Anatomical versus Round Implants: Discrepancy between What the British Public Prefers and What British Cosmetic Clinics Offer as Standard Implants

Abstract

Sir: There are a wide variety of techniques and implants available for breast augmentation. Knowledge of preferences and current trends in what is considered a “desirable appearance” can help reach a mutual preoperative consensus and high postoperative satisfaction. Surprisingly, little is known about the British public's perception and preferences. We conducted a street survey on the preferred breast shape among 43 randomly selected Caucasian British women and compared this to what 10 of the largest cosmetic clinics offered as a “standard augmentation.” We wanted to see whether this preference was related to the type of media exposure and whether this differed from 40 (more informed) plastic surgery nurses recruited from our unit. All subjects completed a demographic questionnaire, were asked whether they read scientific journals or magazines, and were asked which postoperative photograph (exhibited on the Web) they preferred. All were shown the same photographs, one with a natural appearance and one with a “pushed-up” appearance. The cosmetic clinics received a blinded telephone inquiry, asking what types of implants they had available and what standard implant they offered. No individual surgeon was approached. Subject ages ranged from younger than 20 years to 60 years. There was an overwhelming preference toward the natural appearance in both groups, 34 members of the public (80 percent) and 35 nurses (87 percent), which did not seem to be influenced by age or media, with 22 members of the public and 20 nurses reading magazines only. Among the nine members of the public (20 percent) and five nurses (13 percent) who preferred the pushed-up appearance, eight and four only read magazines, respectively. In contrast, a larger number of round implants were offered by the clinics. Although all offered both round and shaped implants, six offered round implants as standard procedure, which were less costly. One clinic offered anatomical implants as standard and three clinics did not recommend any preferred implant choice (Table 1).Table 1: Implants Offered by 10 of the Largest Cosmetic Clinics in the United KingdomOur survey gives insight into some factors influencing the British public's preferred appearance. Previous studies have shown that the media and acceptance from society motivate patients to undergo surgery.1,2 However, despite an excessive pushed-up appearance from media exposure, our survey seems to indicate a changing trend in the British public's preference. This change was difficult to establish because there were no previous studies available for comparison. The discrepancy between the preferred appearance and what is currently offered in the British cosmetic sector as the standard implant could be attributable to keeping the cost minimal, lack of experience or training of the “cosmetic surgeon” with anatomical implants, poor patient information, or lack of awareness of available choices. Alternatively, it could be that clinics are slower in moving with change. We recognize that our sample size was small and that the standard offered is not a reflection of each of the surgeons within those clinics. Nevertheless, it gives some indication of the current British public's preference, which may help British surgeons achieve greater patient satisfaction. It would be of interest to compare these findings with similar information for the American and Asian public. Anita A. Liem, F.R.C.S.G.(Plast.) William J. Holmes, M.R.C.S. Azhar Iqbal, F.R.C.S.(Plast.) Department of Plastic and Reconstructive Surgery Whiston Hospital Merseyside, United Kingdom