Smooth Breast Implants

There has been a resurgence recently in the use of smooth breast implants for breast enlargement.

Breast implants were invented in 1961 and the first manifestation of them had a smooth shell.

This was not adherent when placed inside the breast and had a tendency to move and for visible rippling.

In 1968 polyurethane foam implants were introduced which consisted of a silicone implant surrounded by a three-dimensional foam.

The scar tissue would grow into the foam rather than forming a smooth shell around the implant and so when it contracted, it was broken up by the foam and it did not compress the implant and make it feel hard.

In the 1990s there was controversy about polyurethane implants and they were withdrawn from the market for a period of time.

It was recognised that the roughness of the foam was beneficial in the development of capsular contracture and so the shell of smooth implants was roughened in a process known as ‘texturing‘ to roughen the surface and mimic polyurethane foam.

In the UK, textured silicone implants have been the mainstay for breast enlargement with only a minority of cases performed with smooth silicone implants.

Until now…

ALCL is a cancer of the capsule around breast implants and has been associated with the texturing of the implant.

For a long time there were no cases of ALCL in patients with smooth breast implants.

There are some now, but it is a lot less likely to occur in patients with smooth breast implants compared to those with textured or polyurethane foam implants.

For this reason, many surgeons are moving towards smooth breast implants rather than textured breast implants.

Time will tell whether we start to see more problems with rippling or capsular contracture.

Here at the STAIANO Clinic, we are not tied to any make or manufacturer of breast implants.

We will talk to you about the pros and cons of smooth implants, textured implants and polyurethane foam implants so that you can make the best decision for you.

There are risks of using smooth implants which is why they were modified in the early days of implant development.

However there is now the benefit of the low risk of ALCL which needs to be balanced against these risks.

If you have any questions about breast implants you can download my guide with Frequently Asked Questions here or join me on Facebook LIVE at 7pm every Tuesday evening when I hold a Q&A every week.

I am holding a breast implant event from 5-7pm on Wednesday January 29th 2020 if you have any questions about breast implants and want to learn about the pros and cons of the different types of implants as well as alternatives to having breast implants at all.

Feel free to come along and please bring a friend. There is no need to book but if you book in advance, you can have a free sizing session with our clinic nurse Vicki.


If you have any questions you can contact us on 0121-454 3680 or email us at


Who makes the best breast implants?

The Best Breast Implant?

Patients do a huge amount of research about the best breast implant.  It is good to be informed before having breast augmentation and in this day and age with the internet and information that is freely available, it is reasonable to come to the clinic armed with ideas and expectations of which implant you would like.

We encourage this and one of the unique things about the clinic is that we are all fully trained plastic surgeons, so I feel that we appeal to a group of patients who do tend to research things a bit more and will choose a clinic based on the experience, expertise, and aftercare, rather than purely the price.

However, when it comes to the ‘best breast implant’, I do think that patients can tend to over-estimate the importance of certain aspects.

I often hear them asking for a certain make of implant because they have been told they are the best.

Now if you think about what a breast implant is, it is a silicone shell filled with silicone gel, the gel inside the implant comes from one factory in Texas, so regardless of the make they all have the same gel and the shell is either textured, smooth or polyurethane foam.

There is not a great deal to distinguish between different makes of smooth implants, and whilst there are some differences in the texturing between different makes of implant, I am not sure whether it would be enough to say that one is the better than another.  If you want polyurethane implants, then there is only one manufacturer in the world who makes them, Polytech, so you have no choice!

If there was one manufacturer that was best, we would all use it, but the reality is that there are several very good well-respected manufacturers all of whom make high quality implants.

Trust me, if one make was the best we would be using it.

It is a bit like suggesting that one make of car is better than another.

Is BMW better than Mercedes?

What it often comes down it is actually a model.

It is hard to compare a two-seater sporty BMW with an enormous Mercedes 4 x 4 SUV, but just like choosing a car, you need to think about what sort of model you want, what sort of shape you want, and what sort of look you are trying to achieve, and this is going to affect the outcome much more than the actual manufacturer of the implants.

You can see in the video below, I discuss the importance of the shape and profile of the implant in achieving the final result.

It is not enough just to choose a certain shape and profile for an individual, because that shape and profile has to be matched to your body frame in terms of the dimensions of your chest and the shape and volume of the breasts that you have currently.  The best breast implant for one person may not be the best breast implant for you, even if you think that person has a great result.

