West Herts Breast Care Unit
Breast Surgery
Breast Surgery at West Herts NHS Trust
At the West Herts Breast Care Unit we offer a full range of procedures for symptomatic breast disease and for patients from breast screening, including all standard cancer operations and diagnostic procedures.
The majority of our operations are performed at St Albans City Hospital, which is an elective surgery site and so has the advantage of avoiding the busy acute hospital wards. However, a minority of our patients will need a greater degree of medical backup and need to have their operations performed in an acute hospital, currently Watford General Hospital.
Along with most other hospitals, we have adopted the new sentinel node biopsy technique, our surgeons having completed the initial validation phase.
We also offer a full range of breast reconstruction techniques in the Trust, apart from major abdominal flap procedures which are done at the Royal Free Hospital in conjunction with the plastic surgeons.
Sentinel Node Biopsy
In breast cancer management it is important to know whether any disease has spread to the lymph nodes, (armpit glands), as this will affect what subsequent treatment we shall recommend.
Where there is no clinical or imaging evidence of disease in the lymph nodes, we need to confirm this by taking glandular tissue from the axillary area as part of the cancer operation. As long as the breast tumour is not too large, we only need to take a sample of the nodes rather than all of them.
Sentinel node biopsy is a new technique, which helps us take the most relevant nodes when we are sampling them, by seeing which nodes take up dye injected into the breast.
To improve accuracy, we use two “dyes”. One is a small amount of radioisotope which is injected into the breast on the day before the operation in the nuclear medicine department at Watford or Hemel Hempstead General Hospitals. The second is a blue dye injected during the operation (can stain the urine for a day or two and the breast for a few months, but it eventually disappears).
The great advantage of the technique is that if the sampled nodes (usually 2 or 3 are taken) show no disease, which is most often the case, we can avoid a much larger operation to remove all of the lymph nodes.
Reconstructive surgery
For some patients it is necessary to remove all of the breast (mastectomy) and in these we can offer reconstruction surgery. There are a number of types of breast reconstruction, but the two commonest sorts are done either at St Albans City Hospital (simple implant reconstruction) or Watford General Hospital (LD flap reconstruction with implant).
In certain cases we can do the reconstruction at the same time as the mastectomy, but it can otherwise be done at any time after six months post-treatment.
We also schedule procedures on the opposite breast, if this becomes necessary to achieve better symmetry. This may involve reducing its size or lifting the breast by tightening the skin, with or without an additional implant.
Many patients also like to have a nipple reconstruction, which we can do under local anaesthetic followed by nipple tattooing at least 3 moths after the reconstruction.
Major free flap procedures, which usually involve moving abdominal tissue to the chest, are done in conjunction with the plastic surgeons at the Royal Free Hospital.
Our surgeons and breast care nurses provide counselling on the options available for reconstruction, with the aid of photographs of patients who have had reconstructions at West Herts.
Breast Clinicians
Mr Simon Thomson, Consultant Breast, Reconstructive and General Surgeon
Qualifications: MD MBChB BSc(Hons); FRCS(Gen Surg) FRCSEd
Simon Thomson did his higher surgical training in the North West Thames region, culminating with an attachment at the Royal Marsden Hospital. He has two additional research degrees: an MD for breast cancer work and a BSc(Hons) Anatomy.
He has worked in West Herts NHS Trust since 2002 and was appointed as Lead Clinician to the new West Herts Breast Care Unit in 2006.
As well as offering a full range of procedures for symptomatic breast disease, Mr Thomson performs breast reconstructions with implants and with LD flap (shoulder flap with implant). He has started a nipple reconstruction and nipple tattooing service. He also has an interest in thyroid surgery and takes part in the general surgery emergency rota.
Mr S P Raymond, Consultant Breast, Reconstructive and General Surgeon
Qualifications: MBBS (Cey); FRCS(Gen Surg) FRCSEd
Mr
Raymond has had a wide-ranging career in general surgery. His higher surgical training was in Belfast and he has worked at St Albans City Hospital since 1986. His advanced breast training was at St Bartholomew’s Hospital, London. He was appointed consultant in breast and general surgery at West Herts NHS Trust in 2003.
