Breast Enlargement

Custom Package; £2995

The custom package is an excellent ‘entry-level’ option for women seeking an affordable breast enlargement. Surgery is undertaken by Mr Sterne at a top private Birmingham hospital. You can be reassured that you will receive the highest level of skill and care and you will be in very safe hands.

In order to offer this service at such an amazing price, I have had to include only those elements which are absolutely necessary, and I need to ensure that my service runs efficiently. Patients choosing this custom package will therefore be given a limited choice of theatre dates.

What is included and what is extra in the custom package:

• Initial consultation                                                                                                    £100 
• Any necessary additional pre-op consultations                                                    £100
• Length of stay                                                                                                      Daycase
• Implant type                                                                                                                CUI
• Treatment of complications                                                                                30 days
• Nurse  follow up                                                                                                      1 week
• Nurse advice post-operatively                                                                  up to 6 weeks
• Consultant follow up                                  once at 6 weeks                                    £100                                                                       once at 6 months                                 £100 Additional consultant follow ups                                                                              £100

Platinum Package; £4330

For those women who are looking for the very best, we have our Platinum Package.

This bespoke package allows you your choice of the very best implants, including Allergan Natrelle, Nagor Impleo, Allergan ‘Teardrop’ shaped, and Silimed Polyurethane –coated implants. Many of these implants come with a manufacturer’s lifetime warranty.

This bespoke package also includes a unique 5 year warranty against capsular contracture, which will cover all hospital, surgeon’s, anaesthetists and outpatients fees in the event that you develop a distorted or uncomfortable breast due to a capsular contracture, within 5 years of the original operation.

What is included and what is extra in the custom package:

• Initial consultation                                                                                             Included
• Any necessary additional pre-op consultations                                             Included
• Length of stay                                                              1 night included free if required
• Implant type:  Allergan or Nagor round implants                                         Included
• Upgrade – overnight stay                                                                                  Included
• Upgrade – Superior Private room                                                                    Included
• greater choice of sizes, more texturing, better warranty                             Included
• Anatomical 410 implant or Polyurethane implants           available at additional fee
• Lowest rate of capsular contracture of any available implant                      Included
• Unlimited follow up with surgeon for life                                                         Included
• 12 month insurance against correctable complications                                 Included
• Pre and post op photos                                                                                       Included
• 5 year warranty against capsular contracture                                                Included

(Grade III/IV only, minor grades of contracture do not normally require surgical intervention. Not available for anyone who already has had a capsular contracture included)

Firstly I would like to reassure all of my patients that I have never, ever used PIP breast implants. Therefore if I undertook your surgery then you do not need to be concerned about the adverse publicity surrounding these PIP implants.

Secondly, the recent adverse publicity refers ONLY to PIP implants. All other breast implants are safe.

The implants that I have used are all excellent implants with proven safety records. As I discussed with you at our pre-operative consultation, rupture is extremely rare and there are no long-term health risks associated with normal silicone implants.

PIP implants – the problem

Poly Implants Prostheses (PIP) implants were made by a French manufacturer. Initially these implants were manufactured to an acceptable level, but it appears that due to economic pressures, the company made a decision to make them to a lower standard. It appears that these changes were made some time in 2001. There appear to have been two significant changes in the manufacturing process:

1)      The outer shell initially comprised a multilaminar silicone, but the outer protective layer was omitted, rendering the implants more likely to rupture.

2)      At the same time, the gel filler was changed from medical grade silicone to cheaper, industrial grade silicone containing Baysilone (a fuel additive), Silopren and Rhodorsil (both used in the production of rubber tubing).

Thus, these implants rupture far more frequently than other silicone implants, and the leaking gel appears to be more irritant than the extremely inert medical-grade silicone.

As long as 5 years ago, reports started to appear in the Plastic Surgical Journals that these PIP implants had an increased risk of rupture and most plastic surgeons avoided them.

These implants were finally withdrawn from use on 31st March 2010.

What happens when an implant ruptures?

When a breast implant is inserted into the body, the body creates a thin wall of scar tissue all around the implant. This wall of scar tissue is known as a capsule and cannot usually be felt. Rupture of an implant usually causes the capsule to thicken and shrink down on the implant; known as a capsular contracture. This capsular contracture changes the shape of the implant and makes it feel harder. With time the breast may distort in shape and become painful. Pain is often limited to the breast itself, but the pain may be poorly localised and may even radiate to the chest wall and down the arm.

If the silicone leaks out of the implant and the surrounding capsule, the body usually identifies the free silicone rapidly and forms a wall of scar tissue around it so that it forms a lump of scar tissue and silicone – a silicone granuloma. This usually presents as lumpiness around the hardened implant. These lumps may or may not be tender.

Some silicone may be absorbed into the lymphatics around the implant capsule and these lymphatics carry the free silicone to the armpit, where the silicone collects in the glands (lymph nodes). These glands swell up and if the silicone is irritant, then this may cause pain, which may radiate down the arm.