This is why it is so hard to give an opinion to someone in an on-line chat or in a forum, because we would need to see you, measure you, and formulate a plan to decide on the best breast implant which is unique to you.

We won’t tell you what implant to have, but we will help you come to a decision as to what implant might be the best for your frame.

In fact, I always say that the most important decision is not about choosing the best breast implant.

The most important decision is your surgeon; it does not matter what make or shape of implant you have, if it is not placed correctly it will not look good.

If the implant is placed too high or too level, too wide apart or too close together, you will be unhappy with the result regardless of the make, shape, profile, or texturing.
This is the decision that is going to make a tangible difference to the outcome that you get.

So, choose your surgeon wisely, both in terms of their qualifications and experience, but also in terms of their personality and your rapport with them.

I do not think you can underestimate the gut feeling that you get when you see a surgeon, because whilst it is only a one-off operation, we do like to keep an eye on you and see you for months and years afterwards.

It is important that you feel you can talk to us, raising any questions or concerns, and convey your desired results to us.

If you do not feel that you can, then I suggest you keep looking.

There are plenty of fully qualified plastic surgeons around.

As long as you choose someone who is or has been an NHS consultant in plastic surgery, then you can be sure they are fully trained.

If you want to know more about what is involved in plastic surgery during the training and how to choose a plastic surgeon, you can get a free copy of my book from my website entitled ‘Never Accept A Lift From Strangers, and if you have any questions, you can find me on Facebook every Tuesday night at 7 o’clock and I would be happy to answer them.

But whilst it is important that you are happy with the manufacturer, shape, the texture, and the profile, and all the aspects of your implant choice, please try not to worry about it too much as it might not be as important as you think.

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When can I go back to work after surgery?

 The major surgery which we do at the Staiano Clinic, such as breast augmentation, breast reduction, breast lifts, gynaecomastia and tummy tucks have a dramatic effect on your body both physically and mentally and you should allow enough time to recover from them.

Surgery often involves tightening or stretching the skin, so it can feel tense and swollen for some time and you should avoid exerting yourself.
Not only does this run the risk of putting tension on the wound and the possibility of the wound not healing up as well as we would like, but it will also increase the swelling and the swelling can take some time to subside.

If you overdo it in the early stages then it can be a false economy in the long run and you would have been better off giving yourself more time to let things settle to start off with, and although cosmetic surgery has an image of a lunchtime procedure with no downtime, if you are seeking a dramatic change in the shape of your body then you should expect and plan for a period of rest and recuperation.

The First Week

The first week after surgery is always uncomfortable.

Everything feels tight and tender and you will not feel like doing much.

You will be able to potter around the house and look after yourself, but you should plan for little more.

After the first week you will come back to have the dressings removed and you usually do not need any dressings after this time.

However, everything will still be quite fragile and you should continue to take things easy in the second week, although you may be able to work from home for short periods.

Depending on the procedure you have had done and how you are feeling, you should be able to drive after two to three weeks although occasionally you are able to drive after one week.

You should always check with your car insurance company to make sure you are insured and talk to us as we will be able to guide you.

Every individual is different and you should listen to your body, so that if things are uncomfortable or start to swell, then you should ease off and rest.

It is important not to be too immobile and we always encourage you to keep your legs and arms moving, either by walking around or gently exercising while sitting, as well as taking deep breaths to expand up your lungs.

We encourage you to cough if you feel like you have anything on your chest.

After Two Weeks

After two weeks you may be able to resume gentle activities and you may be able to go back to work as long as it is not too strenuous.
If you have had surgery to your upper body, now is the time you can start exercising your lower body on the exercise bike or the stepper at the gym, but you should avoid too much activity with your arms.

Two To Four Weeks

Between two and four weeks you will start to feel better, although the scars will still be quite fragile and the tissues will still be quite swollen.
We normally advise people to wait at least four weeks before starting to massage their scars with cream, as they might be quite red and firm at this stage.

Four To Six Weeks

After around four to six weeks you can start engaging in more strenuous activities including heavy lifting or upper body exercises at the gym.  I would stress that this is the time to start these activities which does not mean that you should go straight in, doing the same level that you were pre-operatively.  It is merely that you can start to gently see how you feel and gradually build up.  If it is uncomfortable or the tissues swell then you should stop and give yourself more time to rest.

