Dr. Raj Ragoowansi is one of the world's leading Consultant Plastic Surgeons. His primary practices are on Harley Street, London, and at The Wellington Hospital. This interview is part of a larger article on cosmetic breast surgery, entitled 'Do I Really Need Surgery? An Unbiased Cross-comparison With 3 Of The World’s Best Plastic Surgeons.' The article also features advice from Dr. Patrick Mallucci and Dr. Dan Marsh so, if you are considering cosmetic surgery, we highly recommend reading it.
1. How do you feel that the field of cosmetic breast surgery has changed in the past 5-10 years?
That depends on whether you’re discussing the social or clinical aspects of it. Both have undergone significant transformations. From a social perspective, breast surgery has become a lot more acceptable and far less of a taboo than it previously was, largely due to the media’s portrayal of it. That has its pros and cons; however, thankfully, most doctors have portrayed the surgery in an ethical way. It’s enabled us to encourage those considering surgery to actively research the options on the internet, both in terms of the surgeons themselves (i.e. their histories, their specialisms, their previous patient case studies, references and results) and also the clinic- and treatment- options available; and to rationally consider how they feel about their breasts and if they’ll benefit from the surgery, or may actually be happy without it. This has resulted to patients being more informed and aware of the surgical options available to them and, importantly, what to look for than ever before. They know what to look for, what to avoid, what the norm is, what the standard norm is for their age, skin type and so on. Consequently, they’ve become more aware about their breasts, looking at them in a logical, more anatomical and very structured way. Not only has this helped the field of cosmetic breast surgery but, inevitably, it’s encouraged more women to self-examine their own breasts and improved breast cancer awareness too.
2. What about in terms of the treatments and techniques available?
The treatments and techniques haven’t changed that much in the last 5-10 years. The main difference is that surgeons are placing a much greater importance on achieving minimal scarring. That’s something I’m very happy with and renowned for myself. The best surgeons will aim to leave minimal scarring. The scars should be short, easily hidden around the areola of the nipple or under the breast and, in some cases, it’s possible to leave no scars at all. (Note: Fat transfers tend to result in some scarring, compared to pure implants, but it will be minimal.)
What about scarring that already exists? Do you prefer to cut there or somewhere else? No, I’m a scarring specialist so, if the scarring already exists, I tend to use that scarring and improve upon it. Often the patient is left with smaller, less visible scarring than they had pre-surgery.
3. Everybody knows about breast implants and augmentation but less is said about breast reductions and rejuvenation. What is the best method currently available to rejuvenate ones natural breast, giving a youthful, fuller and perkier aesthetic?
That’s such a broad question and I could go on all day to be honest but, essentially, I think, you’ve need to look at your skin, your nipple and where your gland is. If the gland is not descended and just a bit loose, then you can tighten it. If the gland is descended with the nipple, then you lift the nipple and the gland. The third thing to look at is if you’ve got excess skin. For example, patients with weight loss, especially those who have lost a lot of weight within a short space of time, tend to have lots of skin. Consequently, their gland may be slightly low but may still be in a reasonable position, as will the nipple; however, there is so much excess skin that the whole breast appears dissociated from the rest of the skin envelope. It’s something that is also seen in women whose breasts have greatly augmented and reduced during several pregnancies and, in these cases, it can greatly affect the woman’s confidence – even making the daily activities, such as shopping for bras or clothes, feel depressing. For them, breast rejuvenation and lifting can make the world of difference, not only improving their physical aesthetic, but also their quality of life, relationships and how they feel about themselves.
Most people don’t realize but breast reductions don’t always mean smaller breasts. In most cases, reducing the excess skin and restoring the contours of the natural breast shape can make the breast more perky and with an improved skin elasticity and aesthetic for the remaining skin. This rejuvenation provides an extremely natural looking- and feeling- breast.
4. In terms of the nipple, depending on the size and if somebody goes up or down, do you change the size of the nipple or do you keep it the same?
I do, yes. I’m very meticulous about the nipple when it comes to the breast, and also about the positioning of the belly button when it comes to the tummy. They’re focal points of the anatomy so it’s important to make sure that their positioning and size convincingly fits in well with each individual patient’s body.
5. Is there a perfect, if we can say perfect, bust size for a natural effect?
Yes, definitely. It all depends on the patient. You need to consider their psychical, social and mental characteristics; their background; hobbies (i.e. do they do a lot of sport? What impact that has on the breast? And the impact of the breast in allowing them to perform those activities etc.); their personality and style, and many other factors. It’s very personal. It’s vital that the final breasts work for their lifestyle.
6. Some women often lose fullness and incur stretch marks at the sides of their breasts after having children, losing weight or when their breasts are subjected to regular natural hormonal dramatic increases and decreases in size. For each of these women, what would you recommend and why?
I think, again, it’s very difficult to answer this. With surgery, there’s no such thing as ‘one size fits all’. Every woman is different so I’d recommend them arranging a consultation. Then I can examine them and offer them a bespoke solution and rational, tailored to their individual body and concerns.
7. Is there a way to achieve the desired effect without having full implants?
Yes, you can have fat transfer or simply an uplift. I.e. where the breast becomes higher and perkier without any added volume.
How does the uplift without volume work? Sometimes, when the gland drops, by lifting it up, it’s possible to restore the volume. Then the surgeon will tighten the skin envelope on top of it and that can be enough. You don’t have to have more volume but if the woman would like some volume added during the procedure, that’s possible to.
Would that reduce the cup size then? Not necessarily. In fact, it may increase it.
How long do the effects of each procedure last, and how much do they cost? A fat transfer can last up to 18 months and costs £6000; whereas an uplift can last 10-12 years, after which the woman may need to come back in to have it revised. An implant can last for 12-14 years.
8. When women are coming to see you as a surgeon, what should they bring with them to help you advise them on the best thing for them?
I always recommend bringing pictures along from when they were young. That helps us to create a look that fits naturally in with their own body and frame, something closer to restoring what they had, rather than creating a new look.