Will there be a charge for my consultation?

Mr. Rayatt is a consultant plastic surgeon, having reached this position through years of training. He will listen to your desires and concerns and examine you. At the end of the consultation he will give you medical advice and an unbiased opinion on the options available to you. At no point will there be any hard sell, and Mr Rayatt will not be offended if you do not wish to proceed for any reason. You are paying for his time and expertise.

Free consultations offered by some providers are not usually with the surgeon who will be performing your procedure so always be wary of these offers. Some of the hospitals that Mr Rayatt attends do offer a 10 minute ‘free chat’, and there are occasional ‘open evenings’ for groups of patients wishing to know more about cosmetic surgery.

Do I need to bring anything to my consultation?

Some people find it useful to bring a list of questions and this can be helpful so that you remember to ask everything you are unsure about. Sometimes it can be difficult to express yourself and in these cases it may be helpful to bring old photographs of yourself from when you were most satisfied with your appearance. A couple of magazine photographs of ideal body parts of celebrities may help if you find it difficult to express yourself but stacks of magazines are discouraged.

Is cosmetic surgery covered by my private health insurance?

All consultants are recognized by the major health insurance companies.(BUPA, PPP, Norwich Union etc). Cosmetic surgery is not usually covered by insurance companies, however if it is related to a medical condition or part of a reconstruction then you may be covered. You should check with your company before your consultation and Mr Rayatt can also write to them on your behalf.

Prior to Procedure

What can I do prior to my procedure?

There are several things you should do to prepare for your procedure:

• Avoid using aspirin for at least 2 weeks before your procedure. This is because aspirin thins the blood and can lead to increased bleeding and bruising. Some herbal preparations like ginseng and gingko biloba can also cause increased bruising and should be avoided in the week before your surgery.
• Avoid drinking alcohol, as it can also have the same blood thinning effect as aspirin.
• You must stop smoking for at least 3 weeks prior to the procedure. Nicotine interferes with blood flow in the small vessels which are important for healing. You are more likely to have healing problems and complications if you continue to smoke. Smoking will also affect recovery from the anaesthetic. You should avoid smoky atmospheres as well because passive smoking is also harmful. Nicotine patches are less damaging than smoking itself.
• Unless told otherwise by your anaesthetist, do not eat or drink for eight hours prior to your surgery.
• Unless instructed otherwise, take your normal medication on the morning of the surgery, with only a small amount of water.
• If you have sedation or a general anaesthetic you must arrange for a responsible adult to accompany you home and stay with you after your procedure. Avoid long car journeys or aircraft flights prior to your procedure as periods of immobilization this can increase the risk of deep vein thrombosis which is also a risk of a general anaesthetic.

After the Procedure

Will I need to have medication after my procedure?

Depending on the procedure you may require pain killers and antibiotics. You are advised to take the pain killers regularly so that you are comfortable.

Will I be able to eat normally after my procedure?

You should eat healthily after the procedure. After certain procedures such as a facelift or chin surgery you are advised to follow a soft diet to minimize chewing to allow the tissues to heal quicker.

How long after my procedure can I go back to work?

This depends on your procedure. (see specific procedures) In general you may feel ‘hung over’ from the general anaesthetic for a few days, but you should be able to return to light duties after 2-3 weeks. You should be able to resume normal activities after about 6 weeks.

What if my surgery does not go according to plan?

Even if a complication rate is overall less than 1% likely to happen, it is still 100% if it happens and 0% if it does not happen. Sometimes despite the best efforts of both the surgeon and the patient, things may not go according to plan and a complication may occur. Mr Rayatt and his team will help you through and endeavor to correct any undesirable results. If both Mr Rayatt and the patient agree that the outcome of the surgery was short of expectations then Mr Rayatt will waive the surgical fee. However, the hospital expenses and the anaesthetist's fees must still be paid by the patient.

Why should I not go abroad for plastic surgery?

A lot of patients do go abroad for plastic surgery, attracted by the cheaper prices. A lot of them have good experiences, however there is a growing problem of such patients presenting to the NHS with serious problems that need treating. In addition some patients have unsatisfactory results and have to pay again to have them corrected in the UK. In addition, even though some of the surgeons abroad may be on the GMC register, this does not mean that they are trained to the same level as a UK trained plastic surgeon. Their qualification has to be honored by the GMC due to EEC rules.

What is capsule contracture?

Capsule contracture or hardening of the implants occurs in about 10% of patients with implants. The body makes a scar around any foreign implant. In most cases this scar is soft but in some patients this scar can become firm enough to cause discomfort or change the shape of the breast. The exact cause is not known but infection and smoking are implicated. In itself, this does not need treating and some patients just need reassurance. Many celebrities in the media who have ‘new boob job’ are probably having surgery for capsule contracture. If you do need surgery, in most cases this is a straight forward procedure, using the old scar, removing the implant, releasing the tightness (Capsulotomy), and replacing with a new implant. The chances of further problems remains at about 10%.

How much larger can you make my breasts using implants?

