Frequently Asked Questions (FAQs)

When considering a cosmetic or reconstructive procedure many questions will arise. Here are some of the questions most frequently asked during booking or consultation, along with Mr Nishikawa's answers.

If you have a question you'd like to pose to Mr Nishikawa, even if you are not a patient, please feel free to email to hiroshinishikawasurgeon@gmail.com and we'll either answer it personally or post it to the website for others to gain the benefit of the answer.

Select a procedure below to filter FAQs

I have been researching breast implants and currently have Allergan, but my friend has Polytech and her breasts look more natural and round. Can I change my implants?

The simple answer is yes. You can safely have your implants exchanged or removed.

Before this procedure we would have a consultation and discuss the reasons you are requesting the implant exchange or removal.

I have been using the Nagor implants for many years and am very happy with the results achieved. They are soft but tough, and very dependable. And because of the time I've worked with them I have an extensive evidence base regarding the outcomes that can be achieved with the Nagor breast implants.

But ultimately, the decision is yours and I will work with you to achieve your desired outcome.

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What type of bra do you recommend after breast surgery?

The breasts need to be well supported following any breast surgery (exchange of implants, removal of implants, breast augmentation, breast reduction, even nipple correction surgery). I recommend a comfortable sports-style bra, the one made by Dunlop has been recommended by many of my patients as it is made of soft mesh yet tight enough to provide support.

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My areolas are quite large and dark brown, is there a way to make them smaller and more pink?

Areolas can be made smaller but not pinker unless some kind of tattooing is used. I do not do medical tattooing although we do have someone at The Westbourne Centre who can do this procedure.

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  • Nipple correction

Is correction of inverted nipples permanent?

Yes - the surgical procedure I perform for inverted nipples is permanent

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  • Nipple correction

Will I have sensation in my nipples after surgery?

Usually there is no loss of nipple sensation post nipple correction surgery.

Numbness after breast reduction surgery can be up to 20%, although numbness is less likely after breast augmentation surgery.

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  • Nipple correction

My ears are quite pointy at the top, can otoplasty fix this?

Probably - without seeing you in person I can not accurately comment. The best way forward is to arrange a consultation. So you know, the shape of the ear can often be changed and/or corrected with otoplasty, a lot of the surgery success is dependant upon the desired outcome, which we will discuss in detail during consultation

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I’m only 15 years old but my ears stick out quite far, am I too young for surgery?

No, I am happy to meet with teenagers regarding their ear shape, size and protrusion. Together we can decide the best way forward to reach your goals, but at age 15 you are not too young for surgery.

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Is ear pinning surgery permanent?

Yes - ear pinning surgery, or otoplasty, is a permanent procedure for changing the protrusion or shape of the ears.

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Is liposuction permanent?

Liposuction can be permanent as long as the person's weight is stable, fluctuations can affect the results of liposuction.

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Will liposuction work for back fat?

Yes - liposuction can work for many areas of the body including stubborn fat on the back. It can safely be performed as a day case under local anaesthetic with or without sedation.

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Do I have to be asleep during liposuction surgery?

No, you don't need to be asleep during liposuction as it can safely be done with a local anaesthetic, if only a small area is involved. For larger areas, a local anaesthetic can be coupled with sedation.

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Can I have liposuction done on my thighs and stomach in the same procedure?

Yes, there are many procedures that can be safely performed at the same time, liposuction to both thighs and stomach are two of them. In this instance there is a bit of a cost saving by having both of these procedures done together, talk with my secretary for the full details.

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Can I decide where on my body I want the fat taken from, for breast augmentation?

Yes. As long as there is fat in the location requested then we do our best to harvest from the area of the body the patient requests. This is not always possible but I will discuss that with you during consultation.

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My friend had to go to the surgeon several times to have her breasts enlarged with fat transfer, how many procedures does it take?

