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Mother hoping for brighter future following 'once in a lifetime' surgery at OUH

28/02/2022
Nathalie Brett underwent successful surgery in June 2021

A UK-first operation that replaced the sternum of a cancer patient using the chest wall of a deceased donor has been carried out at Oxford University Hospitals NHS Foundation Trust (OUH).

The operation, an allograft sterno-clavicular reconstruction, was performed by the Trust's Francesco Di Chiara, a Thoracic Surgery Consultant, and Tom Cosker, Consultant Orthopaedic Oncology Surgeon and Lead Clinician for Sarcoma, in June 2021 at the John Radcliffe Hospital in Oxford.

The innovative procedure replaced the cancerous sternum (the breastbone) of 34-year-old Nathalie Brett, who was diagnosed with metastatic (stage four) breast cancer when she was 24, with a healthy one used from a donor.

Her entire sternum and part of her collarbone were removed and replaced with a donor bone and attached back in place with titanium and steel.

Following successful surgery and recovery, mother-of-one Nathalie is now virtually pain free and, despite advanced cancer, has now been given a better chance of living longer.

It is believed to be the first time surgery like this has been done in the UK, being a version of an operation that was carried out in Italy. It was a 10-hour theatre case involving six surgeons, two anaesthetists, and 10 support staff.

Once the bone was integrated with Nathalie it became 'alive' again because her bone marrow cells ‘inhabit’ the implant. Therefore, there is virtually no risk of rejection or chronic infection.

Francesco Di Chiara, Thoracic Surgery Consultant at the Trust, said: "When I was offered the opportunity to meet with Nathalie, I found it astounding that she had been diagnosed with advanced stage cancer a decade ago and on top of that that she managed to deliver a healthy baby less than a year before.

"It is amazing how the paradigm of treatment has changed for patients with cancer, with a greatly extended life expectancy even in the face of a diagnosis of advanced stage cancer, the surgical community more and more has to think of new solutions that take into greater consideration the quality of life and longevity of patients.

"Nathalie is a phenomenal woman who has gone through so much physically and mentally, and we are overjoyed to see her doing so well after undergoing an operation that has never been done before."

Tom Cosker, Consultant Orthopaedic Oncology Surgeon and Lead Clinician for Sarcoma at the Trust, added: "I am so proud of our colleagues who helped us carry out this ground-breaking operation which, never done before in the UK, has resulted in a remarkable outcome for the patient, removing the cancer from her body and helping her to live a longer life with her family.

"From the moment I met Nathalie I have been amazed by her extraordinarily positive mental attitude, her desire to embrace even the most radical treatment, and her determination to get through whatever has been thrown at her.

"She is an extremely brave and determined patient who has faced almost insurmountable challenges with the utmost enthusiasm."

'I can see a future'

Go back to 2012 and Nathalie, who lives in west Oxfordshire, was given very limited chances of survival having been diagnosed with metastatic breast cancer. She received radiotherapy and different chemotherapies among other treatments and, although this helped her condition, the cancer caused constant pain.

After giving birth to a healthy baby girl against the odds in 2020, Nathalie was referred to Francesco Di Chiara by an OUH Oncologist because the cancer wasn’t progressing as expected and, apart from the sternum, she had no other site with evidence of disease. This therefore presented the opportunity to explore if there were any surgical options available that would improve her life.

Treatment options were considered but, in Nathalie's words, "there wasn't really an alternative" and her pioneering surgery went ahead on 16 June 2021.

Nathalie said: "I was baffled that they were able to even do something like this and I was excited at the prospect of what it could bring.

"I was offered a once in a lifetime surgery and, although it was a hard decision to make, I had to take it – for my daughter and for my family. I couldn't say no. I had complete faith and trust in Mr Di Chiara and his team which made the decision to go ahead with the surgery a much easier one.

"My biggest concern was the recovery and not being able to look after my then nine-month-old daughter independently for a long time and that proved to be the hardest part of the surgery."

More than eight months on and Nathalie is feeling well and can care for her young child, Elsa, without support.

Nathalie said: "We're still in the early days but it has certainly given us a lot of hope. For the first time in over a decade I have no active cancer in my body and that is something we never thought would happen.

"For the first time in a very long time I can see a future in which I might get to grow old and most importantly get to see my daughter grow up."

She added: "Mr Di Chiara's team have been wonderful, and I am unable to thank all the staff enough for what they have given me and my family. It's very hard to put into words."

Nathalie also wanted to thank the generosity of the person who allowed their sternum to be donated. She said: "I'm very grateful that someone out there chose to be a donor in the event of death, and I wish that person could know what a difference their decision made – thank you from the bottom of my heart."

'Proud'

Professor Meghana Pandit, Chief Medical Officer at Oxford University Hospitals, said: "Delivering compassionate excellence is at the heart of what we do at OUH, and this allograft sterno-clavicular reconstruction is a fantastic example of this.

"The team involved should be really proud of what they have achieved in making such a positive difference to a patient and their family using such a unique approach.

"It is so pleasing and heart-warming to hear about what this operation has meant to Nathalie in both the short and long term, and we wish her and her family all the best for the future."

Kyle Bennett, Assistant Director for Eye and Tissue services at NHS Blood and Transplant, said: "We are so pleased that Nathalie was able to get this life-changing transplant thanks to the generosity of a donor and their family.

"It was a privilege for us to be able to work with the team at Oxford University Hospitals to enable this incredible operation to go ahead. Transplants, and firsts of this kind, just wouldn't be possible without the generous support from families who say yes to donation, at what is often some of the hardest and most difficult times of their lives."