Enhanced Recovery

Most if not all patients will be given a general anaesthetic for their procedure. This is where you are made completely unconscious and sleeping for the duration of the surgery.

It involves a small cannula in the back of the hand, and then going to sleep with some medication injected into the cannula whilst breathing some oxygen. This works very quickly and you will be asleep within 30 seconds of the injection starting.

Having optimised pain relief during surgery, post-operative recovery is enhanced by the majority of patients having drainless surgery.

None of my patients having breast reduction, mastopexy or primary breast augmentation typically require drains.

My practice is based on published evidence and my own clinical experience over the last 10 years as a consultant breast surgeon.

Occasionally complex revisional augmentation patients will benefit from a drain for a short duration (see clinical photography section).  I use slowly dissolving sutures and water-resistant dressings.

I always review my patients post-operatively in recovery before they return to the ward. I then review them early the following morning to check they are well and comfortable, prior to nurse led discharge later that morning. Ideally, it is best to keep the dressings bone dry if possible until the patient is dressing free. Patients are fully mobile on discharge and can walk unlimited distances for exercise.

Patient having more significant surgeries such as mastectomy, breast lift (mastopexy) or breast reduction will generally be offered a regional anaesthetic technique in addition to the general anaesthetic. This ”nerve block” injection stops the nerves in the chest from transmitting pain information to the spine and then onwards to the brain. Whilst it is not mandatory, it is very effective for pain relief in the immediate period after your surgery and can last up to 24 hours, after which you will be given pain medications to take via mouth.

The type of nerve block performed by Billy is called a “para-vertebral block” which refers to the specific area of the body where the medication is injected, close the spine and the lining of the lungs. This is an advanced procedure and there are few anaesthetists who can offer this gold standard technique and even fewer who will have performed as many as Billy !

The nerve block is done whilst you are asleep, and before surgery starts. You will be turned onto your side, and an area on one or both sides (depending on planned surgery) of the back around the shoulder blade(s) will be cleaned and scanned using an ultrasound machine. This involves harmless sound waves being used to generate pictures, similar to a baby scan. Billy can use these pictures to identify important areas of your back and then direct a small needle to where the relevant nerves are that need to be “blocked”. Once in the correct place, the local anaesthetic medication is injected and then the needle is removed.

Whilst very effective and very safe, there are always some risks associated with medical procedures and these will be discussed if and when you attend for surgery, and alternative options can also be explained. If you are having a smaller procedure, a nerve block is not usually recommended as infiltration of local anaesthetic by me would be just as effective in these cases. However, every patient and surgery is different and you can discuss your own thoughts and wishes with Billy and I prior to surgery.

My regular theatre sessions are typically on a Thursday afternoon/evening. I review all of my patients on the ward the following morning prior to discharge.

Patients return to the nurse led dressings clinic the following Friday morning (Day 8) for dressing removal and a wound check. I am usually just over the corridor in my clinic and always pop across to check all is progressing as expected (see clinical photography section for expected bruising at 2 weeks).

I then see the patients in my Friday morning clinic the following week (Day 15). Most patients will be dressing free beyond this point, and are allowed to bathe and shower normally (avoid deep, hot, prolonged baths or swimming for 4-6 weeks).

Most of my patients are surprised by the speed of their recovery. A recent breast reduction patient of mine went to see Bruce Springsteen day 9 post-op! Most patients are fit to drive after 1 week. The main barrier is really a significant discomfort or restriction of movement. Patients should practise an emergency stop in a parked car and then avoid very busy roads or motorways until confidence is restored.

Cosmetic Breast Surgery is a quality of life choice, and it is imperative to minimise risks to the patient wherever possible. Tobacco and certain vape fluids contain nicotine, which is a powerful vasoconstrictor. Nicotine reduces blood flow in the tiny vessels that maintain healthy skin and promote wound healing.

We know that any nicotine exposure significantly increases patients to a wide range of post-operative complications, including wound breakdown, wound infection, skin loss, nipple loss, fat necrosis and implant loss.

For these reasons I will not perform cosmetic breast surgery on a patient currently using nicotine. I advise at least 4 weeks free of a nicotine vape and at least 8 weeks free from smoking prior to surgery.