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Wednesday, December 14, 2005

Byline: Words: Lynne Michelle.

TheyOve got money and the worldOs best-known surgeons at their disposal. Yet for every celebrity with a subtle breast enhancement, there are 10 with what look like two melons strapped to their chest. And if the stars canOt get it right, what hope is there for the 10,000 Brits who go under the knife each year in search of a sexier bust? We asked leading NHS consultant Vikram Vijh* what you need to know about getting a better breast op.

1IMPLANT MISFITS The main reason fake breasts look so, well, fake is simple I they donOt fit. OMany surgeons just ask their patients, OHow big do you want to be?OO says Vikram. OThen they ask women to put their chosen implants inside their bra and say, OThatOs what youOre going to look like after the op.O But itOs not that simple. Implants usually come in standard sizes which donOt take into account the size of the patientOs chest cavity. If the implant doesnOt fit the womanOs chest, it wonOt look natural. Sometimes, the implant doesnOt fill out enough of the chest so youOre left with a large gap between the breasts. Other times, the implant is too wide and sticks out under the armpits.O

SOLUTION: You can now get made-to-measure implants which take the guesswork out of boob jobs (see the Custom Cleavage box, below right). OIf youOre average-sized, you may be lucky and get an implant that looks OK, says Vikram. OBut custom-fitted implants give a much more natural result.O

2COSMETIC COWBOYS ThereOs a lot of bad practice out there, says Vikram. OI saw a US plastic surgeon on TV boasting how he puts implants in through the navel. He said, OItOs dangerous I one slip and I could go into the heart.O So why is he doing it? No reputable surgeon would make an operation more difficult for themselves and riskier for their patient, but unfortunately some doctors will do anything to generate publicity. Be especially wary of anyone who describes themselves as a Ocelebrity surgeonO. Those who do good cosmetic work on the stars donOt shout about it.O

SOLUTION: Make sure your surgeon is a member of either the British Association of Plastic Surgery ( or the British Association of Aesthetic Plastic Surgery ( Find a surgeon through personal recommendation, or get referred via your GP. And donOt assume a surgeon is good just because theyOre on TV, says Vikram. OOn one recent show about , not one of their OexpertO surgeons was accredited by either BAPS or BAAPS.O

3STUCK-ON SILICONE A good boob job should look natural. OSome implants pop out like two pudding bowls,O says Vikram. OThis happens when a surgeon puts in round implants. A few women may want this glamour model look, but most women I see donOt want it to be obvious theyOve had cosmetic surgery.O

SOLUTION: ORound implants look OK on fuller-figured women who have enough tissue to cover them, but teardrop-shaped implants give a more natural result, especially on slimmer women,O says Vikram. OThe upper part of the breast flares out gently rather than sticking out like a shelf.O

4 WRONG CUT ThereOs a lot of nonsense talked about the best way to do a breast op, says Vikram. OItOs easier to insert implants through the breast crease than through the armpit, so thatOs how you should do it. The surgeon can see what they are doing and ensure the implant is in the right place. Some surgeons insert the implant through the nipple, which has no advantage, and leaves scarring and reduced sensation. ThereOs also a higher risk of infection from the bacteria inside the breast ducts.O

SOLUTION: Ask your surgeon how they intend to do the op. If they opt for an armpit incision, make sure they use an endoscope to see where theyOre going. Poor visibility means a poor result. OIOve heard cases of implants being put in sideways and upside down because the surgeon couldnOt see what they were doing,O says Vikram.

5THE WRONG LOCATION Some surgeons insist you get a better result if you put the implant in below the breast gland, others say itOs better to place it deeper, under the chest muscle. So whoOs right? Vikram says it all depends on the patient. OItOs simpler and less painful to place the implant above the muscle, but not all women have enough tissue to cover the implant properly. Slim women often need to have the implant put underneath the chest muscle to avoid an obvious outline.O

SOLUTION: Your surgeon should do the pinch test, says Vikram. OIf you can pinch at least 2cm of flesh on your chest, just above the breast, the implant goes on top. If not, it goes underneath.O If youOre planning to lose a lot of weight, tell your surgeon. OItOs better to have the op when youOre at your ideal weight because the implant could start to show if you slim down.O

