Breast Enlargement & Uplift Surgery Cost & Guide
Written by Medical Quality Manager, Clare , BN (Hons)
Medical Review by Consultant Plastic Surgeon, Mr. Richard Baker , MB BChir, MA(Cantab), MD(Res), FRCS(Plast), Eur Dip Hand Surgery
Combination breast enlargement and breast uplift is also known as an augmentation mammoplasty and mastopexy is a highly popular plastic surgery procedure in the UK. While lifting and firming, breast implants provide the breasts with volume so the patient is left with a shapely aesthetically pleasing result.
SUMMARY
Procedure time
2 to 3 hours
Overnight stay
0 - 1 night
Anaesthetic
General or local with sedation
Recovery time
6 - 12 months
Please note that we do not offer cosmetic surgery services. The information provided on this page is intended as a general guide for patients. For personalised advice and treatment options, please consult with a qualified healthcare professional.
Overview
Surgery Goals
Goals of breast enlargement and uplift surgery
While it is necessary to perform a breast uplift and a breast enlargement as two separate surgeries if the surgery is particularly extensive, it is usually perfomed in one surgery.
The goal of this surgery is to create firmer, fuller, more youthful-looking breasts. To create the breasts patients may desire, the BAAPS/BAPRAS surgeon will remove any excess skin patients may have on their breasts. After, they will then reshape your breast tissue. They may need to re-position the nipple and areola (the area of skin around the nipple). In addition, they may also need to alter the size and/or shape of the areolae. Lastly, they may use implants to enlarge the breasts. All of these changes aim to enhance the breasts and achieve the goals that patients have.
Patients may consider this procedure if they:
- Are currently unhappy with the appearance of their breasts.
- Would describe their breasts as droopy or shrunken in appearance.
- Feel that weight loss, pregnancy, breastfeeding or ageing has negatively affected their breasts.
- Feel self-conscious about their breasts.
- Would like to achieve fuller, firmer, more youthful-looking breasts.
Breast Enlargement and Uplift Surgery Cost
Cost of breast enlargement and uplift surgery
The price of breast enlargement and uplift surgery can vary between £6000 to £9000 on average. In the UK, one can expect to pay around £7000 for the procedure. There are varying factors that could cause price fluctuations, e.g.:
- Surgeon experience
- Hospital fees
- Anaesthetist fees
- The complexity of the procedure
- Amount of hours required in surgery
- Additional combined procedure requirement
To receive a bespoke price adapted to each person, patients will need to be examined by a surgeon to ensure that the procedure can be carried out, taking into account their individual needs. A patient's personalised price will be all-inclusive; the price will include:
- Any overnight stays that are required
- Follow-up appointments and aftercare
- Highly rated CQC hospital cost
- Surgeon's experience
- Anaesthetist time and expertise
Breast enlargement and uplift consultations, like all plastic surgery consultations, are free with no obligation. A patient's breast enlargement and uplift consultation will enable patients to ask all their questions, get to know a surgeon and for the surgeon to assess them and discuss likely outcomes and possible risks and complications all patients should be aware of.
Candidates & Medical Conditions
Who are the best candidates for breast enlargement and uplift?
Breast enlargement and uplift surgery is a popular plastic surgery procedure for patients in the UK. Consequently, many patients are suitable for breast enlargement and uplift candidates. As people age, it is only natural that their breasts will change. For example, pregnancy and breastfeeding can cause great changes to the breast tissue. In addition, weight loss or gain and the natural process of ageing also contribute to breast change. People may, therefore, no longer feel happy or confident with how their breasts look anymore.
This procedure aims to lift and enlarge a patient's breasts and give them a fuller, firmer, more youthful appearance. Suitable breast enlargement and uplift candidates are patients who:
- Are relatively fit and healthy.
- Have a healthy BMI.
- Have no serious health conditions.
- Do not smoke.
- May have excess skin on their breasts.
- Think their breasts look droopy or saggy.
- Believe that their breasts have lost their shape.
- Feel that pregnancy or breastfeeding have negatively affected how their breasts look.
- Believe that weight loss or gain has had a negative impact on how their breasts look.
- Think that ageing has negatively affected how their breasts look.
- Have realistic goals for this procedure.
- Are emotionally ready for surgery.
Why have a breast enlargement and uplift?
