Breast surgery: when and why? An expert explains

Written by: Miss Fiona MacNeill
Published: | Updated: 21/07/2022
Edited by: Lauren Dempsey

Breast surgery is any procedure performed on the breast of a woman or a man. There are numerous reasons why breast surgery is done. Highly experienced London-based consultant general and oncoplastic breast surgeon, Miss Fiona MacNeill explains the different types of procedures that are undertaken, when they are necessary, and outlines some of the most common procedures. In her second article in this series, Miss MacNeill discusses what to do and what to avoid whilst recovering from breast surgery. 

Recovery do's and don'ts: breast surgery


What are the different types of breast surgery?

There are a lot of different types of breast surgery. I would loosely classify them into surgery for breast cancer, that's perhaps the most obvious reason for operating on the breast, and surgery for non-cancerous conditions. There's a whole range of non-cancerous conditions, such as breast mice (fibroadenomas) or bleeding from the nipple. Also, we operate on men both for cancer and non-cancerous reasons.

The third category would be cosmetic or aesthetic surgery. We're seeing an increasing number of both women and men having surgery on their breasts because of a personal choice to change their appearance. It's normally done by plastic surgeons and also, breast surgeons like myself.

The final category, which is something that we're starting to increasingly see more of in the last decade, is gender surgery. People who wish to identify as a different gender may have surgery on their breast or their chest wall to help reaffirm their gender identity. There are very specialist breast and plastic surgeons who offer that type of surgery. 


Why would someone require breast surgery? 

That's a very good question because, on the whole, we try to avoid operating on the breast for obvious reasons. Surgery generally requires an anaesthetic and usually leaves a scar; both of which are fairly undesirable situations. That being said, the majority of surgery takes place for breast cancer to remove cancerous tissue.

As previously mentioned, there are benign conditions both in men and women where you may have a lump that you don’t want or you may have undesired bleeding from the nipple which is caused by a papilloma, a little growth inside the nipple, which can be removed surgically.

Sometimes, we see men who’ve developed a condition called gynaecomastia, which is where they get swollen breasts, colloquially termed moobs or male boobs. They may want a plastic surgeon to help them redefine their chest wall and their contour.

Mainly surgery is performed for breast cancer and occasionally for non-cancerous conditions. Additionally, there is an increasing number of people having cosmetic surgery and gender-affirming surgery.


What is the most common type of breast surgery and what's involved in this procedure?

The most common type of breast procedure is for breast cancer. Generally, it’s what is referred to as a lumpectomy, where you cut out the cancer. A lot of breast surgeons prefer the term wide excision, as lumpectomy suggests just the lump is taken out but cancer surgery is generally a lot more than that; you cut out the lump but you also cut out a rim of healthy tissue so that you get out the little rootlets of the cancer. That's called breast preserving or breast-conserving surgery and it's usually always followed by radiotherapy. About 60 percent of women who've got breast cancer have a breast-conserving or preserving surgery followed by radiotherapy.

The other 40 percent have a mastectomy, a procedure to remove the whole breast. Of the women who require whole breast removal, approximately one-third of them will have reconstruction surgery at the time of having their breasts removed. The most commonly performed surgeries are breast-conserving surgery followed by mastectomy either with or without breast reconstruction surgery.

 It's interesting to note, that we don't actually know how many men and women have cosmetic breast surgery because there is not very clear data as it takes place in the private sector. We estimate that there are approximately 12,000 or 15,000 operations a year for cosmetic surgery, whilst there are approximately a hundred thousand operations annually for cancerous or non-cancerous conditions and gender reaffirming surgery.  


If you would like more information on breast surgery and would like to book a consultation with Miss Fiona MacNeill, you can do so by visiting her Top Doctor’s profile. 

By Miss Fiona MacNeill

Miss Fiona MacNeill is a highly achieved and pioneering consultant oncoplastic breast surgeon in the London area where she practises at her private clinic and with the NHS. Originally specialising in general surgery, Miss MacNeill is now a specialist in all things related to the breasts, breast surgery, and breast cancer. Some of her top focuses are rapid access and diagnosis of breast problems, oncoplastic breast surgery (including reshaping and remodelling), breast reconstruction, risk reducing breast surgery, and second opinions.

Qualifying in 1983 from St Bartholemew's Hospital and receiving awards in her education, Miss MacNeill was later appointed as a consultant in 1996 with the Colchester NHS. Here she established a considerably successful breast unit, which she led until moving to The Royal Marsden NHS in 2006. Since then, Miss MacNeill has continued being a groundbreaker by practising novel drugs and treatments, leading prominent associations of breast surgery, and working with the best of partnering departments to provide the highest quality care and results for her patients.

Miss MacNeill is still involved in local and national research trials, striving to achieve the optimum results for patients. She also continues to lecture world-wide, training physicians and surgeons on delivering modern breast cancer care by the evolving role of breast surgery in the treatment of breast cancer, as well as the importance of working with a multidisciplinary team and having a treatment plan. Miss MacNeill is an advisor to multiple Department of Health committees and is a steady member of various associations and societies; one of these is the Association of Breast Surgery, where Miss MacNeill sits as the chairman of the education and training committee.

Furthermore, Miss MacNeill is the National Clinical Lead for the Getting It Right First Time (GIRFT) Programme, which is a standard setting and quality improvement programme for the NHS. Previously, she was the Breast Tutor at the Royal College of Surgeons of England to educate the future generations of breast surgeons by establishing the UK sentinel lymph node training programme and oncoplastic surgery portfolio. This was the first General Medical Council recognised curriculum for breast surgery training.

Miss MacNeill presently practises at the private London Breast Clinic and the Royal Marsden NHS.

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