Why opt for microsurgical breast reconstruction?

Consultant Mr Stuart James regularly finds himself offering hope to patients during one of the most challenging times in their lives. The plastic and reconstructive surgeon, who specialises in breast reconstruction, frequently sits down with people who have a cancer diagnosis and have been told they need a mastectomy, and possibly treatment. His job is to discuss the options around breast reconstruction.

The difficult decisions his patients face only drives him harder to achieve the very best he can for them. 

“I’m not curing the cancer or saving their life. The priority is always cancer management. But I’m one of the few positives. They have received a huge blow, yet they can have a high-quality breast reconstruction. I see how much that means to them."

“I do get people who say I’ve changed their life,” he adds. He agrees a successful reconstruction can make an immeasurable difference. “We believe it helps patients with their recovery; their mental and physical wellbeing, so I want to get the best result I can for these patients. I’m proud I can deliver that.”

Problem solving is what drew Mr James to plastic surgery as a trainee 30 years ago. It’s why The Royal College of Surgeons Fellow, who holds a Master of Surgery (MS) degree and an Arris and Gale Lectureship and College Medal from The Royal College of Surgeons for his research in wound healing, still finds fulfilment in his work today at HCA Healthcare UK The Harley Street Clinic.

While he also performs cosmetic surgery, the majority of his work remains reconstruction. This includes the use of breast implants, but his field of expertise remains the more complex method of microsurgical reconstruction, a specialist procedure that few private hospitals in the UK can offer.

This is an intricate surgical discipline in which a highly-skilled surgeon uses microscopes to aid the delicate movement of tissue from one area of a patient’s body to another, in order to repair and rebuild. It also includes the removal of blood vessels connected to that tissue, and their careful reconnection in the area of reconstruction.

In 2006, Mr James perfected the procedure at the world-leading MD Anderson Cancer Centre in Houston, Texas, where he spent a fellowship year. But in large part, his excellence is due to the sheer volume of surgery he performs. He estimates that he has carried out some 1,200 breast reconstructions using microsurgery.

This includes around 1,000 DIEP flap procedures, a form of microsurgical reconstruction which takes tissue and blood vessels from the lower abdomen, but avoids the muscle, therefore creating a low risk of muscle weakness.

This process can be carried out immediately following mastectomy, or years down the line, meaning skin must also be moved to rebuild on a “blank canvas”. Mr James also uses it to correct issues if previous reconstructions are no longer to a patient’s liking, or, in the case of implant reconstruction, may have developed complications including rupture or leaking.

The level of naturalism that can be achieved with this procedure is one of many benefits. However, Mr James explains that implant reconstruction is still most suitable for some patients, especially if they’re younger, with smaller breasts, are unfit, or reluctant to undergo more complex surgery. The key is that all patients should have a choice in their reconstruction and be able to make an informed decision about how they move forward.

“The reconstructed breast using microsurgery is soft, it’s warm, it’s natural and it’s you, because it’s your tissue. It moves freely when you go swimming, play tennis or lie on your back. You can only duplicate that with your own tissue.”

From breast volume to nipple height, Mr James is committed to achieving a high-quality aesthetic, even sitting the patient upright during surgery, while they’re under general anaesthetic, to ensure natural shape. “I have patients who’ll go for a mammogram five years down the line and the technician can’t tell which side has been reconstructed,” he says.

And while an implant will deteriorate and age, possibly requiring further work or replacement, a microsurgical reconstruction does not. “It ages with you. It’s permanent and you get to draw a line under your treatment” he adds.

Mr James says he has not been a single failure in his use of this procedure at The Harley Street Clinic - not one instance where the transferred tissue has not “taken”. “Typically, the accepted failure rate for this kind of surgery is two per cent, or one in 50,” he explains. 

He puts this success down not only to his own expertise, but the hospital’s experienced team and emphasis on safety. “The hospital has a great intensive care unit “And because so much complex surgery is carried out here, theatre nurses bring quality and reliability to procedures”, he adds.

“I try and work with the same anaesthetists and assistants. Every little aspect that can be finessed, I have finessed. It’s basically as perfect as I can get it. And that’s reflected in the outcomes.”

The same attention to detail is brought to patient aftercare. The average microsurgical breast reconstruction on one side usually takes six hours, with four days required in hospital. Patients - a third of whom travel to Mr James from overseas - are mostly recovered in two to three weeks, and fully recovered in two or three months.

He explains: “We use an enhanced recovery programme fitted to the individual to minimise the hospital stay and the length of time they have to have drain tubes, which reduce fluid build-up and possible risk of infection. We have great physiotherapy support, and a specific reconstruction senior nurse.”

It is knowing he and his team can achieve excellent results for patients by working seamlessly together, truly impacting their lives for the better, that keeps him fulfilled. For a schoolboy who chose to study medicine simply because “I liked Biology”, he has gone on to build a career which has become a passion. “I really feel I have lucked out,” he says.

HCA Healthcare UK The Harley Street Clinic, is a hospital in central London offering a wide range of cutting-edge treatments and services in buildings steeped in history. We are recognised as a cardiac centre of excellence and offer access to a range of specialist centres.

Mr Stuart James is a Consultant Reconstructive Surgeon with nearly three decades of experience in microsurgical reconstructive surgery. He is highly regarded within the field due to his meticulous attention to detail and impeccable credentials. He sees private patients at The Harley Street Clinic.

 Find out more about Mr James.