Consultant Breast Care Surgeon

Miss Sasirekha Govindarajulu has worked in the Breast Unit at Southmead Hospital Bristol for the past 12 years and maintained the highest possible standard of care for patients, always seeking to improve the experience of patients.

With continuing interest in research, publications and lecture tours maintained high standards of care for patients: Faculty of the national ultrasound course, Faculty of the National vacuum assisted mammotomy training course, National peer review panel, Faculty National Survivorship Programme Patient User and information lead for ASWCS network.

As an Audit Lead of the breast unit, Miss Govindarajulu is always passionate about standards and excellence of care.

Her clinical interests are diagnosis and treatment of breast cancer, including surgery for breast cancer and reconstructive surgery, sentinel node biopsy for breast cancer assessment, diagnosis and management of all benign problems including breast pain. Miss Govindarajulu is also experienced in performing diagnostic breast and axillary ultrasound, diagnostic and therapeutic ultrasound guided interventional procedures, ultrasound guided minimally invasive procedures for therapeutic excision of benign lumps using vacuum assisted procedure and radio frequency ablation, and localising small lesions with ultrasound. 

Her clinical interests also include latissimus dorsi breast reconstruction, all implant-based reconstructions including use of acellular dermal matrix, breast reduction and augmentation, and symmetrisation procedures and other onco-plastic procedures.

Consultant Breast Care Radiologist

• FRCR
• Consultant Radiologist with subspecialty interest in Breast Radiology
• Clinical Governance lead of Breast Care Unit
• Principal Investigator of Mammo-50 Trial
• Educational Supervisor

Consultant Breast Care Radiologist

Alexandra was appointed as a Consultant Radiologist at the Bristol Royal Infirmary and Avon Breast Screening in 2006, and was Director of Screening from 2012-2019, co-leading on the centralisation of breast services in Bristol. She was Clinical Lead for the Bristol Breast Care Centre from 2018-2020, and has been a Professional Clinical Advisor for PHE since 2014. Alexandra is currently a member of the Breast Screening Clinical Professional Group and the Clinical Advisory Group. Her main interests are Breast MR and breast interventional procedures as well as Quality Assurance in the NHSBSP and increasing the efficiency of breast screening and symptomatic pathways.

Oncoplastic Breast Consultant

Michelle qualified from the University of Bristol in 1995 and underwent her surgical training in Bristol and the West Midlands. She has always been interested in breast disease and undertook research at The Royal Surrey County Hospital in sentinel lymph node biopsy, as part of the Medical Research Council ALMANAC Trial. Michelle has been appointed as a Trustee for the Association of Breast Surgery and sits on the Clinical Practices and Standards Committee.

Her advanced surgical training in Oncoplastic Breast Surgery was in the UK and the United States, practising at the University of Michigan, Ann Arbor, and the Henry Ford Institute in Detroit. She was admitted as a Fellow of the Royal College of Surgeons of England in 2006. In 2008 Miss Mullan won the European Society of Surgical Oncology Travelling Scholarship and spent her time at the Nottingham Breast Institute. Her first consultant appointment was in Worcestershire in 2008, where she was Lead Cancer Clinician for the county. She was appointed to her current position as an Oncoplastic Breast Consultant at North Bristol NHS Trust in 2019.

Her clinical interests include breast cancer surgery using oncoplastic techniques (surgery with minimal scarring), sentinel lymph node biopsy, lipofilling of breast defects (Colman fat transfer), breast reconstruction, nipple reconstruction and nipple tattooing.

Breast Care Senior Research Nurse

Breast Care Research Nurse

Breast Care Research Nurse

Breast Care Research Nurse

Breast Care Research Admin

Senior Research Midwife

Mary qualified as a midwife in 1991 and has worked at NBT since qualifying. Marys research career began in January 2015 when she was given the lead midwife role on the IMox study; she was subsequently promoted to the role of senior research midwife in 2017. Mary is also a faculty member of PROMPT maternity Foundation, a research champion for the West of England and is an alumni of the NIHR’s Advanced Leadership Programme. Mary aims to create a research culture at NBT where research is seen as ‘everyone’s daily business’ and where all women will have an opportunity to engage with world class research. Mary recently completed an MScR award with the University of Bristol. Using qualitative data from the women and midwives who participated in the ASSIST II study integrated qualitative study, Mary produced and will publish a framework to ensure that recruitment to intrapartum research is a whole pregnancy process, is fair and woman centred.

