Mr Stephan Hamilton, Consultant Plastic Surgeon and leading Breast Surgery expert at the London Cosmetic Specialists answers your questions regarding Breast Surgery, from what you can expect from a consultation, to the key factors that need to be considered when determining the right cup-size and aftercare.
Tell us a bit about yourself and where you currently practice?
I’m Stephen Hamilton, Consultant Plastic Surgeon and also Clinical Director for Breast Surgery and Plastic Surgery. I’m currently the Treasurer of the British Association of Aesthetic Plastic Surgeons and I have a specialist interests in cosmetic and reconstructive surgery of the breast, aesthetic surgery of the abdomen and trunk and skin cancer diagnosis and management.
For breast augmentation, is there a certain type of implant you use?
Implants come in varying shapes and sizes and need to be tailored to the individual patient. I use both round and shaped (teardrop) implants and discuss the exact choice with the patient. It’s important to consider implants with a proven track record of safety and durability. These might be more expensive but it’s a worthwhile investment.
What can a patient expect when they come in for a consultation with you?
A patient considering breast augmentation will be seen at least twice before surgery. In our first consultation, we take time discuss the patient’s goals and motivations, consider any medical history and then carefully examine the patient to identify the options available. If breast augmentation seems a reasonable plan, we try some implant sizers in a bra to get a real idea of the change that might be achieved and see if it matches the patient’s expectations.
We take time to discuss the merits and potential complications of treatment and implications for the future.
The patient then goes away to think things over. If suitable and keen to proceed, we meet at least one more time to confirm the plan. We discuss the first consultation in detail, answer new questions that have come to mind, then look to decide on the exact implants we would use. It’s sometimes helpful to look at some pre and post-op photos of previous patients who have had similar treatment.
In terms of choosing the right size cup size, what would your best advice be for the patient?
This is a key part of the consultation process and we spend quite a bit of time on it. Cup size is a fairly unhelpful measuring system and seeing a change in person is often easier. A variety of factors need to be taken into account – the overall build of the patient, the back size, the tissue the patient already has and natural width of the breast to name a few. Patients need to be able to make enough of a difference for the procedure to be worthwhile though choosing very large implants tends to bring problems in the longer term and is best avoided.
In the end, it’s a joint decision. I feel my role is to guide the patient as to what is achievable and to ensure that the implants we choose together are a sensible and safe choice both in the shorter and longer term.
How long do breast implants last for?
That’s a “piece of string” type question! The first thing, and something we always discuss, is that implants do not last forever. They are subject to wear and eventually will need replacing or removing. Ten years is often quoted and is probably a reasonable average though implants can certainly last much longer in some women.
Finally, what can a patient expect on the day of their surgery here at Hospital of St John & St Elizabeth?
The majority of patients having breast implants under my care go home on the day of surgery though some choose to stay overnight. They come into hospital in the morning or afternoon depending when their treatment is planned and are admitted to one of the lovely refurbished wards in the hospital. The nurses carry out the usual pre-op tests and then I come see her to re-confirm the plan, finalise the consent paperwork and draw some guiding pen marks like you see on TV! My anaesthetist also comes to see the patient and talk over the anaesthetic.
From there, we move to the procedure itself which usually takes about one and a half hours.
Twenty minutes or so are spent in the recovery bay and then the patient returns to her room upstairs.
After gently coming round and something to eat and drink the patient is usually ready to get home later the same day. Generally I pop up to see her, confirm all has gone well and rediscuss the follow up plan. I don’t usually use drains which makes getting home simpler.
How long is the recovery time and what is the aftercare?
Most patients find the recovery less uncomfortable than they would have imagined. Patients go home in a supportive bra which they wear for about 6 weeks. They are up and about pretty much immediately and those doing light (eg office) work can usually return to work after about 10 days, though some go back sooner. We ask them not to do any strenuous exercise for 6 weeks.
I see them around 10 days after surgery to remove the dressing and trim the dissolving sutures – a bonus as these don’t need to be removed.
Typically I plan a review at about 6 weeks thereafter and a further check at 6 months when things have mostly settled and we see a (near) final result.
Make an appointment
To book an appointment with Mr Stephen Hamilton or one of our specialist Consultant Plastic Surgeons at the London Cosmetic Specialists contact us on 0207 2666 532 or email [email protected]
Flexible appointment times are available.