The following case demonstrates a ruptured PIP implant in which silicone has migrated to the armpit glands (lymph nodes):

Figure 1. A PIP implant which has been removed from the right breast via the original scar. The implant that has been removed is shown contained within the ‘capsule’ of scar tissue, which the body has formed around the implant. Note, the right breast is smaller, but of a normal shape – it is acceptable to leave the implant out and close the incision at this stage if the patient is happy to lose her implants. Alternatively, a new implant can safely be inserted into the pocket in the breast at this stage.

Figure 2 . The capsule has been removed, revealing a large tear in the shell of the implant. Some of the silicone filling is missing.

Silicone lymphadenopathy with PIP implants

Figure 3. The right armpit glands (lymph nodes) are enlarged with silicone. As they were painful, they have been removed via a separate incision in the armpit. Note that a new implant has been inserted into the right breast and the wound closed and dressed.

What should I do if I have PIP implants?

1. Firstly, do not panic. There is no urgent need to have these implants removed immediately – they do not pose an immediate health concern.

2. Secondly, you should confirm whether you have PIP implants or not. Contact the surgeon or clinic who did your operation and they will provide you with this information.

3. Thirdly, if you do have PIP implants, and they are currently causing you problems (ie hardening, distortion of the breast, pain or evidence that they are leaking) then you should arrange to see a surgeon promptly to discuss removal of the implants.

4. Fourthly, if you have PIP implants but they are not causing any problems then there is mixed advice:

a)      The current UK government position on PIP implants is that there is no need for removal of these PIP implants, unless they are causing problems.

b)      The French government position on PIP implants is that, regardless of symptoms, these implants are substandard and should be removed.

c)      My personal opinion is that these implants should be removed. The reasons for this are: they are substandard; they have a high risk of rupture (the consequences of which can be significant); and they contain non-medical grade silicone which, although is probably inert is not specifically manufactured for use in the human body and so should be removed.

How can these implants be removed?

Simple removal of PIP breast implants is a relatively safe, straightforward procedure. The old scar is opened and the implant and ‘capsule’ are removed together. It is a personal decision upon whether you wish to receive a new, safer implant, or would prefer to avoid implants altogether. This could also be considered an opportunity to change the size of your implants if you wish.

If you have painful silicone granulomas or lymph-node enlargement, then the operation may be a little more involved. I will discuss this with you in more detail if necessary at the time of your consultation.

Who should pay for implant removal?

There is much debate at the current time about who is responsible for paying for corrective surgery. The PIP company has gone into liquidation. Over 300 patients are being represented by a lawfirm and are attempting to recover costs. The clinics which inserted the implants are denying responsibility because they bought the implants in good faith from the manufacturer. I would recommend that in the first instance you appeal to the clinic where you received your implants in the hope that they will be prepared to undertake corrective surgery free of charge. If this fails, then you have 2 options:

If your implants are causing problems, then you are eligible for NHS surgery to remove the implants and thus alleviate your pain or discomfort. However, the NHS will not replace the implants for you – so you will return to your pre-enlargement state.

If you do not have implant-related problems but are (understandably) keen to have the implants removed and exchanged for good quality implants then, at the current time, you will need to fund this operation for yourself in the private sector. I would urge you to visit an expert plastic surgeon to discuss this procedure. If you wish to arrange a consultation with me then you can contact Jude on 0121 361 8008. If you would prefer to find a suitably qualified surgeons in your own area then I would advise you to visit either SaferCosmeticSurgery (SCS) or the British Association of Aesthetic Plastic Surgeons (BAAPS) websites.

Caption: Implant/Strattice Reconstruction

There are two options for removing a tattoo: surgery or laser depigmentation.

With surgery, the skin bearing the tattoo is cut out and the hole in the skin is sewn shut to leave a scar. The aim is to leave as small a scar as possible, in the best direction to result in the most ‘hidden’ scar – which often just looks like you have had an operation. Small tattoos can usually be treated in a single procedure under local anaesthetic (with you awake) in the outpatient department. Larger tattoos may need to be removed in two, or more, procedures. This allows the tight skin to stretch and go slack between excisions so that more of the tattoo can be removed after several months (known as serial excision)

Laser treatment works by firing an intense light at the tattoo. Certain pigments absorb certain lights and ‘heat up’. This heat destroys the cells which hold the pigment. This can work quite well with some colours (red, green) but  is much less effective with other colours (eg blue-black). However, often the pigment which is released from the cells is simply ‘eaten’ by other nearby cells and this results in ‘smudging’ of the tattoo. Occasionally the ‘heating’ effect may change the colour of the tattoo but not remove it.

You may consider it worth trying Laser treatment in the first instance because if it works well and the colours fade then you would have minimal scarring. But in reality, many many laser treatment sessions are required, which can prove very costly, and the final result is that the colour often ‘fades’ or ‘smudges’ – but it still looks like a tattoo!