Senior Research Midwife

Nicky was a clinical midwife for 16 years before entering research in 2016, to lead on a large intrapartum study at the Great Western Hospital, Swindon.  From this, she developed a keen interest in research processes and the difference research can make to both current and future patients.  Keen to pursue this as a new career pathway, Nicky took a fixed term research contract at North Bristol NHS Trust, which was made permanent in October 2019.  From March 2019 Nicky has been substantively employed as a Senior Research Midwife, jointly leading the Womens’ and Childrens’ research team of nurses and midwives.  The growing portfolio covers studies in maternity, gynaecology and NICU and is successfully expanding in breadth and depth.  Nicky is also a Midwifery Research Champion working with a national network of midwives and nurses representing all Clinical Research Network regions and the devolved nations. 

Research Midwife

Annie has worked in research delivery across multiple studies for over seven years and witnessed first-hand how research improves the health and wellbeing of women and children in maternity services. She acknowledges that women need to be given the highest quality evidence to make decisions about their care and this can only be achieved through an NHS trust that is research active with motivated staff. She feels privileged to work in such an environment.

With 38 years of nursing and midwifery experience prior to entering the world of research, I have had the opportunity to use my clinical knowledge to support women considering and participating in research to make an informed choice when they become involved in the research process.

Research Midwife

Naomi joined the Women and Children’s Health research team in 2016 and brought with her a wealth of clinical midwifery
experience. She qualified as a midwife in 2002 focussing on mainly providing care to families within the labour ward and
antenatal settings. 

Naomi is a core member of the W&C research team and has engaged families in a wide range of maternity, gynaecology,
reproductive health and more recently, neonatal research studies. Naomi helps provide a link between the community and hospital settings by regularly attending NBT’s antenatal classes, giving families the opportunity to learn more about research much earlier in their pregnancies. 

She is keen to share the positive impact research can have on health care and recognises the wide range of benefits that 
taking part in research offers to patients, staff and NBT.

Research Midwife

Katie qualified as a Midwife in 2016 after studying for her midwifery degree at the University of the West of England. Since then she worked as a rotational Midwife at the Great Western Hospital in Swindon and completed two secondments to the Midwife led birth unit there. Katie joined the Women and Children’s research department on secondment in October 2019 to work on the AKID study, investigating Acute Kidney Injury and Diabetes in pregnancy. Katie is passionate about evidence based practice and the positive impact research can have on improving patient care.

Research Midwife

Anne is a midwife with extensive clinical experience particularly in intrapartum care. She is passionate about research and has previously been involved in Women and Children’s studies as a series of secondments before being welcomed to the team in a permanent role in 2021. Joining at an exciting time of expansion for Maternity Research at NBT, Anne particularly enjoys building relationships with the women and their families who are so enthusiastic about participating in studies. She is looking forward to the team continuing to expand their research portfolio and striving to lead pioneering research and improve care for generations to come.

Research Midwife

Rachel has enjoyed a varied midwifery career since 2016, working in different midwifery roles at King’s College Hospital NHS Foundation Trust and Great Western Hospitals NHS Foundation Trust. She qualified as an International Board Certified Lactation Consultant (IBCLC) in 2021. This process furthered her interest in women and children’s research. Rachel joined NBT in 2023. She is keen to ensure that the research process is available and accessible for all families with a baby in NICU. Rachel is enthusiastic about the impact research can have on health outcomes and in ensuring the highest quality, evidence-based compassionate care experience for families and those providing care.

Research Midwife

Paula is a Registered Nurse who also qualified as a midwife many years ago, and then developed a career in Neonatal Nursing.  She  joined the  Research Team with a wealth of clinical experience  to deliver Neonatal studies in 2021. Paula is passionate about expanding neonatal research, to ensure the care of  sick babies is evidence based  and of the highest quality.  She believes that every baby and every family have the right to take part in research.

Since joining the team 6 new national and international studies have opened, with the majority of parents willing to take part. The rapid expansion of projects has an impact on the workload  large neonatal clinical team and Paula is keen to train and motivate professionals, increasing awareness and knowledge to support the delivery of studies.

Research Midwife

Since qualifying as a Midwife in 2003, Michelle gained a wealth of experience in many clinical settings including Antenatal and Postnatal wards, Community and Central Delivery suite within United Hospitals Bristol and Weston NHS Trust. Michelle is passionate about the provision of high quality, evidence based care and recognises the fundamental role research plays in achieving this.  In 2022, Michelle decided to explore a more active role the world of NHS research and joined the Women's and Children's research department at North Bristol Trust.  Since joining, Michelle has worked on a variety of studies covering fertility and maternity care.  Michelle is enthusiastic about the promotion of embedding research into every day clinical care, ensuring opportunities are available to all women and their families.

