Breast Practice

Created on 05th March 2009

Cosmetic Surgery & Aesthetics Magazine interviews Mr Philip Turton, specialist breast surgeon

How would you describe the work you do?

I have specialised as a breast oncoplastic and reconstructive breast surgeon. I carry out hundreds of breast operations per year. There are two main areas to my work. I do all aspects of cosmetic breast surgery, predominantly breast enlargements and reductions, through my private practice and also complex reconstructive breast surgery for breast cancer patients but this is mainly in my NHS practice.

What is your usual approach with your patients?

Because of my background as a breast specialist and dealing with patients who are very worried about breast problems I feel I have a very emphatic and thorough approach which I also bring to my private cosmetic breast surgery practice. Attention to detail at all stages is the key to success. You've got to really listen to what the patient wants because then you have a much better chance of getting the result they want.

Once you establish that rapport it is also possible to manage expectations and detail what can be achieved. About five per cent of the patients I see will have subtle underlying developmental breast problems, for example, and this has to be taken into account to try to bring about the best result. If there are limitations you have to be honest and describe these.

How important is it that a patient likes their surgeon?

I think this is critical. A patient should never go ahead with surgery unless they immediately feel like they have established a good rapport with their surgeon. If they feel something is amiss at the first consultation they should follow their gut instinct. Patients should also be given time to go away and think about the decision. They should always be wary of anyone chasing them to make a firm commitment.

How important is the consultation?

An example with breast enlargement is that I will spend a very detailed and thorough hour in my initial consultation. Sometimes I feel like I will want longer and I'll ask the patient to come back and have another talk. It is critical to really appraise all of the dimensions of the breast, taking into account areas such as the tissue elasticity and the ratios of different breast and chest wall dimensions.

Without that hour long consultation I don't believe that I could get the results that I get. I suspect I'd be either putting implants in that were the wrong size for the patient's desires or missing a problem that needs dealing with.

Why did you choose to specialize in breast surgery?

My initial interest when I was doing my surgical training was vascular surgery; I loved the technical challenge but found the reality disheartening as patients often had chronic diseases and weren't going to get better. This contrasts with breast surgery, particularly my work with breast cancer patients. The diagnosis can be devastating but if you can perform expert surgery, remove the cancer and reconstruct the breast so that sometimes it looks even better than it did before, then you can go a very long way to counteracting the horror of having the breast cancer diagnosis. It is an incredibly rewarding field to work in. I really enjoy using my expertise in breast surgery in all of my cosmetic breast surgery work. Patients are always so grateful for the improvement you achieve. It is wonderful to make such a difference to women's lives.

What do you think you can offer to patients because you are a specialist?

When you study a specialist area like breast surgery, the volume of information that you need to know is vast and even though I've been a specialist for many years now I'm constantly reading, going on courses or attending international meetings. I feel it would be impossible to cover all areas of surgery and offer the same level of expertise; you would fall down somewhere. I concentrate on breast surgery so that I can offer my expertise at the very highest level.

Implants - how important are they for the best results?

There is a big range of implants on offer now, from the cheapest which cost just £50 to the top end of the market where they cost just over £600. The cheap ones certainly have a much higher rupture rate, much higher contraction rate and the patient might need to have more revisional surgery done in their lifetime.

I never say to anyone that implants will last for life but some of the manufacturers of the best implants are now giving guarantees that the implants will not rupture in the patient's lifetime.

Are patients coming to you as well informed as they should be?

Most of the patients coming to me for first time breast augmentation surgery have done their research. Patients who had implants put in over fifteen years ago are less well informed on the other hand. They often have no idea what sort of implant they have in or what size and that they were never told they might have to have them exchanged.

What advances can you see coming up either in technology or technique?

Implant technology will continue to improve and I'm sure they will produce an implant that will have some sort of medication coating that will inhibit capsular contraction.

The second area, called lipo transfer, is in its infancy. This is the transfer of fat from other parts of the body to the breasts. The restrictions on it currently are that the fat you transfer tends to shrink quite quickly and also you can get small specks of calcium forming in the breast which can interfere with mammograms. I am involved in an international study looking at stem cell enriched lipo transfer but it will be a number of years before we know how effective it is.

The third area is the injection of other substances. I am not a huge fan of this because I believe it is very expensive and within a year the product disappears which can lead to disappointment.

When do you know that you have done a great job?

Often you know at the initial consultation if it will be a great result if the patient has a good starting point. The first post-op visit with me is at two weeks and by that point they are about 80 per cent there. They can wear more glamorous bras and are looking really great. The second visit at three months is when everything has settled down and they are really happy with the result.

Breast augmentation patients need that time for the implants to fully settle but with my breast reduction patients you get instant results; they are happy they've lost all the discomfort and pain of their large breasts just a few hours after surgery - and they can see their tummy again!