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If all you have is a hammer everything looks like a nail

There are a lot of different surgeons who perform cosmetic surgery.

They range from plastic surgeons to general surgeons, ENT surgeons, maxillofacial surgeons and even people who are not surgeons at all such as GPs or dermatologists.
This is not a problem in itself as long as the doctor is working within their scope of practice.
It may be that an ENT surgeon will be just as competent to perform a rhinoplasty as a plastic surgeon would. The problem comes when surgeons start working outside of their scope of practice and this is something that The Royal College of Surgeons is trying to address by credentialing surgeons which means they will assess them to make sure they are only working within areas that they have been trained to be competent in.
The problem with this is that first of all it has not been launched yet and secondly, it is a voluntary process so unless you know to ask or check whether your surgeon has the appropriate credentials then

untrained doctors will continue to be able to perform procedures on unsuspecting patients who may not know or feel comfortable to ask the necessary questions.

I am always surprised when I talk to people about some of the topics in my book.

They are shocked when they hear that there are surgeons out there performing breast surgery whose formal surgical training may have been in ENT surgery or accident and emergency surgery.  While it might sound unbelievable, it is happening and there is absolutely no law against it.
Unfortunately many surgeons do not make what their area of specialist training is, if it does not fit with the more lucrative cosmetic procedures that they mainly perform. You cannot assume that just because your surgeon is working in a plastic surgery clinic and is talking to you about having breast implants that they are a plastic surgeon or have any specialist training in cosmetic breast surgery.
We are very fortunate that the complication rate of most cosmetic surgery is very low but this allows untrained surgeons to get away with performing surgery on patients.
However, the problem comes when there is a complication or if the patient has a complex problem such as a breast asymmetry or a chest wall deformity.
It is in these situations where a surgeon who has experience of not only cosmetic breast surgery but also reconstructive breast surgery will have the necessary skills and experience to be able to foresee potential problems and tackle any issues that may arise.

Cosmetic breast surgery is not easy.

All patients will have some degree of asymmetry to a greater or lesser degree.
It is about identifying this, managing the expectations and knowing when and what to do about it.
It may be putting different size implants in, sometimes to maintain the base width of the implant and different profiles of implants will need to be used in each breast and this requires skill and experience.
It may be the use of internal sutures to redefine the inframammary fold and to ensure that the placement of the implants are accurate.
It may require a combination of a breast lift or possibly surgery to address the chest wall.

This is why I feel it is important to see a specialist for your procedure and to Never Accept A Lift From Strangers.

Here at the Staiano Clinic we are all plastic surgeons who specialise in breast surgery.
We love seeing people who have done their research and welcome questions.
If you do not feel that you are in a position where you can ask questions of your surgeon in your clinic then beware.
If you want to know more, then you can get a copy of the 5 Questions To Ask Your Plastic Surgeon here.
If you have any questions, then you can tune in watch Consultant Plastic Surgeon and  our Director, Jonathan Staiano on Facebook Live every Tuesday night at 7pm for a live Q&A session.  You can join in live or post your questions in advance to laura@staianoplasticsurgery.estaging.co.uk using the hashtag #AskJJ.
If you want to know more about plastic surgery training and what it takes to become a cosmetic surgeon.  Check out Jonathan’s book ‘Never Accept A Lift From Strangers – how to choose the best plastic surgeon for your cosmetic breast surgery’.  It is available to buy through our website or on Amazon.

Second Hand Breast Implants on Ebay!

Did you hear about the lady who was selling her 2nd hand breast implants on Ebay?

She said that they didn’t quite fit her, so she got a new pair!

I think the story was a bit of a joke.

I don’t doubt that someone would actually try to sell their old implants,

I mean you can get anything on Ebay these days (how about a hand made suit of armour for a guinea pig?).

But I don’t think that anyone would have actually bought them and seriously thought about implanting them, would they?!