The number of procedures depends on the degree of augmentation needed. It is not unusual to need several lipo-filling procedures to achieve a desired breast volume. Two or three times, or even more, is not unusual and done safely under local anaesthetic with sedation.

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Can fat transfer be used to plump up lips?

Yes, lipo-filling is a good way to plump up lips

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My cheeks are quite sallow, I want to plump up my cheeks so I have apples – is lipo-filling a better option than botox?

Yes, lipo-filling is a better option as Botox will not make cheeks bigger/more plump.

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How soon after a facelift can I have my face peel done?

A gentle peel can be done at the same time as a face lift. However, usually one should wait until 6 weeks has passed after a full facelift to consider having a facial peel.
Interestingly, some people confuse these two procedures: the chemical peel is done to improve the condition of the skin while the facelift is done to deal with the mechanics of the face. Great question!

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Will the Blue Peel get rid of my freckles and dark brown spots on my face?

The Obagi Blue Peel can get rid of freckles and dark brown spots when used in conjunction with Obagi creams containg hydroquinones and Tretinoin

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How often can I have the Obagi Blue Peel done?

The Obagi Blue Peel, a TCA peel, can be done every 6 months as part of a complete facial rejuvenation routine

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Does a chemical peel hurt or burn?

Chemical peel can feel like burning or heat, but this is temporary and will subside. Not everyone has the same sensation.

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Will a blepharoplasty improve my peripheral vision?

If there is excess skin in the upper lid, an upper lid blepharoplasty can improve upper field vision. This should be discussed during consultation.

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Will there be a scar near my eyes or eyebrows?

Following eyelid surgery (blepharoplasty), the scar should run within the eyelids.

In the upper lid it should look like a natural crease line. It will not be in the eyebrow.

In the lower lid it will run just under the eyelashes.

In trans-conjunctival blepharoplasties the scar will be hidden. These blepharoplasties are designed just to address fat excess in the lower eyelids.

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Can I have my eyelids done at the same time as a facelift?

Yes, there are many procedures that can safely performed at the same time. Eyelids and facelift are two.

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Can I have a tummy tuck if I might have more children?

Yes, but pregnancy can undo the cosmetic results of a tummy tuck.

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Can you recommend anything to help make my scar invisible?

There will always be a scar following abdominoplasty. There can be complications concerning its maturation. It can become thick but usually it will settle so that it less obvious, but I am afraid it will be a permanent feature.

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Will I still have a belly button after a tummy tuck?

Yes, you'll still have a belly button after a tummy tuck, although sometimes it may be repositioned depending upon the extent of the abdominoplasty.

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Will my belly button change after a tummy tuck?

In a full tummy tuck the position and the shape of the belly button is likely to change, and can be improved.

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Where will my tummy tuck scar be?

The scar is usually designed to run just above the pubis in an area that can be hidden with underwear. The extent of the scar outwards (laterally) really depends on the type and extent of the tummy tuck (abdominoplasty).

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Is capsulectomy procedure common for most women who have breast implants?

Probably more than 10% of women who have silicone implants will develop capsules. Capsulectomy can be carried out if the capsule causes unacceptable distortion of the breast or if the capsule is painful.

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Are you happy to perform a capsulectomy if you did not perform the original breast implant surgery?

Yes. There are many reasons a person changes surgeons, which I discuss in the Frequently Asked Questions regarding Consultation.

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Is there any deformity to breasts when having implants removed?

There can be some changes in the breast shape and/or size due to excess skin. This can improve with time and skin shrinkage but there is always the risk of breast ptosis (drooping) and wrinkling after implant removal.

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What happens if I gain weight after breast reduction surgery?

The breasts can still enlarge again with weight gain following breast reduction surgery, usually in the same proportions to your body as it happened pre-surgery.

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What if my nipples look too big with my new breast size after (breast reduction) surgery?

The nipple size can be adjusted so that they look in proportion to the new reduced size of the breast.

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Will I still have nipples after breast reduction surgery?