Three Months

It takes about three months before the shape and the scars really start to settle and there can be numbness or altered sensation, which can take many months to subside.

Twelve Months

At around twelve to eighteen months, you will be getting an idea of what the final results should be like, but it is not uncommon to still have some degree of settling after this.

We keep a close eye on you in the clinic and encourage you to get in touch if you have any concerns about how you are healing.  We realise that everyone is an individual and this is just guidance.
If you have any questions or concerns then we’d love to hear from you.  You can e-mail us or call us.
Or you can ask our director, Jonathan Staiano, a question LIVE on Facebook at 7 o’clock every Tuesday evening, so feel free to drop in.

What Is The Minimum Age For Cosmetic Surgery?

How Young Is Too Young To Have Cosmetic Surgery?

We often get enquiries at the clinic asking what age patients can have cosmetic surgery.
There is a simple answer to that and a more complicated answer.
The simple answer is that we only treat patients who are over 18 due to the strict guidelines and controls over operating on children

…but the real answer is that there is no limit on the age for cosmetic surgery.

One of our surgeons at the clinic, Khurram Khan, is a specialist in paediatric plastic surgery and holds an NHS consultant post at the Birmingham Children’s Hospital.
Children undergo cosmetic surgery all the time.
Cleft lip deformity is primarily a cosmetic problem.  This is performed on babies.
Prominent ear correction is commonly performed around the age of 6.
It is not unusual to treat children with vascular lesions, moles, or birthmarks which are primarily a cosmetic problem.
It comes back to the image of cosmetic surgery – the public has a picture of a glamour model with enormous breasts and huge lips.
We are about improving quality of life and this is what we, as plastic surgeons, are trained to do.
Cosmetic surgery comes in many forms and it may be clearly ethical and justified to perform surgery on a child if it is in their best interest.
However, I think the question is often used when talking about breast surgery and in those circumstances there is a good reasons for waiting before having surgery.
It is important before operating on any growing organ, to wait until it has stopped growing before performing surgery, so it is completely reasonable to wait until around the age of 18 before considering having any breast surgery.
Having said that, there may be an argument to perform surgeries sooner in situations of significant asymmetries or extremely large breasts, but by and large, it is common practice to wait until puberty has finished and in fact, the longer you wait, the better.
This is particularly true if considering breast implants because these can have ongoing issues and the need for further surgery in the future, so will require detailed discussions with the patients and the family before embarking on any surgery.
So whilst the easy answer is that you should wait until you are 18 before having cosmetic surgery, like most things it really depends.
It is not so easy to give blanket answers to all-comers.

It depends on what your problem is, how that problem is likely to develop, and how that problem affects you.

It really requires a conversation, and perhaps several conversations with you and your family so that we can create a plan and give you the best result possible.
We are delighted to have Khurram Khan at the clinic, as he is one of only a very select group of plastic surgeons who specialise in paediatric plastic surgery and so he has experience of operating on children of all ages.
We are also very lucky to have close links with local private hospitals who have facilities in theatres and on the wards to treat paediatric patients.
So the headline answer is that you should wait until you are 18 before having cosmetic surgery, but if you think that you or your child might benefit from surgery before the age of 18, we would be happy to discuss it with you, and we always love to hear from you.
Call us on 01214543680 or e-mail
Our director Jonathan Staiano does a Live Q&A on Facebook every Tuesday at 7pm, so feel free to drop in there.

If You Are Considering Cosmetic Surgery, Download My Guide With ‘5 Questions To Ask Your Plastic Surgeon’ To Make Sure You Are Treated By A Specialist

Breast Implants & Pregnancy

Have you had breast implants and have now become pregnant?

Or are you thinking about getting breast implants and worried what the effect of pregnancy might have?

Then you are in the right place! Our consultant plastic surgeon Jonathan Staiano has done a vlog to discuss the impact of pregnancy on breast implants. It is nothing to worry about if you do get pregnant once you have implants but it is definitely something to consider before having breast implants as pregnancy does change the breasts.
You can find out more about this here.