Firstly, it is important to say that a patient's opinion of their body is the most important one. In addition, many of the breast changes mentioned above are natural and common in all women. However, if patients feel that they are not confident with their current breast appearance, then exploring surgery options may be something to consider.
If patients are not happy with how their breasts look or feel, breast enlargement and uplift may be the procedure to help. It will remove any excess skin, which makes breasts appear droopy. Furthermore, it will reshape and enlarge the breasts. As a result, patients will have fuller, firmer, more youthful-looking breasts.
Pregnancy
Hormonal and physical changes happen to patients while pregnant and breastfeeding. Hormones increase the size of the breasts and can darken and enlarge the size of the areolas and nipples. The increased milk production for breastfeeding engorges the breasts, making them larger. This alteration of breast size stretches the skin, and following cessation of milk production, the breasts become less engorged, and it’s common for the new shape and position of the breasts to be more droopy and feel like, or actually have less volume.
The Procedure
The breast enlargement and uplift procedure
A breast enlargement and uplift procedure usually takes from 2 to 3 hours to perform. After the surgery, patients will either be able to go home the same day or stay in the hospital for 1 to 2 days.
Patient Consent
Before surgery, patients will meet with their surgeon. They will go over the procedure and the risks involved. Patients will be able to ask any questions they may have. If patients still want the surgery, the patient will then give consent by signing a consent form. This may be at the pre-operative appointment or on the day of surgery. It's advised that patients fully educate themselves on the procedure and understand all the possible risks before signing the consent form. The surgeon will examine the patient's breasts and may draw some lines using a marker on the area. They may also ask for permission to take before and after pictures.
Anaesthesia
Patients will meet their anaesthetist on the day of surgery. During the consultation, the surgeon and patient will decide together if the surgery will be done using a general anaesthetic or local anaesthetic with sedation. The anaesthetist will then give the patient the chosen anaesthetic before they have their surgery.
Incisions
The surgeon will first clean the skin and place a surgical drape over the body to ensure the chest remains sterile during the surgery. They will then make the incision and begin the surgery.
There are a number of different incisions the surgeon may use for the breast enlargement and uplift procedure. The incision that the surgeon will choose depends on breast size and shape. In addition, the areola size and position, the degree of breast sagging and the quality and quantity of skin will also affect their decision.
Crescent incision (periareolar)
The surgeon may use a crescent incision if the patients only have minor breast sagging. It cannot achieve a great degree of lift, which means that surgeons do not often use it.
Donut incision (circumareolar)
This incision allows more removal of skin than the crescent incision but less than the following techniques. It is therefore used for patients who need repositioning of their nipples with a mild to moderate degree of skin tightening.
Lollipop incision (vertical)
The surgeon may use this type of incision if there is moderate to severe breast sagging.
Wise pattern technique for breast augmentation and mastopexy
The Wise Pattern technique is the incision style that surgeons most commonly used for a breast enlargement and uplift procedure. This involves making an anchor-like incision on the breast. This incision permits the removal of more excess skin and tissue after the insertion of the breast implants.
This is a reliable technique that provides an excellent lift to even the most sagging breasts.
Insertion of the breast implants
During the preoperative consultation, the surgeon will discuss the types of breast implant available, and together the patient and the surgeon will decide which is the most suitable option. During the procedure, the surgeon will then insert this implant into the breast. They can place the implant on top of the chest muscle (pectoralis major), under the chest muscle or as a combination of both.
Subglandular implants (on top of the chest muscle)
A subglanduar implant is also known as a submammary implant. The surgeon will place this implant over the chest muscle. This will create a more defined breast shape as the implant is closer to the skin’s surface. As this procedure is less invasive, patients may feel less pain in the first few days after surgery. Placing the implant over the muscle leads to less implant movement when the chest muscle moves or flexes.
Submuscular implants (under the chest muscle)
A submuscular implant is also known as a subpectoral implant. The surgeon can place the implants under the chest muscle. These are less likely to be felt or seen because the muscle provides excellent soft-tissue padding. As these implants are not directly below the breast tissue, they are also less likely to interfere with mammograms. This placement is more invasive and can, therefore, lead to a longer recovery period.
Dual plane implants (combination)
A dual-plane implant is a mix of both techniques. The top part of the implant sits under the muscle. This reduces the risk of implant visibility and ripples. The bottom part sits directly in contact with the breast tissue. This helps create more fullness in the lower part of the breast.
