Everything you have ever wanted to ask about reconstructive breast surgery, the augmentation 'boob job' and all the connotations around breast surgery have been answered in one fell swoop by Mr. Miles Berry MS, FRCS, co-author of The Good Boob Bible.
The book itself is easy to understand- you don't need a science degree, for one - and covers a range of personal stories from mastectomy reconstruction to a lady who calls herself '“Tit-less Tash”.
To an extent this is pure semantics. Some feel that ‘plastic’ is slightly morally superior to ‘cosmetic’ surgery, but all plastic surgeons train with the dual aims of ‘form and function’ – that is, it is a combination of best possible outcome by appearance and how it works.
This is the fundamental basis of our specialty and holds true whether one grafting after a burn, repairing a cleft lip, replanting a sawn-off digit, rebuilding a breast after cancer and so on.
There is still a stigma about cosmetic surgery though – such as making breasts bigger?
I am not sure that equates to stigma – somebody willing to accept the risk of complications and a permanent scar is clearly unhappy: their individual risk-benefit ratio has shifted.
It is more a media concoction that ‘plastic’ surgery equates to ‘vanity’ surgery.
Plastic (derived from the Greek plasticos meaning to mould) surgery was coined in the early 20th century when the pioneers such as Harold Gillies and Archibald McIndoe were reconstructing the highly disfiguring facial injuries of the 2st World War.
Remember that not all have a perfect, symmetrical pair of breasts given by nature.
The B cup wishing to be a D might be cosmetic surgery, but what about the asymmetry (I have a patient who is A cup on one side and DD on the other) that makes clothes buying and wearing, sport and intimacy challenging?
Nature also exerts its toll on breasts chiefly through breast-feeding.
Despite popular misconception, our most common patient is not the young wannabee glamour model, but the 30-something mother simply wishing to restore what she had before.
A more interesting comparison would be the psychological drivers behind women seeking reconstruction after breast cancer and those after children. Whatever one’s personal moral inclination, the forces are often equally potent.
Should we try harder to accept our breasts before considering surgery?
Probably, but as with every facet of life, it is an intensely personal decision.
The breast exerts a very important influence over a woman’s life that is both conscious and subconscious.
Many studies have confirmed the benefits psychologically, emotionally, to self-esteem, confidence and the like.
There was also a very interesting study reported in 2009 of UK, French and German women that showed that 77% of those presenting for breast augmentation consultation did not proceed further so three-quarters do appear to ‘accept their breasts for what they are’.
What should we ask ourselves before considering surgery?
The most important is: ‘am I willing to invest time and energy in finding out what is the best possible solution for me personally? Or am I simply interested in the lowest possible price without consideration of quality?
Is there anything women say they wish they'd asked beforehand?
I’m not sure whether it is lack of being informed or whether it is simply so much information that not all is taken in and retained – that’s the main reason we wrote the book to address this aspect.
It should be noted that a five-minute consultation such as is the norm with the ‘pile it high, sell it cheap’ mentality of the large commercial clinics is unlikely to satisfy this in any way, shape or form.
We schedule longer appointments (45 minutes) for a breast augmentation patient and always offer a second free of any charge. There is an immense amount of information, most of it new, that must be absorbed and processed.
A large quantity is also forgotten unconsciously as the brain tries to protect us from things that might harm us. Also consciously and a number of patients have, rather sheepishly, admitted that they disposed of any implant-related information to conceal from partners and perhaps also themselves too.
What tends to be the best size?
Smaller is better in the long run; large implants on top of the muscle will cause more damage – through stretching of the breast – so it is better to be slightly smaller than too large.
What happens when people don’t listen to that advice?
I saw a patient last week who went several sizes larger than the surgeon recommended and has been rueing it for the past 6 years.
It will now cost her more in terms of money and scarring to put matters right.
We offer two consultations and have the most modern-sizing kit that should be combined with a bra of your choice, a tight-fitting top and no time pressures at a second consultation.
How do the breasts feel firm after surgery?
A variable issue, but longer than one expects. Also depends on woman: a young one with no children will feel tighter for longer. On the other hand, those whose breasts have been stretched by pregnancy and breast-feeding or marked weight changes and age will tend to settle quicker.
Six months is not unusual and, in fact, the breasts continue to subtly alter over time. Patients are often surprised to see just how much their augmented breasts evolve over the first year when shown their pictures.
Should someone considering a boob job have counselling?
Not generally, but those who have an high level of concern and spend a large proportion of their time thinking about the particular feature that displeases them should be considered.
Surgeons are constantly on the look-out for the body dysmorphics (think Michael Jackson, Lolo Ferrari, Alicia Duvall etc). The latter is an interesting (not in a good way) example of somebody who is clearly not satisfied by surgery as she has had a rumoured 100-plus procedures.
The frustrating thing for we surgeons is her attitude: recently she underwent yet more surgery, but blamed earlier surgeons for putting her in that position. In almost the same sentence, she then admitted to going abroad when UK surgeons refused to operate further!
How safe is it?
Extremely safe. 50 years of continuous development have given us one of the best-researched and safest medical devices around. PIP aside, current devices are pretty good with increasing durability, more natural (or perhaps one should say less unnatural) textures.
Techniques have also vastly improved with regards to tissue handling, understanding of what suits which individual.
Our creed, despite some misconceptions and some so-called surgeons whose practice starts with profit, is ‘first do no harm’ (from the Hippocratic Oath). Anaesthesia has made significant progress over the past couple of decades and it is not surprising to find patients waking up after surgery in the recovery area asking ‘ are we ready to start yet?’
What tend to be the main concerns right before surgery?
In my 20-year experience, the order of concern is 1) the anaesthetic (‘will I wake up’?), 2) pain (‘how much will I have’? and 3) the surgery. In reality, these concerns can be relatively easily allayed during consultation.
Clearly, somebody genuinely worried should not be proposed for surgical intervention, but such people rarely make it to the consultation as the level of general medical/surgical awareness is much higher since the internet’s arrival.
The Good Boob Bible, £7.99, John Blake Publishing.