Yes - during breast reduction surgery the nipples are preserved and located to a better position aesthetically.

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Can I have liposuction done at the same time as breast reduction?

Yes. There are several procedures that are able to be done safely together; liposuction and breast reduction are two of those.

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Does the bilateral arm reshaping procedure include the underarm pit area as well as the “bingo wings”?

Yes, the upper arm reshaping procedure will deal with the entire arm area and all excess skin can be adjusted. You asked about exercises to deal with loose skin and I would not advise surgery if I did not think it would help. Exercise cannot address the issue of loose skin.

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When can I start exercising again after upper arm reshaping surgery?

Q: I am an art teacher so not an office job but not hugely physical either - so how long will I need off work and how soon after surgery can I start exercising again?

A: I would take a week off from your art work if is just teaching (assuming that you are not painting etc.) For the first week you can do everyday things, but plenty of rest. If your job is very physical work you should take three weeks off.

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Can you explain the recovery period for upper arm reshaping?

You will have a compression bandage on for about a week, at which time you'll come back in and have the wound inspected. There should be no sutures to remove.

You will be able to use your hands normally straight away after surgery but during this first week no heavy lifting. By ten days the wound is healed but not strong. By two weeks it will have 20% strength. By three months 70%, so plan work and lifting accordingly.

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In placing the implants under the muscle, does this damage the muscle in any way? What happens to the muscle if the implants need to removed for any reason?

This is a good question. The reasons for any muscle changing in function if it is not used for any reason, injured, the nerves been damaged or the muscle length and therefore its tension has changed. Initially the muscle is damaged because we have to incise it partially to get the implant under it. This is why sub-muscular implants are more painful postoperatively than implants placed directly under the breast. Also initially because it is stretched the muscle will function slightly differently, but nature is forgiving because the muscle will learn to behave as normal after a period of recovery.

I have not detected any long term functional problems with the muscle (called the pectoralis major muscle). However, if you were a professional swimmer, tennis player, athlete (such as a javelin thrower, gymnast) I would not recommend any sub muscular implants to be inserted. For “normal people” in the long term, I do not think that there should be any impediment to sporting activities and every day life. Long term the muscle, I believe, fully recovers.

If the implant is removed the muscle will function as before but I suspect that there will be a relatively short period of full functionally recovery as the muscle gets used to the decreased length and tension after the implants have been removed.

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MRI scans – should I do this every few years to check for any ruptures?

This is a complex and important question. There is no indication for regular MRIs in my opinion to check the state of the implants. An MRI should be carried out only if there is clinical suspicion that there is something wrong with the implant. For example a volume change, a change in shape or the presence of pain, may indicate rupture (implant failure) or capsule formation. I also believe if the patient is anxious , or feels she is experiencing odd symptoms or the implants has been in a very long time; then a scan should be done. A simple ultrasound is probably as good as an MRI in the right hands for detecting implant rupture. If an implant is damaged then they should be removed with the option to replace them with a different implant, perhaps consider fat filling.

What is a long time? This is not really known but after 10 years it maybe prudent to have an ultrasound. This is an arbitrary figure based upon the fact that nothing man-made lasts for ever and the cause of implant failure is multifactorial. Unfortunately, sometimes I am sure that an implant maybe damaged and ruptured but not detected clinically. This is because the natural capsule that forms around the implant keeps the implant in shape and in position. This logically begs the question of whether it is dangerous to have a ruptured implant in your body with internal extrusion of silicone. The opinion of the majority of medical practitioners and available research of statistical data (known as meta analysis), indicates that it is not dangerous. There is no evidence that silicone is harmful to the human body although of course, if the silicone used in implants is of low-industrial grade (such as in the PIP implants), then I believe that they can cause side effects and abnormal internal inflammatory responses. In my practice with Nagor, Allergan and Mentor implants I have not seen ruptured implants causing serious systemic problems. For some PIP cases, I have seen bad abnormal capsule formation and lymph node involvement and also historically in patients who have had implants that ruptured many years ago with old generation implants.The patient has to listened to and examined carefully should there be some change in.