Closure of incisions
The surgeon will then use sutures to close the incisions and put a dressing over the wounds. They may insert a drain below the skin to reduce swelling and bruising. Usually, they will remove these drains before a patient is sent home.
Return to the ward
Finally, the patient will be taken back to the ward to recover from the surgery and anaesthetic. Patients will either return home the same day or spend one or two nights in the hospital for monitoring.
What are the different types of breast implants available?
Breast implants can be filled with saline, silicone gel or highly cohesive silicone gel.
- Saline
Saline implants consist of an outer silicone shell that encases sterile salt water (saline). The surgeon will insert the empty silicone shell into the breast, then inflate it with saltwater through a small valve. Insertion of saline implants leaves a smaller scar than surgery with silicone implants. This is because silicone implants are pre-filled before surgery.
Saline implants are often one of the least popular breast implant types. This is because they are more prone to rupture, deflation and loss of volume over time. Due to their consistency, they may also look and feel less natural than silicone-based implants.
- Silicone gel
Silicone gel implants consist of an outer silicone shell with a soft, silicone gel core. To insert silicone gel implants, the surgeon will have to make a larger incision. This is because, unlike saline implants, they are pre-filled before surgery.
Silicone gel implants have a firmer consistency than saline implants, making them less prone to wrinkling. Many patients agree that silicone gel implants feel and look more natural than saline implants.
- Highly-Cohesive Silicone Gel
Highly cohesive gel implants consist of an outer silicone shell and contain a much firmer silicone gel. This firm consistency allows the implants to achieve the most natural look and feel. They are the least likely implant type to rupture, and even when they do – the contents do not spill out as they do with the other types of implant.
The current design of breast implants means that they can generally last for over a decade. Therefore they do not have to be replaced regularly. High-quality implant manufacturers usually offer lifelong guarantees to show their confidence in their implant reliability. Some brands even offer to subsidise a potential implant replacement in case there are any problems. The surgeon will choose the best fitting implants for each patient based on their experiences with the different brands.
What are the different breast implant shapes available?
There are two different breast implant shapes available, as seen in the diagram below: round and teardrop (anatomical).
The surgeon will work with each patient to find the most suitable implant shape for them.
- Round
Round breast implants add volume to the upper and lower part of the breast. These give a fuller, more lifted breast appearance.
- Teardrop
Teardrop, or anatomical, implants add more volume to the lower part of the breast than the upper part. This gives a more discreet look that is more in keeping with the natural shape of breasts. This may be the preferred option for patients looking to achieve a more natural result from breast enlargement.
The Consultation
What to expect from breast enlargement and uplift consultation?
Before surgery, patients will meet with their BAAPS/BAPRAS surgeon for breast enlargement and uplift consultation. This will usually last from 15 minutes to 1 hour. During this time, the surgeon will ask a patient a number of questions to find out more information about them. They will discuss the procedure itself and its risks and complications. In addition, they will find out a patient's personal goals for the surgery and ensure they are realistic. They may examine a patient's breasts and ask for permission to take before and after pictures. Remember that patients have the right to say no if they do not feel comfortable with this. The surgeon may ask about:
- Current health
- Any medical conditions
- Past surgeries
- Any medications taken (these include prescribed, over-the-counter and herbal medications)
- Smoking/vaping and quantity
- Alcohol intake.
- The use of recreational drugs
- Any allergies
- Goals and expectations of the surgery
During this consultation, patients will reveal a lot of personal information about themselves. Patients are reminded that surgeons are highly professional medical experts who must keep private information confidential unless it poses a risk to the patient or others. Therefore, it's recommended that patients be as open and honest with their surgeon as possible. As a result, they will be able to use the information given to provide the best care suitable for the patient.
What questions should patients ask during a breast enlargement & uplift consultation?
Breast enlargement and uplift consultation is also an opportunity for patients to ask questions. Patients may like to spend some time thinking about things they'd like to know before going to this meeting. Furthermore, patients may find it useful to write questions down. This way, they'll be less likely to forget to ask something important to them. Below is a composed list of questions patients often ask surgeons on the day of the consultation:
- Are my goals for this procedure realistic?
- Which incisions will you make on my breasts?
- What will the scarring be like after the procedure?
- How long will recovery be?
