Breast surgery: breast clinic assessment, cancer surgery, reconstruction and cosmetic operations

Breast surgery sits between general surgery and plastic surgery. A symptomatic breast service assesses new lumps, pain, nipple changes and abnormal screening mammograms. An oncoplastic service combines cancer removal with reshaping so that the breast looks as natural as possible afterwards. A reconstructive and aesthetic service deals with rebuilding after mastectomy and with elective procedures such as reduction, uplift and implant surgery.

The lead clinician is normally a consultant breast surgeon, usually trained in general surgery with additional breast training, or a consultant plastic surgeon for reconstruction and cosmetic work. They work in a team with radiologists and radiographers who perform imaging, pathologists who examine samples, oncologists who deliver chemotherapy and radiotherapy, and clinical nurse specialists. The NHS notes that if you are told you have breast cancer, a clinical nurse specialist will be your main point of contact during and after treatment.

The NHS lists the symptoms that should prompt a GP visit: a lump or swelling in the breast, chest or armpit, dimpling of the skin that may look like orange peel, a change in breast size or shape, nipple discharge that may contain blood, a nipple turning inwards or a rash on it. Breast pain on its own is not usually a symptom of cancer, although the NHS advises seeing a GP if it is not improving, if there is a family history, or if pain comes with signs such as a hard lump that does not move or dimpled skin.

If the GP is unsure of the cause, referral is to a breast clinic. Cancer Research UK describes this as usually a one-stop clinic where several tests are done in one visit, sometimes called a triple assessment. The tests are a breast examination, imaging by mammogram and/or ultrasound, and a biopsy where needed. A mammogram takes a few minutes and compresses the breast briefly between two plates, which may be uncomfortable. A breast ultrasound usually takes about 10 to 15 minutes. A biopsy is the only way to find out whether you have breast cancer or another breast condition, and the cells are examined by a pathologist.

• Examination: the breasts and the lymph nodes under the arms and in the neck are felt.

• Mammogram: an X-ray of the breast, usually taking only a few minutes.

• Ultrasound: uses high-frequency sound waves and gel, and can be used alongside mammography.

• Biopsy: samples of tissue taken by needle; types include needle core biopsy, fine needle aspiration and vacuum-assisted biopsy.

• Further tests if cancer is confirmed: scans such as CT, MRI or PET and blood tests, which the NHS says help show how far the cancer has spread and what type it is.

Most breast problems seen in clinic are not cancer. Fibroadenomas are non-cancerous growths of breast tissue, and cysts are fluid-filled sacs; both are named by the NHS as common causes of lumps. Cyclical breast pain linked to periods typically begins up to two weeks before a period, feels dull and aching, affects both breasts and settles when the period ends. Infection of the breast, called mastitis, and abscess cause redness, heat and pain and need prompt treatment.

Gynaecomastia, meaning enlarged breasts in men and boys, is common. The NHS lists hormone changes in puberty or after age 50, being overweight, certain medicines and some conditions as causes, and says surgery can reduce the breasts if other treatments have not worked, though it may not be available on the NHS. Men can also develop breast cancer, so new lumps or nipple changes in men still need assessment.

The NHS says the type of surgery depends on how large the cancer is and whether it has spread. Options include breast-conserving surgery, which removes only the area with cancer, mastectomy, which removes the whole breast, and removal of lymph nodes from the armpit. Mastectomy is done under general anaesthetic and usually takes about an hour and a half, or around three hours for a double mastectomy, and longer if reconstruction is done at the same time. A mastectomy can also be chosen to prevent cancer in people at high risk.

Surgery is rarely the only treatment. Chemotherapy may come before surgery to shrink a cancer or afterwards, radiotherapy is often given after surgery to lower the chance of recurrence, hormone therapy is used for cancers affected by hormones, and targeted medicines or immunotherapy for certain types. A multidisciplinary team agrees a plan based on the cancer type, size, location, spread and your general health. Genetic testing may be offered where family history or cancer features suggest an inherited change.

Breast reconstruction can sometimes be done at the same time as mastectomy or in a later operation, using an implant or your own tissue. Some people choose not to be reconstructed, and that is an equally valid decision. Lymphoedema, a swelling of the arm after lymph node surgery or radiotherapy, is a recognised risk and specialist lymphoedema services exist.

Breast reduction is described by the NHS as a major operation to make breasts smaller, lighter and better shaped. It may be available on the NHS if other options such as professionally fitted bras have not worked and large breasts cause health problems such as back, shoulder or neck pain, skin irritation or grooves from bra straps; criteria depend on where you live. Done for appearance alone, it is paid for privately. The NHS gives a cost of around £6,500 for breast reduction in the UK, plus consultations and follow-up, and says the operation takes 2 to 3 hours with usually 1 or 2 nights in hospital.

Uplift (mastopexy), implant augmentation, implant removal or exchange, and correction of asymmetry follow similar principles: a consultation about expectations, a plan for scars, and a clear discussion of risks. For any cosmetic procedure the NHS advises checking that the hospital or clinic is registered with the Care Quality Commission, that the surgeon is registered with the GMC and listed as a specialist, and meeting the surgeon beforehand to ask about qualifications, experience, complication rates and follow-up. Implants are not lifetime devices and may need further surgery.

For symptoms, the NHS route is a GP referral to a breast clinic. Urgent referral for suspected cancer aims to confirm or rule out cancer within 28 days under the Faster Diagnosis Standard, with an appointment often within about two weeks. Non-urgent consultant-led treatment has a maximum waiting time of 18 weeks, and you may choose your hospital in most cases. Screening is a separate programme: NHS breast screening uses mammograms to look for cancers too small to see or feel, and invitations follow national rules.

Privately, you can usually refer yourself to a breast clinic or surgeon, and many private units offer same-visit imaging. Insurers typically cover investigation of symptoms and cancer treatment but often exclude cosmetic procedures, so check wording and obtain pre-authorisation. Costs depend on the procedure, implant or device used, hospital stay and aftercare, so ask for an itemised quote that includes follow-up and revision policy. The Private Healthcare Information Network publishes independent information about private hospitals and consultants.

See a GP for any new breast lump or change, and do not wait for a routine screening invitation. Ask for an urgent GP appointment or call NHS 111 if you have breast pain with a very high temperature or shivering, if part of the breast is red, hot or swollen, if there is a hard lump that does not move, bloodstained nipple discharge, dimpled skin, a rash around the nipple or a nipple that has sunk inward. After surgery, contact your team promptly for fever, spreading redness, wound discharge, rapidly increasing swelling or severe pain.