Cancer and general surgery

Two types of surgery for breast cancer removal: Lumpectomy or Mastectomy. Either of these can be performed in a variety of ways depending on disease extent, shape and size of breast, breast composition, whether reconstruction is undertaken, or symmetrisation surgery of the normal side is performed at the same time or in the future. A patient’s medical condition is also an important factor in the decision making.

Either to assess for spread of disease to nodes or clear nodes and disease from axilla. Axillary surgery plays a pivotal role in management of breast cancer. It provides information that guide local, regional and systemic treatment.

The decision between immediate and delayed is made based on disease factors and patient preferences. Often immediate breast reconstruction can be undertaken which has significant psychological benefits and can lead to avoidance of a second surgery and anaesthetic. However, in my experience, breast reconstruction is a journey not a single procedure and most require more than one surgery to achieve the desired result.

This reconstruction uses a back muscle often with its surrounding fat and overlying skin paddle to reconstruct breast. It is an amazing option for people who have had failed implant reconstruction and for those with previous chest wall radiotherapy. I am experienced in LD flap surgery and has published a paper about it.

There are a variety of options to immediately remodel the breast after lumpectomy. These include reduction pattern mammoplasty, Lateral mammoplasty, Round block mammoplasty etc. These often require symmetrisation surgery to the normal breast. These are personal favourites and patients like them too – because it combines removal of the cancer with aesthetic breast surgery.

Achieved using local tissue flaps from around breast based on specific arteries to replace the lost volume after lumpectomy examples include lateral intercostal artery perforator flap (LICAP) or anterior Intercostal artery perforator flap (AICAP). They can be done in the immediate setting or delayed. In my opinion, they are excellent additions to the armamentarium of the breast surgeon. Despite their relative recency, I have carried out quite a large number of these procedures with excellent patient recovery and cosmetic outcomes.

Fat is sucked out from undesired areas and injected into breast after lumpectomy, or to improve breast reconstruction after mastectomy. It is effective, minimally invasive, and safe, but often more than one procedure (surgical session) is required.

I have extensive experience in removing skin lesions including non-cancerous lesions for diagnostic purposes, and cancerous lesions like basal cell cancer, squamous cell cancer, and melanoma. These are often carried out under local anaesthetic, and I often do them in minor operations room. Sometimes, when there are several lesions, or lymph node surgery needs to be carried out (Groin, axilla), a general anaesthetic is required.

Whenever there is accumulation of pus (infected fluid), antibiotics alone may not be sufficient. The area should be lanced and the pus let out. Depending in on the size and area, it can be done under local or general anaesthesia.

Abdominal wall hernias such as umbilical hernia, groin hernia, and hernia after surgery (incisional hernia) are quite common. These can cause pain and risk intestinal obstruction, entrapment and strangulation. With my background in general surgery, I have extensive experience with hernia repair with or without mesh.

Common lumps include lipoma, sebaceous cysts, dermoid cysts. These are benign lumps and usually clinical assessment with or without a scan is sufficient for diagnosis and reassurance. They are often asymptomatic lumps, but can cause pain, become tender with compression such as from seatbelts, or cysts can get recurrent infections. They can be removed under local or infrequently under general anaesthesia.