The press love to get hold of a story about dodgy cosmetic surgery and dubious practices, but I think that part of the problem is the lack of regulation in the industry.

The fact of the matter is that there is no law against anyone selling a used pair of implants and perhaps more worrying, there is no law against anyone buying these implants and implanting them in someone.

Of course, if that someone was a surgeon and a member of a professional association (like BAPRAS and BAAPS for plastic surgeons), the association and probably the GMC would take a dim view of this and I am sure there would be disciplinary action.

However, the problem is that that someone does not have to be a member of any professional body and doesn’t even have to be a surgeon.

In fact, that someone doesn’t have to be a doctor at all!

There is more regulation on who can operate on your goldfish than there is on who can operate on your daughter (perhaps goldfish is not a good example and your dog would be better, anyway, the point is that there is no regulation on who can operate on a human).

We are currently relying on patients being able to get enough information about their practitioner to make an informed decision and avoid being treated by non-trained individuals (aka cowboys).

The problem is that it is happening and it is happening to high profile people – Colin Hendry, the premiership footballer and Usher and Kanye West, the music stars have all had family members come to harm having plastic surgery performed by surgeons who were not fully trained and affiliated with the plastic surgery associations.

If it can happen to them, what hope have the rest of us got.

I see that Ebay has withdrawn the listing for the breast implants, but you can still buy dermal fillers from Ebay and you can invite people around to your house and inject them on your kitchen table.
Sounds frightening (and it is), but all perfectly legal.

Totally against good medical practice that all doctors are bound to work within and there is no way the CQC (Care Quality Commission) would approve the facilities in your kitchen table to be suitable to be performing non-surgical procedures.

But the fact is that, because you don’t need to be a doctor to perform these procedures and you do not legally need to work in a facility that has been approved by the Care Quality Commission, these sort of practices go on and we don’t really know the extent of it.

We only hear about it when it goes wrong.

It is good to raise awareness about the perils of this unregulated industry, but it would be nice if there were some positive stories now and again.

Plastic and cosmetic surgery can have a tremendous impact on people’s lives and is a powerful force for good.  It has been given a bad name, but there are still a huge number of appropriately qualified doctors and nurses providing high quality care in an ethical way in safe and clean medical facilities.

Please ask questions and be aware of the level of training and experience your surgeon or practitioner has (check out my book for an in depth guide about surgical training).

Caveat Emptor – Let The Buyer Beware

Oh yes, and don’t buy your breast implants from Ebay!






B-Lite Implants – Should we be protecting our patients from them?

I was very pleased to see the arrival of B-Lite implants recently on visiting one of our plastic surgery conferences.
The concept of manufacturing an implant that is lighter than the standard silicone implant is something that I heard about some time ago.
I talk about them in one of my Facebook Live Q&A’s here:

When I discussed this amongst a panel of experts I was in a few years ago, we were uniformly agreed that it would be beneficial if there could be a lightweight implant.
My patients often comment on the weight of implants and although I am always quick to point out that they feel heavier when you hold them in your hand compared to when they are in your body (because of the moment effect, see below). Nonetheless, they do still have a weight and obviously the bigger the implant the heavier they are.

B-Lite Implants – The Moment Effect

The moment effect is something that you might have heard about from your maths lessons and it is the concept that when a weight is held further away from a pivot point it creates a greater downward force than when it is closer to the pivot point.

This is why when you hold a box out with your arms stretched it feels heavier than if you hold it close to your body and so when breast implants are held in your hand or placed in your bra they feel heavier than when they are implanted in your chest and therefore closer to your body.

There is no doubt that breast implants alleviate a huge amount of suffering and unhappiness by restoring volume and shape to the breasts.

However, it is also true that carrying excess weight in your breasts can be uncomfortable which is why breast reduction surgery has such a high patient satisfaction rate.

The B-Lite implants are now available in the UK and you might think:

Great, we no longer use standard implants anymore.

However, you will find that we are very cautious about introducing new things, particularly in medicine.

