The cost of consultations and surgery
Up-to-date costs can be given by email or by telephone Boulcott clinic on 0800 268 526.
There is a charge for the initial consultation. There is no charge for additional consultations prior to surgery and this is strongly encouraged if there are any concerns or questions. In the case of breast augmentation, many patients come back to my rooms to trial the various implant sizes in their own time to ensure they are comfortable with the size selected. There is no charge for follow-up consultations in the first year after surgery
The quoted cost for surgery covers everything including anaesthetist fees, theatre fees, consumables, the implants, staying overnight in hospital after surgery, any additional consultations after the first consultation and all the follow up for dressings and checks in the first year after surgery.
I do breast augmentation for a fixed cost. The cost may differ if non-standard implants are used in special situations or a breast lift is required at the same time.
Mastopexy and Breast Reduction cost
The cost of a mastopexy and breast reduction vary depending on the theatre time and consumables used. I give everybody a fixed quote for surgery after I have examined them and know what is likely to be involved. Prior to a consultation staff are happy to give a range of likely costs based on recent cases.
The cost of the surgery is prepaid to the hospital on the day of surgery. There is no booking or prepayment fee. Some people would like the option to pay off their surgery over time and use Nova Medical, a medical finance company to do this. I am not connected with them in any way but they offer a discounted finance rate for surgery with appropriately qualified surgeons including myself. You can apply online at Nova Medical. You should ensure that you are aware of the total cost over time if you choose this option.
What happens at the consultation?
I meet my own patients personally rather than a “nurse consult”. You are very welcome to bring a close friend, partner or other support person. You will be asked about your reasons for wanting surgery and your expectations. Your personal history of breast pathology, family history of breast cancer and any breast imaging will be covered. Your medical history, medications, allergies, smoking and activities you do that will affect recovery will be covered. What occurs during surgery and subsequent recovery is discussed along with the potential risks and complications. An examination of your chest is performed in particular assessing your tissue type, any asymmetry and various measurements will be recorded.
Photographs are taken for your medical record. These do not include your face and you will be asked to remove any identifiable pieces of jewelery. Images are stored on an encrypted drive and you are able to have access to these any time in the future. In the case of breast augmentation you will be shown implants identical to those used and an explanation given about the choice of shape, style, texture, fill, incisions and plane given. A range of implants are trialed inside a surgical bra. After the consultation I send a letter summarising what we discussed so that you can consider everything in your own time.
What happens during surgery?
I see everyone in their room prior to surgery and again go over everything that will happen and answer any new questions. You may have your partner or close friend present if you wish. Markings are made on the chest while you are standing. The consent form is double-checked. You will meet the anaesthetist who will explain the anaesthetic and check specific medical concerns. In theatre the team introduce themselves and a final check (Time Out) is performed.
Once you are asleep an antibiotic is given. I inject a long-acting local anaesthetic into the nerves under the ribcage and the chest wall muscle. A different local anaesthetic is given around the operation site. After sterilizing the area surgery is performed using incisions that will have been discussed in detail. You are moved from recovery back to the ward once fully awake. I check you later that day and the following morning. You are given a written instruction sheet with my telephone number in case of emergency and an appointment to be seen in clinic about 5 days later for removal of the dressings.
Pain relief after surgery
Everyone has different analgesia needs after surgery. In general, most people have paracetomol, a NSAID and an opiate based medication at discharge. Most people do not need to take all three medications at once however they may do so without interactions. A typical regime is:
- Paracetomol 1 gram 4-6 hourly as needed
- Diclofenac (eg Voltaren) Slow release. Two 75 mg tablets daily. NSAIDS are very effective for musculoskeletal discomfort but cannot be used in those with sever asthma, gastric ulcers and some other conditions. It is very important that it is take on a full stomach to minimize the risk of stomach irritation.
- Tramadol. 50-100mg every 6 hours. Good for severe pain but may cause nausea and I prescribe an antiemetic to be taken at the same time.
What if something goes wrong during surgery?
There are a number of complications that can occur after surgery. These will be explained during the consultation and in written information given to you. Most are explained in more detail below. Most potential complications or adverse outcomes can be improved by further surgery. If the complication was caused by a technical error on my part I would fund the total cost of revision surgery. If this is not the case, for instance a capsular contracture, then I would not charge a surgical fee if the complication occurred within 5 years of surgery however the patient would have to fund the cost of the hospital and anaesthetic fees.
