Rachel O’Connell (ROC): I'm a consultant oncoplastic breast surgeon at The Royal Marsden in London, where we provide comprehensive breast cancer treatment that is personalised for each and every patient that we meet. As a breast surgeon, my aim is to provide safe breast surgery so that we can completely remove a tumour and, where possible, try to preserve the breast.
In some situations, we have to perform a mastectomy to remove the breast. Following this procedure, for those who wish to have breast reconstruction, we work closely as a multidisciplinary team with our plastic surgeons and other oncoplastic breast surgeons, to provide this service for all of our patients.
Marios Tasoulis (MT): I'm also a consultant oncoplastic breast surgeon. Our main focus as a team, and for me personally, is multidisciplinary management of breast cancer, providing an individualised approach. Another area of interest is how we manage women that do not have breast cancer, but have breast implant-associated lymphoma – an uncommon type of blood cancer that is related to the use of breast implants – which can occur after using implants for either cosmetic or reconstructive purposes.
A particular area of focus from my point of view is how we tailor a patient’s treatment plan after the use of neoadjuvant systemic therapy – the administration of therapy before main treatment. We also try to minimise the amount of surgery that is required both in the breast and the axilla [armpit], to provide the best possible oncological and aesthetic outcome.
For some women, a mastectomy cannot be avoided, and in patients who wish to have reconstructive surgery, we work closely with our plastic surgery colleagues to provide autologous reconstruction. This is where tissue from other parts of the body, such as the stomach, is used to reconstruct the breast and provide a long-lasting and natural-looking reconstructive outcome. If this is not an option, then we can perform implant-based reconstruction, again trying to balance the best possible aesthetic and oncological outcomes.
ROC: Every patient that we see at The Royal Marsden receives a full evaluation, which involves examining the patient and looking at their medical history, as well as diagnostic imaging that can include mammograms, an ultrasound and MRI scans. We would also examine tissue samples, which is called a biopsy.
Some of our international patients may already have had such tests and can bring their images and results with them – our pathologists are always very happy to review tissue samples from elsewhere. Often, patients that have arrived from another country would like to proceed quickly and that is something we can accommodate.
One of the benefits of working in a large, comprehensive cancer centre is that we have international experts in all fields of oncological management, so that we can make a very targeted plan for the patient. The Royal Marsden is solely dedicated to cancer care, so we have all the relevant specialists, specifically trained to look after patients with cancer.
MT: Our multidisciplinary care involves not only medical doctors and consultants, but also includes highly trained breast-care nurses and psychologists to help with supporting patients through every step of their treatment. From the surgical point of view, we know that breast-conserving surgery comes with several advantages, including psychological, emotional and sexual wellbeing, by maintaining the body image, as well as functional wellbeing.
ROC: Yes, absolutely. Some treatments for breast cancer can continue for several years, so when patients finish their initial treatment we will write an individualised medical report with our recommendations, which the patient can take home. Patients can also use The Royal Marsden’s own app, MyMarsden, where they can access all their notes and scan reports to pass on to their doctors. Our team is also happy to communicate with local physicians, if necessary.
MT: Our breast unit has received numerous accolades, including the Team Science Award from the American Association for Cancer Research (AACR), one of the world’s most prestigious team science awards, for work that has transformed treatment for many patients with breast cancer. We have presented our findings at international conferences and we work with major cancer centres worldwide to further our knowledge of breast cancer and treatments.
One of our current areas of research is into de-escalation of surgery, assessing whether, and when, it would be safe to reduce the extent of surgery we perform. We are actively involved in identifying women that have an exceptional response to neoadjuvant chemotherapy, and whether it is safe for these women not to have surgery at all. We're also trying to identify women that could avoid surgery under the armpit completely, where they have low-risk cancers.
We also work closely with our
colleagues in plastic surgery, looking into why some women develop a very uncommon type of lymphoma that is associated with implants, and we run one of very few studies exploring this. We have seen more than 25 patients with this issue, which can develop seven to 10 years after receiving an implant. The more women that have implants, the more we will see of this type of cancer, although it isn’t common. Our aim is to establish The Royal Marsden as a specialist cancer centre internationally for women that have this type of problem.
ROC: One of the things that is becoming more critical in the way we manage a lot of cancers is our understanding of the genetic causes. Such information can help us identify those at increased risk of breast cancer, so that we can help them by carrying out extra screening or, potentially, even risk-reduction surgery. We can also use genetic information to assist with providing specific treatments, including drugs that are more targeted and have fewer side effects.
MT: In the longer term, perhaps 10 to 15 years from now, it may also be possible to provide 3D-printed implants. This approach is in its early stages, but it’s an exciting development that will use a precise image of the shape of the breast to create a scaffold that is 3D-printed, using biological material. Then, instead of using a silicone implant, we would use this scaffold and transfer some of the patient’s own fat to reconstruct the
breast. This gives patients a more natural look, as breast shape and size is individually customised for the patient.
For more information about The Royal Marsden Private Care or to refer a patient, please:
Visit: royalmarsden.nhs.uk/private-care
Email: int@rmh.nhs.uk
Call: +44 (0)20 7808 2063