- How long will the results last?
- Do you have any before and after pictures of previous breast uplift and enlargements you have performed?
- What are the options if I am unhappy with the results?
Risks & Complications
Breast enlargement and uplift risks and complications
As with any other surgery, there are certain breast enlargement and uplift risks and complications that a patient should know about. We advise that patients take time to educate themselves on what these are before they make any decisions. Surgeons typically advise that patients take a two-week ‘cooling-off’ period after consultation with them before they decide to go ahead with the surgery. This will ensure that patients are making a fully informed decision.
The main breast enlargement and uplift risks include:
Infection
Generally, surgeons take all the precautions to ensure patients don’t get an infection. However, if an infection does occur patients must take it seriously. Most infections are mild infections (often wound infections or delayed wound healing). They will generally settle down with a short course of antibiotics. Unfortunately, however, if the infection persists or becomes worse, it is likely that patients will need to return to the hospital for treatment. If the infection affects animplant, it may need to be removed and replaced d 3 to 6 months later.
Bleeding & bruising
Usually, when bleeding occurs, it is directly after surgery while patients are still in the hospital. Sometimes, however, bleeding can occur days or weeks later. Patients may notice that the breast appears very swollen and tight. If patients do experience bleeding, they may have to have further surgery. Patients may have to spend an extra night in the hospital and in addition, may experience more bruising, but things should settle down after this.
Capsular contracture
This is when the body creates more scar tissue around the implants. This new tissue is a lot tighter than normal breast tissue. This can result in a hard or painful feeling in the breast for some patients. The amount of tight tissue which the body creates varies greatly from patient to patient. This may need investigation such as a scan or treatment including removal and replacement of the implant.
Nerve injury
Some temporary change in breast sensation after surgery is quite common. The most common symptoms are increased or reduced sensitivity around the scar and nipples (the areola). Usually, both numbness and increased sensitivity gradually settle down. Patients should be aware that it can take several months to do so. In rare cases, numbness can persist for longer than this and can be a permanent change.
Scarring
The surgeon will have to make incisions on the breasts to perform the procedure, so scarring is unavoidable. Some scars may be well hidden, while others will not. Generally, with time, scars will begin to fade. Occasionally scars can become excessively thickened and need treatment. Patients can discuss the scars they are likely to have with the surgeon during the consultation.
Aesthetics
There is always the risk that patients may not be happy with the results of the surgery. This may be because of aesthetic reasons (the size, shape or symmetry of the new breasts). To avoid this, we advise patients to choose their surgeon carefully and make sure that they fully understand the patient's goals for the procedure. Furthermore, it is important to be aware that the implants may move over time. If this were to occur, patients might want or need revision surgery.
Implant rupture
This is when an implant splits open and leaks out its contents. If this happens, it is usual practice that the surgeon removes, and if desired, replaces the implant. Implants are made in such a way so as not to cause any damage to the body’s tissue. If patients think something has gone wrong with their implant, we advise that they contact the surgeon to arrange a consultation. One possible cause of implant rupture is direct damage to the implant. For example, being thrown against a steering wheel during a car accident could cause implant rupture. Rupture can also occur if the implant is inadvertently damaged during its initial placement.
Tissue necrosis
During the procedure, the blood supply to certain areas of the body may be lost. For example, part or all of a nipple or areola may die. The risk of this is greatly increased by smoking. If this were to occur, there may be some residual asymmetry, and in severe cases further, surgery may be required. Fortunately, this is rare
Preparing For Surgery
Breast enlargement and uplift preparation
Being prepared for breast enlargement and uplift surgery will enable patients to have a more stress-free recovery. This involves getting a few things in order before patients go into the hospital. We have put together some breast enlargement and uplift preparation tips for patients.
Cleaning
Cleaning and doing household chores can be hard work even on the best of days. Therefore, getting some of these tasks out of the way before the surgery can be really useful. For example, doing the washing and taking out the bins. Then, while the patient recovers, they will not have to worry about these jobs for a few days.
Shopping
Patients may not feel up to going to the shops for a while after the breast enlargement and uplift surgery. Therefore, doing a big shop the day before they go into the hospital could be really helpful. In addition, some patients like to make use of online shopping services which can be delivered straight to their door. Patients may also like to make up some meals and freeze them so that they can avoid having to cook for a few days too.
