Patients with breast implants have been advised to contact their surgeons to identify the type of implants that were used in their surgery. I would like to reassure all my patients that I have never used PIP breast implants.

I have always been concerned to ensure that all products I use are of the highest quality and had previously assessed and rejected PIP implants as poorly manufactured products, with the potential for high rupture rate.

If you are concerned that you have, or may have, PIP implants from another surgeon or clinic, please see the advice below

Patients with PIP implants:

Should you have any friends who have undergone breast implant surgery elsewhere, and are concerned about the safety issues the advice is simple :

•     Contact your surgeon or surgical provider to identify your implant manufacturer
•     Any patient who has had a PIP implant used since 2005 should see a surgeon and have an ultrasound examination performed
•     If the ultrasound shows signs of rupture, or if there is any evidence of silicone within the tissues then the implants should be replaced
•     If there is no sign of rupture then the patients should be reviewed on an annual basis

I am happy to see any concerned patients and provide advice. I have set up a number of clinics where I will see and assess patients free of charge.

Should anyone wish to find out more about these clinics, they can call my Practice Manager, Sue Hinchcliffe, on 0161-232-2670.

Rates:

I have been able to negotiate reduced rates from my hospital and implant providers so that I can offer exchange of PIP implants for either Allergan, Nagor or Silimed, life-time guaranteed implants from £3200. I would be happy to discuss the appropriate choice of implant with you at your consultation.

The Problem with PIP implants:

The latest information from French Society of Plastic Surgery (SOFCPRE) warns of two concerns with the PIP breast implants. The first problem is that the manufacturing company seem to have dispensed with part of the protective barrier around the gel, leading to a weaker implant that is more liable to rupture. The second concern is that the gel inside the implant is not the gel that the company was issued a license to use. The French regulatory authority who issued the license to the company are still undertaking tests on the gel in an attempt to determine whether the gel presents a health risk – we will keep you updated. At this stage we suggest following the guidance given by BAAPS (The British Association of Aesthetic and Plastic Surgeons).

BAAPS  released an interim statement to provide advice for patients with PIP breast implants:

NEW UK GUIDANCE ON CONTROVERSIAL FRENCH IMPLANTS

Protective Barrier Had Been Dispensed With – Women Urged to Have an Ultrasound

London – 18 June, 2010 – The British Association of Aesthetic Plastic Surgeons (www.baaps.org.uk), welcomes today the clarification provided by a detailed study into France’s controversial PIP implants by the French Society of Plastic, Reconstructive and Aesthetic Surgery (SOFCPRE). The BAAPS, the not-for-profit organisation established for the advancement of education and practice of Aesthetic Plastic Surgery for public benefit, today issues new safety recommendations to the UK public such as a call for all women who have PIP implants to undergo an ultrasound scan in the next six months, to determine whether there is any rupture or weakening.

Despite proving unpopular with the majority of BAAPS members, it has been estimated that roughly 50,000 women in the UK could have these breast implants, as they were the product of choice for some clinics.

According to consultant plastic surgeon and BAAPS President Nigel Mercer:

“This comprehensive study concludes this situation is clearly not the fault of the surgeon, who acted in good faith – it would be similar to blaming a dealership for a faulty car. There was no way of knowing the gel was untested or that the protective envelope, which adds strength and restricts the gel from traveling into the body, had been dispensed with.”

The study by SOFCPRE found that the company making PIP implants, which has now gone into administration, not only dispensed with the protective barrier since 2005 but was also using a gel (within the implant) which had not been the one tested originally for its CE mark, ie, to make its use legal. To determine how the altered version might react with the human body, SOFCPRE contacted the gel manufacturers for any studies – however, these were unavailable, as they had understood the substance to be intended for use in mattresses.