This is particularly true in the field of breast implants with the recent PIP scandal although the PIP scandal was not created because a new implant was introduced to the market.

The PIP scandal was created because of criminal activity of an implant manufacturer in France.

Nevertheless, it has tainted the whole industry and made everyone even more cautious than they already were.

I am a believer in offering my patients all the available options which is why for some time now I have offered polyurethane foam implants where many of my colleagues do not even inform patients of their existence because they do not use them.

This is how I feel about the B-Lite implants.

They are new and I tell everyone that they are new and they are also more expensive than standard implants and so they may not be for everyone.

I also have to say that in my practice I do not tend to use very large implants as most of my patients are looking for a natural result in keeping with their frame.

I do not really see patients who have problems with the weight of their implants.

Having said that I am happy to talk about them although I do not necessarily recommend them because we do not have a large experience of their use and so we do not know what the results will be like in 5 or 10 years.

On talking to some of my colleagues, I know that they do not offer or mention these implants for this very reason because they want to see the long-term results.

This is perfectly understandable.

However, it does leave me to think whether we can be too paternalistic towards our patients sometimes.

As doctors go, I see myself as being on the conservative side.

I am not one to embrace new technologies or devices as any rep who has come to see me will tell you.

I certainly do not believe in trying to look for solutions to problems that do not exist.

In my breast reconstruction practice there are always new types of mesh or glue that are being introduced and claims that they will transform the operative time or the postoperative stay.

I have never been one to adopt them and would rather see the outcome through long term patient studies.

This is why I found it odd to be at the other end of the argument with the B-Lite implants and my colleagues were saying that they prefer to wait and see long term results.

I think the difference is that there is a significant element of patient choice when it comes to implant selection which is not true in breast reconstruction.

When it comes to selection of type of suture or mesh or whether glue is used or not with a reconstruction, I do not feel that the patient will have a significant opinion on this, so I feel I can make that decision on my own without involving the patient.

There are many patients who are happy to leave it up to the surgeon as to the type of implant too, but then there are also those who get very involved with the implant selection.

This is understandable because it is something that is going to go into their body for a very long time.

I do my best to facilitate the decision and present the pros and cons of each type of implant and I certainly have my own preferred makes and manufacturers but I am not tied to any particular make and so happy to discuss and offer any of the implants available as I have used most of them.

This is how I feel about B-Lite implants and I simply inform patients that they exist and give them as much evidence as I can so they can make an informed decision as to whether it is something that might be right for them or not.

It is not like they are a prototype or unlicensed, as they have all the relevant approval to be used in the UK. They are actually made in the Polytech factory which makes the polyurethane implants that we use.

I know that patients can be swayed by what we say and there is a lot of hyperbole used in breast augmentation surgery talking about the best method for this or the most advanced technique for that, but when it comes down to it, there is often no strong scientific evidence to support one method or technique over another and it is just an opinion, not facts.

Our job as doctors is to work through the opinion and look at the facts.

I also think our job is to pass those facts on to you to help you make a balanced and informed decision.

I will continue to mention B-Lite implants to my patients and give my opinion, but I will try not to sway you one way or another.

Download our FREE Guide: BREAST IMPLANTS – YOUR QUESTIONS ANSWERED






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.






When Should You Change Breast Implants?

There is a lot of information about when to change breast implants but it is important to separate the facts from opinions.

  • Have you heard that you need to change breast implants every 10 years?
  • Do you know what to look out for if you have had your implants in for several years?
  • Do you need to change breast implants if you have a capsular contracture?
  • How can you tell if your implants have ruptured?
  • Do you need to have a check up of your implants at a certain time?
  • Are there risks if you were to change breast implants?

Jonathan is one of the UK’s leading plastic surgeons with a practice dedicated to cosmetic breast surgery. If you are worried or just curious about whether your breast implants need to be changed, watch this video to find out the answers.

If you have any questions or would like to come to the Staiano Clinic to have your breast implants checked, please get in touch and one of the team will be happy to help.

