What is a breast consultation?

Your breasts change throughout your life, with your cycle, pregnancy, age and weight, and most of those changes are normal. A breast consultation is how you find out which ones are, without waiting weeks to be told.

Whether you have found something specific or simply want a proper check, knowing what the appointment involves makes it far easier to book one. This guide walks through it.

01What a breast consultation is

A breast consultation is a private, unhurried appointment with a doctor who specialises in breast health, at our clinic, a consultant breast surgeon or a consultant radiologist with a breast subspecialty. It is dedicated time to describe what you have noticed, be examined properly, ask everything you want to ask, and leave with a clear plan.

It is not a screening mammogram and it is not a hospital referral queue. You book it yourself, you are seen by the specialist from the first minute, and if imaging is needed it can usually be done in the same visit rather than at a second appointment somewhere else.

The most useful thing a consultation does is turn a vague worry into a specific answer, and, most of the time, that answer is reassuring.

Dr Ayman Mahfouz, consultant radiologist

02The two reasons people book one

Diagnostic: something has changed

Most consultations are prompted by a symptom. Breast cancer is very treatable when it is found early, so any new change deserves a prompt, expert look. The changes worth booking for include:

• A new lump or thickening in the breast or armpit
• A change in the size, shape or symmetry of a breast
• Dimpling, puckering or an “orange-peel” texture to the skin
• A nipple that has started to pull inwards, or discharge from the nipple
• Redness, a rash or a change in skin colour or texture
• Breast pain that is new, persistent or in one place

The chart explains why a lump is taken seriously. It is by far the most common first sign. It also explains why we look carefully at the other five: they are less common, but they are real.

Cosmetic: you are considering surgery

The second group of consultations is about the appearance of the breasts rather than a symptom. A consultant breast surgeon will talk through the options, the trade-offs and the recovery for procedures such as:

• Breast augmentation, enlarging the breasts with implants or fat transfer.
• Breast lift (mastopexy), raising and reshaping breasts that have dropped after pregnancy, weight loss or with age.
• Breast reduction, reducing size and weight to ease back, neck and shoulder discomfort.
• Nipple correction, for size, shape or inversion.

Even for a cosmetic consultation, a baseline examination and, where appropriate, imaging are part of doing it properly, surgery should never be planned around a breast that has not been checked.

03What to expect on the day

A good consultation is thorough without being slow. This is the shape of a typical first visit at 99 Harley Street:

1. 1

   Your history

   The specialist asks about the symptom, your general health, hormones and medication, and your family history of breast or ovarian cancer. This is how your personal risk is understood.

2. 2

   Examination

   A careful examination of both breasts and of the lymph nodes in your armpits and neck, looking and feeling for changes in size, shape, texture or tenderness. A chaperone is always available.

3. 3

   Open discussion

   Time for your questions. Nothing is too small to ask; the specialist is there to explain, not to hurry you.

4. 4

   Imaging, if it is needed

   For many women the right next step is an ultrasound, and we can usually do it in the same visit. For women over 40 a mammogram may also be advised; in younger, denser breast tissue ultrasound is often the more useful first test.

5. 5

   Findings and your plan

   What was found and what it means, explained face to face, then a defined next step: reassurance, monitoring, a biopsy, a referral or, for cosmetic consultations, the surgical options with their risks and recovery.

04Why finding it early matters

The strongest argument for not waiting is in the survival figures. The earlier a breast cancer is found, the smaller it usually is and the more treatable it is.

None of this is a reason to fear every change. Most turn out to be benign. It is a reason to have changes looked at promptly by someone who does it every day.

05How to prepare

There is nothing you need to do in advance, and you can go straight back to your day afterwards. Two things make the appointment easier:

• Wear a separate top. You will be asked to undress to the waist for the examination.
• Bring someone if you would like to, a partner, friend or relative is welcome, and it can help to have a second pair of ears.

If you have had previous breast imaging elsewhere, bring the report or tell us where it was done; comparing with earlier images is often very useful.

06Who should consider one

Anyone with a concern about their breasts. Some situations where a consultation is particularly worthwhile:

• You have noticed any of the changes listed above.
• You have a family history of breast or ovarian cancer.
• You are between NHS screening invitations (offered every three years from 50 to 71) and something has changed.
• You have breast pain that is worrying you.
• You have implants and want them checked.
• You are considering augmentation, reduction, a lift or reconstruction.

07What happens next

Most women leave a breast consultation reassured, with a clear explanation of what they felt and why. If something does need further attention, you will not be handed a report and left to work it out. Your specialist tells you face to face, and whatever comes next, an ultrasound-guided biopsy, an MRI through our imaging partners, or a referral to a breast surgeon, is arranged from here, usually within days.

That is the whole point of the appointment: one visit, a specialist from start to finish, and answers rather than a wait.