The Daily Schedule Of A Breast Surgeon

A breast surgeon is a specialist surgeon who focuses on the diagnosis of breast related diseases and conditions and manages these issues either conservatively or, in most cases, surgically. 

Primary healthcare workers such as nurse and general practitioners refer patients with breast conditions, that affect men and women, to these specialists. These patients will usually present with symptoms such as breast tenderness, enlargement, skin changes, nipples discharging clear fluid, milk or blood, retracted nipples and masses being felt.

The breast surgeons will then assess the patient to determine whether they have a benign condition that would need to be managed conservatively, such as mastitis which is inflammation of the breast tissue which can be managed with anti-inflammatory medications and antibiotics, or if there are signs of a more malignant issue, such as an aggressive breast cancer.

Training

A breast surgeon needs to complete a series of training programmes before they can specialise in their chosen sub-specialty. The specialist will first have to attend a medical school where they will take part in a medical and surgical undergraduate training programme which takes 5-6 years to complete. Thereafter, they must complete a 1-2 year internship phase where they are exposed to the numerous medical and surgical disciplines that exist.

The now qualified doctor is allowed to specialise and they will enter into a surgical residency programme that takes 5 years to complete. The doctor is now a general surgeon and can decide to specialise further if they want. In this case, the surgeon will complete a 1 year fellowship training programme in breast surgery.

Conditions managed by a Breast Surgeon

As mentioned, a breast surgeon will deal with many breast related conditions that range from mild to severe. The following are such conditions:

Masses/neoplams

Breast masses can be benign or malignant. Regarding the benign masses, such as fibroadenomas, the patient and specialist need to discuss whether it would be beneficial to remove such a mass or not. An indication for removal would be if the mass causes so much discomfort that it affects the patient's everyday activities.

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Malignant masses would need to be managed surgically since aggressive cancers can spread quickly to the other breast and to other organs such as the lungs and liver. These patients would be sent for investigations, such as ultrasound or mammography of the breasts and biopsies of the mass would be taken to determine the aggressiveness and staging of the cancer. The type of surgery performed would then depending on the results of the lesion.

Infections and inflammations

Inflammatory changes and infections affecting the breast tissue can be managed by the patient's primary healthcare worker most of the time, but there are cases that need to be referred for further management. These would include issues such as severe bacterial mastitis, chronic subareolar abscess, retromammary abscess, syphilis of the breast and tuberculosis of the breast.

Infective conditions that haven't caused an abscess yet would need to be managed in hospital with intravenous antibiotics. In the case of tuberculosis of the breast, the patient would need to be isolated while they are still able to pass the bacterium on to others. Abscesses of the breast are managed surgically by incising and draining them in the operating room.

The Daily Schedule Of A Breast Surgeon

Breast surgeons will provide post-operative care for their hospital patients on a daily basis in the wards, and they will be managed until they are ready to be discharged home. General and nurse practitioners refer patients to these specialists, but they are also consulted by other specialists requiring an opinion regarding a patient's breast condition.

The breast surgeon's office will be based in the hospital so that they have faster access to their patients in the case of an emergency, and so that they can get to the casualty department to consult with patients that need an opinion there.

The breast surgeon provides on call services for the hospital they work at during after hours and weekends. Breast conditions are almost never emergency surgical cases unless the patient presents at these times with a severe painful breast mass or abscess that requires urgent draining. These specialists would therefore be on call to provide medical help for any other general surgical case since they do possess the required training experience.

Monday

This is usually an administrative day where the specialist will deal with confirming and attending meetings with hospital staff, management and surgical representatives.

The breast surgeon will then begin consulting with patients once these aspects have been dealt with. The patients will be managed conservatively, sent for further investigations, admitted to the ward for further therapy or be scheduled for elective surgery at a later date.

Tuesday

The breast surgeon will spend this day operating in theatre. The procedures that will be performed are usually complex and time consuming ones that include mastectomies (they can be single or double, with or without the removal of lymph nodes) and breast-conserving surgery (a less radical alternative to a mastectomy in patients where breast tissue is attempted to be saved).

Other surgeries that are performed by these specialists include lumpectomy (removal of breast lumps), fibroadenectomy (removal of a benign fibroadenoma), breast abscess incision and drainage and microdochectomy (removal of a lactiferous duct).

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Wednesday

The breast surgeon will perform surgery during the morning and the afternoon will be used for filling in of motivations for surgeries to medical insurance companies, or performing research for their own academic purposes.

The specialist will also be attending a breast surgery-oncology multidisciplinary meeting to discuss treatment protocols with oncologists regarding patients with malignant breast cancers.

Thursday

The specialist will be performing surgery in theatre during the morning and the afternoon may be reserved for the training of undergraduate medical students and postgraduate residents in general and breast surgery.

Friday

The breast specialist will consult with patients in the morning and then finalise any unresolved administrative issues in the afternoon.

Once all patients have been seen and the specialist has confirmed their surgical list for the following week, then the current work week can be concluded.