Frequently asked questions

Am I a suitable candidate?

The best candidates are healthy, emotionally stable women with fully developed breasts, who are realistic about what surgery can achieve. Every patient has a different view of what is a desirable size for breasts and it is important that you have a clear idea of what you wish to achieve by surgery. You should not have surgery to please someone else.

 

What is the history of breast implants?

The first silicone breast implant was carried out in Texas in 1962. Over the years various fillings have been tried in the implants but with now over 45 years of experience with silicone implants there is no doubt that they feel the most natural, (because of the inherent smoothness of the silicone gel filling).  The early implants had a smooth outer coating but it was soon apparent that capsular contracture was a big problem with these.  An outer thin coating of polyurethane was tried next and the results seemed to improve greatly, but these implants were removed from use in the USA until their safety could be tested.  The American company Surgitex stopped making the polyurethane implants so we were unable to use them any more in Europe.  We didn't realise that the Brazilian company Silimed continued production, flourished and sold to South America and Australia.  These countries  have continued to use and gather data on their results and the polyurethane implant results are the best of all the types.  The textured silicone implants were introduced to mimic the polyurethane coating but unfortunately the results are not as good, with more and more patients developing capsular contracture every year.  Thanks to the media and the lawyers rushing to protect our ladies without accurate study results, a generation of our patients have missed out on the best implants. 

What about the silicone horror stories of the past?

There was a lot of unfavourable publicity about silicone implants 15 years ago and in 1992 the U.S.  Food and Drug Administration imposed a ban on the use of silicone gel breast implants in the USA. In 2006, following 10 years of intensive research, the FDA gave approval for the use of silicone gel implants again in the USA. Ten years ago it was claimed that silicone breast implants caused breast cancer but studies since have shown that implanted women have up to 30% less chance of developing breast cancer than the general population.

What happens at the consultation?

We know you may be shy and nervous, but don’t worry, we are there to help you. Firstly you meet Gail Levick, my wife and Practice Manager, who has a chat, gets you to fill out a medical history form and gives you a ‘Fact Sheet’ to read while you wait for me. We then meet and go through the examination and explanation of the procedure and possible problems. We then return to Gail who shows you photo’s and tells you about the administrative details. There is no pressure or persuasion at any stage, because we know you must make the correct decision for yourself, in your own time.

What about the shape and consistency of silicone implants?

Silicone implants are either round or “teardrop” in shape. Many ladies like to wear a “push up” bra sometimes to give a rounded breast shape and better cleavage, but this may not be possible with the firmer, teardrop implants, (some of which rotate or turn back-to-front which looks and feels very abnormal). I have stopped using the teardrop implants and prefer the round ones which still give a perfectly natural shape. Round implants vary according to the amount of silicone gel filling, so they can be low profile or high profile. I have found “low profile” implants wrinkle with time, whereas “high profile” implants maintain their smooth shape more reliably.

What make of implants do you use?

I have used Nagor implants for 20 years (together with other manufacturers at times) and I believe that they are the highest quality silicone textured mammary implants, they are made in the UK and the company staff are always helpful and efficient. I have changed to Silimed Polyurethane coated implants because I believe the results are superior.  20 years ago I used Surgitex Polyurethane implants (about 2,000 in all) and capsular contracture and seroma were rare. (see question about history of breast implants above)

What warranty does the manufacturer give?

In addition to the standard manufacturing defects warranty, you receive a lifetime no-fault free of charge warranty against rupture or severe capsular contracture in which event we will replace the implants free of charge (hospital and medical fees may be payable outside of the first post operative year).

What about sizes of implants and bra cup sizes?

Implants come in a very wide variety of sizes. Following augmentation the bra number (e.g. 34 or 36) remains the same and the cup size alters. There is no formula to say to say that a certain size implant will produce a certain size breast because ladies all vary with the amount of breast tissue they have, many shops measure breasts inaccurately and bra manufacturers vary anyway. From experience I will be able to give you a good idea what size you will be.

What size shall I choose?

One of the purposes of the consultation is to establish the size you prefer by trying various implants in your bra. It is good to bring along a partner or friend, but the final decision should be your's alone. Many say that they wish they had chosen or could have had larger implants - it is very rare for patients to say they are too big. The implant size is limited by the space available under the breast and in general the best results are from filling that space completely. If you pad out your bra before surgery no-one will notice and afterwards you soon get used to the new size and shape.

What about having my breasts measured?

A Consumers’ Association study in 2004 revealed 80% of their investigators were offered poorly fitting bras. In other words don’t assume your bra fitter will be correct with her assessment. Bras are not an exact science and manufacturers often vary their sizes. Make sure your bra has the correct number and then find the right cup size for you.

Does a breast augmentation affect cancer detection?

Breast augmentation patients are less likely to contract breast cancer and their survival rates are improved. Mammograms are more difficult after breast augmentation so Radiographers have refined their techniques. Most breast cancers are discovered by self examination and many clinicians feel that the presence of the implant with the breast tissue stretched over it makes the detection of breast lumps easier. MRI scans are the gold standard for breast investigations and should be used whenever possible.

How long do implants last?

Silicone breast implants are extremely strong and durable but are not immortal. Patients should have them checked for possible leakage or rupture every ten years or so and the MRI scan is the most reliable method. If the patient ever feels the implant has become misshapen then she should see her surgeon and have a scan. Countless implants have been in place for many decades.

