More about the Breastcare unit

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.

We also offer a full range of breast reconstruction techniques, apart from major abdominal flap procedures which are done at the Royal Free Hospital in conjunction with the plastic surgeons.

However, if the sampled node contains cancer, patient may require a second operation axillary clearance to remove all their lymph nodes. Occasionally, we can get the lymph nodes analysed by a pathologist during the operation and proceed immediately to an axillary clearance if the pathologist finds cancer in the nodes. This facility is only available at our Watford General Hospital operating lists.

Sentinel Node Biopsy

In breast cancer management it is important to know whether any disease has spread to the lymph nodes in the axilla, (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 identify the most relevant nodes that need to be removed at the time of surgery. These are identified by dyes 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 Hospitals; if your surgery is on a Monday the dye will be injected on the morning of the surgery. 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). For these patients, we can offer breast reconstructive surgery. We can offer implant-based breast reconstructions and occasionally incorporate new techniques such as using biological meshes such as the Acellular Dermal Matrix.

For reconstructions using purely the patient’s own tissue (autologous) such as the DIEP/TRAM flap, we work in conjunction with the plastic surgeons at the Royal Free Hospital. We work closely with our plastic surgeons and have weekly joint clinic with them to facilitate our reconstructive practice.

We can offer immediate reconstructions during the same mastectomy operation or as a delayed procedure for patients who have had previous simple mastectomy operations.

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. Nipple areola tattooing can be performed three months after reconstruction, but currently there is a waiting list for this procedure.

Our surgeons and breast care nurses provide counselling and information on the options available for reconstruction, with the aid of photographs of patients who have had reconstructions at West Herts and the Royal Free Hospital.

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Breast Surgeons

Mr Simon Thomson, Consultant Breast, Reconstructive and General Surgeon

Qualifications: MD MBChB BSc(Hons); FRCS(Gen Surg) FRCSEd

Picture of Mr Simon Thomson, Consultant Breast, Reconstructive and General SurgeonSimon Thomson did his higher surgical training in the North West Thames region, culminating with a post at the Royal Marsden Hospital and an attachment at the Christie and University Hospitals of South Manchester. He has two additional research degrees: an MD for breast cancer work and a BSc(Hons) Anatomy, both of which led to publications.

He has worked in West Herts NHS Trust as a consultant since 2003 and was appointed as Lead Clinician to the West Herts Breast Care Unit in 2006. In 2012 he was appointed as clinical lead to Mount Vernon Cancer Network Breast Site Specific Group.

He offers a full range of therapeutic and oncoplastic procedures for symptomatic breast disease, including breast reconstructions with implants and with latissimus dorsi shoulder flap. He started a nipple reconstruction and nipple tattooing service with Marian Parfitt, breast care nurse specialist. He also has an interest in thyroid surgery and takes part in the general surgery emergency rota.

Outside of work he is a classically-trained pianist and a keen gardener and house renovator.

Miss Lee Min Lai, Consultant Breast, Reconstructive Surgeon

Qualifications: MBBCh FRCS(Eng) FRCS(Gen Surg)

Picture of Miss Lee Min Lai, Consultant Breast, Reconstructive SurgeonLee 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.

Miss Lai treats all conditions of the breast including benign and malignant breast disease. Her surgical interests include oncoplastic resections and breast reconstructive surgery in the treatment of breast cancer and for risk reduction; other interests are the management of developmental abnormalities of the breast and familial breast cancers. Miss Lai works closely with her oncological and radiological colleagues to encourage the best possible outcomes for patients.

Mr Kelvin Chong, Consultant Breast, Reconstructive Surgeon

Picture of Mr Kelvin ChongMr Chong graduated from Glasgow University and received his early surgical training at the West of Scotland Basic Surgical Programme. In 2003, he secured a clinical research fellow position at St George’s Hospital, London in which his research focussed on the role of growth factor receptors in breast cancer biology. His findings have been published in numerous peer-reviewed journals and culminated in a Doctor of Medicine (MD) degree from the University of London.