Nigel Mercer adds:

“This is certainly an unusual situation but so far there is no serious cause for alarm – whilst further tests are conducted into the substance, we recommend that women who’ve undergone breast augmentation contact their surgeons to find out what type of implant was used. If it’s PIP they should have an ultrasound in the next six months to establish whether there is any weakening or rupture. At present removal is recommended in these cases, but if there is one ruptured implant, the contralateral one should be taken out as well, as a preventative measure.”

What if they are not ruptured?

This is a more difficult group for me to advise. At the moment, the government is advising that there is no medical reason to remove these devices, but the whole scandal has understandably shaken the industry’s confidence in the implants. I think it is unlikely that the government will support the exchange, or even removal, of apparently intact implants and these women are likely to be expected to pay for the peace of mind of having their implants exchanged for a more reputable brand.

Fazel Fatah, President of BAAPS and one of the members of the government-commissioned panel investigating the scandal, said private clinics have an “ethical and moral obligation” to patients after fitting them with cheap implants.

“My personal view is the clinics which originally profited from these implants have an ethical and moral obligation to these patients,” he told The Daily Telegraph.

Unfortunately, I think that many of these commercially ruthless clinics are unlikely to agree to free exchange without a legal fight. They will argue that they supplied the implants in good faith and had no reason to suspect that the quality of the implants was sub-standard. If this is the case, it will undoubtedly take several years to resolve this issue, which leaves many of these understandably worried women in a difficult position.

I am inclined to agree with Tim Goodacre, a previous  colleague of mine and current President of BAPRAS, who said that if the government panel confirmed the initial findings – in which almost one in 14 implants had leaked – then they should all be taken out in every case.

“With this sort of level of implant failure, particularly with this sort of material that isn’t medical grade, it’s sensible that they be removed,” he told The Daily Telegraph. “I think that would be a reasonable way forward.”

We both think it unlikely that the Department of Health would make a decision on whether or not to recommend blanket removal until it had scrutinised data from across the industry in more detail.

Due to the way information on breast implants is held – individually by clinics but not centrally – he warned that could take “weeks”.

Future developments:

4^th January 2012: The government is meeting today with leaders of BAAPS and BAPRAS to discuss the management of the PIP problem. An announcement can be expected at some stage after this meeting, though no timescale has been given. Watch this space for further developments.

According to HealthDay, researchers followed 160 mothers with breast implants to gauge their success with the feeding method. They found that 86 percent of those who failed at breast-feeding thought that it would make their breasts look worse. On the other hand, among those who successfully nursed their babies, only 13 percent believed that it would affect the appearance of their breasts.

“It makes sense that breast augmentation patients would be concerned about the effect breast-feeding could have on the appearance of their breasts,” said the study’s lead author. “After all, these women have invested both time and money into them. However, available evidence tells us that although breasts sag more with each pregnancy, breast-feeding doesn’t seem to worsen these effects in women with or without breast implants.”

Doctors involved with this study say that the results prove that more education is necessary for women with breast implants who plan on having children and breast-feeding. They insist that breast-feeding alone will not negatively affect the appearance of breast implants.

Breast augmentation surgery is one of the most common plastic surgeries. In fact, according to the American Society of Aesthetic Plastic Surgery (ASAPS), it has been the most popular cosmetic surgical procedure for the past three years, with more than 318,000 surgeries performed in 2010 alone.

Click for information on all types of cosmetic breast surgery.

The prospect of making a fast buck is the obvious temptation but the consequences for individuals hoping they’ve secured a bargain can sometimes be horrendous, or at least horrendously expensive.

Liposuction can be a perfectly appropriate way for a person to get closer to the kind of body shape they consider more desirable but as an invasive procedure it carries risks and should only be carried out by experts with the right background and the right credentials.

Some less than scrupulous surgeons are happy to take the money without asking the right questions and this can often lead to serious patient dissatisfaction or the need for subsequent procedures to repair tissue damaged by non-specialist workmanship. Indeed, in some rare cases the consequences can be much more serious and even life threatening.

At the British Association of Aesthetic Plastic Surgeons (BAAPS), we have made our position on the issue perfectly clear, not just in the context of liposuction but in all areas of the industry.