ALCL – Rare Cancer associated with Breast Implants

You may have heard in the news about ALCL, a rare form of cancer associated with breast implants.

Read more

Polyurethane implants: 5 key questions, answered

Polyurethane breast implants are used widely for breast augmentation surgery in South America, Europe and Australia. Although popular with high satisfaction rates, they have also sparked controversy in the past. Here are the key 5 questions and answers about Polyurethane implants.

1. What are they?
Polyurethane breast implants are silicone implants with a foamy texture on the outside of the implant. They are manufactured by a German company called Polytech.

2. What are the benefits?
The most significant benefit of Polyurethane implants is the reduced risk of capsular contracture. Capsular contracture is where scar tissue forms around the implant after breast augmentation surgery. This is a natural part of the healing process. In some cases however, over a period of time, the scar tissue can squeeze the implant. This will cause the breasts to harden and they can become painful. With a polyurethane implant, the textured foam layer prevents these harmful, later stages of capsular contraction. The scar tissue grows into the foamy texture and the implant becomes part of the breast tissue. With other types of implants, studies have shown that the chances of capsular contracture can be as high as 20% (1 in 5 women), 10 years after the operation has taken place. With polyurethane implants, the chances of capsular contracture were just 1%, up to 15 years post operation.

In addition, the polyurethane implants are also less likely to rotate in the breast, as the implant is more firmly attached to the breast tissue than with other types of implants.

3. What are the risks (including cancer)? 

As the implant becomes part of the breast tissue, it can be difficult to remove it. If a removal needs to take place due to infection for example, it can make the operation more difficult. The implants were also controversially linked to cancer studies carried out in the 1990s. In a series of trials, a high level of one of the chemicals used in the polyurethane implant was injected into rats and the rats developed the disease. However, this chemical has never been shown to cause cancer in humans and has been found in patients who do not have breast implants. After further studies, an FDA panel calculated the risk to be 1 in 1 million, the equivalent to smoking one cigarette in the lifetime of a patient!.  In other words “ negligible. It is important to note that cancer has never been linked to polyurethane implants in a human being.

There is a rare type of cancer that has been linked with breast implants, but this has been associated with all breast implants, particularly textured silicone implants.  I have written a blog post about it here.
4. Will I need to get them replaced in the future? 

There is a lower chance of needing replacement as the chances of capsular contracture are significantly decreased.  However, you should always consider that there may be a need to have your implants changed in the future.

5. How do I decide whether to have polyurethane implants? 

There are many factors to consider when choosing breast implants, and my previous blog on choosing the right breast implants may help you understand other types of implants and what to consider. There are many factors involved and it’s important that you discuss the right implants for you. I highly recommend talking to as many women as possible who have had surgery and doing your own independent research.
Speaking to a consultant like myself can also help! If you have any questions, do not hesitate to contact me on info@staianoplasticsurgery.co.uk.

I want to be a DD and nothing else will do!

When talking to patients considering breast surgery, I always ask what bra cup size they would like to achieve “ some patients have a very clear view ‘I’d like to be a DD and nothing else will do!’, while others are not so specific ‘I’d like to look natural, be comfortable and in keeping with my frame’.

I always ask the question because cup size is the way that we talk about breast size but I then always say that I cannot guarantee the final cup size.

The bra size is made up of two measurements, there is the chest size, 32, 34, etc., and the cup size, A, B, C, etc.  The chest size should not change following breast surgery (there may be a temporary increase due to swelling) and it is the cup size that is likely to be affected.  However, the precise change in the cup size is difficult to predict for several reasons:

  • bra size is relative.  The bra size is measured by measuring the circumference of your chest (this is the chest size), then the circumference around your bust.  The difference between the chest circumference and the circumference around your bust gives the cup size.  1 inch difference is an A cup, 2 inches is a B cup, 3 inches a C cup and so on.  Because the cup size is the difference between your chest and your bust circumference, it is not an absolute measurement, an A cup will be different for a person with a wide chest compared to someone with a narrow chest.  Therefore, I cannot show you a photograph of a pair of breasts and tell you the cup size, because the same sized breasts on you may be a different cup size if your chest circumference is different to the person in the photograph.
  • bra size varies between manufacturers.  I often have patients tell me that they wear a C cup in one make of bra or a D cup in another make
  • people often wear the wrong bra.   Most people could probably fit in to one cup size bigger or one cup size smaller than they normally wear if they were to adjust the strap size.  It may well be that someone who is a 34D could wear a 36C or a 32DD.

Having said all that, bra size is all we have got to go on, so I always ask what cup size you would like to be.  Just don’t be surprised when I say that I can’t guarantee that I will achieve it!

Watch My Webinar To Learn More About How To Choose The Right Breast Implants 

Only The Best Breast Implants

I often get asked ‘what are the best breast implants?’. Like most things, there is no one answer to this question otherwise we would all use those implants. Most plastic surgeons will only use the best quality breast implants from the top manufacturers like Allergan, Nagor, Polytech and Mentor, which is why very few of us ever used PIP implants.

Most of these carry a lifetime guarantee and have a proven track record in terms of capsular contracture and implant failure rate.

Nagor

Nagor implants are manufactured in the UK and their premium round implants are the Impleo range. They also have the CoGel range, which is their anatomical (or teardrop) implants. They have dense texturing with a double shell and come with a lifetime warranty.  The warranty covers capsular contracture as well as shell failure, however it is important to be clear about exactly what the warranty covers:

  • they will provide a replacement implant as well as an implant for the other side
  • they will allow a size change above and below the replacement implant
  • they will not cover any of the other costs associated with surgery

Polytech

Polytech is a German company who manufacture polyurethane foam coated implants.  They also have a range of silicone implants, however, it is their range of polyurethane foam coated implants that I use mostly.  Polyurethane foam implants have always been known to have a significantly lower rate of capsular contracture when compared with silicone implants and this makes them particularly appealing.  However, there was a study done that suggested that some products of the foam could cause cancer in rats in an experimental setting and this led to their use being greatly reduced in this country.

They have continued to use them in Brazil and there is a large experience of their use in Australia and there is no evidence to suggest that they cause cancer in humans.  Nevertheless, this is something that you should discuss with your surgeon and do your own research on, because you must weigh up the pros and cons of having them.

I think that they are good implants but have an open and honest discussion with patients and give them the information to allow them to make an informed decision.  You can read more about them here.
Polytech polyurethane implants also come with a lifetime warranty which includes:

  • exchange of implant in case of shell rupture for lifetime of the patient
  • free of charge exchange of the implant in case of capsular contracture Baker grade III or IV up to 10 years after implantation
  • free of charge exchange of implant in case of implant rotation or dislocation for up to 10 years after implantation
  • the original implant can be exchanged for an implant of the same type and the size may be chosen freely
  • the hospital costs associated with exchange of implants will not be covered, however there is an additional insurance policy provided with Polytech implants which provides up to £1500 per implant to go towards the cost of revision surgery required within 2 years of implantation.

 

These are the manufacturers that I use most often and I am happy to recommend them to my patients.

There are other manufacturers out there, such as Allergan and Mentor, who are major, reputable companies and produce good quality implants.  They all have slight differences and I have samples of all of the implants that I use in the clinic to allow patients to see and feel them.

Ever since the PIP scandal, patients are becoming more aware of the implant manufacturers and this can only be a good thing.  Most reputable surgeons should be happy to talk about the companies that produce the implants they are using and you should feel free to ask questions, after all, you will be paying for them.

For more information head over to our Breast Enlargement page.




How do I choose the perfect size breast implant for me?

When you are first thinking about having a breast enlargement, this might seem like any easy question.  You may know someone who has had breast implants, so you ask them what implants she had and she says she had 390cc implants, so you think, her’s look great, so I’ll  have 390cc implants too please.