If you would like any more information on breast implants you can download our guide here or you can visit our webpage dedicated to implants, which contains before and after pictures, testimonials and further information. You can also call us on 0121 454 3680 or email on

Do I Need A Mastopexy To Make My Breasts More Perky?

Do I Need A Mastopexy?

A mastopexy is a great way to reshape the breasts but when it comes to achieving a good outcome, it is important for us to communicate what might be possible so that we can align our goals.
Over time the shape of the breasts can change and these changes can be accelerated by having children or losing weight, resulting in a droopy or saggy appearance to the breasts.
Many patients want to achieve a more perky appearance to rejuvenate the breast contour.
The reasons that breasts lose their perkiness is because the skin gradually stretches.
This happens over time in all of us because of the effect of gravity.

The Alternative To Mastopexy

It is not possible to give elasticity back into the skin, and so there are two options to combat the problem.

  1.  To remove the extra skin and tighten the breast.
  2. To add volume to the breast to fill the skin envelope and tighten the skin.

So for this reason, patients often wonder whether it is a mastopexy they need or breast implants; with a mastopexy doing the former, and implants the latter.


Option 1: Mastopexy to remove the skin and tighten the breast


Breast Implants instead of mastopexy

Option 2: Breast Implants to fill the skin (without a mastopexy)

The main difference is the size of the resulting breasts and that will be about the same size after a mastopexy, but bigger after implants.

So it depends on how big you want your breasts to be.

If you want the breasts to be the same size as they are or smaller, then it is a mastopexy or a breast reduction that would restore the perkiness, but if you wanted them to be bigger, then implants might be all that is required.
However, if the breasts have sagged significantly, implants might not be able to fill the skin envelope enough and you may need to combine it with a mastopexy.  You can read more about a mastopexy combined with implants here.
Often if restoring the breasts to a more perky shape is the primary goal, then a mastopexy on its own is the best option. 

The Limitation Of Mastopexy

You will need to be prepared for the sort of shape that you can achieve with a mastopexy.
We always stress that gravity will continue to operate on the breast and so it tends to settle to a more natural shape without the round and full look that is associated with breast implants.
The problem comes when people want the rounded look and do not want to be bigger, because sometimes you may consider having implants just to achieve this look.
This is an option, but does carry with it the potential complications and limitations associated with implants.
This is why an in-depth consultation is always advisory, so that you can discuss your aims and objectives with your surgeon to see if a mastopexy would be suitable for you.
We can discuss whether the shape you could achieve, which can often be quite transformational to the breast, will be in line with what your goals are.
When you have a mastopexy, there will be a full and rounded look in the upper part of your breast to start off with, but over time they will settle to a more natural shape.

Mastopexy settling

After mastopexy, the fullness in the upper part of the breast settles into the lower part of the breast

Our primary goal is to have a happy patient and a happy patient is one who knows what to expect and can make an informed decision as to what might be the right operation for them.
We will not dictate to you what surgery you should have, and we will always inform you of what likely outcome you can reasonably achieve.
There is never any obligation to proceed.
If you have any concerns or doubts, then it is always best to go away and think about things and consider what surgery might be the best for you.
If you would like to come to the clinic for a chat, you can email or call us on 0121 454 3680.

For more information you can download one of our guides below:

Request Our Mastopexy Guide

Request Our Breast Augmentation Guide

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The Pros and Cons of Fat Grafting

The Pros and Cons of Fat Grafting

 I have recently seen a patient of mine in the clinic on whom I performed fat grafting to the calf.  She is a young lady who was born with a congenital defect of her ankle which meant that her left leg did not grow in the same way as her right leg and her calf and ankle were much thinner on the left side. We spoke about her options which were either to perform fat grafting or use an implant.  There can be particular problems with implants in the calf, particularly in terms of infection or being able to feel the edges of them and sometimes they can erode through the skin.
Of course, there are potential complications with any operation and there are complications with fat grafting too, but the main thing was that she was so young that the long-term durability of fat grafting is superior to implants and so we chose to go down this route.  She needed two operations spread over several months, but she has really got a fantastic result.  Her calf feels soft and supple just like the other side which is not surprising because once the fat is grafted it is normal fat.  The beauty of it is that it will change with you, so that if you put on or lose weight fat cells will get bigger or smaller just as they would have done if they had stayed in their donor site, (in this case her thighs).
I love the technique of fat grafting and you can produce really exceptional results, particularly when there is a 3-dimensional defect, because the fat can be laid down in a very careful and precise pattern.