The other reason for scans and investigations would be for diseases that may affect your breast in the future. This is a separate issue and must be treated on their own clinical merits. The implants would not affect the efficacy or the way diseases of the breast itself can be investigated. There is no evidence that you are more at risk or there is less chance of diagnosing breast disease because of silicone implants. There is certainly no evidence that they cause cancer.

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What would be the likely costs of re-operation or replacement?

Any emergencies will be covered free of charge.

But long term surgery is not free. For example, if a hard capsule forms around the implant after several years, the cost of the implant will be covered (as this is under warranty) but not the cost of the surgery. The rate of capsule formation is about 10%.

If the patient wants bigger implants or the implants removed then there will be a cost in the region of £2900 to £4900 dependant upon the surgery required/requested.

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How would I best control pain after the (breast augmentation) surgery?

We will give you the appropriate pain killers and instruct you how to use them. Postoperatively, after the local anaesthetic has worn off, it will be painful. However if the pain killers are used as instructed then the pain will be tolerable and last a few days, although this is so variable.

On a scale of 10 (when 0 is no pain and 10 is the worst pain ) from our audits the pain has varied from 0 to 9. The average is between 5-7. however the perception of pain is so variable between patients. I have observed that the unknown and anxiety causes pain perception to increase.

The knowledge that pain after a procedure is normal and expected will always somehow help patients dealing with discomfort along with the appropriate use of analgesics.

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In the past I have been very susceptible to recurrent mastitis, does this have any relevance?

Mastitis means bacterial infection of the breasts (not the same as mastalgia which is pain in the breasts or inflammation sometimes associated with the menstrual cycle). If it is mastitis, this may be important. If this is spontaneous and unrelated to pregnancy it is quite unusual We would need to have a conversation about when and how often this situation occurs prior to deciding upon breast implants.

Putting the implant under the muscle would lessen the chances of infection of the implant during mastitis but if this is a frequent problem I would not recommend any form of breast implant and you will need to be investigated as to the cause (unless this is related to pregnancy or breast feeding).

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How is the risk of infection during surgery minimised?

Infection is prevented by the appropriate surgical technique. This means very strict sterility of instruments and the technique has to be meticulous. The environment and correct theatre air flow conditions are very important and there are very strict safeguard controls concerning this. We also reduce infection rates by making sure that the patient is fit and healthy and is MRSA negative pre operatively.

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How would the risk of infection be minimised? Would I be taking preventive antibiotics after the op?

Infection is prevented by the appropriate surgical technique. This means very strict sterility of instruments and the technique has to be meticulous. The environment and correct theatre air flow conditions are very important and there are very strict safeguard controls concerning this. The surgery is carried out efficiently and with as minimal direct handling of the implants as possible during insertion. I believe if there is prolonged surgical exposure this is not good for the patient.

We do audit this problem regularly so I do know that my personal infection record with breast implants is very low. I have had to remove one infected implant in the last 17 years but I can never ever afford to be complacent. We also reduce infection rates by making sure that the patient is fit and healthy and is MRSA negative pre operatively. You will be given antibiotics during the surgery and will go on a short course after the operation.

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In terms of after care/follow up/complications such as seroma, bleeding, infection, what would be the costs involved?

These would be dealt with free of charge.

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What makes a good cosmetic surgeon?

This is a complex question in reality. Firstly a cosmetic surgeon must be a good doctor. Cosmetic surgery should be no different from any other form of healthcare delivery. To be a good cosmetic surgeon one should have had thorough training. Experience and judgement are the keys. Also an ability to have the emotional intelligence required to fully understand the needs and expectations of the patient and to make sure that there is no mismatch with what is possible.

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Can I have a tummy tuck and breast lift at the same time?

