Another day in the life of a cosmetic surgeon

Usual 8 am start in theatre. Another ' breasty' day.

First patient is someone who has a very strong family history of breast cancer (seven other female relatives) and was confirmed to have the breast cancer gene.

Two years ago she underwent prophylactic mastectomy of both breasts and I reconstructed her with tissue from her tummy. Benefits - reduction of breast cancer risk by at least 95%, slightly larger and more pert breasts, and a tummy tuck.

She had nipple reconstruction a few months ago and I am doing the tattooing of the areola and nipple today to complete her reconstruction.

The tattooing takes about 45 minutes, and is performed under local anaesthetic. I love this procedure, as I get to play around with colour swatches, mixing and matching to achieve best colour match - plus it's a great opportunity for me to chat with the patient about family, work and life.

This was followed by three straightforward breast enlargement using silicone implants.

My absolute favourite procedure - quick (45 minutes each), technically easy,  and stress free, with immediate results for the patient. Perfect: minimal recovery time and happy patients.

I get request for a wide variety of final 'look' from super natural to obvious full and round. Today's was nothing out of the ordinary - D and DD cups. 

Fifth patient had me sweating in my theatre suit. She has implants of 275ml (C cup) about six years ago. Two years ago, she had a nerve stimulator inserted into her brain, which is connected to a device buried under the skin of her tummy.

There is a wire buried under her skin that runs from the left side of her temple, behind her ear, down her neck, her left cleavage just above her implant into the device in her abdomen. She has a controller that triggers an electrical impulse in her abdomen into her brain for pain relief for a neurological problem. 

My task is to change her present implants to larger 425ml. My challenge - I cannot use my usual electrical device for stopping bleeding, as it will at the very least damage the nerve stimulator device worth thousands of pounds, and at worst burn her brain.

As such, I had to proceed extremely cautiously and slowly. It all went well and she is delighted with her DD cup size.

The next patient had a breast reconstruction four weeks ago using tissue from her back. Unfortunately, she has developed some fluid collection in her back (seroma) and a minor wound breakdown.

She underwent a drainage of the seroma and a closure of the wound. The nature of surgery is such that complications do occur no matter how careful the surgeon is.

The number of complications is closely audited by the BAAPS and the data for each individual surgeon is available for view on their website.

Yearly submission of these audit figures is a requirement of all BAAPS members, and is an effective way of maintaining standards of surgery and care. 

The next patient had a breast reduction, which in my mind is not just cosmetic but a functional procedure. It relieves thepatient immediately of neck and back pain, rashes under the breast, and indentations in the shoulder from bra straps.

In total, I removed five pounds of excess weight from the patient's chest. She will recover from the procedure within the next fortnight, and her life will change forever.

Usual post-operative ward round and relieved that my patient with the nerve stimulator is absolutely fine, and her device appears not to have suffered any untoward effects.

Roads were awful because of the snowfall but got home in one piece.

Home by 8pm, which is relatively early for a change.

Excited by the prospect of tomorrow's Open Evening at our clinic, where I am hoping there will be lots of fun demonstrating our services amidst food and champagne.


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