Inside Medicine: Breast surgeon

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Mr Hamed also sees men with breast problemsIn a series focusing on medical specialties, the BBC News website meets breast surgeon Hisham Hamed.

His speciality is treating patients, women and men, with breast problems ranging from cancers to benign conditions.

<a class="bodl" href="#table">Mr Hisham Hamed's CV</a>

WHAT IS YOUR JOB?

I am a full-time breast surgeon and head of the breast surgery service at Guy's & St Thomas' Hospital Foundation Trust and University Hospital, London.

As well as my clinical duties I also have managerial and research commitments.

WHAT IS THE MOST COMMON CONDITION?

Although breast disease predominantly concerns women, I also see a number of men with various breast problems - most commonly breast enlargement.

Guy's & St Thomas's NHS Foundation Trust is one of the largest teaching hospitals in the country, so teaching medical students and training young surgeons are a part of my regular daily activity.

It just isn't possible to get used to breaking bad news Mr Hisham Hamed

The majority of my patients have benign conditions, or are the "worried well".

Breast pain is one of the most common conditions affecting women.

But while breast cancer represents less than 10% of the cases I see, it takes up nearly 90% of my working time.

WHAT IS THE MOST COMMON PROCEDURE?

Most of the surgical procedures are related to breast cancer treatment.

Mastectomy used to be the most common procedure.

But with advances in breast surgical treatment, mastectomy has been replaced in a significant number of cases with less extensive surgery called a lumpectomy.

Also reconstructive surgery (rebuilding the breast) has become an integral part of breast cancer surgery and has been carried out more frequently in recent years.

WHAT IS THE HARDEST THING ABOUT YOUR JOB?

Ironically, the best part of the job - the doctor-patient relationship - constitutes the hardest.

It just isn't possible to get used to breaking bad news.

Developing breast cancer is one of the most critical life events. In most cases the lives of the patient's whole family get turned upside down.

Away from patients, changes in the NHS and the development of a new management style have also proved to be one of the most challenging tasks of a senior clinician's job.

In the modern NHS clinicians are now playing a significant role in running their own departments.

This can be challenging - and sometimes frustrating - but is undoubtedly rewarding because I am taking an active part in shaping the service to provide the best possible care for our patients.

I am also fortunate to be a part of an academic and research programme that gives me the chance to work in such an exciting field where so much is going on in the development of breast cancer treatment.

Consistent efforts to deliver high quality care both from physical and psychological aspects within limited resources can be hard and frustrating.

But despite all my commitments I wouldn't change my job for anything else!

WHAT IS YOUR MOST SATISFYING CASE?

It may sound like a cliché, but truly it is seeing breast cancer patients get better and turning from desperation to hope.

It is also very satisfying to be able to support patients during one of the most difficult times in their lives.

For the worried well and those with benign conditions, it is to be able to give good news that they have no serious problem and to alleviate their anxiety.

Patients' satisfaction and their acknowledgement that they received the best care possible do certainly keep me going.

WHY DID YOU CHOOSE THIS SPECIALITY?

I consider myself fortunate.

During my training I felt that learning to become a breast surgeon would provide me with the most satisfying aspect of my medical career: that is close involvement with patients' care and getting to work with patients as people and not just interesting cases.

In the meantime there was the opportunity of a training post in one of the most prestigious Cancer Research UK breast units.

Also breast cancer provides a fertile field in research to find answers to one of the most intriguing malignancies.

IF YOU HAD YOUR TIME AGAIN WOULD YOU CHANGE YOUR SPECIALTY?

I have no regrets and still enjoy my job.

There is hardly a dull moment and every day provides a new challenge. There is a lot to learn about breast cancer and its victims.

HOW DO YOU SEE THE ROLE DEVELOPING IN THE FUTURE?

The field of breast cancer surgery is continually evolving

There are advances in our knowledge and new skills to learn.

A holistic approach to management of breast cancer has become a fundamental aspect of patients' care and it is important for carers to embrace it.

A humane and sympathetic approach is a crucial skill needed by all breast surgeons.

Patients' recovery depends on this as much as on physical treatment. So it is an integral part of any surgeon's curriculum.

Reconstructive surgery and its impact on patients' quality of life is also now a fundamental skill for the modern breast surgeon to learn.

The field of cancer genetics is growing at a rapid pace and the modern breast surgeon has to be up to date with all the latest developments. That is certainly a major challenge.

Finally, the care of patients with breast cancer is no longer the responsibility of a single doctor.

Today patients have the advantage of being looked after by a multidisciplinary team of experts who are able to provide comprehensive care.

<a name="table"></a> <a class="bodl" href="#top">Click here to return</a> CV - Mr Hisham Hamed 1976: Qualified from the Cairo Faculty of Medicine 1983: Fellowship of the Royal College of Surgeons 1995: PhD from the University of London 1987: Appointed as Cancer Research UK Clinical Fellow at Guy's Hospital Breast Unit 1995- Present Cancer Research UK Consultant Breast Surgeon at Guy's & St Thomas' Hospital Foundation Trust, Breast Unit