If this is clinically judged to be appropriate by your surgeon, then doing both these procedures at the same time is often a very good way of managing the dual cosmetic problem of excess tissue causing looseness and droopiness of the breasts and abdomen. However this will never be recommended if the patient has any significant problems such as a high body mass index (30 is a probably a universal cut off), diabetes or unstable weight or mood.

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How soon after breast surgery can I resume exercising?

After breast surgery I believe that normal activity should be resumed as quickly as possible. Normal activity means walking and light duties and this can occur between 24 and 48 hours for some patients, and there is much individual variance.

I also believe that when the body is challenged, such as after surgery or any form of trauma, recovery is enhanced with sensible rest. Simple surgical wounds take ten days to heal primarily and three months to reach 70% strength.

During this time, in breast augmentation, the capsule that surrounds the implant develops and strengthens and all the inflammation, which is essential for healing subsides. However there is probably much individual variation as to the exact timing in this process as well.

Therefore, as a compromise, I would not recommend extreme or severe exercise until at least six to eight weeks has passed. Remember it is possible to keep fit and have a sense of well-being by sensible graded return back to full on exercise, and to do this one should always be in touch with how you feel and of course discuss this with your surgeon or the clinical nurse specialist at any stage.

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The bottom portion of my nose is quite wide, can it be changed?

This procedure is known as a tip rhinoplasty. It involves adusting the size and shape of the cartilaginous skeleton that has a major and important influence on the size and shape of the nasal tip. The procedure can either be carried out as a “closed operation” which involves scarring inside the nostril but often an open approach is used which results in a small scar on the collumellar (the bridge of delicate skin between the nostril).

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I want to get rid of my bingo wings. How much does upper arm reshaping cost?

For people who have diminished the fatty component of flabby upper arms and are left with excess loose skin, we can decrease the surface area of the loose skin through upper arm reshaping. This costs approximately £4,200 to have both arms done, and is performed at The Westbourne Centre under local anaesthetic with sedation.

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How many cosmetic procedures do you perform each year?

I perform around 100 private cosmetic procedures per year working around my busy NHS and charity commitments, which account for another approximately 190 surgeries per year, mostly craniofacial and reconstructive in nature.
To accommodate the increasing number of people who want private cosmetic procedures, and who have patiently waited for me to be available, I have increased my private practice hours since April 2015.

The most popular procedures in my practice (which may not reflect average cosmetic trends) are Facial procedures (facelifts and rhinoplasty, blepharoplasties), Breast augmentation, Liposuction, lipofilling, breast reduction and mastopexy.

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Can I see before and after pictures of patients considering the same procedure?

Most certainly! During consultation I am happy to share before and after photos with you of people who have had the same procedure(s) you are considering. By doing this during the consultation, and in person, I have the opportunity to relate the example specifically to your situation, highlighting outcomes and helping with expectations.

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Where did you train to become a surgeon?

I have had a long training in surgery. I was a medical student at Cambridge University and did my clinical part at Kings College hospital in London. As a young doctor I experienced general surgery, orthopaedics as well as neurosurgery before entering a plastic surgery career. I was inspired by reconstructive plastic surgery but gradually came to realise that I could not manage deformity unless I could also deal with normal patients with cosmetic problems. I presently work at the Birmingham Children’s Hospital as part of the craniofacial team dealing with facial deformity. I also am one of the directors of The Westbourne Centre, which carries out cosmetic surgery. Once or twice a year I work for a charity called Facing Africa and we operate in Ethiopia for facial deformity.

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Are you board certified?

Yes, I have been certified with the General Medical Council since July 1982 (GMC no: 2573614) and received my FRCS (Plast) in September 1995. I also hold a Master of Arts from Cambridge (MA) and medical doctorate for research into microsurgery and free radicals (MD).

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What if I’ve already had a consultation elsewhere, are you happy to provide a second opinion?

