Mr Debashis Ghosh on rebuilding breast surgery around the patient — and why he refuses to hand her over
There is a moment in most breast cancer pathways that patients rarely see coming. The cancer has been diagnosed, the plan agreed — and then the woman is handed on. One surgeon removes the disease; another, weeks or months later, attempts to restore what was taken. Two teams, two waiting lists, two sets of expectations, and a result that nobody owns entirely.
Debashis Ghosh has spent the better part of two decades arguing that this is a design flaw rather than a necessity. A Consultant Breast and Oncoplastic Surgeon at the Royal Free London NHS Foundation Trust, The London Clinic and 146 Harley Street, he is one of a small number of surgeons in the United Kingdom who hold dual European Board certification — FEBS in both Breast Surgery and Surgical Oncology — and who, in 2026, added formal board certification in cosmetic breast surgery under the Intercollegiate Cosmetic Surgery Board scheme. The combination is unusual, and it is deliberate. It means the cancer operation and the reconstruction are performed by the same pair of hands.
He also serves as an Expert Adviser to NICE, is Clinical Network Director for Breast at the North Central London Cancer Alliance, and is Divisional Director of Surgery at The London Clinic. In February 2025 he was awarded an honorary DSc. He performs more than four hundred cancer operations a year. He speaks six languages. He is, by any measure, busy — and yet the conversation keeps returning to a single, stubbornly simple idea: continuity.
You describe your practice as “one surgeon, the full spectrum.” What does that actually mean for a woman sitting in your clinic?
It means that whatever she needs, she does not get passed along. If she needs a lumpectomy with a local flap to keep the shape of her breast, I do that. If she needs a mastectomy with an implant-based reconstruction, I do that. If she needs a free flap using her own tissue, I do that. If, years later, she needs a revision because an implant has hardened or the symmetry has drifted, I do that too. She is not referred on to a plastic surgeon she has never met. The person who took the cancer out is the person responsible for how she looks and feels afterwards.
Why does that matter so much? Plenty of excellent units work in pairs.
They do, and I have great respect for colleagues who work that way. But something is lost in the handover, and it is usually accountability. Reconstruction is not a separate project bolted on afterwards — it begins at the moment I decide where to place the incision, how much skin to preserve, whether the nipple can be saved. Those decisions are made in the first operation. If the person making them is not the person who has to live with the aesthetic result, the incentives diverge. When it is all one surgeon, there is nowhere to hide.
You have built your practice around technology most patients have never heard of. SAVI SCOUT, fluorescence-guided surgery, LYMPHA, intraoperative radiotherapy. Translate.
Each one solves a specific, unglamorous problem.
SAVI SCOUT is a tiny reflector placed in the breast before surgery so I can locate an impalpable tumour precisely. The older method involved a wire inserted into the breast on the morning of the operation, which is uncomfortable and dictates the timing of the whole day. The reflector can be placed days or weeks earlier and it does not constrain where I make the incision, which matters enormously for the cosmetic result.
Fluorescence-guided surgery uses a dye that glows under near-infrared light so I can see lymphatic drainage and tissue perfusion in real time — is this skin flap actually getting a blood supply, or is it going to fail in a week?
LYMPHA is preventive. When lymph nodes are removed from the armpit, some women develop lymphoedema — permanent swelling of the arm, and one of the things patients fear most. LYMPHA involves reconnecting the divided lymphatic channels to a nearby vein at the time of the original operation, to reduce that risk rather than treat it later.
Intraoperative radiotherapy delivers a single dose of radiation to the tumour bed while the patient is still asleep, which for selected women can replace weeks of daily hospital visits.
And robotics?
That is the direction of travel, and I have been preparing for it carefully rather than quickly. I was the NICE expert involved in the guidance on robot-assisted soft-tissue surgery. I have observed ten robot-assisted mastectomies in Turin, completed forty hours of platform training, done cadaveric work with the da Vinci SP system and a cadaveric course in Athens on implant-based reconstruction after minimally invasive mastectomy. I am currently going through the formal new-procedure approval process at The London Clinic. I am not interested in being first. I am interested in being ready.
You introduced keyhole mastectomy at the Royal Free back in 2010. Are you drawn to novelty?
I am drawn to problems. Novelty for its own sake is dangerous in surgery — patients pay for it. But if a woman can have the same oncological operation through a hidden incision in the fold beneath the breast rather than across the front of it, that is not a gimmick. That is the difference between a scar she sees in the mirror every morning and one she does not.
Your research on aesthetic outcomes takes a fairly sceptical view of technology, though.
It does, and I think that is healthy. We recently completed a study of 160 patients who had DIEP flap reconstruction, comparing three ways of judging the aesthetic result: BCCT.core, which is semi-automated software; a panel of four expert plastic surgeons; and BREAST-Q, which is the patient’s own reported satisfaction.
The findings were sobering. The software agreed only moderately with the expert panel and consistently scored results more generously than the surgeons did. But the important finding was this — patient satisfaction correlated with the experts’ assessment and did not correlate meaningfully with the software’s. In other words, the algorithm was measuring something, but it was not measuring what the woman herself cared about.
That is an awkward result for anyone selling AI in medicine.
It should be. I use AI daily and I am building tools with it — a risk assessment system based on validated models like BOADICEA, and a patient companion app to support women through treatment. I am not a sceptic. But I am very clear that these tools assist judgement; they do not replace it, and they certainly do not replace the patient’s own account of her life. Symmetry measured in pixels is not the same as a woman feeling like herself again.
You also do cosmetic breast surgery. Some cancer surgeons regard that as a separate world.
I think that separation is artificial and it disadvantages patients. The technical skills overlap almost completely — implant selection, pocket planning, managing capsular contracture, correcting asymmetry, revision work. A woman who had implants twenty years ago and now has a cancer diagnosis is dealing with both worlds simultaneously, and she needs one person who understands both. The board certification in cosmetic breast surgery this year was about making that dual competence formal and externally verified rather than merely asserted.
What do you want a woman to feel when she leaves your consulting room?
That she understands what is happening to her. Most of the distress I see is not caused by the diagnosis itself but by the fog around it — not knowing what the options are, not knowing who is in charge, not knowing what she will look like. I would rather spend an extra half hour drawing on paper than have a patient go home and spend the night on the internet frightening herself.
What are you working on now that most interests you?
Prediction, mainly. Getting better at telling an individual woman what her actual risk is rather than a population average — which is what the risk modelling work is about. And the app, which is really an attempt to give patients reliable information at two in the morning, which is when they need it and when the clinic is closed. Beyond that: getting the robotics programme properly established, and finishing the outcomes research.
Six languages. Does that change the clinical relationship?
More than people expect. Cancer conversations are the hardest conversations a person has, and having them in a second language is exhausting. When a patient can switch into Bengali or Gujarati or Hindi and say the thing she actually means, rather than the thing she can manage in English, you get a different consultation. You get the real one.
Mr Debashis Ghosh, MBBS, MS, FRCS (Gen Surg), FEBS (Breast), FEBS (Surgical Oncology), DSc, consults at Harley Street Breast Centre and The London Clinic.