| At home with Dr Chris Steel |
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Dr Winters believes there is a need for greater investment into clinical academia in surgery as a whole. The basis of medical progress is rooted in asking key clinical questions that remain unknown today. The discipline of clinical research has been waning in the UK compared to the USA; however there has been a growing awareness that such an approach is extremely short-sighted in the big scheme of a solid and fruitful medical future. The art and science of breast surgical practice is one of the most exciting areas with rapid advances over the past 10 years, much of which has centred on scientific developments relating to personalising individual breast cancer patterns of growth and treatment, to technical advances in breast reconstruction, fat filling (or lipofilling), and perhaps most excitingly, the concept of ‘growing’ a new breast through the science of fat stem cells recently discovered in Melbourne, Australia. Dr Winters is particularly focused on evaluating patient reported outcome measures as an important adjunct to traditional clinical outcome measures in women before and after different types of the back flap or latissimus dorsi (LD) breast reconstruction. Such an approach to assessing clinical effectiveness and establishing robust clinical evidence in the field are strongly endorsed by the National Institute of Clinical Excellence (NICE) as well as healthcare providers and other official bodies such as the FDA (Food and Drug Administration). Currently this work is hosted at the University of Bristol and the basis of the study is to produce high quality clinical evidence evaluating the impact of immediate breast reconstruction on important areas of a woman’s quality of life (QoL). It is anticipated that this work will contribute significantly to the field, which following a review of the literature from 1978-2009, shows that the majority of studies are biased because of lack of patient recall. The studies to date have been poorly designed with inadequate numbers of patients and duration of follow-up. Many have also used general questionnaires that may not be sensitive enough to measure the QoL effects following abreast reconstruction. We are therefore lacking high quality evidence in this field to inform women and their clinicians as to the optimal type of immediate breast reconstruction or whether all reconstructions should be performed immediately when it is anticipated that radiotherapy may be required after mastectomy. A recent UK audit has assessed the frequency of all immediate and delayed breast reconstructions and evaluated that the majority of oncoplastic breast surgeons are performing implant only as well as pedicled (or intact vessel-based) flaps either alone or assisted by an implant. In the future, there will be an opportunity in the UK for multiple centres to participate in the first clinical trial in breast reconstruction called QUEST, which will attempt to establish the highest level of clinical evidence relating to a woman’s quality of life after immediate and delayed LD breast reconstruction. In this capacity, it is hoped that the UK will be able to make a significant contribution in the field. To download the full article please click here |