Organising the house
When we are fit and well patients don’t usually realise all that the body does in a day. However, after surgery, patients will feel the effects of even the smallest of tasks. For this reason, patients may like to have a look around the house and make important things more accessible. For example, patients may like to move some crockery, clothes or other essentials down to lower shelves so they do not have to overstretch.
Children & pets
Looking after children and pets is not an easy task. Therefore, patients may like to ask a friend or a relative to help look after any children or pets they may have for the first few days of their recovery. This way, they can remain as stress-free as possible.
Driving
Patients will not be able to drive themselves home after the operation. This is because of the side effects of the anaesthesia and because they will be in pain. Therefore, patients should arrange for someone to pick them up.
What to wear
BAAPS/BAPRAS surgeon may tell patients to bring a supportive bra on the day of the operation. It will be useful for the recovery if patients leave some comfortable clothes somewhere that will be easily accessible to them for when they get home. Loose-fitting clothing that open at the front is the most appropriate. Patients may also like to make sure they have some slip-on shoes so that they can avoid having to bend down for a few days.
Eating & drinking
After surgery, it's advised that patients eat foods that are high in protein and low in sodium and sugar. These include fresh fruits and vegetables. It's also recommended that they try to drink plenty of water and avoid beverages containing caffeine or high levels of sugar. Maintaining a healthy diet will help patients recover more quickly.
Sleeping
It can be useful to have some spare pillows around the house as patients may find it more comfortable to sleep propped up after the surgery. It is advised that patients rest and sleep on their back continuously in an inclined position (25-to 45-degree angle) for the initial postoperative days.
These breast enlargement and uplift preparation tips should help patients during recovery. It is important, however, to follow the exact instructions that the selected surgeon gives you.
Aftercare
Breast enlargement and uplift aftercare
Its important that patients are aware of what to expect after surgery. During the consultation with a BAAPS/BAPRAS surgeon, the aftercare process will be explained. The surgeon will give an approximate idea of when a patient will be able to return to work, begin exercising again and when they will be able to drive after the procedure.
Patients will be given an appointment to come back and see the surgeon before they leave the hospital. This appointment will usually happen 1 to 2 weeks after surgery. The surgeon will review the progress and make sure the patient is recovering as expected. In addition, they will remove any undissolvable stitches and advise the patient on further aftercare and the need for further dressings. Below is some general information on breast enlargement and uplift surgery aftercare.
Waking up after surgery
If patients have a general anaesthetic, they will wake up slowly after surgery. Patients may feel drowsy for the same reason, but this will wear off within a few hours. In addition, the general anaesthetic can affect memory and concentration for the first 1 to 2 days after surgery. Again, this, too, will wear off. Patients will likely stay in the hospital for 1 to 2 days after the procedure.
Getting home after surgery
After the procedure, patients will not be able to drive home for safety reasons. This means patients must arrange for someone to pick them up or arrange for a taxi to take them home. Depending on the surgeon’s advice, patients may not be able to drive for 5 days to 2 weeks after surgery.
Looking after the breasts post-op
After surgery, it is important that patients nurse their breasts carefully. The surgeon may advise that they do a gentle massage of the breasts.
Usually, scars tend to be quite red in the 6 weeks after surgery, changing to purple in the following 3 months. From that point onward, they fade to light lines. The surgeon may advise that patients follow the following techniques to reduce the appearance of their scars:
- Scar massage – can be started after the removal of any dressings and after incisions have healed.
- Silicone gel, cream or sheets – can be used for six months to a year soon as scars heal fully.
- Keep scars out of the sun and use a high-factor sunscreen to avoid colour differences in scars and protect skin from cancer.
Post-op garments
The post-operative bra may be an important part of breast enlargement and uplift aftercare. The surgeon will advise patients on which kind of post-operative bra they may need to buy and how long they will need to wear this for.
Pain management
It is likely that patients will experience some discomfort and swelling in the first few days after surgery. Patients can often easily manage this with over the counter pain medication such as paracetamol. Pain relief and compression bandages for the first 24 to 48 hours after surgery can be helpful.
Time off work and physical activities
If patients have a less active job (e.g. office work), 1 to 2 weeks off work should give them enough time to recover. If, however, the job is more active (e.g., factory worker, carer), patients should take at least 2 weeks off. The surgeon will tell the patient exactly how much time a patient needs to take off.