A decision to move forward with surgery following a consultation forms the basis of a contract between surgeon and patient; if you are not comfortable with your medical professional in this process then you certainly must seek out a second opinion.

I am happy to provide a consultation for someone who has already had a consultation with another cosmetic surgeon. The process is the same as any initial consultation and I will likely ask many of the same questions but this is necessary for me to make a decision about suitability, outcomes and potential risks.

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How many consultations do you recommend?

A consultation lasts approximately 30 to 45 minutes which usually allows both of us the time to get to know each other and ask all of the relevant questions. I certainly do not want anyone to have a surgical procedure if they are unsure, so a second consultation may be necessary for additional concerns or questions to be expressed. It is vital to make sure that there is no mismatch between expectations and what can be achieved clinically.

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How much does a private consultation cost?

Are there natural pain relief solutions you recommend after breast surgery?

I have found with my patients who have undergone breast surgery that the level of post-operative pain is very variable. There are many factors influencing the degree of discomfort after surgery. One of the most important aspects of pain perception and how one can deals with it is the knowledge that postoperative pain is normal and inevitable! I believe pre-operative advise about this is very important in coping. Anxiety enhances pain.

There are certainly operative factors that influence pain. Patients tend to experience more discomfort if the implant is placed under the muscle. Probably larger implants will be more uncomfortable initially. If local anaesthetic infiltration is used during surgery, this very much helps to reduce early post-operative pain. The proper application of dressing and post-operative breast support will also enhance comfort.

I believe that there are significant psychological benefits with early mobilization after surgery. To get out of bed soon after the operation will enhance confidence and wellbeing and prove to the patient that despite surgery she is not sick or disabled. This is more likely with the use of local anaesthetic and sedation techniques. It allows rapid recovery, less likelihood of nausea and vomiting and allows breast augmentation to be carried out as a day case. Going home and being in a familiar environment with the distraction of family life will influence pain perception. In fact distraction is the most natural way to relive pain. Eating your favourite food, warm comforting drinks are also important. Books, TV, DVDs. These psychological aspects of pain perception should be augmented with analgesics prescribed by the surgeon and taken regularly, especially in the first forty-eight hours. It is in the long hours of darkness at night when the pain usually becomes worse that distraction and wellbeing becomes important. During the day, rest, gentle normal activity, having help from family and friends and keeping the mind free of anxiety and stress are important strategies.

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How can I avoid complications from eyelid surgery?

Complications from cosmetic eyelid surgery are relatively infrequent. However, problems with symmetry, unwanted changes in shape, the quality of scars and overcorrection of the original problem such as the looseness of skin or bagginess of the eyelids due to the amount of skin or fat removed can occur.

Watery eyes, asymmetry and blurred vision can sometimes be temporary as they can be caused by changes in muscle tone following surgery. Disturbance of function such as ptosis (upper eyelid damage) and eye injury are very rare.

Complications can be reduced by the proper selection of patients and of course careful technique. This can only be achieved with the proper training, judgment and experience.

So my recommendation is to always do you research when choosing a surgeon, ask for recommendations, and actively participate in your consultation.

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Can you tell if rhinoplasty will help me based upon photographs?

The question whether a rhinoplasty would help really depends on the patient’s insight into what they feels is wrong.

However, to judge the possible outcome of a rhinoplasty it is necessary to have a good idea of the true proportions of the face. This includes the vertical and horizontal relationships between the lower middle and upper thirds of the face with the apparent length of the nose from the tip to its root at the base of the forehead. The relationship of the position of the eyes as well as the width of the eyelids and the position of the eyes in relationship to the width of the nose are also important features to analyse.

It is very difficult to accurately ascertain this information from photographs and to give truly objective advice, hence the reason an in-person consultation is always recommended.

Wide angle photographs can distort the position of the eyes and make the size of the chin appear small.