My colleague, Rajiv Grover, a consultant plastic surgeon and president elect of the Association, is recently quoted as saying “The single most important factor in determining the outcome of surgery is the choice of surgeon” and I couldn’t agree more.

“Sadly, it is becoming increasingly apparent that in the United Kingdom the average patient spends longer choosing their bathroom tiles than choosing their surgeon.” Sad but true.

Liposuction is a surgical procedure and, as such, requires training, skill and experience to obtain satisfactory and safe results. Given the bewildering array of technologies available today (ultrasound, laser, radiofrequency etc), the important decision for a liposuction patient is not so much which device or technique is being used, but more who is on the other end of the sucker!

The message from us, the genuine cosmetic surgery specialists and leaders in the industry, is that cutting prices means cutting corners, and anyone considering liposuction needs to keep this notion firmly in mind.

These organisations felt the series and Tuesday 7th June’s programme in particular, highlighting a stem cell breast augmentation performed by a GP, was at best biased and commercially driven, and at worst, potentially dangerous to the public.

In my opinion, this specific programme was advertising an unproven technique without any independent challenge or advice that was not commercially driven. It is highly irresponsible to offer stem cell breast enhancement unless is it part of a controlled,  clinical trial conducted in a specialist centre under the care of a proficient specialist with access to investigating and  treating breast disease. The main associations are working to develop guidelines on the use of fat transfer in the breast and promoting this procedure to the public is viewed with very grave concern.

There is no reliable evidence based on peer reviewed, controlled clinical trials to indicate that the use of stem cells in the breast of a young woman is safe or necessary. This highly sensitive procedure carried out by a non-specialist should not be given publicity and is doing the millions of women who watched it a huge disservice.

The female breast is highly sensitive and we know from generations of safety studies that breast implants are safe.  However, this stem cell therapy is new and its effects are currently uncertain.  Like all new procedures it should be carefully evaluated in controlled scientific circumstances over a number of years before being carefully rolled out to more general use.

BAPRAS deplores any short cuts to patient safety and urges ITV to protect the public by adding a cautionary note to any publicity they continue to give to this technique.

Richard Rainsbury, President of the Association of Breast Surgery, agreed, saying;

“We echo these views entirely. Women should be fully informed that the long term safety of this approach is unknown, and that they could be putting themselves at risk.”

BAAPS, my professional organisation, has submitted a complaint to Broadcasting Standards and its response is awaited.

As a member of BAAPS (British Association of Aesthetic Plastic Surgeons) we are obliged to submit our figures on annual basis for scrutiny by our colleagues and this year’s National Audit has revealed some interesting highlights in Cosmetic Surgery:

Women had 34,413 procedures in 2010, up from 32,859 (an increase of 5%) but interest in male surgery increased by 7% rise overall (from 3,623 last year)

Breast augmentation (or boob jobs) remains the most popular cosmetic surgery procedure, showing a significant growth of over 10% (9,418 breast augmentations were performed in 2010)

Facelifts proved popular with both men and women, with an average rise of 12% for both genders

‘Man boob’ ops or Gynaecomastia rose from 3rd most common procedure among males to 2nd, rising an impressive 28% in 2010 from 581 to 741 ops

Male brow lifts and male nose jobs (‘Rhinoplasty’) both rose quite considerably (up 13%), from 109 to 123 and 877 to 993 respectively – in fact brow lifts went up from being the 7th most common procedure for men, to 5th place in 2010

Nose jobs proved popular with both sexes, increasing by nearly 10% combined overall

The only procedures to decrease were tummy tucks (Abdominoplasty), which was down 7.5% and pinning back prominent ears (Otoplasty), down 17%

It seems while men seek a slimmer look, women are after a voluptuous hour glass shape, made again popular by Mad Men’s Christina Hendricks, who has an impressive bustline.

