Breast Cancer is very common in New Zealand, and every week I operate on at least two breast cancers. I have completed a full 12 months specialising in breast cancer management in Australia and bring this expert care back to Northland. As part of any breast disease work up there are three aspects to this: A thorough history and breast examination, usually a breast mammogram and sometimes an ultrasound and occasionally a needle sample. When you come and see me, I will tailor your care for the most optimum outcome.

This may be: Simple or Total: all breast tissue, skin and the nipple are surgically removed but the muscles lying under the breast and the lymph nodes are left in place. Modified Radical: all breast tissue, skin and the nipple as well as some lymph tissue are surgically removed. Partial: the breast lump and a portion of other breast tissue (up to one quarter of the breast) as well as lymph tissue are surgically removed. Lumpectomy: the breast lump and surrounding tissue, as well as some lymph tissue, are surgically removed. When combined with radiation treatment, this is known as breast-conserving surgery. Breast Reconstruction When a breast has been removed (mastectomy) because of cancer or other disease, it is possible in most cases to reconstruct a breast similar to a natural breast. A breast reconstruction can be performed as part of the breast removal operation or can be performed months or years later. There are two methods of breast reconstruction: one involves using an implant; the other uses tissue taken from another part of your body. There may be medical reasons why one of these methods is more suitable for you or, in other cases, you may be given a choice. I do not perform reconstructive surgery, but if you do need this I will refer you to a colleague of mine. Implants A silicone sack filled with either silicone gel or saline (salt water) is inserted underneath the chest muscle and skin. Before being inserted, the skin will sometimes need to be stretched to the required breast size. This is done by placing an empty bag where the implant will finally go, and gradually filling it with saline over weeks or months. The bag is then replaced by the implant in an operation that will probably take 2-3 hours under general anaesthesia (you will sleep through it). You will probably stay in hospital for 5-10 days. Flap Reconstruction A skin flap taken from another part of the body such as your back, stomach or buttocks, is used to reconstruct the breast. This is a more complicated operation than having an implant and may last up to 6 hours and require a 5- to 7-day stay in hospital. If you require a flap reconstruction I will refer you to Auckland where flap reconstruction is done routinely. Oncoplastic Breast Surgery In oncoplastic breast surgery, plastic surgery techniques are used at the time of lumpectomy to restore a natural appearance to the breast shape. I will ensure that the cosmetic appearance after a lumpectomy is as close to a natural shape as much as possible.

Thyroidectomy An incision (cut) is made in the front of and at the base of the neck and part or all of the thyroid gland is removed. Thyroid ultrasound guided fine needle aspiration I am able to perform same day ultrasound guided fine needle aspiration if clinically needed. Not all patients are suitable for this, but I have been trained to do this on site in my clinic for thyroid nodules. Parathyroidectomy An incision (cut) is made in the front of and at the base of the neck and one or more of the parathyroid glands are removed. Parathyroid treatment has come a long way in the last few years and after spending 12 months in Calgary, Canada working with one of the leaders in parathyroid disease, I can offer this same expert, safe and effective surgical treatment for parathyroid diseases. Often this surgery can be performed through a small 2-3cm neck incision (minimally invasive parathyroidectomy) and requires usually only one night in hospital.

Skin conditions dealt with by general surgery include lumps, tumours and other lesions of the skin and underlying tissues. These are often fairly simple conditions that can be dealt with by performing minor operations under local anaesthetic (the area of skin being treated is numbed). Often these procedures are performed as outpatient or day case procedures.