With all rhinoplasty procedures one has to be very careful in reducing the size of the nose in terms of the width of the area between the eyes and also the length because by doing this there is a chance of accentuating other features of the face unintentionally. The eyes may look further apart and because the chin is small the nose may still appear large post operatively. Perhaps the shape of the tip can be altered but only after assessment clinically by an experienced clinician who can look at your features accurately as well as the state of your health, skin and psychology that can greatly affect outcome of any surgery.

With all rhinoplasty and septorhinoplasty procedures, the surgeon can concentrate on aspects of the nose which are troubling you as well as excluding any functional problems such as airway disturbance.

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Are man breasts genetic? Will they grow back after gynaecomastia surgery?

Man breasts (gynaecomastia) are not usually due to genetic causes. The vast majority is due to a developmental problem during growth often stimulated by puberty.

It is likely that there is an oversensitivity of the developing male breast to the circulating hormone of puberty such as progesterone an oestrogen that are present in small amounts during male growth. Rarely hormonal problems can cause male breast such as excess adreno-cortical hormones and feminizing syndromes. Rarely male breasts are caused by certain drugs such as Cimetidine, Spironolactone and cannabis abuse.

Liver disease can also cause man boobs along with some very rare pituitary tumours such as prolactinomas. It is important the “man boobs” are not part of general obesity. A competent surgeon will rule out all these possible causes to reassure you. Proper surgery should then deal with the problem and there should be no recurrence.

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What will happen to the excess skin after gynaecomastia surgery?

For mild to moderate gynaecomastia the skin will often shrink back. However for larger “breasts” some form of tightening surgery may be necessary resulting in external scars. Your surgeon should be able to assess this and advise accordingly.

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Is there a chance that the breasts will be a different size after gynaecomastia surgery?

Perfect symmetry is difficult to achieve but most normal men will have some asymmetry occurring naturally as well. The aim of treatment is to allow the patient to regain confidence and at least be happy in T shirt or when swimming, if possible.

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Do I need to build up muscle underneath the fat tissue before gynaecomastia surgery?

No. There will almost certainly be enough muscle under the breast to give a good post operative result.

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I’ve noticed that my breast size is not reduced by exercise, it’s very stubborn fat, will liposuction help?

Liposuction can help if this is genuinely due to fat. If it is due to breast tissue then surgery will be needed as well. This can be assessed clinically by your surgeon.

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I’ve had man breasts since I was a child, how much will gynaecomastia surgery help?

Surgery can help a great deal.

True gynaecomastia is abnormal or excessive amounts of breast tissue in males. It can affect one or both breasts.

However, there are different degrees of gynaecomastia which will affect the type of corrective surgery. needed. If the gynaecosmastia is associated with a lot of fat tissue then liposuction as well as surgery will help. If gynaecomastia was mainly due to breast tissue then some form of open surgery, usually involving a scar around part of the nipple may also be needed.

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Does jaw alignment have an affect on rhinoplasty?

I think that the position of the jaw can sometimes have a significant effect on the out come of rhinoplasty. It is always important to assess the proportions of the whole face before planning any surgery that may alter the dimensions of a nose. I believe that it is wise to make sure nasal asymmetry or apparent size is not due to disproportion elsewhere in the face. For example, the nose may appear large or protruding because of a small recessed chin or an upper jaw, which is disproportionately backward in relationship to the lower jaw. The prominence of the cheeks, or the lack of, can also influence the planning of rhinoplasty especially when determining any change in projection.

The surgeon should also check that a bend in the nose is true and not apparent. Abnormal neck positions, known as torticollis, can give the optical illusion that the nose is bent. Sometimes the nasal deviation is part of rare craniofacial conditions such as plagiocephaly, when the twist to the nose is part of a larger facial deformity. Lastly, the position of the eye sockets (orbits) can greatly influence the apparent shape and size of the nose. If the orbits are slightly positioned wider apart then noses can appear smaller therefore decreasing the width of the nose can accentuate the characteristic of the widely placed eyes.

