Immediate bilateral mammoplasty

At The Breast Unit within The Harley Street Clinic, we’re at the forefront of innovation in breast assessment technologies and surgical capabilities. We’re also proud to provide dedicated clinical nurse specialists who support our patients throughout their treatment and recovery. Our one-stop service attracts some of the best clinicians in the UK, who work as part of a multidisciplinary team to tailor their approach to our patients’ needs. We caught up with Mr Daniel Leff, Consultant in Oncoplastic Breast Surgery, to talk about immediate bilateral mammoplasty, a procedure he performs at The Harley Street Clinic which can benefit our breast cancer patients.

"This is innovation that matters. It’s service innovation that doesn’t involve technology, but instead involves us offering people with cancer better care and better treatment, which should always be the goal," says Mr Leff, talking about the immediate bilateral mammoplasty he and Mr Paul Thiruchelvam offers to their patients. "We’re changing the way we deliver care for our patients."

Historically, women with larger tumours in their breast would have been recommended a mastectomy but can now be offered "reduction mammoplasty" – a surgical intervention that seeks to remove the cancer but preserve as much of their original breast tissue as possible. Usually, when one breast is reshaped and lifted as the tumour is removed, the other is left as it is or resized, in another surgery, at a later date. In his work with the NHS at Imperial College Healthcare, Mr Leff and the team found the gap between the two surgeries can be 14 months on average.

Mr Leff and Mr Thiruchelvam both noticed this gap between surgeries was significantly impacting their patients’ quality of life. Anecdotally, patients reported being unhappy with their appearance. Being imbalanced affected their confidence and self-esteem, which are both key to the emotional resilience often needed in recovery.

An immediate two-team, dual-consultant bilateral mammoplasty is a procedure that grew from those patients reporting their dissatisfaction with the delay between procedures. In immediate bilateral mammoplasty surgery, a woman has both breasts worked on at the same time, with each breast reshaped and resized by a separate surgeon.

Mr Leff and Mr Thiruchelvam both realised there was a valid reason for two surgeons working at once, with one surgeon removing that patient’s tumour and lifting and resizing one breast, and the other working to resize the other breast.

"It’s all about the right mix of personalities. It requires trusting each other, and it can’t work without constant, great communication. We are better surgeons for this collaboration, and the patients are grateful to be cared for by two surgeons."

They also found benefits that were difficult to quantify but still important from a patient satisfaction perspective. Patients seemed reassured and comfortable with two surgeons overseeing their care. When meeting and talking to both surgeons in advance, patients responded well to their different communication styles, often noticing things they’d been told before but hadn’t been able to take in at the time.

"It’s the hidden benefits that make this so worthwhile. Cancer is emotionally and physically draining to recover from. Anything we can do to make that process easier, to give people with cancer their feeling of being themselves back, is something we should do if at all possible" – said Mr Leff.

An immediate bilateral mammoplasty isn’t a procedure that will work for everyone - it should be used judiciously in the cases of patients who have much smaller volume removal and lower magnitude lifts. In these cases, it should be the decision of the patient together with their surgeon.

Read more about this procedure, and see Mr Leff and Mr Thiruchelvam’s paper here

Find Mr Leff’s consultant profile here

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