6SAGGING SKIN The hardest patient to treat is also the most common I the woman with small but sagging breasts, says Vikram. OThis is the typical post-baby patient. If you just put an implant under her breast tissue, it will look like a snooker ball in a sock. But if you put it under the muscle it creates a double-breast effect, as the saggy tissue dangles below the implant.O

SOLUTION: It depends on the severity of the sagging. If itOs moderate, implants alone may give a good result I if the surgeon knows what theyOre doing. OThe implant goes in under the muscle,O explains Vikram. OThe secret is for the surgeon to then release the chest muscle so it slides up, leaving the top of the implant under the muscle and the lower part under the breast gland. This is called dual planing and creates a natural-looking shape, but itOs a specialised technique and not many surgeons do it.O If the sagging is more severe, the only answer is to lift the breasts as well as insert an implant. OHowever, this will leave obvious scarring on the breast and around the nipple,O adds Vikram.


The latest thing in breast surgery is Ohaute coutureO implants customised to fit your chest exactly for a more realistic result. The surgeon takes a ObreastprintO by measuring the height and width of the patientOs breast. ODimensions vary hugely from person to person,O says Vikram. Once the surgeon has these measurements, they know how wide and high the implant has to be. All the patient has to do is pick the projection, ie, how far the breasts will stick out. The implants come in almost 500 combinations, so women can choose their new boobs down to the last inch. Expect to pay about pounds 1,000 extra, says Vikram, who charges from around pounds 5,000 for a custom boob job. l For info on Inamed McGhan 4100 custom implants, call 0118 977 0022 or visit



OWhen I had my baby last year, my chest went up to a 34G, which was fantastic. Then it vanished as soon as I stopped breast-feeding, and my breasts were even smaller than they had been before I barely a 32A. I felt so unhappy with the way I looked, I decided to have surgery to enlarge and lift them. I was referred to Mr Vijh, who told me he could make my breasts higher just by using implants, so I wouldnOt have obvious scarring. He measured me up and explained he would use an implant that was exactly the right size for my build I large, but natural-looking. IOm very pleased with the result. IOm now a 32DD, which sounds big, but the shape is so good it doesnOt look fake. Unless you knew what I looked like before, you wouldnOt guess IOd had plastic surgery.O



That mark on her breast isnOt from her bra, says Vikram. OIOd guess itOs the original crease of her natural breast. It looks as if theyOve lowered the fold of her breast to squash in a big round implant thatOs much larger than her chest I thereOs not enough room for it. If you look at the breast in profile, you can see where her own breast starts, an inch or so above the implant. A bad result.O


The model wants her 34FF breasts reduced, but doesnOt want scarring from an uplift. OSheOs young, so her skin should be elastic enough to shrink to some extent,O says Vikram. OShe could lose 10-15% of bust volume before she has to have some form of uplift. IOd swap her implants for smaller ones and ask her to wear a support bra for six months to see how well the skin retracts.O


OIOd guess sheOs had an uplift as well as implants,O says Vikram. OThe scarring around her nipples is visible because the op has been done with the Benelli technique (incisions made around the nipple only). This avoids a line under the breast, but the scar tissue round the nipple stretches because thereOs nothing supporting it. In my opinion, itOs better to have a small vertical scar to avoid this.O


The strange outline you can see is caused by a fold in the implant, says Vikram. OThis often occurs when an implant is too big for the chest and creases. Over time, the edge of the crease will erode the tissue above it and can leave a lump in the breast. This is more likely to be visible in a thin woman like Courtney, who doesnOt have much tissue to cover her implants.O


MegOs breasts are naturally far apart, but the implants have exaggerated the gap between them. OI would have used a wider implant and also lifted the breast muscle towards the centre to bring them slightly closer together,O says Vikram. OHowever, she would never have had a perfect result because of her natural chest shape.O


If thereOs too much sagging to correct with an implant alone, a surgeon can perform a mastopexy op, where excess skin is removed to raise and reshape the breasts. Patients will be left with visible scarring where the skin has been cut away.

*Vikram Vijh can be contacted on 0870 742 6049 or via


Pictures: Rex Features/