I was appointed as Plastic & Reconstructive Surgeon at the Royal Devon University Healthcare and Torbay Hospital nearly 10 years ago.
I have been practising in reconstructive breast surgery, including micro-surgical breast reconstruction in my NHS practice and have also been working in the independent sector, both in Exeter and Mount Stuart Hospital in Torquay; this has included all areas of cosmetic surgery, comprising facial, breast and body contouring surgery.
I am the Chairman of the Specialist Training Committee for overseeing the training of Plastic Surgeons in the South West. I am also a member of the Peninsular Network for the treatment of skin cancers. I am a full member of the British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS) and the British Association of Aesthetic Plastic Surgeons (BAAPS).
I think with any patient making a decision to undergo cosmetic surgery or any procedure which is not essential for their physical health, then the key to this process is information and consent. Only by explaining in detail the likely outcome of surgery, and any possible risks, complications or side effects, can a patient make a decision which can be regarded as an informed consent.
This reflects GMC guidelines on best surgical practice. There should be no pressure from any surgeon or provider to encourage patients to have surgery as this is a decision they must make on their own when they have had a full explanation of everything which is involved. Importantly, this discussion must be with the surgeon who will perform the procedure.
Attention from the media can be both positive and negative. The cosmetic surgery industry has been unregulated for far too long and it is generally the unregulated side of cosmetic surgery, in particular the injectable treatments, that have come under increasing scrutiny and rightly so.
There has also been considerable publicity with regard to the PIP breast implant scandal and obviously legislation may be brought in to increase the regulation of manufacturers of any medical device.
Plastic surgery is a highly variable specialisation. Procedures range hugely in complexity from operations involving highly complex micro-surgical techniques to relatively straightforward excision of skin lesions.
Plastic surgery also involves all areas of the body, all sections of the community, including the very young and very old. Plastic surgery is the most general of all the surgical specialties in this regard. The ability to use experience and surgical techniques, tailored to each individual’s problem, is the challenge in plastic surgery in order to achieve the optimum outcome for each patient.
This range of procedures and variability was one of the main attractions to the specialty as no case is ever exactly the same as the one before or after it.
A situation is only stressful if an individual is unable to cope with the stresses and strains placed upon them. With good training, experience and a good team around you, including anaesthetist colleagues, nursing staff and office staff then there is no reason for the job to be stressful.
Most patients do not want to see stress in any healthcare professional, as this undermines confidence and really nobody should be doing a job which they find too stressful. As in all walks of life a little stress can focus the attention but too much stress will start to negatively impact on performance and can be avoided with good training and experience.
Living in this part of the West Country there are so many activities to do in away from work such as sailing, kayaking and enjoying the outdoors so there is plenty to do to get away from medicine. The coastline from the Exe estuary across to Torbay and Dartmouth are all my favourite locations, particularly for sailing.
Now we have a first class rugby team with Exeter Chiefs, there is also premiership rugby to watch.
There are also fantastic restaurants and the emergence of new micro-breweries in the region can only add to the attractions.
Key note speakers included Dr Hall-Findlay from Canada, and Professor Hamdi from Brussels who are both specialists in breast reduction and have international reputations in this field. Different options for breast reduction were discussed.
Dr De Bruijin from the Netherlands showed his results for mastopexy using an internal supporting mesh with excellent long term results using his technique.
Breast Augmentation talks focused on the latest 5th generation style of breast implants and micro-polyurethane coated foam implants. In addition there were sessions on the latest advances in breast augmentation and how to minimise risks and complications. There were specialist presenting work on fat transfer in breast reconstruction and a variety of other topics covering every aspect of cosmetic breast surgery from breast implant selection to surgical techniques and long term follow up.
“No matter how many times that a surgeon performs an operation there are still areas that can be refined and techniques modified to try and do each procedure even better.
Continued medical education, with courses such as these, is the cornerstone of appraisal and revalidation for doctors in the future. Patients can then be reassured that their surgeon is always up to date with the latest advances in their field of surgery”
With the arrival of spring, it’s natural to start thinking of the coming summer months and holidays, and the impending beach body battle that many of us go through! Many people consider having cosmetic surgery, and a breast enlargement procedure tends to be one of the most requested procedures - this has been so for the past decade. It may be that you have small or underdeveloped breasts and would like a larger or fuller look this summer?
The key to a positive outcome is to ensure you chose a professionally accredited surgeon to perform the procedure for you, in a modern regulated healthcare environment without having to travel far from your home, or importantly, from your surgeon for post-operative appointments.
