Breast Reconstruction Insights from Mr Martin Jones

My guess this hour is Martin Jones. Martin is a consultant plastic and reconstructive surgeon at the MacKindo Centre. Martin, good morning. Welcome to Ashtown Radio. Good morning, Peter. Thank you for inviting me in. You're very welcome. Before we talk about your specialism, Martin, just tell me a bit about yourself and your journey through medicine. So I grew up locally. I grew up in East Crinstead and went to school in East Crinstead. And I was lucky enough to go to medical school, but knew that I wanted to do plastic surgery before I got to medical school, thanks to one of the plastic surgeons from Queen Victoria Hospital coming to our school and giving us a lecture on it. I found it fascinating and I was that's it. That's what I wanna do. Exactly. Okay. And where did you do your training? So I was at UCH Middlesex School of Medicine, which is now UCL. It's joined up with Royal Free. And then most of my training in plastic surgery was in London and at Queen Victoria Hospital, which is in Easternston. Now, you now work at the McKindo Centre as a consultant plastic and reconstructive surgeon. Is most of your work on breast surgery? Is this where your your specialism is in? Yes. About eighty percent of what I do is is breast surgery, whether it's reconstructive or adjustment of breasts. So twenty percent is about is skin cancer as well. Alright. And before we go on and talk about the details of it, I know this person is not quite exactly your area of specialism, but for people listening, general signs and symptoms that that people perhaps should just be aware of and look out for? So I think any change to the breast, whether it be finding a lump when examining yourself whether there's a noticeable puckering to the overlying skin whether the discharge from the nipple I think if that carries on the best thing to do is monitor it over week. If there's persistent change, pop her on to the GP and then get referred to the one stop breast clinic in your local area. So talk a bit about the the breast cancer patient journey. You know, at what point do you as the the plastic surgeon become involved? Well, there's unfortunately an increasing number of women that are being diagnosed with breast cancer, perhaps over sixty thousand a year. And we either get involved at the fairly soon after the diagnosis if there's going to be a reconstruction at the same time as a mastectomy. Around about one in four women who have breast cancer will end up having a mastectomy and sometimes you can reconstruct the breast at the same time if it's oncologically safe to do so. Some women would elect to have it reconstructed down the line, perhaps a year or two after they've had the mastectomy. So if it's an immediate reconstruction, we get involved quite quickly with our breast surgery colleagues and the MDT. In terms of the the team itself, know, who and what's involved in doing this? So it's, it's a very, very large team, obviously the patients at the centre of the team, and then we have fantastic breast care nurses that we work with, anaesthetist doctors that put the patients to sleep and a breast surgeon who will do the mastectomy. We also have physiotherapists for encouraging movement after the surgery and ward staff nurses that look after the patients extremely well once they've had the operation. In terms of the operation, if we take it in two halves, the mastectomy itself, is that called a long operation usually? So that, depending on where the tumor was is within the breast and the size of the breast, that can be anything from forty five minutes to two hours. And sometimes the lymph nodes in the armpit will be harvested or sampled and that can add another twenty minutes to an hour onto the surgery. And then if you opt to do the reconstruction at the same time, what sort of time period are we talking there then? So it all depends on how you do the reconstruction. What I specialize in is taking the woman's own tissue either from their tummy or their inner thighs and then we detach it and then plummet into a vessel within the chest under the microscope and that can take anywhere between three and eight hours depending on the intricacies of the operation. Because the alternative is to traditionally use an implant isn't it? That's right, yes and by that's still the the biggest proportion of mastectomy mastectomies will be reconstructed with an implant and different operations and different techniques suit a person at different stages in their life and also one is not necessarily better over the other, but we're finding more and more women want their own tissue being used because it's warm, it's part of them and it once you get it right, it tends to last the lifetime of the patient, whereas implants sometimes do need to be changed after ten to twelve years. Is this a is it a clinical decision between yourself and the patient, or is it more of a patient choice decision as to which way they go on this? So I think our job as clinicians is to provide the pros and cons of each technique and then the patient should make their own mind up. They definitely have, you know, them the most important person in this and so choice is a big factor. You mentioned at the beginning that sometimes you do the implants at the same time as the mastectomy. What's the pros and cons here, Martin? So, often the implants done at the same