The "Big Four"

At the outbreak of the Second World War, there remained only four recognized Plastic Surgeon in Britain. They became known as “The Big Four”

Following a flying start, when arguably it became a defined surgical specialty at Sidcup during World War I did plastic surgery thereafter take off so slowly in Britain? It developed much more rapidly in those countries, to which surgeons returned from Sidcup – Australia, New Zealand, Canada and particularly the USA. Nevertheless, Harold Gillies, Thomas Pomfret Kilner, Archibald McIndoe and Rainsford Mowlem became the dominant inter-war years “first generation” of British Plastic Surgeons, responsible for training a second. This new batch became essential to staff the rapidly established Emergency Medical Services hospitals set up to treat both civilian and services casualties at the beginning of World War II, later becoming the initial batch of NHS plastic surgery units.

The ”Big Four’s” individual significance is ranked, coincidentally, in alphabetical order. Each was consecutively a protegee of Gillies. Kilner having trained and worked at Sidcup with him during the first World War, became junior partner in the Gillies private, pre-NHS, post-war practice. That practice gradually acquired two additional trainee assistants, in first McIndoe, then Mowlem. Both, like Gillies, New Zealanders with close associations to Dunedin Read more about ther Dunedin Connection. The practice gradually split as each gained experience, hospital appointments in and around London, and greater desire to be independent practitioners. 

Variously known also referred to as “The Four Great”, or “The Four” these giants of the nascent specialty undoubtedly established the foundations of plastic surgery in Britain. Throughout their careers they continued to exert significant a pervasive influence in the way plastic surgery was developed, practiced and taught, from their initial vantage point in the centre of London. This dominance was only broken once the Second World War forced regional units to be established, demonstrating that reconstructive surgery could be practiced and evolved to high standards outside the capital.