Research Nurse

Ashleigh joined the Women and Children’s health research team in 2021. She is a qualified nurse with over 10 years of experience, she started her career in surgical admissions and went onto working in the Emergency department at Southmead Hospital. More recently Ashleigh started working in the fertility sector which led her to working in the Women and Children’s research team.

From personal and professional experience, Ashleigh is very passionate about fertility and women’s health research. When she first started working in research, she worked on the BRIST-IVF study, a study that looked to improve outcomes for couples undergoing IVF. Ashleigh now works with Katie on the Gynaecology research portfolio alongside the Gynaecology team on Cotswold Ward at Southmead Hospital.

Research Administrator

Sally joined North Bristol Trust in 2008 with an extensive secretarial and administrative background. She began working within the respiratory department and then transferred to the maternity Unit where she worked on Quantock Ward and Day Assessment Unit for 9 years as Ward Clerk. Sally joined the research department in 2017 as Trial Administrator for studies including Imox, Mifemiso, Parrot and ASSIST and ASSIST II. Her increasing knowledge of the Women & Children’s department and passion for research helps support and facilitate correct governance for studies within the maternity research department.

Research Midwife

Claudia is a Midwife that qualified in Chile in 2019, and has been in the UK since 2022. She has mainly worked in a central delivery suite setting and has recently joined the research team in November 2024. She is committed to improving maternal and neonatal outcomes by addressing disparities in care and reducing health inequalities through research and evidence-based practice.  

 Research Midwife

After graduating from The University of Nottingham in 2015, Laura worked as a midwife at United Lincolnshire Hospitals NHS Trust before moving to NBT in 2016.  She has worked in all areas of clinical midwifery, both in the UK and abroad, with a particular focus on providing woman-centred intrapartum care in midwife-led settings. She has been a part of the Mendip Birth Centre and homebirth teams at NBT since 2018 and joined the Women’s and Children’s research team in 2024. She is passionate about women and their families receiving both evidence-based and individualised maternity care, and loves being able to support families who want to contribute to our knowledge and understanding of pregnancy and childbirth by participating in maternity research studies.

Research Administrator

Kody has been with the trust since 2023, utilizing their strong administrative and interpersonal skills to support the Urology department, where they assisted with clinic utilization, booked surgeries, and provided patient support. In late 2024, Kody transitioned to the Women's and Children's department as a research administrator, motivated by the significant impact research has as well as the trust's extensive research initiatives. Since joining, they have been actively involved in the DIVO, GENERATIONS, and PIONEER studies, and is looking forward to contributing to the department's ongoing research efforts.

A pacemaker is made up of two main parts, the generator and lead. The generator is a tiny, sealed box containing the electric circuit and a battery. The battery in most pacemakers will last 7-10 years. (There are several factors that affect battery life but none that you can control yourself). The lead is a flexible, insulated wire. One end is attached to the generator and the other end is passed through a vein into your heart. You may have one, two, or three leads depending on the type of pacemaker.

What are the different types of pacemaker? 

• Single chamber pacemaker - this will pace the right atrium or right ventricle. It has one lead.
• Dual chamber pacemaker - this will pace the right atrium and the right ventricle. This has two leads.
• Bi-ventricular pacemaker - in some cases you may benefit from both ventricles being paced. This improves the ability of the heart to pump. This has three leads.
• Single pass VDD pacemaker - this is a special type that has only one lead, but can sense in the top chamber and pace in the bottom chamber.

Eating and drinking

If your procedure is in the morning you can have an early, light breakfast before 06:30. You must not eat any solid food after 06:30. You can keep drinking water if you are thirsty, If your procedure is in the afternoon you need to eat no solid food from 10:00. You can have water after this if you are thirsty. You can eat and drink as normal after the procedure.

Medication

Before your procedure, you will have a pre-op assessment with a cardiology nurse. They will talk to you about your medications at that appointment. Please keep taking all your medications until then. If you need to stop any of them before your procedure, the nurse will tell you.

The procedure and risks are explained below, and you will be asked to sign a consent form to confirm you understand them.

• In the procedure lab you will lie relatively flat on a narrow X-ray table.
• In most cases the pacemaker will be placed on the side opposite the hand you write with. You may be shaved in the upper chest area.
• The doctor will clean your skin with some antiseptic solution. You will be covered with sterile drapes. It is important to keep your hands by your side to avoid contamination.
• The procedure is normally done using local anaesthetic. You will be awake but the area will be numb. You won’t feel pain but may feel a bit of pushing. If you feel any pain, tell a member of the team.
• If you are anxious about the procedure, you may be given a mild sedative to help you relax.
• A small cut is made, and a pocket formed for the pacemaker to sit in.
• A lead will be passed along the vein into your heart using X-ray imaging to help, a the lead will be connected to the generator (pacemaker).
• The would is stitched with dissolvable stitches and covered with a dressing.
• You will be taken to the recovery area for a short while, and then moved to a ward or go back to the ward you were on before.
• The procedure can take between 40 minutes to 2 hours depending on the number of pacing leads and how easy it is to access.

