I was one of the youngest surgeons in the UK to secure a position on an intensive 6-year Plastic and Reconstructive Surgery training program. This was in the West Midlands. Early in the rotation, I decided to subspecialise in micro-vascular free flap surgery for both breast reconstruction and lower limb trauma. This coincided with the unique yet tragic period where my surgical training at Selly Oak hospital included treating many military casualties with devastating battlefield injuries, in particular to their legs.
As part of my surgical training program, I was privileged to be accepted for a fellowship at the internationally renowned breast reconstruction unit in Gent, Belgium. The focus of my fellowship was on the latest techniques in micro-vascular free-flap and aesthetic breast surgery. Whilst there, I was first introduced to vascularised lymph node transfers (VLNT) for the treatment of lymphoedema. I have always felt that lymphoedema patients are often poorly managed and offered little hope of curing or improving the condition. Patients are often expected to be grateful that they have been treated for breast cancer. However, the ruinous impact of lymphoedema on their life can often be ignored.
VLNT was then a groundbreaking development, which I was determined to offer my patients. At that stage, there were no other surgeons in the UK that I knew of who offered this technique. So, many patients had to travel to Europe, the US or Far East for this surgery. To further my experience in lymphoedema surgery, I visited Corrine Becker in Paris. She is credited with originally developing the technique and is one of the most experienced microsurgeons with lymph node transfers in the World. During that time, I was able to assist her in VLNT, lymphatic venous anastomosis (LVA) and liposuction; all in the treatment of lymphoedema.
This allowed me to widen the breadth of my surgery to all patients with lymphoedema, including those affected in the lower limb and to selected patients with congenital lymphoedema.
I have now been performing liposuction and VLNT for over seven years. To date, I have performed seventy VLNT to both upper and lower limb with noteworthy success. Where appropriate I have also expanded my repertoire to include LVA. I am growing an international reputation in lymphoedema surgery and have been privileged to be asked to present or chair sessions at international meetings on the condition. I firmly believe that lymphoedema is best treated with a tailor-made combination of appropriate techniques to address both the fluid and fat component of the lymphoedema.
Treating lipoedema patients was part of a natural progression in lymphoedema surgery, as well as my background in lower limb trauma. Patients with lipoedema have lymphatic dysfunction at a very early stage of the condition, although this often does not become clinically apparent until the later stage of the disease. In order to manage lipoedema properly, a surgeon needs to have an intimate understanding of lower limb anatomy and lymphoedema surgery in order to minimise the risks and complications of surgery. Furthermore, my role as a plastic and reconstructive surgeon includes extensive experience in liposuction as well as procedures to remove the loose skin, which can often be necessary.
Lipoedema and lymphoedema patients have many similarities, as there is both a fat and fluid component to both these conditions. Both conditions are misunderstood and poorly managed by many healthcare professionals. Lymphoedema nurses in the UK are, undoubtedly, the mainstay of managing both these conditions. Yet, their services are poorly funded and under resourced. As a consequence, there are many patients in the UK lacking support and care.
I have been humbled and privileged to develop my practice with lipoedema patients. I have operated on many from throughout the country and around the world. I am one of the few surgeons offering surgery for patients with Stage 1-4 of the condition. Also, I have developed a multidisciplinary team, including a lymphoedema nurse, clinical psychologist and anaesthetist with a specialist interest in lipoedema. I currently operate on over a hundred new lipoedema patients per year and many of these require several procedures to fully treat the disease.