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Hello. My name is Alex Humphrey. I am the vice chair of the memory fold, which is the training organization for the Association of Breast Surgery. And I'm delighted to be talking today about why Breast is a brilliant specialty to think about as a career choice. And I'm gonna run through some of the reasons of that. So let me just share my screen. So breast really is best. And I'm going to explain why to you for the course of this talk. But before I get on to breast as an individual specialty, really, what I want you to do is to pick a specialty that you really feel passionate about and that you really enjoy, because that is what was going to give you the best satisfaction of your work. And so when you're deciding on a surgical specialty, I think there's some kind of core themes to think about and the first thing to think about the type of patients that you're going to be looking after and how they fit into your treatment of them. And then think about the team and the organization that you're gonna be working within. Then look at the surgical procedures and then think about the innovation of the future of that surgical specialty. And then also look and think about the work life balance because that's really important as well. And one way to look at all of that factor is is really to get onto the shop floor and get into a unit and see how it works and speak to the people that are working there and speak to other trainees and consultants about their specialty and why they enjoy it. But if I focus more on the breast side of it, when I think about the patients that I look after, I'm looking after mainly cancer specialty. It's an oncology surgery, and that's a very challenging but very rewarding career to be in. I look after mainly female patients. It's very rare that we see male breast patients occasionally see them presenting the things like gynecomastia, and very rarely we see male breast cancer. But the predominant patient demographic that I'll be looking at for a female. But what's wonderful about breast cancer surgeries that it has excellent oncological outcomes, and that's really rewarding and as a consequence we have high levels of patient satisfaction, both from an archaeological perspective, but also with the innovative techniques that we have now created in allowing breast conservation surgery but also reconstruction and allowing patients to have a very kind of well rounded, psychosocial and psycho sexual aspect of their bodies. After going through the traumatic event of having a cancer diagnosis, the team is really important and integral to you, enjoying your work. And what brilliant about breast surgery is that you are so embedded in lots of different teams and you work really collaboratively and really cohesively with them. You work with teams both in the outpatient setting and also in theaters. But you also work really closely with your MD tea or your multidisciplinary team. And that is your breast care nurses, your pathologists, your oncologist and your radiologists, and you meet every week to discuss and manage your patients. And you also liaise really closely with the plastic surgeons for patients that might need more complex reconstructive surgery. The surgical procedures for breast surgery are predominantly day case, and that is also a really nice aspect of the job because it means that we don't have a very high in patient load, so patients will only really stay as an inpatient if they're having more complex reconstructive surgery. And so it means that you're a predominantly elective type of of specialty, working mainly in the outpatient and take a theater settings. What's great about breast surgery is it's a really interesting decision making process about what operation is really going to suit that patient, and you think about that, really, from an archaeological perspectives. You got really high in depth knowledge about the oncology and the tumor biology and how that will impact your surgical decision making. But it's also very artistic because what you're trying to do is preserve the patient's body, either in the terms of their own breast mound or reconstructing their breasts. So it's a very artistic surgical specialty, and it's very holistic because all of that is deeply embedded in the decision making with the patient. And there are now some very, um like a plastic techniques that really crossed over between breast and plastics. With regards to being able to provide that to our patients. When I think about the ankle plastic breast surgery, our mainstay of treatment is either breast conserving surgery or mastectomy, with or without reconstruction, We also do auxiliary surgery in the form of central, no biopsy and auxiliary clearances. If there's metastatic disease, we also do some like a plastic adjuvent surgery as well. And these are things that regard to trying to again improve the patient's body. Body habit is and psychosocial aspect of there after their cancer surgery to things like like fulfilling and nipple reconstructions. And the reason, really the specialty came about was that for many years the surgery was being done by surgeons who weren't trained in this aspect, and so patients were ending up with quite disfiguring outcomes from their surgery. And so what really has happened in the