Last Word: Mr Philip Turton

By: Mr Philip Turton
Created on 18th May 2011

Philip Turton, one of the UK's leading aesthetic breast surgeons, discusses what breast health check-up or screening women should consider in relation to cosmetic breast surgery (view profile)

All breast specialists know that the UK incidence of breast cancer is rising and has doubled over the last 20 years. Unfortunately, one in nine women will now develop breast cancer in their lifetime.

Although the exact reasons are unknown, it is clear that there are many lifestyle factors associated with this rise, including prolonged use of the oral contraceptives and hormone replacement therapy, obesity and alcohol consumption. But there are also genetic factors at play, some of which are highly associated with breast cancer.

With breast enlargement and breast reduction being amongst the commonest aesthetic surgical operations performed in the UK, women should ask themselves questions about their breast health in advance of such surgery.

If they are in any doubt they should discuss this with their GP or obtain a more expert review from a consultant breast surgeon. Specialist consultant breast surgeons are always members of the Association of Breast Surgery (ABS) or the British Association of Surgical Oncology (BASO). If possible, patients should seek out a consultant breast surgeon who is super-specialised in reconstructive breast surgery, aesthetic breast surgery and oncoplastic breast surgery. This is, so to speak, their ‘bread and butter' area, and what they do both within the NHS and privately. It is their focus.

The approach I take with all my patients is based on a detailed initial risk assessment. Next comes the family history enquiry which is particularly pertinent, on both the paternal and maternal sides, detailing any cases and ages of onset of breast or ovarian cancers. If you aren't being asked any questions like this, you are almost certainly not seeing the right specialist. If in doubt ask your GP.

The clinical examination is completely different to the assessment of the dimensions of the breast in relation to the proposed aesthetic surgery. I perform the clinical breast examination first, and always with a chaperone, and the bio-dimensional assessment (a more advanced assessment of contours, size and tissue characteristics) second. Being able to state with confidence what is normal glandular breast tissue takes years of experience.

Women who are over 35 are able to have a mammogram, but younger women would require targeted ultrasound assessment. Evaluating abnormalities or obtaining a baseline scan in this way provides important reassurance, generally costs about £150, and can be done on the same day at most specialist  centres.

Breast reduction surgery provides further opportunities for the tissue that is removed to be examined by a breast pathologist. This could pick up a small breast cancer that would otherwise have gone undetected. This risk is low (0.1-1 per cent) but there is a higher risk (up to 10 per cent) of finding pre-malignant conditions that would at the very least raise awareness of an increased future
risk. The ins and outs of this need to be discussed carefully with your breast specialist to understand it fully and, with your consent, your tissue can then be examined.

The surgical maxim, primum non nocere (first do no harm), requires the patient to find the right surgeon initially and travelling if necessary to get the level of expertise required.