then you get involved. So, talk to me about the process. Okay. So, if somebody's diagnosed with breast cancer, and in they come. So, the breast cancer surgery is done by a different team of breast surgeons and then we come in to do the reconstruction, which can either be done at the same time as a mastectomy, which is called an immediate reconstruction, or later on which is called a delayed reconstruction. Of course, women who are eligible for immediate reconstruction, have to fill certain criteria. But, yeah, it can be done in one or the one or the other. And there are different procedures that can be done for breast reconstruction, and that includes implants or the patient's own tissue which we call autologous breast reconstruction. This is what I specialise in, autologous breast reconstruction and typically we either take the tissue from the lower tummy, which is called a DIEP flap, or from the inner thighs, which is called a tug or a lug flap. And what's the advantages of using the patient's own tissue as opposed to synthetic Of course. So there are lots of advantages. It creates like for like, It's warm, pliable, soft tissue, very similar to breast tissue, and it's it's very much a a part of the patient. So if they put on weight, it increases in size, and if they lose weight, it shrinks, and it's it stays with them forever. It's a lifelong reconstruction. And for a woman who's considering or not considering having to go through this process, but is considering having implants, you said sometimes they're done at the time of the removal and sometimes later. Is this a patient choice or is it clinically led? So we always give patients a choice but we guide them in their decision making because it's a very personal decision. For some women implants might be absolutely the right choice. It has advantages. Using implant is much faster, it's a quicker recovery. It doesn't create additional scars anywhere else on the body. However, if the patient, for example, requires radiotherapy, we know that the risk of complication with breast implants is much higher if the patient either has had or requires radiotherapy afterwards. But of course and we noticed there is now a very rare breast cancer called BIA ALCL, which is thought to be associated with the texturing of breast implants that patient can be worried about. With regards to using the patient's own tissue, again, it's very much a personal choice, but if we feel that this is the right thing for the patient, then we will guide them and provide information for that. And the point you make there, if somebody chose to go down that route, of course, there would be additional scarring as to where you take the tissues from? Correct. So in in the case of a Dieppe flap, then there will be a scar in the lower abdomen, and for the inner thigh would be, the lower groin and then along the inner thigh, some not quite as low as any, but yeah, extends to the inner thigh. And with this type of surgery though, the healing in these areas where the tissue is taken from, Actually, how can I put this? It can be extremely good that in fact, after a bit of time like that, it almost becomes invisible. Is that fair? Well, there's always a scar. We can never completely erase the scars, but for many patients, it's similar to a tummy tuck scar, and they don't mind getting rid of that bit of excess tissue that they carry, either in their lower abdomen or or their inner thighs, so they sometimes seen as a benefit. And presumably, you you do the, the removal below what we call the bikini line? Correct. Yes, so the scar is not visible when they wear, you know, swimwear or regular underwear. And one question I wanted to ask you about implants. There was some really bad press, I think probably a couple of years ago, about some real problems with some implants that were being used at the time. Do you want to comment on that? So that that's a bit more than two years ago. We had the PIP implant scandal, for, implants that were made of a non medical grade silicon. It was a factory in south of France that obviously closed down a long time ago now, and patients who had these implants pretty much have all been removed now. Right. So that's that's no longer a concern? No longer a concern. No. But, of course, there's this new BIA ALCL, this very rare type of cancer that patients can be worried about, and some patients will choose not to have a breast implant as a result. And do you find that more patients are perhaps becoming more akin to moving towards the type of surgery you're talking about, which is using their own tissue? Is that becoming more popular? So, nationally, the majority of patients will still go for an implant reconstruction, because not every hospital offers the type of reconstruction we offer, so autologous breast reconstruction. But we do see patients also who have had a breast implant in the past who choose to have that implant removed and exchanged for their own tissue. And there's also some procedures that go alongside breast implants as well, aren't there? So not implants, but any kind of reconstruction. In the case of unilateral reconstruction, there will be a degree of asymmetry between both breasts. So, it's very frequent for the patient to come back and require a secondary procedure, usually either a breast lift or a breast reduction, or what we call fat transfer as well to enhance the cosmetic result and symmetry. And a nipple reconstruction? Yes, that can be done as a last stage. So if the patient wishes, we can once they are happy with the size and shape and symmetry of both breasts, we can reconstruct a nipple for them. That can either be done using the patient's own skin, or sometimes we just do three d tattooing. Alright. And in terms of people listening, they might think, this is all done on private medical care, but that's not the case, is it? No, of course. We also do these procedures on the NHS. I myself work at Queen Victoria in East Grandstead and the Mackinder Centre. So you're doing both? Both, yes. And if people want to come through for your services, GP first course? So GP and breast surgeons will refer patients to the NHS and the private sector as well. And if people would like to find out a bit more and know where's the best place of going, presumably the MacKinder website? So the MacKinder website has got lots of information on there, and we have a team of seven consultant plastic surgeon have a specialist interest in breast microsurgical reconstruction who work there. We always have a two consultant approach, so every operation we do is done with two consultants. We have much faster surgeries, very safe. We carry out very safe procedures that way, and it's it's very enjoyable. We really enjoy working with each other. And Sorry. Go on. I was just going to say that we have done, since from two thousand and twenty until now, three hundred autologous breast reconstruction in two hundred and eleven patients, and that makes the MacKindo Centre, you know, the top hospital outside of London to perform this type of operation. I was gonna ask you timing wise for somebody who comes in for this type of procedure. Appreciate everybody is different, but roughly speaking, how long would somebody spend in hospital, having had this procedure done? So we now have what we call an enhanced recovery pathway after this type of operation, and we have had a few patients managing to go home the day after surgery, but on average they go home after two days, sometimes three. Alright. Well, it's been really good to talk to you, and hopefully some people listening, some ladies listening, could be inspired by what you're saying and want to find out more. So the MacKinder Centre is the website to go to. I also believe you can have your own website in the near future as well? Correct. Yes. We'll have our own website explaining what we do and being a source of resources for patients. Yes. Now, have I covered with you all the key points that you wanted to get across this morning? Yes, I just also wanted to mention, of course, the key to our success at the Mackinder and also Queen Victoria is not just down to the surgical expertise, we have a fantastic team working with us, so nurses, specialist nurses, anaesthetists, ODPs and physiotherapists, and they all contribute to the patient's journey and their positive experience. And we also want to perhaps give a quick shout out to Katie Smith and her team, who have actually put things together today, She's frustratingly stuck in the traffic down the a twenty seven at the moment. Doctor Katia Sindali, thank you ever so much for joining us this morning. Thank you very much, Peter.