British dancer Claudia travelled with friends to the United States to undergo buttock enhancement surgery which she believed would help her in her career as a hip-hop dancer. The 20 year old student ‘treated’ herself to the buttock injections for her forthcoming 21st birthday; only she had to travel to the US as this procedure is illegal in the UK.

The unlicensed silicone was administered illegally in the bedroom of a budget hotel room in Philadelphia. Just hours after her top up session, Claudia’s health deteriorated; suffering from chest pains and struggling for breath, by this time her ‘doctor’ had left Miss Aderotimi’s side and had also vacated the hotel. Tragically, she was taken to hospital but could not be saved.

A preliminary examination found the silicone filler had leaked into her bloodstream, leading to heart failure.

The recently launched campaign will investigate complaints from patients and punish registered clinics that breach safety standards.

The campaigners are hoping to eradicate the unregulated clinics that offer injectable parties and cheap deals to entice those searching for cosmetic treatments into their waiting rooms. It is clear that these “cosmetic cowboys” should be stopped before they do more damage and people should think twice before attending a Botox party or buy into a cheap deal here or abroad.

As a responsible practitioner of cosmetic surgery, I can only hope that highlighting these tragic events and exposing the dangerous and unethical practices in the UK and abroad will encourage people to think more carefully about the risks before embarking on any form of treatment or surgery.

It is important to undertake a detailed evaluation of the neck area in order to apply the appropriate technique and this involves both static and dynamic examination of the neck, including the skin tone, subcutaneous fat, platysma muscles and submandibular salivary glands.

Depending on the severity of the skin laxity and the degree and positioning of the visible bands in the platysma muscle, the patient may require a further small incision under the chin to gain access to the bands and surrounding fat. The neck lift then involves one of a combination of manoeuvres, depending on the anatomical configuration in the neck. A lateral platysmaplasty involves a lifting and tightening of the platysma muscle to re-support the underlying structures and produce an improved contour to the neck . 

If a patient has significant platysmal bands under the chin, the second incision is used to bring these bands together and tighten the muscle in a so called medial or corset platysmaplasty. This is an extremely powerful operation that can produce dramatic changes in the neck and can greatly contribute to a significantly fresher and younger look. More recently, further refinements have been added to the range of techniques that involve addressing the positioning of the salivary glands under the jaw and these can greatly help with improving jawline definition and making the neck look slimmer and tighter. Refinements in liposuction techniques have also led to great improvements in the level of refinement that can be achieved.

With this increased level of understanding and a range of techniques available, I now categorise my patients into four different groups depending on their anatomical problem and discuss appropriate surgical techniques depending upon the category.

Type 1 No skin laxity, excellent skin tone with excess fat

These patients, usually younger {under 30}, will often respond well to liposuction alone. They have enough tightness in their skin that the removal of the subcutaneous fat does not produce any laxity and dramatic, stable and natural results can be achieved in this group of people with little or no scarring and a relatively minor surgical procedure.

Type 2 Mild skin laxity with narrow medial platysmal bands

These patients respond very well to a neck lift with lateral platysmaplasty but the platysmal bands will recur to a degree if they are not dealt with directly. For my patients, I offer one of two treatments. The first is to perform a corset platysmaplasty through an incision under the chin at the time of surgery to tighten the bands by suturing them together and producing a more pronounced change to the area under the chin. The scar for this may not be acceptable to all patients and another approach is to treat the muscle bands postoperatively with Botox. The bands respond very well to this treatment, which is temporary and requires repeat treatment every six to nine months.

Type 3 Moderate skin laxity with or without wide platysmal bands {over 2 cms}

These patients respond very well to a classic neck lift using lateral platysmaplasty alone. They do not require a medial corset platysmaplasty as the muscle bands are too far apart and would produce over-tightening and distortion. They do occasionally require removal of fat from under the chin but this can be done by liposuction through a very small {5mms} incision under the chin.

