Miss Judith Hunter is a Senior Consultant Plastic Reconstructive & Aesthetic Surgeon within Imperial Healthcare NHS and Imperial Private Healthcare based at Charing Cross Hospital, the second busiest centre for free flap reconstruction for the breast in the UK. Over the course of five years, Miss Hunter has performed close to 300 successful DIEPs as a consultant (and many more as a trainee). Within her reconstructive practice, she has performed the same number of tummy tucks, in addition to her aesthetic and body contouring practice. She talks about the importance of caring for her patients in their journey; an eye for aesthetics and how everyday challenges have only served to heighten her gift for producing such natural results.
Microsurgery- A key component of breast reconstruction
Microsurgery (free tissue transfer) is recognised as the most challenging aspect of plastic surgery; there is no margin for error, it requires stamina and attention to detail, all qualities that I have honed whilst undertaking microsurgery fellowships at the Royal Marsden, St Thomas’s and in Melbourne, Australia. Most of this training pertained to breast reconstruction (DIEPs, TUGs) as it is the most common application of free flap surgery.
Breast reconstruction is not simply about a technical challenge of successfully moving a piece of tissue from one location to another, it is about the patient journey and the aesthetic outcome. I am used to talking to people when they are at perhaps their most vulnerable, having received a cancer diagnosis and I am happy to spend time talking through their options with them. I also look after them throughout this journey and enjoy getting to know my patients in this time, which may last two years.
All of the types of free flap for breast reconstruction have historically been born out of the same people (plastic surgeons) performing both reconstructive and aesthetic surgery, thus a DIEP flap utilises tissue discarded during a tummy tuck, a TUG flap utilises tissue from an inner thigh lift, so a surgeon performing breast reconstruction is also thinking about the aesthetic results of the donor site as well as the breast.
Undergoing symmetrisation surgery
The aim is often to try and match the other breast, which itself requires an aesthetic eye but it is not always possible to achieve this, or it may not be the outcome the patient desires. A large part of my NHS practice, therefore, is symmetrisation surgery, where I am using plastic surgery techniques of breast reduction, breast uplift (mastopexy) and augmentation (including a large fat transfer practice) to achieve balance after breast reconstruction surgery. Patients are also referred from other specialties, such as breast surgery, when problems have occurred that require my expertise. These operations require a clear understanding of how various techniques can be adapted to give the best possible result. Another aspect of my NHS practice involves body contouring for those extreme cases that gain funding under strict criteria so I am therefore familiar with performing difficult breast reductions and abdominoplasties/body lifts after massive weight loss.
Working in a busy teaching hospital also means a free flow of ideas between colleagues and the teaching of junior surgeons, as well as being up to date and participating in the latest research, so we are constantly striving to improve outcomes for patients, auditing our results and challenging ourselves with more complex procedures where deemed appropriate.
Miss Hunter holds clinics within her private practice at:
- Charing Cross Hospital & the Lindo Wing St Mary’s and The Lister Hospital, Chelsea – click here to make an appointment through Doctify.
