- Cosmetic Surgery
- Minor Ops
Wednesday, April 25, 2018
The story has raised several questions about patient safety and the ethics of surgeons performing such procedures.
As aesthetic plastic surgeons, it is our goal to meet patient expectation. This Morning (ITV) this week featured three women with supersized breasts with post-operative breast sizes from 34M to 34OO. Beauty is in the eye of the beholdee, not the beholder: it is not for surgeons to tell patients what their aesthetic goals should be. However, this must be balanced against our fundamental ethical code to 'do no harm'.
The full round upper breast is a desired look in clothing: overinflated breasts do not correspond with the attractiveness of the naked breast as verified by our previous population study, which showed that 82 percent of 660 women preferred a natural breast profile.
The consequences of over-sized implants include being able to feel them, visible rippling or wrinkling (especially in slim athletic women), 'double-bubble' deformity (a double-convexity of the lower breast), bottoming out (the breast implant migrating downwards), shrinkage of breast soft tissue, reduced skin blood supply (with the risk of wound breakdown and implants literally falling out), and increased capsular contracture rates (scar around the implant), resulting in increased re-operation rates.
The most important principle is that it is possible to have larger implants as long as the anatomy of the chest allows this: this depends on careful examination and evaluation, pre-operative planning and implant selection, and the intraoperative use of temporary sizers to check that the tissues are not distorted before inserting the definitive implant. The two issues that must be addressed and understood are safety and the unclothed aesthetic result. Pre-operative imaging software that demonstrates 'try-before-you-buy' 3D post-operative images can be useful here. As surgeons, we need to ensure that women want to be left with the result that they believe they desire before surgery. It is our responsibility to not contribute to distorted images of beauty by deviating from a natural breast aesthetic. This is the domain of unscrupulous surgeons with wayward marketing practices, poor preoperative planning, high revision rates, and unhappy patients.