Size is Not Important

Unfortunately, like most things in life “ it is not that simple!  The volume of the implant (in this case, 390cc) is only one factor when choosing which implant to have.  In fact, when I am deciding on which breast implant to use on a patient, it is probably the last thing that I consider.

Watch my webinar where I talk about some of the difficulties in choosing breast implants

Width is Important

The first thing that I think about is the base diameter of your chest as this will dictate how wide an implant that I can use.  This is crucial.  If the implant is too wide for your chest, then you may get a web between your breasts (known as symmastia or synmastia), or there may be too much of the implant to the sides of your breasts and your arm will hit your breasts which will be uncomfortable.  If the implant is too narrow it is not so bad, but it will not fill the footprint of your breast and so it is more difficult to give a nice shape to the cleavage.

You Cannot Compare Implants without Knowing More than the Volume

There are many different breast implants that have 390cc volume because implants come in different shapes and projections.  The different shapes of implant are round, teardrop (also known as anatomical or shaped implants) and conical (the conical shape is only available in polyurethane foam implants).
There is also a variety of projections for each shape “ low, medium, high and extra high.

This means that a 390cc low projection implant will look different to a 390cc extra high projection implant.  In fact, the low projection implant will have a wider base diameter than the extra high profile implant.  This brings us back to the base diameter, which is the key when deciding on a breast implant.

How I Choose a Breast Implant

When choosing a breast implant, the first thing that I do is to measure the base diameter of your chest.  This is a fixed measurement and will dictate the size of implant that you can have.
The next step is to try on some sizers.  I have a sizing kit in the clinic, which has sizing bras and vests and allows you to ‘try on’ different volumes in your bra to get an idea of the sort of size increase that you would like.

Cup sizes are unreliable and whilst I always ask patients if they have an idea of the cup size that they would like to be, I always stress that I am unable to guarantee a particular cup size.  The sizing kit is more accurate and will give a good idea of what is achievable with the different volumes.

Finally, we go through some of my before and after photographs of patients with different shapes and different projections of implant to see what sort of ‘look’ you are after.  Everybody is different and your final result will depend on the size and the shape of your breast before you start, but you can get an idea of what the different shapes and projections look like.

It is then a case of putting these pieces of information together to come up with a final cup size:

  • Base Diameter of your breast as established by my measurements
  • Volume of Implant as established by the sizers in sizing kit
  • Shape and Projection of implant as established by the ‘look’ you desire based on photographs

Sometimes, everything fits together nicely and it is relatively straightforward to come up with the implant that is right for you, but at other times, a compromise may be needed.

You May Need to Compromise on Size or Shape

The base diameter of your chest is set and you cannot change it and this will narrow down the range of implants that I can use in your case.  Sometimes patients choose a certain volume of implant and then chose a certain shape, but it may not be possible to use an implant of that shape and volume in their breast.

The common situation when this occurs is when patients choose quite a large volume and may have a narrow chest.  They may then go on to say that they don’t want too much fullness in the upper part of the breast and want a more natural look.  It may be that in order to use an implant of the volume that they like, they will have to have an extra high projection, which will give a lot of fullness in the upper part of the breast.  Alternatively, if they wanted a more natural look with a lower profile or anatomical implant, then they would have to accept a smaller volume of implant. We can have a discussion about this and you may want to go away and think about things.

I am very happy to see you again and again to go over things to make sure that we are confident that we have chosen the best implant for you.

It may all seem daunting, but don’t worry, it usually comes down to some pretty simple choices.

It is important not to get too bogged down in deciding between the exact volume of implant.  The result depends on many factors and the actual implant volume is only one factor.  Whilst it is impossible to guarantee a cup size, breast augmentation delivers predictable and life-changing results and has a very high patient satisfaction rate.

Download my guide on ‘Breast Implants – Your Questions Answered’ here.