Dr Heath Wilms will assess and treat all breast cancers and work with other specialists such as oncologists to coordinate a tailored multidisciplinary treatment plan for each patient. This includes diagnosis, providing extensive information on treatment options, undertaking surgery and also follow up surveillance.

There are many non-cancer breast issues that we assess and manage. These may only need medical treatment, some might occasionally require surgery. Symptoms might include breast pain, breast lumps or nipple discharge. Conditions include those such as:

• Breast infections
• Fibroadenoma
• Cystic breast disease
• Granulomatous mastitis

A small sample of breast tissue is removed and examined under a microscope to see if cancer is present.

This is an operation that can lift and reshape sagging breasts. The procedure usually involves removing skin from an area below the nipple and reshaping the breast. The surgery is performed under general anaesthesia (you will sleep through it) and will take about 2 hours. You will probably stay in hospital overnight and will need to arrange for someone else to drive you home the next day.

Your breasts will be bruised and swollen for several days and you may need to take some medication for pain relief. You will need to wear a special support bra continuously for 3-4 weeks after surgery. You will probably be able to return to work after about 1 week. It will take several months for the scars to fade.

When a breast has been removed (mastectomy) because of cancer or other disease, it is possible in most cases to reconstruct a breast similar to a natural breast. A breast reconstruction can be performed as part of the breast removal operation or can be performed months or years later.

There are two methods of breast reconstruction: one involves using an implant; the other uses tissue taken from another part of your body. There may be medical reasons why one of these methods is more suitable for you or, in other cases, you may be given a choice.

Implants

A silicone sack filled with either silicone gel or saline (salt water) is inserted underneath the chest muscle and skin. Before being inserted, the skin will sometimes need to be stretched to the required breast size. This is done by placing an empty bag where the implant will finally go, and gradually filling it with saline over weeks or months. The bag is then replaced by the implant in an operation that will probably take 2-3 hours under general anaesthesia (you will sleep through it). You will probably stay in hospital for 2-5 days.

Flap reconstruction

A flap taken from another part of the body such as your back, stomach or buttocks, is used to reconstruct the breast. This is a more complicated operation than having an implant and may last up to 6 hours and require a 5- to 7-day stay in hospital. This is done in conjunction with plastic surgical specialists.

Surgery to reduce breast size involves making a cut (incision) around the areola (the dark area around the nipple) straight downwards and along the crease beneath the breast. Glandular tissue, fat and skin are removed and the breast reshaped. The surgery is performed under general anaesthesia (you will sleep through it) and will take 2-4 hours.

You will probably stay in hospital 1-2 nights and will need to arrange for someone else to drive you home.

You may need to take some medication for pain relief for several days and you must wear a special support bra continuously for 2 weeks after surgery. You will probably be able to return to work after about 2 weeks. It will take several months for the scars to fade.

An oncoplastic procedure is where a breast cancer is removed and then plastic surgical techniques such as breast reduction are used to restore the shape of the breast.

Gallstones are formed if the gallbladder is not working properly, and the standard treatment is to remove the gallbladder (cholecystectomy). This procedure is usually performed using a laparoscopic (keyhole) approach.

Laparoscopic: several small incisions (cuts) are made in the abdomen (stomach) and a narrow tube with a tiny camera attached (laparoscope) is inserted. This allows the surgeon a view of the gallbladder and, by inserting small surgical instruments through the other cuts, the gallbladder can be removed.

Open: an abdominal incision is made and the gallbladder removed.

A hernia exists where part of the abdominal wall is weakened, and the contents of the abdomen push through to the outside. This is most commonly seen in the groin area but can occur in other places. Surgical treatment is usually quite straightforward and involves returning the abdominal contents to the inside and then reinforcing the abdominal wall in some way.

Hiatus Hernia:

Laparoscopic: several small incisions (cuts) are made in the abdomen (stomach) and a narrow tube with a tiny camera attached (laparoscope) is inserted. Small instruments are inserted through the other cuts, allowing the surgeon to push the hernia (part of the stomach and lower oesophagus that is bulging into the chest) back into position in the abdominal cavity. The hiatus (opening) in the diaphragm (a sheet of muscle between the chest and stomach) is tightened and the stomach is stitched into place.

Open: an abdominal incision is made over the hernia and the hernia is pushed back into position in the abdominal cavity. The hiatus (opening in the diaphragm) is tightened and the stomach is stitched into place.

Fundoplication: during the above procedures, the top part of the stomach (fundus) may be secured in position by wrapping it around the oesophagus.

Inguinal Hernia:

Laparoscopic: several small incisions are made in the abdomen and a narrow tube with a tiny camera attached (laparoscope) is inserted. Small instruments are inserted through the other cuts, allowing the surgeon to push the hernia (part of the intestine that is bulging through the abdominal wall) back into its original position. The weakness in the abdominal wall is repaired.

Open: an abdominal incision is made and the hernia is pushed back into position. The weakness in the abdominal wall is repaired.

Umbilical Hernia:

An incision is made underneath the navel (tummy button) and the hernia (part of the intestine that is bulging through the abdominal wall) is pushed back into the abdominal cavity. The weakness in the abdominal wall is repaired.

Incisional Hernia:

Laparoscopic: several small incisions are made in the abdomen and a narrow tube with a tiny camera attached (laparoscope) is inserted. Small instruments are inserted through the other cuts, allowing the surgeon to push the hernia (part of the intestine that is bulging through the abdominal wall) back into its original position.

Open: an abdominal incision is made and the hernia is pushed back into position.

Skin lesions can be divided into two groups:

• Benign (non-cancerous): e.g. moles, cysts, warts, tags. These may be removed to prevent spreading (warts), stop discomfort if the lesion is being irritated by clothing/jewellery or to improve appearance.
• Malignant (cancerous): basal cell and squamous cell carcinomas are generally slow growing and unlikely to spread to other parts of the body. Melanoma is a serious skin cancer that can spread to other parts of the body. Urgent removal is recommended.

Surgery to remove skin lesions usually involves an office or outpatient visit, local anaesthesia (the area around the scar is numbed by injecting a local anaesthetic) and stitches. You may or may not have a dressing put on the wound and it is important to keep the area dry for 24 hours. Stitches may be removed in 1-2 weeks. You may need to take a few days off work after the surgery.