last 10 to 15 years? We've developed a range of techniques where we can conserve the breast either through volume replacements. That's bringing some, um, tissue from elsewhere in the body or volume displacement techniques where we do what we call mammoplasty techniques of reshaping the breast whilst also removing the breast cancer. And what you can see here is that there are lots of different techniques that we can utilize based on what the tumor biology and based on what the what the patients requiring, and this allows us often to give patients a really great cosmetic outcome after their surgery, which is a bonus after they've been through a harrowing cancer diagnosis. We also do mastectomies with or without reconstructions, and these can either be in plant based reconstructions autologous meaning that we bring tissue, fat, skin and perhaps muscle from elsewhere in the body to reconstruct the breast and his breast surgeons, we do pedicle flap, so that means utilizing that whilst the blood supply is still intact. But they're also free flap options and Asterix that because that is predominantly within the role of the plastic surgeons. So it shows you how intimately we work with them in terms of deciding what's the best for our patients. Mastectomy and in plant based reconstructions can either be below the pectoralis or above the Petrocelli's, and we use lots of different types of implants and meshes in order to reconstruct the breast after their surgery. These images show women who've had skin sparing mastectomies where we've had to sacrifice the nipple, and we've reconstructed them so that they've been able to still have a breast mound after their surgery, which you can imagine is a really wonderful outcome for them as well as being oncologically safe. The other surgery that we do in terms of medical flat pedicle flaps, a latissimus dorsi reconstructions where we use the muscle and fat and skin from the backpedal and bring that forward to reconstruct the breast into and recreate the breast mound autologous reconstructions that use free flaps, which what the plastic surgeons do, utilize lots of other resources where either the buttocks or thighs or abdomen in order to do a free flap reconstruction and then do a microvascular anastomosis again to recreate the breast mound So we can see that there's a huge innovation in our surgical specialty, and it really is moving ahead with all the different techniques that we can do and that is really cross pollinated from plastic surgical techniques. But within that breast, cancer itself, as an oncology specialty has got numerous research opportunities and a really strong academic background. And so the advances within our specialty are really vast, and that makes it a really interesting special to be a part of, because it's changing rapidly and there are nuances to that that we need to be aware of, so you have to be up to date with the evidence and the literature. And as an organization, we have a really national, cohesive association through our association of breast surgery, where they were pushing these ideas and innovations with lots of teaching events and conferences and course is throughout the year. And then there's the work life balance, and this isn't to be overlooked because it's really important. Anything that you really feel passionate about, you're prepared to make sacrifices for and, um, and you know, and make sure that the the arduous surgical training for it is worthwhile. But what's wonderful about breast surgery is that it's almost exclusively elective discipline. So we don't do any out of ours breast surgery. And in that respect, there's no one called commitment. Now I've put a little asterisks there because that may change in the future. And certainly, although there's no encore commitment, if you've done a complex reconstruction, you will want to be on call for your patients overnight because you will have a vested interest in them. So a week in the life of a consultant breast surgeon will look something like this and that you will do anywhere between 3 to 4 clinics a week, either a two week weight clinic where you're seeing new patient referred to the GPS with breast symptoms, and then you will have a result clinic for your post operative patients and for the results of their investigations for their breast cancer. You'll usually have a day of operating a week, and then you'll also be involved in the MDT so you'll be part of the oncology Mg T, and you may also be part of an Anca plastic mg T. The current training pathway is either through general surgical training training, where you subspecialist at phase three to come into breast surgery. Or you can also go down the plastic surgical training route as well. If you free flat reconstruction is more of an interest to you, and most trainees will tend to do a post e. C T. So once they've completed their training, some form of like a plastic fellowship, either here in the UK or abroad. So what I would say is think about breast surgeries, a specialty. It really is an amazing area to be involved in. But keep in touch, you're very welcome to join the memory fold. It's free the network member. If you're less than 63 grade and we have a high profile Twitter input and also an instagram feed as well, you're very welcome to contact us If you've got any questions. Good luck.