Patients may not be able to exercise in the first 1 to 3 weeks after surgery. Some very light walking should be fine, but any other aerobic activity can make swelling worse. After week 3, some light intensity sports that don’t include heavy lifting or vigorous movement can be done (e.g. cycling). 6 weeks after surgery, patients should be able to return to all previous activities.
Final results
Patients will be able to appreciate the changes in their breasts directly after the surgery. It may take up to 6 weeks, however, to appreciate the full cosmetic results of surgery.
The breasts will be very sensitive for several weeks, and it may take a few months for them to settle completely. During this time, breasts may appear too high or unnaturally round, and nipples may become a little numb for a short while.
After 6 to 12 months, the body should have healed to the extent that the scars have faded and the breasts have settled. Remember that patients should strictly follow the surgeon’s breast enlargement and uplift aftercare advice to ensure they get the best results from the surgery and reduce the risk of complications.
FAQs
Questions from other patients can be useful. Other patients may ask questions you hadn’t thought of yet. Here are some common breast enlargement and uplift FAQs.
Do I need a GP referral for breast enlargement and uplift surgery?
Generally, most surgeons will be happy to see you without a referral from your GP. However, there may be some complex medication expectations that may require a doctor's sign in order to ensure patient safety. Your Patient Care Adviser will be able to let you know if this applies to you.
It's important to know that if you plan to go ahead with your breast enlargement and uplift surgery, your surgeon will ask for permission to contact your GP. They will do this to request details of your medical history.
Will I need further surgeries after my breast enlargement and uplift?
You may choose to have further surgery in the future for a number of reasons. For example, you may decide to change the size, shape or type of implant you have. You may also need further surgery if certain problems arise. These problems may include implant rupture, capsular contracture and implant re-positioning. Due to huge improvements in implant durability, material, and design over the past two decades, problems like these are now very uncommon.
Will I be able to breastfeed after breast enlargement and uplift surgery?
It is very likely that you will still be able to breastfeed after your surgery if you were able to breastfeed before it. However, some women may struggle to breastfeed after their breast enlargement and uplift. The incision and surgical technique your BAAPS/BAPRAS surgeon chooses may impact your ability to breastfeed. It is therefore important to tell your surgeon during your consultation if you want to breastfeed in the future.
If you are currently breastfeeding, it is likely that you will have to stop for at least 3 to 6 months before having surgery. This will allow your breasts to settle before your procedure.
How much time do I need off work after breast enlargement surgery?
The recommended amount of time you need away from work after a breast enlargement depends on what type of work you do. Overall, it is important to avoid any strenuous activity in the first 1 to 2 weeks after surgery to decrease your risk of swelling and other complications that could impact your results.
If your job includes a lot of physical activity, especially any kind of lifting, moving objects above your head, or any generally high-impact activity, your surgeon will likely tell you to take at least one full week off.
If your job is relatively low or no impact, for instance, office work, you may only need to be away for 4 to 5 days. In any case, you should avoid light duties that could raise your heart rate for at least 1 to 2 weeks.
Could weight gain or loss have any effect on the results of a breast enlargement?
Major weight loss or weight gain may affect the look of your breasts with or without implants.
Drastic weight gain is, in general, less noticeable with breast implants when compared to weight loss. The loss of fat in the chest and breasts tends to make breast implants more noticeable. Keep in mind however that the visual or aesthetic impact of weight fluctuation varies from patient to patient. It is recommended that you should be at an optimum and steady weight before you consider having a breast enlargement procedure. This can help prevent any aesthetic issues arising as a result of rapid weight loss or gain.
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Sources
All of the information found on our website is sourced from highly reputable experts, government-approved authorities and is widely used by healthcare professionals.
- https://www.nhs.uk/conditions/cosmetic-procedures/breast-enlargement/ NHS
- https://baaps.org.uk/patients/procedures/1/breast_augmentation British Association Of Aesthetic Plastic Surgeons
- https://www.bapras.org.uk/public/patient-information/surgery-guides/breast-enlargement British Association of Plastic, Reconstructive and Aesthetic Surgeons
- Understand.com Understand
Our content is written by our Medical Quality Managers and Patient Care Advisers, all of who have medical backgrounds and training. Prior to publishing, all the information is reviewed by a surgeon specialised within the relevant field.