Complications after breast surgery
Complications after breast surgery may include bleeding, infection, changes to nipple sensation, scars, asymmetry, effects on breast feeding and other breast gland changes over time including cysts and calcium deposits. I give my patients a copy of the Australian Society of Plastic Surgeons information sheet for the relevant procedure, which has more detailed information about most of these complications. If a patient of mine has a complication, I will do my best to sort it out. The following are complications that can occur with any breast surgery. More specific complications are discussed with each procedure.
1. Haematoma The main possible complication that can occur during the surgical admission is a haematoma, or bleeding in the surgery site. The risk is about 2% (1 in 50). Haematomas typically occur between 8-12 hours after surgery. Initially the breasts are soft and symmetrical then one side will become very swollen. It may be quite uncomfortable as swelling progresses. If this happens you will need to be taken back to the operating theatre, the incision opened and the clot removed.
Most people will still go home the next day as planned but this will depend on the timing of surgery. I have never had a patient develop a late haematoma after they have been discharged. There is no long-term detrimental effect on the surgery. The cost of the further surgery is covered by ACC as a “Treatment Injury”. You do not have to pay additional costs.
2. Infection Infections are rare after breast augmentation surgery. In severe cases the implant would need to be removed and replaced at a later stage. I have not had this happen. In about 1:30 cases there may be a minor skin infection for which I prescribe antibiotics as a precautionary measure for a few days. Severe infection is more likely after breast reduction in part due to areas of tissue having a compromised blood supply.
The risk is about 1:50 and treatment would require debridement of tissue in severe cases and admission to hospital for intravenous antibiotics.
3. Sensation Sensation may increase or decrease around the nipple- areolar complex. In the case of breast reduction, nerves that pass through the surrounding skin are severed but gradually regenerate over time. The nerves which enter deeply are kept intact however sensory disruption is common in the first few months after surgery. It may take a long time for the sensation to return to near normal and in some cases permanent changes occur.
4. Breast feeding Breast augmentation surgery does not affect breast feeding. Mastopexy procedures which do not severe breast ducts may not affect breast feeding but this cannot be guaranteed. Most breast reduction techniques will permanently affect breast feeding.
5. Asymmetry A minor degree of asymmetry prior to surgery is normal. If the symmetry is marked then surgery will usually attempt to correct this but perfect symmetry of all aspects of the breast is unlikely. However previously symmetrical breasts should not be markedly asymmetrical following surgery.
6. Scars All incisions create scars. I have use modified breast lift and breast reduction techniques to minimize the inframammary crease scar in most cases however a “poor scar” is always possible and may need revision. I recommend patients wear a paper tape on certain incisions in key stress areas after surgery for 3 months. I give patients the tape I recommend.
Bras after surgery
You do not need to wear a bra immediately after surgery because of the way the breasts are taped, but you may do so if it is more comfortable. I recommend wearing a tight singlet, crop top or a very soft single piece fabric sports bra without lots of internal reinforcing. Lots of my patients have been wearing the R-bra from the Warehouse and report that it is very comfortable. I recommend waiting at least 4-6 weeks before getting measured for a new bra. This allows time for any swelling to subside, the position to settle and the breast to soften.
Recovery after surgery is a gradual process over several weeks. Most people return to deskwork 1 week after surgery. Occupations that require lots of arms movement, for example hairdressers, policewomen, courier drivers more typically require 2 weeks off work. Gym work can be gently recommenced a week after surgery with exercises not involving the chest (eg using an exercycle). Vigorous netball games, pump classes, tennis etc can be gradually introduced at 3-4 weeks after surgery. You cannot legally drive within 24 hours of a general anaesthetic. Gentle driving can be recommenced in the week after surgery.
Flying after surgery
A number of people fly in from other areas of the country to have surgery. It is usually ok to fly home on the afternoon after the surgery but I recommend having travel insurance just in case a medical reason arises that may cause travel delay. I recommend waiting a minimum of 48 hours for flights back to Australia.
Mammograms before surgery
Approximately one in every 7 New Zealand women will develop breast cancer during their lifetime. Breast screening is recommended every 2 years for women once they reach age 45. Women who have a strong positive family history of breast cancer will start breast screening at an earlier age. I recommend mammograms in everyone over 30 years of age before breast reduction surgery (because of the way the internal breast architecture is altered) and over 40 years of age for breast augmentation surgery.
Sex after surgery
There is no restriction with sex after surgery but you should use your common sense. After the tape is removed on day 6, your partner may gently touch your breasts but vigorous squeezing should be avoided. Normal activities can resume when the wounds are well healed and it is comfortable for you.