He offers a full range of procedures for symptomatic breast disease and also performs breast reconstructions using implants. He also has an interest in laparascopic cholecystectomy and paediatric surgery and takes part in the general surgery emergency rota.
He has an interest in charity work, regularly offering his services as a surgeon in third world countries.
Miss Lee Min Lai, Consultant Breast, Reconstructive Surgeon
Qualifications: MBBCh FRCS(Eng) FRCS(Gen Surg)
Lee Min Lai graduated in medicine from the University of Wales. She underwent basic surgical training in South Wales in the core specialties of general, trauma, ENT and plastic surgery. Her higher surgical training was on the Northwest Thames rotation with subspecialty training for breast and endocrine surgery at the Hammersmith and Royal Marsden Hospitals.
She completed her reconstructive breast training on a national Oncoplastic Fellowship at Royal Hospital Haslar, Portsmouth and was appointed as consultant breast surgeon at West Herts in 2008.
Mr Sanjay Z. Baldota, Senior Specialty Doctor in Breast Surgery
Qualifications: MBBS(Bombay), MS; FRCSI, FRCS(Gen Surg)
Mr Baldota qualified as a doctor in 1987 and then trained in general surgery, completing his training on the North West Thames rotation. He was appointed as a consultant breast surgeon in 2000, then took up a two year consultant post in County Donegal to develop a modern breast unit there.
He was subsequently a locum breast consultant at the Nottingham Breast Institute for three years and was appointed as Specialty Doctor at West Herts Breast Care Unit in 2009.
Outside of work Sanjay is a keen cyclist and is working towards a pilot's licence.
Mr Joseph Maalo, Senior Trust Registrar General and Breast Surgery
Qualifications: MBChB (Makerere), FRCS(Ed, Eng)
Joseph Maalo graduated from Makerere Medical School, Kampala (University of East Africa) in 1974. He continued postgraduate training at Mulago Hospital, Kampala, during which he was appointed as private physician to the late president of Uganda.
In 1977, he continued surgical training in the UK, including attachments at St Thomas’s Hospital, London and long-term locum Senior Registrar in colorectal and breast surgery at King’s College Hospital. He has been locum consultant general surgeon at King’s College Hospital, Princess Alexandra Hospital, Harlow and Gilbert Bain Hospital, Lerwick.
Mr Maalo worked for one year as Associate Specialist in breast surgery at St Albans City Hospital in 2001 and took up his present post in 2007. Since 2009 he has also provided senior surgical support for the Acute Admissions Unit at Watford General Hospital.
His main interests are oncoplastic breast surgery and clinical audit and he is working towards a masters degree in surgical science.
Sue Coffey, Clinical Nurse Specialist Practitioner
Qualifications: SEN, RGN, BSc (Hons) Oncology Nursing, Non-medical prescriber, ENB 998 (Teaching and assessing), N53 (Pain management), A25 (Surgical nursing), Care of patient with breast cancer ( A 11 Equiv. Royal Marsden Hospital)
Sue qualified at Barnet General Hospital as a state-enrolled nurse in 1981. She has worked at St Albans City Hospital since 1984 and became a registered general nurse in 1997. Sue worked on both acute and elective surgical wards, becoming ward sister in 2001. In 2003 she joined the
peri-operative specialist training programme, St Mary's Hospital, Paddington.
As an Independent Specialist practitioner she works along side the consultants, responsible for her own case load of patients. She is fully-trained in breast examination, assessing and planning care in the rapid diagnostic one stop assessment clinic, family history clinic and follow up clinics.
Sue helps co-ordinate peri-operative management of breast patients in the ward and clinic, and assists the surgeon in theatre. As part of the Breast Unit team, Sue also supports the patient as breast care nurse, counselling of breast cancer patients, discusses clinical issues arising before and after surgical and oncology treatment and provides support for the patients' psychological and spiritual needs.