After that, Mr Chong was accepted into the Southwest Thames rotation in General Surgery in which the later part of the six-year training was concentrated on breast and reconstructive surgery mainly at the Royal Marsden Hospital in London and the Royal Surrey County Hospital in Guildford. After completing his training, he pursued a fellowship with renown breast and plastic surgeons such as Professor  Werner Audretsch in Dusseldorf and Dr Emmanuel Delay in Lyon.

Mr Chong has experience managing both benign breast diseases and breast cancers. He has a postgraduate certificate from the University of London in Breast Ultrasonography which he incorporates into his practice, particularly in his wide local excision operations to reduce cancer margin involvement rates. He regularly employs oncoplastic approaches when performing breast conserving surgery. In his reconstructions, Mr Chong incorporates the Acellular Dermal Matrix (ADM) in his implant-only reconstructions and is also trained in performing Latissimus-Dorsi reconstructions, nipple reconstructions and symmetrising reduction or augmentation procedures.

His current main research interest includes the use of mammographic density in stratifying breast cancer risk and reducing surgical site infection in breast surgery. He is a keen advocate of breast cancer research. Outside surgery, his interests include travelling, cycling and gardening.

Mr Joseph Maalo, Senior Specialty Doctor in Breast Surgery

Qualifications: MBChB (Makerere), FRCS(Ed, Eng)

Image of Mr Joseph Maalo, Senior Trust Registrar General and Breast SurgeryJoseph 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.

Mr Sherif Monib, Senior Specialty Doctor in Breast Surgery

Picture of Mr Sherif Monib, Senior Specialty Doctor in Breast SurgeryMr Monib graduated from Cairo University Medical School in 1994, shortly after he joined National Cancer Institute of Cairo University (NCI), one of the most reputable cancer institutes in the Middle East where he completed his surgical training.

He obtained a Masters degree in General Surgery 1999 and continued to work in Egypt until he moved to the Gulf for a couple of years, then he joined our trust in 2009.

While his main interest is oncoplastic breast surgery, he is also involved in clinical audit and research.

Over the last 22 years, Mr Monib’s surgical practice has benefited from working in three different surgical schools which has enabled him to integrate various techniques in the development of his surgical practice.

Outside of work Mr Monib is a keen cyclist who also enjoys his family time.

Mr Satyen Singh, Staff Grade (Registrar) in Breast Surgery

Picture of Mr Satyen Singh, Staff Grade (Registrar) in Breast SurgeryProfile to follow.

Ms Candice Walls, Clinical Nurse Specialist Practitioner

I have worked in Breast Care since 1995. I worked at the Royal Marsden for 3 years on the Breast ward and clinics whilst completing my BSc In Cancer Nursing. This included the Advanced Breast Care Nursing module and during my time there I completed a Diploma in Lymphoedema among other shorter courses.

I took up a post in West Herts hospitals in 1998 as a Clinical Nurse Specialist in Breast Care where I have supported many patients through their cancer journey. I run the monthly Breast Advisory clinic held at Grove House on the first Monday of the month for patients following surgery for breast cancer.

For the last 18 months I have been training to become an Advanced Nurse Practitioner in Breast Care. I now have my own clinics for rapid assessment of new patients and follow up clinics. I review patients on the ward following their surgery here at St Albans and Watford. l also work with Dr Miles and the Acute Oncology Nurse to help manage patients admitted as an emergency at Watford General with breast cancer related problems.

The Courses I have carried out include Counselling and advanced communication skills training, Palliative care competencies and more recently Advanced Physical Assessment course for nurses at Kings College, London.

I am currently studying for an MSc in Breast Evaluation at Kingston Unniversity.

I am married with 3 children and enjoy dining out, travelling, exploring the great outdoors and water sports with my family.