BREAST CANCER; THE TOP SURGEONS; Who's Best for Breast Reconstruction? We Asked the Specialists Themselves

Article excerpt

Byline: ANGELA BROOKS

LAST month, breast cancer survivor Yvonne Laidlaw, 57, was awarded [pounds sterling]37,000 compensation for reconstruction that left her feeling like a freak, with one breast higher and smaller than the other.

She said her joy at overcoming cancer was replaced for loathing of her body following this 'cosmetic disaster'. She warned other women to see a consultant specialising in reconstructive techniques.

Clearing the canceris naturally the priority. But when it comes to reconstruction, there are a host of other issues: do you go for breast reconstruction at the time of the cancer surgery -- as Mrs Laidlaw did -- or delayed reconstruction?

These decisions might be dictated by personal choice -- some patients feel they want to put the cancer behind them and don't want to be rushed into a decision about the type of breast reconstruction they want so soon after being diagnosed.

For others also undergoing radiotherapy, doctors might recommend postponing reconstruction, as treatment can harden tissues and damage the reconstruction.

More seriously, if the patient develops an infection or other complication following reconstruction, this could delay the start of chemotherapy.

This is because chemotherapy works by hitting the fastest-growing cells, which, as well as cancer cells, include white blood cells that fight infection.

Finding the right surgeon might help resolve these issues. But working out your options can be difficult when removing the cancer and rebuilding the breasts can be carried out by three types of surgeons.

'Breast surgeons are general surgeons whose job is tackling the cancer with a lumpectomy or mastectomy,' says Adam Searle, consultant plastic and reconstructive surgeon at the Royal Marsden Hospital, London.

'Some have done further training in plastic surgery and are called oncoplastic surgeons -- they clear the cancer and will do some reconstruction.'

FINALLY, there are plastic and reconstructive surgeons who offer the full range of reconstruction techniques, including the most challenging microsurgery where fat is taken from one part of the body to rebuild the breast.

'When women want an immediate reconstruction, a plastic and reconstructive surgeon works in a team with a breast surgeon who removes the cancer, and then the plastic surgeon takes over,' says Mr Searle.

So how do you navigate this course and do all you can to avoid Mrs Laidlaw's experience? That's what the Daily Mail set out to do. Our object was to search out the top-rated surgeons across the spectrum in breast cancer surgery up and down the country.

We felt those best placed to rate the top practitioners would be other breast cancer and reconstructive surgeons.

So we canvassed 50 leading surgeons and asked them: 'If your nearest and dearest were to be diagnosed with breast cancer, to whom would you refer them?'

While the top ten surgeons are not evenly distributed around the country, this shouldn't necessarily be an obstacle for patients.

Under NICE guidelines, all patients should be offered all reconstruction options, even if these aren't available locally. Patients are entitled to be referred farther afield on the NHS. Of course, this is only a guide and not a scientific study -- there are countless highly skilled surgeons all over the country who didn't make it into the top ten, yet who spend every day of their working lives rebuilding not just breasts, but shattered self-esteem, too.

OUR TOP 10

HERE are Britain's top ten reconstructive surgeons as voted for by their peers, in no particular order. All work in the NHS and privately.

DICK RAINSBURY

Consultant oncoplastic surgeon, Royal Hampshire County Hospital, Winchester

WHAT THEY SAY ABOUT HIM: Respected and skilful surgeon who can combine cancer clearance with immediate breast reconstruction. …