Individualised Surgical Planning | Professor Fengxi Su

Professor Fengxi Su discussing an individualised surgical plan with a patient and clinician.
01 · Understand the question

What should my surgical plan include?

A useful plan explains what will be removed, how findings will be checked, and what treatment may follow. It should also show where your preferences influence the choice among medically suitable options.

  • Clinical needs: what is required to treat the cancer?
  • Your priorities: what matters among the suitable choices?
Discuss my surgical plan
Clinician comparing breast imaging, pathology and earlier records.

Are we using the complete and current findings?

Ask the team to review the diagnosis and disease extent together. If you have had treatment already, include the earlier and current results so that the operation is planned around the full history.

  • Pathology: which diagnosis is the plan based on?
  • Imaging: what area needs addressing?
A surgeon explaining the proposed removal and tissue margins with a physical teaching model.

Why is this amount of surgery being proposed?

Ask how the proposed removal relates to the cancer’s location and extent, and how the cut edges of the removed tissue (margins) will be checked. A personal plan should explain why a smaller or larger operation is appropriate for you.

  • Ask which alternatives were considered.
  • Ask what would make the plan change.

A physical teaching model helps explain the proposed removal and tissue edges.

Separate educational materials for breast conservation and reconstruction, with an implant demonstration sample.
02 · Weigh the details

How will breast shape be considered?

If breast-conserving surgery is feasible, reshaping may be discussed around the gap left by removing the cancer. If mastectomy is proposed, reconstruction is a separate discussion. The plan should explain what each proposed technique is intended to achieve.

  • Conservation: how will the remaining tissue be managed?
  • Mastectomy: what shape-related options are suitable?

Breast conservation and reconstruction address different surgical situations.

Multidisciplinary clinicians reviewing findings and a treatment schedule.

How will surgery fit with other treatment?

Ask how surgery fits with radiotherapy and medicines. In selected early cancers classified as ER-positive and HER2-negative, Su’s study examined whether a 21-gene test of tumour activity changed chemotherapy decisions. It did not study how to choose breast surgery.

  • ER-positive means the cancer has oestrogen receptors; HER2-negative means no excess HER2 protein.
  • Ask what each test could change and which steps depend on the final tissue examination.
Discuss treatment sequence
A patient discussing her written priorities while a clinician listens.

Have I explained my priorities clearly?

Tell the team about your worries, practical needs and preferences. A study coauthored by Professor Su explored patients’ difficulty making surgical decisions and their satisfaction with those decisions. It did not test whether a particular consultation method improves outcomes.

  • Tell the team which choices or consequences worry you most.
  • Ask for explanations you can repeat in your own words.
Patient and clinician comparing the original plan with final pathology findings.

What if the final findings are different?

A plan can include a next step if cancer reaches the cut edge of removed tissue, or if other findings change the picture. Ask which results could lead to further treatment and how you would take part in that decision.

  • Clarify the likely decision points.
  • Ask when and how final results will be discussed.
A patient explaining her treatment plan in her own words while a nurse listens.
03 · Prepare your next step

Can I explain my plan in plain language?

Before deciding, check that you can describe the planned operation, its purpose, the main benefits, risks and practical effects, and what happens afterwards. This is a discussion checklist, not a validated score or a substitute for clinical assessment.

  • Ask about anything you cannot yet explain.
  • Keep the agreed plan and contact details together.
Discuss consultation planning

Evidence and further reading

This educational guide draws on publications coauthored by Professor Fengxi Su. Additional current guidance is identified separately. The explanations support discussion with your care team and do not determine individual treatment.

Related guides

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