Local surgeon delighted at benefits of new technique for breast cancer patients

A new device that makes it easier for surgeons to locate early stage breast cancers and reduces patients’ stress on the day of surgery is now being used at Oxford Women’s Health and trialled at Christchurch Hospital.

Oxford Women’s Health’s Oncoplastic Breast Surgeon Josie Todd says the device called Scout reflector was implanted for the first time in New Zealand for an Oxford Women’s health patient in July 2022. Her experience and that of subsequent patients has been excellent.

Breast Cancer is one of the commonest cancers, affecting thousands of New Zealand women each year. Many women who are diagnosed at an early stage without an obvious lump, or through the Breast Screening programme, have needed to undergo surgery with a hook-wire in place to help identify the location of the disease.

Typically, these women require the hook-wire to be positioned on the morning of surgery in a radiology suite before the operation, which due to the additional travel, often adds to patients’ stress levels. The SCOUT reflector, which is detected using an ultrasound pulse, is about the size of a grain of rice and is implanted into the breast via a small needle prior to surgery. This can be done weeks in advance in a radiology suite.

“I have been looking for a good alternative to the hook-wire for many years, and believe we’ve finally found a safe and effective option,” Josie says.
 

Oncoplastic Breast Surgeon Dr Josie Todd

“There have been other locator devices introduced over the last decade, but each has had its own disadvantages, including interference with MRI scanners and not being able to be left in the breast for longer than a few days,” she says.

The Scout reflector can be placed at the time of diagnosis and works particularly well for patients who require chemotherapy for several months prior to surgery. The reflector can then be safely removed at the time of surgery.

“There are so many advantages for patients, surgeons and the health system with this technique and it is important for clinicians and patients to be aware of available options,” Josie says.

“One of my patients Bronwyn Jones, who talks about her experience below, provides a wonderful example of why the Scout reflector is such an excellent option.”

Bronwyn's story

Breast cancer surgery was always going to be more difficult for 49-year-old Bronwyn Jones, who was born with congenital heart issues and has had four open heart operations. She takes the anti-coagulant Warfarin and is also at increased risk of infection from any open wound.

To reduce the risk of infection and bleeding from a hook-wire locator for her surgery, Oncoplastic Breast Surgeon Josie Todd suggested a Scout device, prior to her operation at Christchurch Public Hospital. Keen to reduce the risk of any potential complications, Bronwyn decided to self fund the procedure.

Bronwyn started her chemotherapy following her diagnosis in July last year and the SCOUT reflector was placed a few weeks before her scheduled operation in December 2022.

All went according to plan until six days prior to surgery, when Bronwyn experienced excruciating pain in her abdomen. An ambulance was called and she was diagnosed with a twisted cyst on her ovary. She said, “It was effectively cutting off the blood supply to my ovary and was the most painful thing I had ever experienced.”

The ovary needed to be removed but neither her gynaecologist nor Josie wanted to risk two operations and two separate General Anaesthetics for Bronwyn in a short space of time due to her cardiac history.

Bronwyn Jones 

Through a coordinated effort between the two services, they were able to perform both operations under one General Anaesthetic.

Josie said without the Scout device in place, this would have been almost impossible as they would have needed to try and fit a hook-wire device in the radiology suite in a different hospital while Bronwyn was unwell and requiring IV morphine.

Instead the two operations worked like a dream and Bronwyn has recovered well.

Bronwyn says she is ‘incredibly grateful' for all the people who cared for her over this time and “would love the Scout device to be available to anyone in her situation”.

Specialist talks menopause and libido

An estimated 40 to 50 per cent of women experiencing menopause are living with persistent loss of libido but very few are seeking support, says Oxford Women’s Health endocrinologist Anna Fenton.

While it may seem like a difficult subject to talk about, it is important women discuss any concerns with a trusted general practitioner as there are many options available to help. “With loss of libido affecting such a large number of women around the time of menopause, it deserves much more attention than it has previously been given,” Anna says.

“There is even a basic lack of research. We know a lot about sexual dysfunction in men but there is still much to learn about how it all works for women.”

Among the questions Anna asks her patient to consider are what has changed for you – libido, arousal or both? Is there pain with sex? Is this issue affecting your relationship? and what is normal for you?

Visiting a psychologist or sex therapist can also be very helpful if the issues are complex or both partners need to be involved in the discussion.
 

Gynaecological Endocrinologist Dr Anna Fenton

Anna says that while discussing sex with a doctor can be challenging, not tackling sexual dysfunction can have a catastrophic impact on a woman’s life.

“Some women will bring loss of libido as the primary issue to me, saying their partners have sent them or are concerned about it. Because of the way different genders approach intimacy, men can take it quite personally.”

Anna says it is common to hear stories of men frequently asking their partners if they still love them and some questioning the future of their relationships. “Helping people through this time is one of the most rewarding parts of my job,” she says.
 

Welcome to Dr Fiona Bach and Sophie Coulter

We are thrilled to welcome two new Oxford Women’s Health team members, gynaecologist Dr Fiona Bach and physiotherapist Sophie Coulter.

With a special interest in urogynaecology, Fiona’s work encompasses general gynaecology as well as the medical and surgical treatment of prolapse and urinary incontinence, and associated problems.

Her undergraduate medical training was completed at the University of Leeds, and she then worked as a fellow at London’s St George’s Hospital.

She also volunteered in Ethiopia for six months, supporting the training programme at the University of Gondar Hospital. Fiona returned to the UK to undertake her urogynaecology subspecialty training in Birmingham, before moving to Christchurch to work as an obstetrician and gynaecologist.

Physiotherapist Sophie Coulter has a special clinical interest in women’s health, persistent pelvic pain, and sexual dysfunction. She began her career as a musculoskeletal physiotherapist in an Auckland private practice and went on to complete her Postgraduate Certificate in Physiotherapy (Pelvic Floor Physiotherapy) at the University of Melbourne in 2019. The following year, she started her own practice. 
 

Gynaecologist Dr Fiona Bach

Physiotherapist Sophie Coulter

Sophie has worked at Auckland District Health Board as a pelvic floor physiotherapist in outpatient and inpatient settings. In this role, she saw a wide variety of clients seeking support with continence, pelvic pain, and oncological pre and post operative treatment.

To make an appointment to see Fiona or Sophie, please call the friendly Oxford Women’s Health team on 03 379 0555.
 

Breast surgery consults starting in Queenstown

From May, Oxford Women’s Health's Oncoplastic Breast Surgeon Josie Todd will be consulting from our Queenstown rooms. She will be based at the Centre of Medical Excellence each month as well as holding her regular clinics in Christchurch.