The fastest surgeons of all times
There was a time, before the introduction of anaesthesia, when surgeons had to be faster than light, and surgical operations were lasting few minutes at most. 
This wasn’t always easy or pleasurable, and cases are reported where, due to the excesses of a not very careful surgeon, the mortality rate for the procedure was calculated as 300% (the patient, the assistant, and an innocent bystander…). The title of fastest surgeon of all times is generally credited to the Scottish Robert Liston, who on December 21,1846 performed a thigh amputation in 25 seconds from the first cut to the last stitch. Before a procedure, Liston would always address the crowd watching in theatre with the words: “Time me, gentlemen, time me!” (more about the historical amputation performed by Robert Liston can be found here).
Fast forward more than 150 years after the introduction of anaesthesia and longer surgical procedures and you will find out that, at least in commercial cosmetic surgery, fast surgeons are back and trendy again. The normal duration of a breast enlargement used to be, till few years ago, between one and two hours. Most surgeons working for the big cosmetic companies are now taking less than 30 minutes for the same procedure, and few ‘stars’ may enlarge your breasts in just under nine minutes.
Why is this happening? The most important reason is that companies want to use the operating theatre (a fixed cost for most of them) as much as possible. Then, you should never forget how much the surgeons are paid, because they increasingly need to rely on huge volumes of patients to make a decent living (and pay their insurance costs…). On a normal day, the few fastest surgeons can operate on 15-16 patients in about 12 hours. Considering that it takes about 25 minutes to move a patient out of theatre at the end of a procedure, and to put the next one to sleep ready for the knife, if the surgeon is operating 15 patients, 6 hours and 15 minutes are spent moving patients, and 5 hours 45 minutes doing the actual operations, with an average of 23 minutes per operation. Keep in mind that this rough calculation doesn’t include the time that the surgeon has to spend writing notes and talking to patients before the procedure (normally few seconds just to get their consent…), or a lunch break. No wonder some of the ‘star surgeons’ are beginning to use the same words that Liston used: “Time me, nurses, time me!”, in a theatre where nobody but few astonished nurses can watch them…
Just one final question for you at the end of the story, anyway: is this treatment what you wanted when you paid your cosmetic surgery company? (I mean: are you sure you like the idea of a surgeon that works 12 hours without stopping, and that doesn’t have time to talk to you?).
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Hello again Snake, what do you think of Dr Tebbetts 24hr recovery procedure…do you think it will catch on in the UK?? And is it true that these techniques cause less tissue trauma to the paitent?? http://www.thebestbreast.com/book/chapter/8
your professional opinion would be greatly appreciated
Hi again,
Dr Tebbetts published an impressive amount of data, all in peer-reviewed and reliable scientific journals, to support his point of view. I personally feel that there are very good insights in his work, and possibly a bit too much marketing (but not enough to make me ignore that he really improved the way we do breast enlargements).
Will this catch in the UK? Not till cosmetic surgery companies are around. Dr Tebbetts only uses the best surgical instruments and breast implants, and never does more than four procedures a day (at least till the last time I talked to him…). This is a level of quality and patient care that is unreachable by the commercial companies and the private hospitals in the UK, at the moment. Sad, I know.
and i guess with quality comes $$$
hmmm i wonder how much tebbetts charges?? i can but dream
thanks for your response
It will come as a surprise, but at the moment most surgeons in the USA (with the exception of New York City) charge a similar price for a breast enlargement, and their average fee is $3400, which today is worth about £1922.09. This is for the surgeon only, and compares to the £400-£500 that the average cosmetic surgeon working for a commercial company in Britain is paid. The total cost of a breast enlargement in the USA is, on average, $7100, or about £4013.79, which is very similar to what Transform or the Harley Medical Group used to charge till the recent credit crunch. You can see very well that, paying their surgeons such a small amount, cosmetic companies in the UK cannot afford any John Tebbetts on board. What really makes the difference in quality between the USA and the UK is that here companies need to make a profit, while in the USA there is no ‘middle man’.
Hi,
Hope this is the right place to put this type of question.
I was looking for various possible options to define a surgeon’s average operating time. Could anyone tell me what are the factors to be considered while calculating a Surgeons Average operating time.
Possible solution which I have encountered is as follows: In case anyone has better suggestions, please provide. Thanks in advance.
Assumes Dr.XYZ has performed an operation for 45minutes in the month of Novemeber. The avergae operating time will be 45minutes initially.
In case the doctor performs the same operation again in this month and suppos it took 35minutes for him, the total average operating time for the surgeon/operation combination would be calculated as follows:
(45+35)/(number of times operation is performed). i.e 80/2 = 40Minutes.
How about calculating the avergae time based on “Type of Surgery”.
Kind Regards
Shankar
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Dear Shankar,
are you a management accountant? This is the sort of question I would expect from Transform or the Harley Medical Group!
As you guessed, the math behind this calculation is very basic, the problem is: you are calculating an average time. It doesn’t tell you the time a particular surgeon will spend on a particular patient
I believe this approach to cosmetic surgery is flawed, and very unfair to patients and surgeons, because it pushes surgeons to rush and adopt quicker, less sophisticated techniques taking shortcuts, and doesn’t leave time for patients and surgeons to talk and understand each other.