Breast enlargement (or augmentation) surgery is suited to most women of all ages, although many surgeons will not operate on anyone under the age of 18, to ensure the breasts are fully developed. The procedure is performed under general anaesthetic and involves an overnight stay in hospital.
David Oliver will offer you a thorough consultation to ensure that you both understand what you are trying to achieve, and to decide upon the shape and size of the implant that you require. He will perform your operation and will see you post-operatively, so that you are always under his care.
Mr Oliver, Consultant Plastic Surgeon says:
“Many women request the most natural results from breast augmentation, whilst others would like to go a little larger. Implant selection is the key and I will discuss the shapes and styles available and show photographs of the possible outcomes with different choices. Understanding the desired results, and discussing with the patient their implant choices, is the key to successful breast augmentation”
Choosing to have this procedure is an important decision, and you must feel comfortable with your choice of surgeon and ensure that you are fully informed and not pressurised. Mr Oliver's and his team will support you throughout this process.
The beginning of 2012 was a busy time and saw the start of the PIP scandal. This, by chance, co-incided with the launch of the cosmetic surgery service with the Centre for Modern, Medicine, a subsidiary of the Medical Specialist Group in Guernsey, and Mount Stuart Hospital in Torquay, part of Ramsay Health Care. There were a number of patients affected from Guernsey who came for consultation and treatment and were relieved that the opportunity to see a Consultant Plastic Surgeon was available on the island.
The evidence had started to point to a high risk of failure of these PIP implants and there was also the uncertainty about the quality of the silicone gel contents. As a member of the British Association of Aesthetic Plastic Surgeons (BAAPS) I was in full agreement with the recommendations of our association and I therefore advised women affected by these implants to have them removed. This did not have to be immediately and over the following few months I undertook procedures to remove and replace these patients’ implants. Some women chose removal without replacement but most chose to have their implants replaced.
Fortunately 80% of the implants that I removed were un-damaged but some had failed and leaked requiring removal of all the silicone from the breast capsule. Again fortunately only a few patients were affected by the silicone causing problems in the lymph glands. All these implants were replaced with high quality implants from two leading manufacturers, Allergan and Mentor that I use regularly and am very familiar with.
I have also undertaken a number of procedures following weight loss - some patients had lost weight through diet and exercise alone and others after weight loss surgery. Commonly affected areas are the chest, breasts and the abdomen in both males and females. These can often be quite extensive procedures that can take several hours. Breast reduction and enlargement surgery as well as abdominoplasty (tummy tuck) have also been procedures commonly requested.
As part of our service we have made the resources available for our patients to see a consultant anaesthetist on the island before travelling for surgery. This means everyone has an in-depth pre-operative assessment to determine that they are medically fit for surgery and so procedures can be performed on the day they arrive at the hospital, which is just a short drive from Exeter airport.
Because I hold regular clinics on the island I can see patients both before and after surgery locally to minimise the travel times involved in their cosmetic or reconstructive surgery, and give them the peace of mind that I will follow up their procedure with post-operative consultations. In addition I work closely with the excellent nursing team in Guernsey so there is a point of contact for anybody with concerns after their operation when they are back on the island.
We are drawing on our experience as time goes by to refine our patient pathways and to strive to offer a high quality service working with local health care professions at the CMM and Mount Stuart Hospital. We have had a very successful year and our intention is to build on this success and excellent reputation, and in the coming year we hope to do even better.
The most effective way of determining this is by the feedback from our patients, and at the end of the day that is the most important outcome measure for us. We are delighted to have received some glowing testimonials from patients in Guernsey.
Mr Oliver will be attending Mount Stuart Hospital's Christmas Pampering Event in Torquay on Saturday December 1st, from noon until 4pm.
He will be offering the opportunity to have a free mini one to one discussion about any aspect of cosmetic surgery that may be of interest to you. If you have a question you would like to ask him, or are seeking further information, this event would be the perfect opportunity for you to do so, in privacy with no pressure to proceed.
Dr Heden is one of the world's leading experts on breast augmentation and facial aesthetic surgery with experience of performing nearly 16,000 breast augmentation procedures.
Mr Oliver and colleagues were invited to visit Dr Heden in Stockholm and he assisted him with a breast augmentation case, as the photograph shows.
On returning to the UK, Mr Oliver said "Whatever your experience there will always be a little more to learn in order to refine and improve your results further".
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