Type 4 Moderate to severe skin laxity and significant excess fat

The approach to these patients is similar to the patients in Group 2. It involves an incision under the chin and a corset platysmaplasty to maximise the degree of correction. They also often require extensive liposuction throughout the neck to remove the excess subcutaneous fat but in addition, to give greater definition to the jawline, a suture is placed under the border of the mandible to help define the neck from the cheek and provide support for the salivary gland under the jaw which can often protrude downwards.

A neck lift, whether performed as part of a facelift or as a stand-alone procedure, is quite extensive surgery that needs to be performed delicately, accurately and by an experienced surgeon to produce safe, natural and long-lasting results. The repositioning of the muscles in the neck mean that the skin needs to be quite extensively undermined {see diagram} and this can result in significant bruising and changes in sensation which, whilst being temporary, can delay recovery and increase the risks of complications. That said, in the hands of an experienced surgeon, an increased understanding of the way in which the neck ages has led to a range of techniques that will allow us to individually personalise the surgical plan to meet the patient’s needs.

It is extremely important that patients ask their surgeons detailed questions about the procedure that they are going to perform. A surgeon should be prepared to show examples of his or her own work and should be able to explain in a detailed way why a suggested technique is the right one for any given patient. It is also very useful to try and talk to previous patients about their experiences and even meet some of your surgeon’s results in the flesh.

Any surgeon offering breast reduction and mastopexy should be using a vertical scar technique for the vast majority of their cases and cosmetic breast surgery has now reached the point where, I believe, the horizontal scar (so called anchor technique) is largely redundant. Any patient considering breast reduction surgery or breast uplift should question their surgeon carefully about this philosophy. For many years now we have been attaining far superior results with far less scarring by concentrating on the shape of the breast rather than the skin envelope. Examples of what can be achieved through vertical scar mammoplasty can be seen on my breast reduction and mastopexy pages.

The conventional approach, and still the most popular, is to use a standard silicone implant. These have been used for nearly fifty years, often with excellent results. There is a problem with this type of implant, however: the risk of capsular contraction or fibrosis. With this, the body forms a capsule of scar tissue around the implant. As the scar tissue shrinks, it alters the shape of the implant and hardens it, causing an imbalance between the breasts.

There is an alternative, however: Polyurethane Coated Breast Implants (PCBIs). These are also implants filled with silicone gel: unlike the conventional kind, however, the implant is coated with polyurethane foam. This reduces the risk of capsular contraction. And the difference is considerable: the rate of contraction of a PCBI is just 1 per cent, compared with 18 per cent for a conventional silicone gel implant.

If they’re so superior, why aren’t they more widely used? The answer to that lies in history. Although invented in the 1970s, PCBIs were suspended in the 1990s in the UK due to concerns that the coating could break down in the body. Since then, though, rigorous independent tests have found no evidence of any risk.

In 2005, a company called Eurosurgical began to distribute a brand of PCBIs in the UK again, which are made by Silimed in Brazil. Because of the gap in their availability in this country, PCBIs had somewhat dropped off the radar of the Plastic Surgical commutiy – which might explain why no one had told you about them before. In Australia, though, Brisbane-based Dr Daniel Fleming is a strong advocate of their benefits. Dr Fleming has performed many hundred augmentations using PCBI and I have had a number of lengthy discussions with him about the benefits and any potential downsides. I have also spoken to Elizabeth Hall-Findlay, a very eminent Canadian breast surgeon with extensive previous experience of Silimed’s implants. She strongly recommended them and feels that they sometimes offer distinct advantages over conventional silicone shell implants.

If you’re considering a breast reshaping or enlargement procedure, I believe that PCBIs can offer a real advantage over their more traditional counterparts in both the short and long term. I am the only cosmetic surgeon in the North West who offers procedures using PCBIs and who has the experience to know whether they might be the best option for you. I’d be happy to talk you through these matters in more detail and explain the potential benefits. Feel free to contact the office to find out more.