time would be done by the breast surgeon. Plastic surgeons tend to do more what's called autologous tissue where they use their own tissue, whether it's the tummy or the thighs. The benefits of doing it at the same time is there's one less operation a patient goes to sleep with, for intents and purposes, a normal breast that has to to look from the outside, but it does have cancer in it, and they wake up with a reconstruction. So they wake up with a breast mound that although it's different to their original breast, it can be the same size, it can be put into a bra, and it makes clothing wearing a lot a lot easier. So I think from a psychological benefit, having the reconstruction at the same time is definitely worthwhile and it's what NICE recommends as well. But some people prefer to actually have it done in two parts? Yeah, some women would like to get over the diagnosis of having breast cancer and make sure all the treatments done and then down down the line when their life is back on track, then they can have the reconstruction done. And then we tend to use their own tissue then. What are some of the common misconceptions and fears that the patients have about reconstructive surgery? I think the enormity of the operation. Sometimes they've heard of operations going on late into the night. They've been kept in for perhaps five to ten days but these days the efficiency of the operation with everybody involved it's taking less time they are perhaps staying two to three days in hospital for even the major operations from their tummy or their thighs and they get they get back to normal life a lot quicker, back to exercise. So often a chat with someone who does this can allay a lot of the fears. And there's other procedures that go alongside the breast construction surgery. I'm looking here at nipple reconstruction and something called nipple tattooing, and I wonder if could explain this. Yeah. So the operations, the ancillary operations that go alongside reconstruction can be adjusting the target breast to make it smaller or higher to adjust to the reconstruction but the finishing touches often to bring focus to a breast reconstruction to turn it into breast is to put a nipple on it and that can either be done through tattooing alone and the central part can have a shadow tattooed onto it to give it the illusion of projection of a nipple and that can be done as an outpatient procedure. Alternatively, some women would like a nubbins created that looks like a nipple and that's done through some tissue rearrangement on their own breast reconstruction and then the areola is tattooed around it to give it the pink nature of the target nipple on the other side. And once again, I'm assuming that's a discussion with the surgeon as to know which procedure is best. Definitely. I think patient choice is the most important thing. What advice for people who are listening who are perhaps unsure if reconstruction is is maybe right for them? I think there are a number of groups that they can get in contact with and they can certainly get in contact with the MacKindo Centre and come to visit one of our colleagues there and they can just have an unbiased informed discussion to make sure they know what's possible out there. It's actually getting access to the information that is most important so they can make an informed decision. And after operation, after you've had a mastectomy and you've had a reconstruction of some form, what's the sort of the process then for healing? You mentioned physiotherapy, you mentioned other things as well. So there are definitely sort of, if you like, time slots on a pathway that use you say that the average person would be getting back to work after about four weeks. If it's a major reconstruction getting back to exercise at maybe eight to ten weeks. But often you'll find patients that are, you know, a lot quicker than that. I've had one woman decide to run the South Downs Way ten k at three weeks after a major reconstruction. Wow. Wow. People tend to prove you wrong as a doctor, and that's absolutely fine. And as a consultant plastic and reconstructive surgeon, we talked around your work this morning. Is there anything sort of that we haven't covered that you would want to sort of get across to sort of somebody listening who who may be having to consider this? I think it's a very personal choice and really it's just access to the information. The woman has to have the pros and cons to make their own mind mind up and the best intentions I think relatives and friends tend to let them know their, if you like, idea on it, but it's down to the individual. And what somebody's friend or brother or sister may have had done just may not be suitable for you. That's exactly right. Alright. It's really good to talk to you this morning. We ought to give a shout out for the MacKindo Centre because if people would like to learn more, I'm guessing thing to do is get in touch with yourselves at the MacKindo Centre to open up that first conversation. Yeah. That's very sensible. So let's do the website if we could. So the website is w w w dot the mckindo centre dot co dot u k. And what I do is when we put the interview online, as always, I'll put the website address in there as well. That's very fine. Martin Jones, consultant plastic and reconstructive surgeon. Thank you for talking to us this morning. Thank you very much for having me.