The best advice I can give you is: talk to your surgeons, don’t treat them like Tesco is doing with farmers. Surgeons do know their operating times, as long as they are expert and old enough. If you are working with young surgeons (< 40 y.o.) with little experience and/or little knowledge of the English language, then good luck to you, your company and your patients.
There was a very famous American cosmetic surgeon that used the tell his face lift patients: “The procedure would normally take four hours, but rest assured that I will not come out of the operating theatre till I have got exactly what we planned together, even if I will have to spend my all night there”. No wonder he is still one of the best cosmetic surgeons of the world.
Snake
Hi Snake,
I trust you are well.
Snake, if a company charges nearly £5K for a breast augmentation would you be so kind to let me know how much profit this company makes.
If my calculation is accurate:
Implants = £90.00/then they sell the implants to the patient @ £400.00
Hospital fees + medical fees @ £2000.00 with one night stay included.
Surgeon fees @ £500.00 per BA
Would you agree with me if I say that they make nearly £3000.00 profit per BA.
Many thanks for your help on that.
Tamaree
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Dear Tamaree,
I am afraid you are way off the mark. I will not tell you the real numbers, but you should realise that most companies at the moment are selling breast augmentations at a price that may go from £2900-3000, or even a bit lower if you manage to get all the discounts, to £3900-4000 if you are a bit stupid and let the ‘friendly patient advisor” stick to the ‘official’ price without bargaining.
You also missed two big costs: the staff (including administration) and, the biggest one, marketing. The cost of marketing is a closely guarded secret for both Transform and the Harley Medical Group, the two biggest players, but there was a study of a Swiss bank regarding the Spanish company Corporation Dermoestetica, an even bigger cosmetic surgery company that is listed on the stock market, and is therefore more accessible, where the cost of acquiring a patient was 27% of what that patient paid for the procedure (i.e. if the patient paid £4.000 for a breast enlargement, £1.080 was just the cost of bringing that patient in…). Again, I may know a bit more about this on the UK market, but it’s a very fluid matter at the moment, and it wouldn’t make sense to go any deeper.
As you can see, the profit margin for cosmetic surgery companies is getting thinner and thinner, even if some of them are now tricking surgeons from eastern European countries with contracts where they are paid peanuts (about £300-350 for a breast enlargement), but that, once signed, they cannot rescind for at least three years without a significant payment back to the company, that they obviously could never afford.
Best of luck with your work.
Snake
Hi snake…
) Anyway…
According to forums the average BA fee seems to be > £4k…. making for shrewd patient advisors and ‘stupid’ candidates (myself included!
In the case of Mybreast where the founding directors are surgeons, the [smaller] profit margin for the company ultimately goes to them.
So what about the surgeons who aren’t directors but operate for the company….. they obviously get their fee for each procedure, but do they also get a share of company profit? That’s assuming there is profit after the extortionate costs Intelligent Marketing must charge for their services.
With such reputable surgeons who “sort out problems from surgery performed elsewhere” – is there any reason to set up a company in the first place other than for £££s ? Also, why waste £££s on marketing when their customer service does not match. The surgeons themselves say it’s better to call their private secretary rather than the customer service staff of the company. Frequent forum comments such as…… ‘the surgeons have great reputations but their customer service is awful’ …..are easy to find.
Most [if not all?] of their surgeons work for the NHS(?), and do cosmetic surgery independently as well as for mybreast. Why don’t they just work for NHS and solely independent [of mybreast]?
Merry Christmas Snake –
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Dear Thudu,
what can I say… Everybody knows that MyBreast is a ‘virtual’ company, basically just an umbrella for few NHS surgeons that decided to market themselves using the ‘NHS surgeons’ statement as their major selling point.
As any company, they treat patients like somebody that they will never see again for more business. When you rely so heavily on advertisement, you basically behave like a restaurant in a tourist area: no matter how awful your food is, you don’t care because your business will not grow on returning customers. This is a limit of cosmetic surgery in general, as there is only a small number of procedure you can sell to a human being (and some companies would push to sell all of them together, in one big, discounted extreme makeover…). It is different with dentists, for example, and they do try to retain patients for life.
I don’t know if MyBreast is making profits at the moment, and I don’t know if Transform, the Harley Medical Group and the Hospital Group are making any either. I suppose we will see something soon, maybe next year.
One more thing. The fact that somebody works for the NHS doesn’t necessarily mean he/she is a good cosmetic surgeon. In fact, cosmetic plastic surgery and reconstructive plastic surgery are becoming increasingly distant, and I personally would only trust somebody that only does cosmetic surgery for a living.
Merry Christmas!
Thank you Snake,
How many people are kicking themselves for not finding this site sooner? So how about writing a book – Tebbetts ‘Best Breast 2′ was useful but left some questions unanswered – especially for patients who have already undergone surgery and need revision. You could use a pseudonym……..
The forum on the Mybreast website is worth a glance – if only for comedy value – Do you think the surgeon’s are answering the questions? I’d bet the the customer service or marketing staff are answering them.
I’ll look out for the book then.
best wishes
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Hi Thudu,
I am surely not writing a book. I like the interaction with other people, and I am finding the blog a much more powerful tool. Besides, I can tell you that somebody very high up in the food chain for commercial cosmetic surgery in the UK is already writing a book, and whenever that comes out it will make for some interesting reading…
Snake
P.S.
I don’t know who is answering questions on Mybreast (I just find that forum soooooo boring), but I love the pictures of the smiling surgeons!