Fat Grafting for cosmetic breast surgery

Clearly most of the work we do here at the clinic is in the breast and fat grafting for the breast is not as popular as you might think.Moving fat from one area and injecting it into the breast to enhance the volume without the need for silicone implants and all the potential long-term effects they can have is surely appealing.
But the main problem for cosmetic breast augmentation is that fat grafting only produces subtle results, and by definition most people who require breast augmentation are slim and so there is usually a limitation on the amount of fat that can be removed and this then has to be split between the two breasts.
I was privileged to be invited on the Faculty for the BAAPS 2017 Plastic Surgery Conference last week and was delighted to meet Foued Hamza who practices in Paris and London and presented his results of fat grafting in the breast.  He showed some really impressive results and also talked about the limitations that he has found during his extensive experience.  Like any surgical procedure the pros and cons need to be discussed with the patient so that we can make an informed decision together.
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The secret to getting a happy patient…

Is to have one whose expectations are aligned with what is feasible with the surgical technique being considered.  Certainly, there is no way that fat grafting can compete with implants when it comes to adding a predictable and significant volume to the breast.
The volume achievable is usually a cup size or less, and so the procedure often needs to be repeated and whilst it can sound appealing, the fact that it is harvested from the abdomen, buttocks or thighs, there is usually not a significant body contouring effect because fat harvesting is much gentler than traditional liposuction and so smaller volumes of fat are removed.
It can also be a bit uncomfortable where the fat is taken from, and there are risks of infection and fat necrosis or oil cysts, so this all needs to be put into the mix as to whether you think fat grafting to your breast might be right for you.
Because we are all specialists here at The Staiano Clinic we can talk to you about the pros and cons of each procedure and will not expect to have a ‘one size fits all’ approach.
If you would like to know more or have any questions please contact us at the Clinic, you can call us on 0121 454 3680 or email

Do I need a scan to check my breast implants?

Do I need a scan to check my breast implants?

Patients often come to me to ask ‘do I need a scan to check my breast implants?’.
There are different types of scans that can be done to check on the breast:


This is an x-ray that looks at the density of the tissues and is mainly used for looking at lumps in the breast.
It is not very good at looking for problems with breast implants.
*note: a lot of patients worry about having a mammogram if they have got breast implants in, but there is no need for concern because it is routine to use implants in patients with breast cancer who need regular mammograms. You just need to let the xray doctors know that you have implants in so that they can adjust the way that they do the mammogram.

Ultrasound Scan (USS)

This involves using a handheld probe with gel on the skin to look at the integrity of the implant.
It is the same scan that is used when you are pregnant to get a picture of your baby.
It is often the first test for looking for rupture of breast implants.

Magnetic Resonance Imaging (MRI)

This is a bit more involved than an ultrasound scan.
You lie on a table and a large doughnut passes around you.  The doughnut contains magnets so you must tell the operator if you have any metalwork inside your body.
An MRI scan is more sensitive and specific than an ultrasound scan.  This means that it is more likely to be able to tell if the implant is intact.

Intracapsular Rupture Of Breast Implants

All implants are surrounded by scar tissue, known as a capsule and if the implant ruptures but the capsule stays intact, all of the gel will be held within the capsule.  This is known as an intracapsular rupture and this can happen without you being aware of it, in which case it is known as a ‘silent rupture’.
The cause of this is a constant friction of the implant shell, perhaps because of a fold or knuckle in the implant that might be made worse by some degree of capsular contracture.  Over time there can be a thinning of the silicone shell in areas of wear and this can lead to a gradual break or tear.
It is for this reason that I personally do not advocate routine scanning of patients who have breast implants in.
Scans have a cost, both financially and in terms of your health by exposure to radiation (for X-rays and CT scans) and so should only be performed if they are going to change how you are treated.
While they are very accurate in predicting whether your implant is ruptured or not, no scan is 100% reliable. This means that there is a small chance that the scan could say that your implant was ruptured, yet it might be intact and the scan might say that it is intact and it may be ruptured.
I have seen cases where the scan has been wrong both ways.
My practice is to offer all of my patients a yearly review where they can come back to the clinic for a check-up to see if there are any concerns or questions about your implants.
I would only offer a scan if there was a change in the size or shape of your breast that could indicate a problem with the implants.
If there was a problem with capsular contracture, then this is diagnosed clinically, not with a scan.
We make a decision to perform a capsulectomy and replacement of implants based on how bad the capsular contracture looks and feels, not on the basis of any scan.