What are the positions of the incisions?

The incisions for inserting silicone breast implants are infra mammary, peri-areolar or axilliary. The infra mammary incision in the lower part of the breast is the most commonly used and is my preference . It gives the surgeon the best view so he can accurately create the size and shape of the pocket and carefully control the position of the implant.

What are the scars like?

Average scars are red for several months then fade to white or natural skin colour. Sometimes scars become very red and thickened (hypertrophic or keloid scars). These are more common in Asian and African people and although the Scandinavian races in Europe are more prone to them they are uncommon in the average middle European mix; and can be treated with pressure tape and injections.

Should the implant be in front or behind the pectoral muscle?

The commonest and my preferred position is in front of the muscle (subglandular or prepectoral). There are advantages and disadvantages to both but most surgeons agree that the subglandular site gives the most natural result. I use a variation known as the subfascial position and will be pleased to explain this further at consultation.

What happens to my cleavage?

Breast position depends on chest shape which can cause cleavage problems. Implants are centred under the nipples but if the breasts naturally point outwards then this will persist. Some patients have a sternum that is depressed inwards and therefore the breasts tend to point inwards too. Breast augmentation usually improves the cleavage but don’t forget this only appears fully when you wear a push up bra. The gap between the breasts is wider if the implants are placed in the sub-muscular position. If your cleavage is asymmetrical before surgery, it may stay that way, so make sure you are clear about the exact positions of your breasts before the operation.

What type of anaesthesia do I need?

The operation is nearly always carried out under general anaesthetic but rarely patients that cannot have a general anaesthetic for whatever reason may have the procedure done under a local anaesthetic. You will have a full description of the anaesthetic in your consultation ‘Fact-Sheet’ and your Consultant Anaesthetist will talk to you in your room prior to surgery.

How long does the surgery take?

A typical straightforward breast augmentation takes approximately 45 minutes. If there are more complex problems, for example putting in different size implants to correct asymmetrical breasts, then the procedure may take more than one hour.

What is the post-operative care?

Patients receive a post-operative instruction sheet before they go home and the Hospital and I are available at all times.
Your follow-up care has no limits or further consultation fees. The Priory Hospital gives a full and unconditional guarantee for one year but after this further charges may be incurred.     I am always pleased to see you for follow-up if you have any worries and I always advise an annual routine check-up.

What can go wrong?

There can be problems with any operation, namely - Bleeding, Infection, Nerve damage and Scars. There are also special problems with Breast Augmentation - Wrinkling and Capsular Contracture. The consultation includes a full analysis of all these possibilities, their likelihood and what you can do to minimise the risks.

What can I do when I get home?

The most important post-operative message is to be very careful for the first week (at least), problems can occur if you do not rest properly and allow things to heal up inside. Do not lift anything heavier than a kettle and if you have small children its best to have some extra help. You can do a little more as each week goes by and on average two weeks is sufficient time to have off work. It is at least four weeks before you can start significant exercise and always listen to your body, if you are uncomfortable, slow down!  Some have very little post-operative pain and are tempted to overdo things, but they must resist this.

What about dressings, stitches and bras?

The dressings adhere over the incisions and should be left undisturbed and dry for at least two weeks; and the stitches are hidden and dissolve themselves. You should wear a soft but snug sports bra for four weeks, initially day and night, before trying underwired bras at four weeks.

When can I go back to work?

This varies with occupations, but you should have at least two weeks clear of major commitments. If you do upper body physical work such as hairdressing, massage or nail care, add a week or two. The average period before returning to sports and dancing is six weeks and even then, go gently at first.

When am I back to normal?

Most women say they are back to normal at six weeks, but don’t forget, healing progresses slowly for many months and sometimes years. The benefits are obvious immediately, but you must be very patient for the final result.

What about pregnancy and breastfeeding?

The implants are placed behind the breast tissue and milk ducts so do not interfere with breast feeding. There is a suspicion that pregnancy may cause capsular contracture but most women do not have any ill effects. Your breasts will swell during pregnancy so stay well supported at all times. If you limit breastfeeding to three months or less you will reduce your skin stretching and help preserve your shape.

How many breast augmentations does Mr Levick perform?

In accordance with the National Healthcare Commission guidelines, the annual audit figures of the Priory Hospital show that in the last five years (2004-2008) Mr Levick inserted  breast implants for 1,077 patients, that is an average of 215 per year.

What are the fees?

The consultation fee is £100.

Fixed price: £4,240

The fixed price represents the total fees for surgeon, anaesthetist and hospital and all follow-up consultations. 

In the unlikely event of additional surgery being required this is free of charge up to one year from the operation.  After one year further fees will be incurred.

Variations can occur if a different anaesthetic or length of hospital stay is requested.

Summary

I have two rules of Cosmetic Surgery

1. - If in doubt – don’t!

2.- Always talk to real experts.

In other words, be sure that you want to undergo surgery for your own reasons and talk to people who really know about the surgery, that is other patients or an experienced Plastic Surgeon. Many think they know all about Breast Augmentation but in reality don’t and are likely to give you inaccurate and misleading information. This surgery changes many lives for the better but on rare occasions can have the opposite effect, so make sure you are an expert yourself before you decide. Everyone you know loves you whatever your breasts are like, it’s how you feel about yourself that matters!