QA Hospital is helping lead the way in treating breast cancer patients

Many of those have to undergo surgery to have the cancerous tumours removed, sometimes leaving no breast tissue behind.

In Portsmouth, Queen Alexandra Hospital sees around 700 breast cancer patients through its doors each year.

Of those 700 some have a mastectomy, the removal of the breast.

But for those conscious of how their new body will look, QA Hospital offers reconstructive plastic surgery on site as well.

The Cosham hospital is one of 12 oncoplastic units and is one of nine leading the way in this type of surgery.

Clinical lead and consultant breast surgeon Dr Avi Agrawal is one of five members in the team removing the tumours and breast tissue while another team of plastic surgeons work on the reconstruction side of the procedure.

He says: ‘We are an oncoplastic breast unit which covers all forms of breast services for men and women.

‘That includes a full reconstructive team who we work very closely with.

‘We see about 700 patients with breast cancer every year which I think is the highest number in the south. You have to go quite far to find another centre which sees more patients than us; we are a very big unit.

‘The high number of patients we treat, the knowledge of the team and our expertise makes us one of the best breast units in the country.’

As one of nine fellowships, QA Hospital attracts some of the very best professionals in the breast surgery field, something Dr Agrawal is proud of.

He adds: ‘In 2002/03 the Department of Health decided to set up designated reconstructive training centres.

‘There are 12 approved training centres, of which QA is one, in the country.

‘There are nine fellowships a year which are very prestigious and attract the best in the field.

‘It sets centres up to be successful and have the very best on offer for patients.

‘It is very good for people who live in and around Portsmouth to have this level of service so close by.’

The fellowship also means when patients need to have a breast operation and choose to have reconstruction, the procedures can be done together.

But surprisingly less than half of mastectomy patients choose to have the plastic surgery done.

Dr Agrawal says: ‘The fellowships mean patients don’t have to travel to different places.

‘Because we have got plastic surgery services on site, it means patients that have to travel this way for the cancer treatment part can also have the plastic surgery done too.

‘If for example we were in Chichester, they would have to come here or go to Winchester for the plastic surgery. Here, we can do both.

‘An audit on breast reconstruction in 2008/09 showed the reconstruction rate was about nine per cent of patients.

‘Now, of our patients who have a mastectomy, it is about 35 to 40 per cent of patients who opt for reconstruction.

‘Although that might seem low, we have the highest rate in the region.

‘Some women just don’t want the extra surgery, it is up to patient choice.’

As well as having the oncoplastic unit, the QA team can also do an intraoperative sentinel node biopsy.

This means taking lymph nodes from the armpit of the patient during surgery and using molecular technology to see if they are cancerous.

In some sites, the lymph nodes need to be sent off for the results but at QA, they are tested while the patient has their operation.

Dr Agrawal says: ‘When patients have breast cancer we evaluate the armpit to see if the cancer spreads from breast to the armpit.

‘We take lymph nodes from the armpit for the test.

‘In lots of hospitals they have to send the test off and wait for the results to come back. If they are positive then the patient has to come back and have another operation.

‘We test the lymph nodes at the same time and see if there’s disease.

‘If there is, we have permission from the patient, which we get beforehand, to carry on and remove the rest of the glands there and then.

Very few sites offer that.’

QA Hospital has secured the fellowship until 2020 meaning hundreds more women will be able to benefit from the expert team and availability of instant reconstruction once their surgery to get rid of the cancer is finished.

Dr Agrawal adds: ‘Oncoplastic is a very important branch of surgery.

‘It is about not just looking after the cancer side of things but also the aesthetics side as well.

‘We want to pass on this information to the new generation of surgeons so the future of this type of surgery is always available.’