Extracapsular Rupture Of Breast Implants

So far I have talked about a ‘silent rupture’ of breast implants, which is usually confined to the within the fibrous capsule around the implants (intracapsular rupture) and you normally do not notice when it happens.
This is different to an extracapsular rupture which is where the silicone shell of the implant ruptures as well as the fibrous capsule around the implant.
This is a different situation to an intracapsular rupture and this is the sort of thing that most people will imagine when thinking about rupture of breast implants.
It takes a significant amount of trauma to forcefully rupture the implant shell and in these circumstances, the capsule may also rupture resulting in a change in the shape of the breast and the presence of free silicone within the breast tissue.
Silicone within the breast tissue can cause lumps and may travel to the lymph nodes in the armpit causing lumps here.
This is something that we saw quite a lot of during the PIP scandal where a French manufacturer was producing poor quality implants with a weak shell and a high rupture rate. These implants were filled with non-medical grade silicone which was irritant to the breast tissue and removal of these breast implants was recommended by the Plastic Surgery Associations.
The situation today is not as desperate as this because modern day implants have a thick shell (we only use premium breast implants which have a double shell).  Also, the gel in implants these days is firmer than it was in the past, this is known as ‘cohesive gel’ and we call the implants ‘form stable’ which means the silicone does not tend to leak like a liquid if the shell ruptures.
It does mean that modern day implants feel firmer than older implants, but they are safer in situations of rupture.
The silicone gel is medical grade and not so irritating to the breast tissue, but nevertheless, if there is an extracapsular rupture with free silicone in the breast, your implants should be changed.
An extracapsular rupture is normally quite obvious.  There will have been some significant trauma, like a road traffic accident with a seat-belt over the implant, and there will have been a change in the shape of the breast.
In these circumstances, a scan would be indicated.
In fact, in any situation where there has been a change in the size or shape of your breast, or if you have noticed a lump, then a scan may we’ll be required to make sure that all is well.

As well as a routine annual appointment, all of our patients have open access to the clinic and can make an appointment to come and see us at any time.

If you have noticed changes in your breast, then you need to get checked out.
This means that you need to see your surgeon, or your GP.  If you have breast implants in, then your surgeon will be able to get an idea by examining you whether you have a problem related to your implants or your breast.
If the problem is related to your breast and your breast tissue, then your surgeon may refer you to your GP to see whether you needed any specialist investigation or referral.
If it is felt that your problem is related to your implant, then a scan can help to delineate this, not only looking to see if the implants are intact but also looking for any suspicious lumps or swelling that could signify something more sinister.
For more information give us a call on 0121 454 3680 or email

Download Our FREE Guide With Frequently Asked Questions About Breast Implants Here

Breast Uplift With Implants

Have you been looking for more information on having a breast uplift with implants?

In this video Jonathan talks about the combined procedure of having a breast uplift with implants.

Not all plastic surgeons will perform the operation of a breast uplift with implants because it is a difficult operation with a relatively high complication rate.

Here at The Staiano Clinic, we do offer breast uplift with implants as a single operation, but we discuss the potential risks as well as the benefits of performing it in a single operation.
Like many things in plastic surgery, there are no rights or wrongs and it is up to you as an individual to get as much information as you can to allow you to make a balanced decision about what is right for you.
There is no doubt that a breast uplift with implants can produce dramatic changes to the breast and in selected cases is the best way to improve the shape of the breasts.  However, you might want to consider either staging the procedure or maybe even just having a breast uplift or breast implants as you may be happy once the shape or the volume have been improved.
Listen to Jonathan discuss the benefits and risks of a breast uplift with implants with examples of his work.

If you have any questions, you can find Jonathan on Facebook Live every Tuesday at 7pm for a live Q&A, so please like our page and join in.
If you would like any further information, please visit our page at
You can also call us on 0121 454 3680 or email:

Size Doesn’t Matter

In this video Jonathan discusses why size is not the only factor to consider when it comes to choosing breast implants.