CHOOSING A SURGEON

How do I choose a surgeon?

Having decided to have surgery on your breasts, you need to choose a fully trained plastic or breast surgeon carefully.

Qualifications

In the UK, the General Medical Council (GMC) has a list of currently registered qualified doctors with specialist certification. Your surgeon should be on the Specialist Register for breast surgery or plastic surgery. A surgeon who holds a CCST (Certificate of Completion of Specialist Training) in Plastic Surgery will typically have graduated from medical school and completed about 5 years in general surgery to become a Fellow of the Royal College of Surgeons. He or she will then have spent a further six years in an accredited plastic surgery training programme and passed a specialist exam in plastic surgery. An oncoplastic breast surgeon will have had further training in a specialist unit in the specific field of oncoplastic breast surgery. To check your surgeons certification and registration, log onto the GMC web site at www.gmc-uk.org or telephone the GMC on 020 7915 3630

Experience

Your surgeon should have a specialist interest in the type of breast surgery you are going to have performed. In addition, he or she should be experienced with all of the different techniques appropriate for your condition and have a record of successful operations. If your surgeon has an appointment at a NHS hospital or one affiliated with a medical school, this association suggests access to the latest surgical techniques and awareness of recent developments in the field.

Consultation

A consultation by the surgeon who will assess you completely and provide a professional opinion on your condition will take time and cost money. You may want to have consultations with different surgeons before you decide who is the right one for you. Make sure that you personally meet the surgeon who will actually be performing the operation. Your surgeon should openly discuss all your options, the risks and benefits of each and the one(s) most suitable for you. Ask what side effects to expect and be prepared for them. Anticipating problems often makes them easier to handle if they occur. You must feel comfortable with and confident in your surgeon and be fully informed about the operation before going ahead with it.

Professional Referrals

You may ask your GP, practice nurse, breast care nurse or consultant to recommend a surgeon. Private insurance companies have a list of accredited surgeons who they recommend. Private hospitals also have a list of consultant surgeons with their specialist interests, who treat patients at that hospital.

SURGERY AND PREPARATION

What happens at the initial consultation?

Your surgeon will take a medical history and examine you. Measurements and photographs of your breasts may be taken. You may require a mammogram or other investigations. Your surgeon will discuss your options and give an opinion about your particular condition. You should have a thorough discussion about your condition and whether or not your surgeon can meet your expectations.

How long will the surgery take?

The length of each operation will depend on the individual patient. The following is a guide to the usual amount of time taken.

Breast augmentation with silicone implants: 1 - 1½ hours
Breast reduction or mastopexy: 2 – 3½ hours
Breast cancer excision: discuss your particular operation with your surgeon
Breast reconstruction (see page on reconstruction)

What type of anaesthetic will be used?

Breast surgery is usually done under a general anaesthetic (you are asleep).

How long will I stay in hospital?

Hospital stay will depend on the type of operation and your individual circumstance. Discuss this with your surgeon.

How do I prepare for surgery?

You should stop smoking at least two weeks before surgery, as the risk of complications from any surgery is higher for patients who smoke.

You should ask your surgeon if you should stop taking any of your medications such as aspirin before your surgery. Inform your surgeon if you take any other medicines regularly.

If you are taking the oral contraceptive pill, you should stop taking it for one month before surgery and use another contraceptive method instead.

You must arrange for someone to drive you home and for help at home for the first few days after surgery, if needed.

You will need to purchase a Sports bra (non-wired) to wear for two weeks after surgery. This will provide comfort and support for your breasts.

What will happen before the surgery?

The anaesthetist will see you before your surgery.
A consent form will need to be signed by you and your surgeon.

Where will the operation be performed?

Mrs Lewis operates at Charing Cross Hospital, Cromwell Hospital and Parkside Hospital, Wimbledon.

What will it be like when I wake up from the anaesthetic?

You may have drainage tubes that drain blood and fluid from the surgical site. Drains are removed when the amount of fluid flowing from the wound reduces to an acceptable level. This can take one or more days and depends on each particular operation and individual patient.

Will I be in pain after the surgery?

Regular painkillers are usually given in the first few days after surgery to eliminate any post-operative pain or discomfort.

Will I be able to wash after the operation?

Bathing and showering may be allowed depending on the type of dressings you have on.

When will my stitches be removed?

Stitches are usually dissolvable and will not require removal. Sometimes the ends of the stitches or knots require removal.

How long will it take for life to return to normal?

Swelling usually occurs after any surgery and may take days to weeks to settle down. The extent of swelling is unpredictable.

Sporting activities can usually be resumed at about 4 weeks after surgery.

All scars go through a phase where they become hard and red before settling down to become less noticeable.

Will I be followed up after the surgery?

Your surgeon or nurse will review your wound at intervals after surgery. Follow up arrangements should be discussed with your surgeon before you leave the hospital.

What happens if I have a complication from surgery?

Contact your surgeon as soon as possible. Although complications are not common, they do sometimes happen and you will be helped to deal with any that may arise.

ONCOPLASTIC BREAST SURGERY

Why isn’t oncoplastic breast surgery widely practised in the UK?

While oncoplastic breast surgery was more widely practised in Europe until recently, the UK government (in 2002) provided funding for nine training posts in oncoplastic breast surgery in the UK. These posts (lasting one year) are aimed at higher surgical trainees in the latter part of their training from either a general surgery or plastic surgery background. There will therefore be more surgeons who will be trained in this specialty.

Why does the web page on oncoplastic breast surgery appear technical?

The aim of this site is to provide a source of information so that women can be informed about their options. You are encouraged to ask your doctor or nurse to explain any of the content that you do not understand.

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