New Zealand has a very high rate of skin cancer, when compared to other countries. The most common forms of skin cancer usually appear on areas of skin that have been over-exposed to the sun. Risk factors for developing skin cancer are: prolonged exposure to the sun; people with fair skin; and possibly over-exposure to UV light from sun beds. There are three main types of skin cancers: basal cell carcinoma, squamous cell carcinoma and malignant melanoma. Malignant Melanoma This is the most serious form of skin cancer. It can spread to other parts of the body and people can die from this disease. New Zealand is predicted to have the highest incidence in the world. A melanoma usually starts as a pigmented growth on normal skin. They often, but not always, occur on areas that have high sun exposure. In some cases, a melanoma may develop from existing pigmented moles. What to look for: an existing mole that changes colour (it may be black, dark blue or even red and white) the colour pigment may be uneven the edges of the mole/freckle may be irregular and have a spreading edge the surface of the mole/freckle may be flaky/crusted and raised sudden growth of an existing or new mole/freckle inflammation and or itchiness surrounding an existing or new mole/freckle. Treatment It is important that any suspect moles or freckles are checked by your GP. The sooner a melanoma is treated, there is less chance of it spreading. A biopsy or removal will be carried out depending on the size of the cancer. Tissue samples will be sent for examination, as this will aid in diagnosis and help determine the type of treatment required. If the melanoma has spread more surgery may be required to take more of the affected skin. Samples from lymph nodes that are near to the cancer may be tested for spread, then chemotherapy or radiotherapy may be required to treat this spread. As the main melanoma surgeon at Whangarei Hopsital I operate on melanoma patients weekly and see them in my clinic regularly. The main surgery that is performed first, often by your GP, is a simple excision to determine if a skin lesion is a melanoma or not. Once the melanoma diagnosis is made, you will then usually be referred to see me for further surgery, which may involve testing a lymph node (sentinal lymph node biopsy). I always discuss complex cases with my colleagues through the Melanoma Multidisciplinary Meeting, to ensure best practice for my patients. Basal Cell Carcinoma (BCC) This is the most common type and is found on skin surfaces that are exposed to sun. A BCC remains localised and does not usually spread to other areas of the body. Sometimes BCC’s can ulcerate and scab so it is important not to mistake it for a sore. BCCs occur more commonly on the face, back of hands and back. They appear usually as small, red lumps that don’t heal and sometimes bleed or become itchy. They have the tendency to change in size and sometimes in colour. Treatment Often a BCC can be diagnosed just by its appearance. In other cases it will be removed totally and sent for examination and diagnosis, or a biopsy may be taken and just a sample sent for diagnosis. Removal of a BCC will require an appointment with a doctor or surgeon. It will be termed minor surgery and will require a local anaesthetic (numbing of the area) and possibly some stitches. A very small number of BCCs will require a general anaesthetic (you will sleep through the operation) for removal. Squamous Cell Carcinoma (SCC) This type of skin cancer also affects areas of the skin that have exposure to the sun. The most common area is the face, but an SCC can also affect other parts of the body and can spread to other parts of the body. The spreading (metastasising) can potentially be fatal if not successfully treated. A SCC usually begins as a keratosis that looks like an area of thickened scaly skin, it may then develop into a raised, hard lump which enlarges. SCCs can sometimes be painful. Often the edges are irregular and it can appear wart like, the colour can be reddish brown. Sometimes it can appear like a recurring ulcer that does not heal. All SCCs will need to be removed, because of their potential for spread. The removal and diagnosis is the same as for a BCC.

This is a procedure which allows the doctor to see inside your oesophagus, stomach, and the first part of the small intestine (duodenum) and examine the lining directly. What to expect The gastroscope is a plastic-coated tube about as thick as a ballpoint pen and is flexible. It has a tiny camera attached that sends images to a viewing screen. During the test you will swallow the tube but the back of your throat is sprayed with anaesthetic so you don’t feel this. You will be offered a sedative (medicine that will make you sleepy but is not a general anaesthetic) as well. If the doctor sees any abnormalities they can take a biopsy (a small piece of tissue) to send to the laboratory for testing. This is not a painful procedure and will be performed at the day stay unit in a theatre suite (operating room) by a specialist doctor with nurses assisting. Complications from this procedure are very rare but can occur. They include: bleeding after a biopsy, if performed an allergic reaction to the sedative or throat spray perforation (tearing) of the stomach with the instrument (this is a serious but extremely rare complication). Before the procedure You will be asked not to eat anything from midnight the night before and not to take any of your medications on the day of the procedure. After the procedure You will stay in the day stay unit until the sedation has worn off which usually takes 1-2 hours. You will be given something to eat or drink before you go home. If you have been sedated, you are not to drive until the following day. If biopsies are taken these will be sent for analysis and results are available within 2-3 weeks. A report and copies of these are sent to your GP.

A hernia exists where part of the abdominal wall is weakened, and the contents of the abdomen push through to the outside. This is most commonly seen in the groin area but can occur in other places. Surgical treatment is usually quite straightforward and involves returning the abdominal contents to the inside and then reinforcing the abdominal wall in some way.

Lipomas are a collection of 'fat' cells clumped together under the skin. Most of the time they don't cause problems, but sometimes they do. And when they do, surgical excision is the best treatment.

I perform ingrown toe nail surgery, as a day case and under sedation to minimise patient discomfort. The surgery involves surgically excising the nail matrix and the ingrown part of the nail.