Doctors cut waiting list for breast cancer surgery patients

Teams at Guy’s and St Thomas’ operated on 3 months’ worth of breast cancer patients in 5 days, using a method pioneered at the Trust to reduce waiting lists.

Plastic surgeons at St Thomas’ Hospital carried out reconstructive surgery on 22 patients who had been diagnosed with breast cancer, were breast cancer gene carriers, or both. Many had been on the waiting list for over a year for their reconstructive surgery.

Nine of the patients had microsurgical reconstruction to create a new breast using their own tissue, known as an autologous flap. This is where tissue (skin and fat) is taken from the abdomen or upper thighs with blood vessels, disconnected and then re-connected in the chest using microsurgery to create a natural reconstruction.

The operations took place using an adapted version of the High Intensity Theatre (HIT) list method devised by Imran Ahmad, consultant anaesthetist at Guy’s and St Thomas’. Using up to two theatres at a time, with additional staff over five consecutive days including a weekend, this adapted HIT list included long and complex procedures.

The team was led by consultant plastic surgeons Pari-Naz Mohanna (plastic surgery breast lead) and Maleeha Mughal, with the support of Paul Roblin (consultant plastic surgeon), Kerri Larnach (breast cancer reconstruction specialist nurse) and Charlotte Morris (plastic surgery service manager).

Months of planning for this adapted HIT list included a HIT clinic where patients had one-stop consultations with plastic surgeons, anaesthetists and breast cancer reconstruction specialist nurses ahead of their operations. They were given a presentation by a physiotherapist about post-operative rehabilitation and also had their pre-operative checks.

Miss Mohanna said: “We wanted to safely tackle the backlog of reconstructive surgery, whilst continuing to operate on patients with newly diagnosed breast cancers.

We were inspired by the HIT list model, but we needed to adapt it for longer, more complex procedures whilst ensuring that the highest quality of care was maintained throughout the patient’s journey.

“This needed months of detailed planning between myself, Dr Imran Ahmad and a number of other key team members; the plastic surgery service manager, surgical admissions, theatre and recovery staff, breast cancer reconstruction specialist nurses as well as the plastic surgery ward team led by their head nurse. This ensured patients were supported throughout their journey and we were truly blessed with unrivalled enthusiasm, passion, positive energy and commitment from all the staff involved.”

Shanta Holder, 39, was one of the HIT list patients. She had been diagnosed with stage 3 breast cancer in October 2022 and her surgery involved a right mastectomy, removal of the lymph nodes under her right arm and breast reconstruction.

Shanta, a hairdresser from Swanley in Kent, said: “In between my treatments, I had a window of time to have my reconstructive surgery and was lucky that I was able to have it so promptly.”

All the staff at St Thomas’ were amazing - I call them heroes. I am quite young and this surgery is a really major change for me physically and emotionally, but they reassured me.

"From the first moment I met Miss Mohanna, she told me ‘I understand but it will be ok’. I took that reassurance and ran with it. Everyone made me feel comfortable – there was no fear or doubt.”

Valerie, 69, had surgery to create a nipple following a previous surgery for breast reconstruction two years prior.

The grandmother-of-two, from Chelsfield in Kent, said: “I couldn’t praise enough the treatment I had, and the staff have been fantastic, really lovely.

“It’s early days in my recovery from this, but I’m delighted to have been able to have had this surgery.”

The innovation and organisation of the HIT lists has been led by Dr Ahmad, deputy clinical director for anaesthesia and theatres at Guy’s and St Thomas’.

He pioneered the idea of running theatre lists like F1 pit stops; maximising theatre and surgeon efficiency safely to operate on many more patients in a day than would normally be possible.

Running two theatres and teams, the HIT list aims to minimise surgeon down-time, enabling them to move efficiently from patient to patient without waiting for patients to be anaesthetised and theatres to be set up.

The Trust has now run:

• 23 HIT lists
• treated 410 patients
• covered 9 different surgical specialities including gastrointestinal, gynaecology, orthopaedics, ear, nose and throat (ENT) and urology.

Dr Ahmad said: “We started the HIT list model with relatively straightforward procedures which would be done in one day. Through time this has developed to now operating across multiple days for complex, longer and bespoke procedures, which has allowed us to expand the types of patients and procedures benefitting from the HIT list programme.”