Innovative Breast Cancer Surgery: A Personal Journey

At five months into her eagerly awaited pregnancy in 2024, Nicola Purdie discovered a lump in her right breast. This moment was daunting for anyone, yet for Nicola, it felt all too familiar.

Having already faced cancer in 2020, which led to a double mastectomy, chemotherapy, and breast reconstruction, this was a traumatic repeat. However, a groundbreaking suggestion from Nicola to her surgeon resulted in a pioneering procedure: transplanting a healthy reconstructed breast to replace the affected one.

After finishing breastfeeding her first child and preparing to return to her job as a geography teacher in Swansea, Nicola noticed the lump in September 2020. By October, she was diagnosed with cancer, leading to five months of chemotherapy at Singleton Hospital, followed by the mastectomy. Nicola, now 38, reflected: “Although the cancer was only in one breast, my maternal aunt and grandmother had also battled breast cancer. I thought, ‘I’m young; let’s do everything possible and remove it all.’”

She opted for reconstructive surgery using tissue from her abdomen, known as a DIEP flap, which allowed her to have more natural-looking breasts that could adapt to her body over time, as opposed to implants that would require replacement. Given that the cancer was estrogen-driven, Nicola underwent hormone suppression therapy for two years.

‘This Is Not a Coincidence. This Is Cancer.’

“We always planned to have another baby, so we waited two and a half years,” she explained. “All the oncologists agreed there was no increased risk because I had shown a complete pathological response after treatment.” Yet, another lump emerged.

This lump appeared in the skin of her breast, the last area remaining after her initial surgery. “I knew immediately when I found it—this is not a coincidence. This is cancer again,” she said.

Aside from her family and a close friend, Nicola kept her diagnosis private this time, partly to shield her daughter from the reality of the situation. “I wanted to focus on the baby and not on worrying questions like ‘Are you okay, Nicky?’” This mindset helped her manage the situation until her son was born.

Due to her pregnancy, chemotherapy could not commence right away, and she couldn’t have traditional scans to check for cancer spread. Still, some chest X-rays and an ultrasound provided a measure of reassurance—though not completely definitive—that the cancer was localized. She also had a lumpectomy to remove the lump from her breast skin.

The delivery plan anchored on urgency was set for 32 weeks, scheduled for late August. Yet, Nicola was conscious of ensuring the best start for her son. “I think it was the 26th of August when I suggested to my husband that we delay it until the week after for the baby’s benefit. He was perplexed, but I felt it was necessary,” she recounted. They waited, and their son, Fraser, arrived at 32 weeks and six days, spending three weeks in the neonatal unit. “He thrived, which was reassuring given all that I was dealing with,” Nicola shared.

Initially, there was uncertainty about the surgery options. The oncology team considered an LD flap, which would have necessitated swinging skin and muscle from her back to address the removed breast area—resulting in a flat appearance. However, this route was not feasible for Nicola, who had two small children to care for. She also desired symmetry in her appearance, either maintaining both breasts or none.

While discussing with her sisters, the idea sparked: if she had both breasts removed, why not use the skin from her healthy side to reconstruct the affected one? This concept blossomed during a consultation with surgeon Reza Arya, leading to the radical thought of entirely moving the reconstructed breast intact.

Understanding that this approach might allow for reconstructive surgery on the left side with an implant sparked excitement. When she presented this notion, she noted, “I could see the gears turning in his head.” Reza admitted he was taken aback by such an original proposition and had never encountered anything like it. “Extensive discussions with colleagues led us to believe it might be possible,” he said, recognizing the uniqueness of Nicola’s case.

On the day of surgery, Nicola was prepared for various outcomes, whether a successful transplant or a more conventional reconstruction using the LD flap. When she woke up, the unconventional approach had succeeded: the breast tissue had been successfully moved to a different site. “We didn’t know if the microsurgery would work,” she reflected. Now, she was starting several weeks of radiotherapy, with reconstructive surgery on the left side and a saline implant planned for around Christmas.

To manage future risks of recurrence, she would undergo hormone therapy for the next decade but had received the all-clear for her current treatment phase. Remarkably, after enduring such hardships, her spirit remained bright. “When I find myself in dark moments, I allow a minute to feel it, then I move on. Life can throw worse things at you. I’m fortunate to have received tremendous care from a dedicated medical team.”

Notably, Nicola remarked, “Both kids provide the best distractions ever. They symbolize hope for the future.”