Looking after the wound 

Your wound might feel sore and look bruised for a couple of weeks which is normal. If you have pain, you can take painkillers. Keep the wound clean and dry for about 7-10 days, after this you can take off the dressing. Allow the paper stiches to fall of on their own. 

Using your arm

It is important to be gentle with the arm on the same side as the pacemaker. Use it normally, but avoid raising it above your shoulder or lifting heavy objects. This is because over time new tissue will grow around the lead in your heart, helping to hold it in place. Until that tissue forms there is a slight chance that the lead could move out of position (this would mean we need to reopen the wound to fix it).

If you have any questions about how to use your arm, please ask for help.

Before you leave hospital you will have the pacemaker checked and a chest X-ray of the pacemaker and leads. You will be given a pacemaker ID information sheet. This identifies you as a patient with a pacemaker and has information about your pacemaker and lead(s), and information about your cardiologist and GP. Keep this information sheet with you at all times.

Every medical procedure has some risks, including having a pacemaker fitted. You can discuss these in more detail with your doctor. The most common risks are: 

• Infection - you will be given antibiotics to reduce this risk.
• Lead displacement - there is a very slight risk that the wire moves from its original position (becomes displaced).
• Pneumothorax - very rarely the lung is perforated (punctured) during the implant. This causes air to leak from the lungs into the chest. The follow-up chest X-ray after your implant would show this.
• Pain/discomfort/bruising - some bruising can happen as the skin is stretched to fit the pacemaker. You may also have some discomfort around the wound site.

Once the wound has completely healed you can mostly return to normal life. The pacemaker is checked every so often to make sure it is working as it should.

The follow-up for pacemakers usually involves checking it 24 hours after implant, and again at six weeks - this also includes a wound check. You will have checks every year, six months, or three months depending on the age of the pacemaker.

The checks take about 15-20 minutes. These are separate from other appointments with the cardiologist and are only to check the pacemaker.

When you come for a check-up your heart rate will be monitored. The pacemaker will be scanned with an external device that the physiologist will place over your chest.

If you have had any symptoms since your last check, tell the physiologist. During the check you may feel your heart beat slightly differently - faster or slower. If you become uncomfortable tell the physiologist. The pacemaker may be adjusted to get the best performance.

At the end of the check you will be told if there are any problems and when your next appointment is. Please make a note of the date and time.

Do 

• Tell all medical staff you have a pacemaker. Some hospital equipment may interfere with pacemakers, and some procedures like an MRI (magnetic resonance imaging scan) may not be suitable. Some medical procedures may need to use antibiotics if you have a pacemaker. These can be discussed with your doctor.
• Carry your pacemaker ID information sheet with you at all times and show it at hospital appointments.
• Tell the DVLA and your car insurance company (if you drive) that you have a pacemaker. This is a legal requirement. It should not affect your premium costs. You can access the DVLA guidelines at Check if a health condition affects your driving: Overview - GOV.UK
• Tell your GP or pacing clinic if the wound site becomes red and inflamed, if you feel unwell with a fever, or if you have oozing from the site.
• Hold your mobile phone to the ear on the opposite side of your pacemaker when making phone calls.
• Tell airport security you have a pacemaker if travelling abroad.
• Keep all follow-up appointments. If you cannot go to an appointment please phone us so we can rearrange.
• Contact you GP as normal if you feel unwell. They will be able to help you and will contact us if they suspect a problem with your pacemaker.
• Contact your GP if your symptoms return once you have a pacemaker fitted.
• Avoid any strenuous activity for about six weeks after the pacemaker has been fitted. After that you can continue most sports and activities.

Don’t

• Don’t drive until you have had your pacemaker checked at the 6-week appointment. If this is a problem speak to the cardiac physiologist at your 24-hour check.
• Don’t lift your pacemaker side arm above shoulder height or six weeks.
• Don’t carry your mobile phone in a shirt pocket over your device.
• Don’t do arc welding.
• Avoid going near strong magnets.
• Avoid certain massage chairs.
• If you have any queries about what to avoid or can do, please phone the pacing clinic on 0117 414 0791

Regular exercise is beneficial for most people. You are advised not to exercise (including golf and swimming) until you 6-week check, after this you can begin gradually.

Modern pacemakers are designed with modern life in mind and are usually not affected by electrical items such as hairdryers, washing machines, and TVs. Modern microwaves are fine to use as long as they are in a good state of repair.

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