In conclusion, part of the planning for a rhinoplasty must include an experienced assessment of the whole craniofacial skeleton in order to advise the patient about predicted outcomes.

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Will I lose sensation in my nipples?

It is not unusual for nipple sensation changes to occur after breast surgery and this is a recognised complication. Probably this occurs in 10% to 20% of patients. For the majority, this is temporary but in some it may take months before there is full recovery. Rarely numbness is permanent and this can occur in about 2-5% of women. Also, rarely the nipples can become more sensitive.

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Do I need to come back and see you after the surgery?

Yes you do. We like to check that that all is ok a week after surgery. If this is not possible then the patient should see his/her local general practitioner. However, we are always available to give advice and happy to see if there are any concerns. I personally like to check again after about three months to ensure that the patient is satisfied and that everything has healed and settled satisfactorily. Thereafter, in the long term, should there be concerns such as capsule formation or implant failure then The Westbourne Centre should be contacted.

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How long do I need to be off work after my procedure?

It depends on the type of work and the type of person! In general, a patient who has a manual occupation will need more time off work than one with a desk-based job following a cosmetic procedure using local anaesthetic with or without sedation. On average one to two weeks is the normal time off following a procedure, but personal consultation with Mr Nishikawa will give you the most accurate answer.

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Where will the scar be, and will it show under/beside my bikini top?

In my practice the scars are positioned where there is a natural crease at the junction between the bottom of the breast where it joins the lower part of the chest. It will not show if a bikini is worn and should be very difficult to see without one!

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What happens if I change my mind about the implant size we agreed during consultation?

There is no problem if this occurs before surgery. In my practice it is very rare for a change of mind concerning implant size or shape on the day of surgery because I endeavor to be very comprehensive during the initial consultation.

I am very happy to see patients again if there are any remaining questions or anxieties following the first consultation. If on the day of surgery a major change of mind occurs, I believe that this is usually due to a two-way failure in communication and it is unlikely I would go ahead until I am absolutely sure that the patient is clear in her wishes and expectations and I have her full confidence. It is vital that all concerns are fully explored well before surgery. Problems will arise when there are remaining misunderstandings and fears.

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How long will I be at the clinic after surgery?

It is not unusual for patients to be fully awake and changed within an hour after cosmetic surgery using local anaesthetic and sedation. On average patients have left the Centre between one and half and two hours after the surgery has finished.

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I don’t actually want to know what’s going on during the surgery; will I be fully awake?

The degree of sedation can be adjusted in most patients by controlling the amount of sedative drug (Propfol) and pain killing agent (Remifentanyl) delivered.

Some patients actually want to know what is happening during the operation, although most do not - and the vast majority of the patients who want to be aware of the procedure will not recall events at all. A few may remember the initial infusion of drug, and a small percentage believe that they may have heard conversations during the surgery.

For over 90% of patients the experience is pleasant and initially mood lifting as the drug infusion commences. For a few the drugs are slightly depressive for a short time, but I have found this to be very rare.

Pain is not felt by any of the patients, and one of the main reasons we use these techniques (local anaesthetic and sedation) is the very rapid recovery from surgery. The drugs are very short-acting so once they are stopped the sedation rapidly terminates and the patient is fully awake. This permits very rapid post-operative recovery and mobilization and allows a lot of cosmetic operations to be carried out as day cases.

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Are the results different from implants versus fat grafting for breast augmentation?

The results from implants and fat grafting are different.

The volume changes that can be achieved with implants are far greater than is possible with fat grafting (lipo-filling). To achieve similar volumes, fat grafting will usually have to be carried out several times.

The types of complications are very different with each technique. Usually fat grafts will shrink to varying degrees following lipo-filling, but on the other hand, problems that can occur with implant surgery such as capsule formation and implant rupture or the need for implant replacement, will never happen.

I believe that for small volume change fat grafting can be ideal. I also believe that lipo-filling techniques will improve and probably cost less in the future as techniques advance

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