Late in 2010, the NCEPOD Report into cosmetic surgery, “On the Face of it”, was released and looked at the standards of care in cosmetic surgery facilities and hospitals across the UK. It is fair to say that it has already caused a great deal of concern among the public, but, sadly, did not tell me anything I did not already know.

The Report made a number of damning points: in particular, that many cosmetic surgery practices lack experience and are embarking on procedures they rarely perform.

There is often an alarming lack of equipment available in theatres, proper recovery facilities, high-dependency or intensive care facilities and in and out-of-hours surgical cover. Surgical training is not available at most sites. Only 4 per cent of centres provide psychological assessments of patients.

Marketing materials often don’t adhere to IHAS guidelines by including time-restricted financial incentives, special offers and the like.

In short, the pattern of care in this sector is very variable. That many of these practitioners know they are providing substandard care is revealed by the fact that 371 cosmetic surgery providers either did not answer or refused to take part in the NCEPOD study, despite a legal obligation to do so. A further 71 clinics simply disappeared when they were approached and seem to have gone out of business.

In my view, this couldn’t be more important. If you buy a used car or hire a plumber, everybody knows that there are companies who provide a good service – and those who don’t. In some cases this doesn’t matter too much, beyond being annoying. But you have every right to expect that anyone putting “surgeon” after his or her name will offer the highest levels of care.

Sadly, our sector is being tarnished by the failings of a significant minority. Cosmetic surgery has a valuable, and valued, role to play in our society. The opening phrase of the NCEPOD Report is: “There is nothing wrong with cosmetic surgery.” Quite right. But the Report is also right in exposing the practices – or malpractices – of the few. As John Black, President of the Royal College of Surgeons, said: “This incisive report from NCEPOD shows that patients are not being properly protected.”

NCEPOD came up with a number of recommendations, which I heartily endorse. These include the following points, all of which patients should address when considering undergoing a procedure:

• Regulatory bodies, such as the Care Quality Commission, should more closely monitor the adherence to national requirements for audit and scrutiny of sites under licence.
• National professional cosmetic surgery bodies should issue guidelines as to the training, level of knowledge and experience required for a cosmetic surgeon and patients should fell able to ask any surgeon for details of this.
• If you’re considering having cosmetic surgery, check Care Quality Commission registration of any site you attend.
• Good practice demands a two-stage consent process for those undergoing cosmetic surgery.
• A national cosmetic surgery outcome database should be considered.
• More formal training programmes must become established, and like any other surgical training, these should be subject to rigorous assessment of competence, which should lead to a certificate attesting to the surgeon’s level of competence in specified procedures
• Cosmetic surgical practice should be subject to the same level of regulation as any other branch of surgery. Independent health care providers should only allow practising privileges to those cosmetic surgeons who can demonstrate that they have achieved and are able to maintain competence in the procedures which they offer
• Psychological assessment is an important part of any patient’s cosmetic surgery episode, should be routine, and must be delivered by someone adequately trained
• Regulation should be introduced to prevent the use of financial inducements to influence the process of informed consent.

Some of these recommendations may take time to be put in place – although I hope that time is as short as possible. All of them are both sensible and overdue.

In the meantime, you can at least satisfy yourself as to the credentials and integrity of any cosmetic surgery practice you are considering using by using the points made above.

At my practice, I would never consider using financial inducements to encourage patients to embark on surgery. No one is pressured to consent: indeed, I go to the greatest lengths to discuss every aspect of any procedure with anyone considering it. This includes psychological assessment, if appropriate, as recommended by NECPOD, and always the two-stage consent process with a cooling off period.

Details of my experience, expertise, training, qualifications and surgical facilities are all openly displayed and can be easily verified. I never mind being asked about this by any patient and welcome the opportunity to discuss all these matters during a consultation. Testimonies are also available and I have a number of patients who are more than happy to discuss their experiences, counsel and support people who are considering a procedure.

Any reputable cosmetic surgeon should be able to match these standards. And anyone who doesn’t should not be practising as one.