Mr. Rayatt's aim is to give a natural appearance whenever possible. If your main reason for having breast implants is to increase the size of your bust, then you need to be realistic and understand that a 2 cup increase in size is average. The actual size possible will depend on your starting size and tightness of your skin. If you are small breasted or thin to start then having unrealistic expectations will result in an unnatural and 'stuck on' appearance of your breasts. During your consultation Mr. Rayatt may ask you to place some implants within your bra to assess what size of implants would look best. He may also ask you to perform a home 'rice test' (see later). Modern implants come in many shapes and sizes. The same size implant (measures in cc's) are also available in different heights and widths and the type suitable for you will be carefully chosen for you by Mr. Rayatt depending your body type and wishes. You have to also understand that a one cup increase in a small patient will require a different size implant for an equivalent one cup increase in a larger patient.

What is silicone and is it safe?

Silicon (without an ‘e’) is the second most common element in the earth's crust, and becomes silicone (with an ‘e’), when it is combined with carbon, hydrogen and oxygen. This silicone can be manufactured into many different forms including oils and gels. The oil from is found in common creams and hair sprays. Other forms are used extensively in the medical field, including as coatings for needles, syringes, and pacemakers and heart valves. Solid forms of silicone include artificial joints, catheters, and facial implants. Silicone products have therefore been shown to be reliable and compatible within the human body.

Breast Implants

Concerns have been raised about the safety of silicone breast implants. These are principally about silicon leakage, cancer formation and detection and autoimmune diseases.

Leakage

Silicone leakage probably does occur over time. The leakage is contained within the capsule which is the name given to the soft scar that the body makes around the implant. Rarely, it can travel to the glands in the armpit area.

Cancer

There is no evidence that silicone implants cause breast cancer. A number of medical studies have been undertaken.

• A study from University of Southern Calilfornia published in Plastic and Reconstructive journal in 1986 investigated over 3,000 women who received silicone breast implants. There was no increased risk in breast cancer compared with patients with no implants.
• Another paper published in 1992 from the university of Calgary and published in New England Journal of Medicine, looked at 11,000 Canadian women who had breast implants between 1973 and 1986. This study also showed no increased risk of breast cancer.
• A 1996 study published in Plastic and Reconstructive journal, followed 2,000 women with breast implants and found no evidence of a link between breast implants and breast cancer.

There is also no evidence that having breast implants delays detection of cancer by mammaography. Implant patients do need to inform the person performing the scan that they have breast implants and slightly different techniques of taking the mammography scans is employed.

Connective Tissue Disorders

There was some concern about breast implants causing diseases such as Rheumatoid Arthritis and scleroderma.

• A 1994 Mayo Clinic study published in the New England Journal of Medicine compared 749 women who had breast implant surgery, with 1,498 women who did not have breast implant surgery. The results of the study showed "no association between breast implants and the connective tissue diseases and other disorders that were studied".
• A 1995 Harvard Brigham's Hospital study published in the New England Journal of Medicine, analysed 14 years of follow-up data from the Nurses Health Study Cohort. This involved a survey of over 87,000 women, with and without breast implants. The results showed no "association between silicone breast implants and connective tissue diseases".
• Doctors at the Karolinska Institute in Stockholm, Sweden studied more than 7.000 women who had had breast implants and compared them with a group of more than 3.000 who had undergone breast reduction surgery without implants. They found no meaningful association between women with implants and cases of connective tissue, or immunological, disease. In fact the women with augmented breasts were statistically slightly less likely to have encountered these diseases then the breast reduction group.
• A statement prepared and published by the American College of Rheumatology (ACR) - advises that while there may be a theoretical risk of Connective tissue disease (CTD), especially for a patient who already has a CTD, there is "no reason to discourage women from considering breast [implant surgery] on the basis of acquiring or exacerbating a connective tissue disorder".

What is the difference between a plastic surgeon and a cosmetic surgeon?

A plastic surgeon is a surgeon who has undertaken specialized accredited training in plastic surgery which includes reconstructive cosmetic and aesthetic surgery. He will be on the GMC Specialist register in plastic surgery. A UK trained surgeon will have the letters FRCS (Plast) after their name and be a member of the British association of Plastic and Reconstructive Surgeons (BAPRAS).

A cosmetic surgeon is not necessarily a plastic surgeon and may not be on the GMC register as a plastic surgeon. Be aware that just being on the specialist register does not imply that you are a plastic surgeon. You can check online on the General Medical Council (GMC) website or by telephoning GMC registry line on 0845 357 3456.

Smoking and Surgery

The nicotine in cigarettes, e-cigarettes, vapes, patches or gum products is detrimental to normal healing. The effect of nicotine is to squeeze the blood vessels, which is the opposite of what healing tissues need. You are at 3x the normal risk of infection, wound breakdown and bleeding (haematomas).

Any surgical procedure is at risk but particularly procedures that involve lifting of large amounts of tissue such as abdominoplasty, breast reduction, mastopexy and facelifts. Fat grafting is also less successful, if you are smoking.

You should stop smoking for at least 2 weeks prior to surgery and for 2 weeks after the surgery.
Smoking will also affect the recovery from a general anaesthetic with increased chances of chest infection. Some hospitals perform urine or breath tests to check for nicotine levels and there is a chance that your procedure could be cancelled on the day of surgery. You are paying good money for surgery to improve your appearance, so it does not make sense to risk having delayed healing and worse scars by smoking.