One breast is bigger. One is smaller. It sounds simple — it almost never is.

Tuberous breast deformity, Poland syndrome, IMF asymmetry, the augmentation-mastopexy blood supply problem, radial scoring of the constricted lower pole, and the intraoperative sit-up that reveals every mistake before you close. Episode 29 — asymmetric breast, from the diagnosis that changes everything to the periareolar purse-string suture that holds it together.

Same operation. Different tumour. Completely different margin. Get it wrong and the patient either loses their face or their life.

Breslow thickness, surgical margins by tumour type, Mohs micrographic surgery, sentinel lymph node biopsy, specimen orientation, frozen vs. paraffin histology, and the positive margin that arrives after you have already reconstructed the cheek. Episode 28 — excisions and oncological skin surgery, from the punch biopsy to the paraffin report.

He won't take his shirt off. His right ventricle is being compressed. And the treatment is a steel bar passed blindly through the mediastinum anterior to his beating heart.

Haller index, the Nuss procedure, the modified Ravitch, perichondrial sleeve preservation, bar displacement, and the cardiac perforation that happens when the introducer goes one centimetre too deep. Episode 27 — sternoplasty, from the echo to the bar removal two years later.

It feels like a lump. It looks like a lump. It has been there for years. And then the CT comes back and it isn't what you thought.

Differential diagnosis of the hard skull lump, CT bone windows, osteoma excision technique, frontal sinus involvement, mucocele formation, and the missed malignancy that no imaging could have predicted. Episode 26 — osteoma and benign skull tumours, from the GP referral to the burr on the outer table.

The skull is missing. The brain is pulsating through the scalp. The patient flinches every time someone walks past him.Stored bone vs. PEEK vs. titanium mesh, dural adhesion release, temporal muscle re-suspension, bone resorption, infected implant removal, and the syndrome of the trephined that nobody teaches in medical school. Episode 25 — cranioplasty, from the 3D CT plan to the drain at 48 hours.

Everyone knows the scar goes in the groin. Almost nobody anchors it properly — and six months later it's on the inner thigh and the labia are pointing at the ceiling.Colles' fascia, lymphatic anatomy, great saphenous vein, fascial suspension, labial traction deformity, and the DVT risk nobody takes seriously enough. Episode 24 — thigh lift, from the pinch test to the compression garment.

Medial antebrachial cutaneous nerve anatomy, axillary Z-plasty, tension-free closure, lymphoedema risk after axillary clearance, and the scar that must be accepted before the patient goes to sleep. Episode 23 — brachioplasty, from the pinch test to the compression sleeve.

Everyone thinks it's simple. It's not.

Scarpa's fascia, the subdermal plexus, tumescent lidocaine dosing, the zone rules that prevent skin necrosis, and the fever on day 4 that means necrotising fasciitis until proven otherwise. Episode 22 — liposuction, from patient selection to the compression garment.

She cannot close her eye, cannot smile, and her mouth is pulled to the right. Which problem do you fix first — and why does the answer determine whether she keeps her sight?

Facial nerve anatomy, gold weight implants, cross-face nerve grafting, free gracilis transfer, masseteric nerve coaptation, and the 18-month wait before a smile appears. Episode 21 — facial palsy reconstruction, from corneal protection to the first spontaneous smile.

Every other option has failed. The chest wall is irradiated, infected, and exposed. This is when you call for the omentum.

Gastroepiploic artery anatomy, laparoscopic harvest, subcutaneous tunnelling, split thickness skin grafting over omentum, and the bowel injury that cannot happen in a contaminated chest wound. Episode 20 — omentum flap, from the CT scan to the VAC dressing.