WOULD madam care for something a little larger? Breast enlargement patients are being given the chance to oversee their own operations and decide just how big they really want to be.

The move follows surgical advances that allow the operation to be done under local anaesthetic — so the patient stays awake.

Besides allowing women

to choose their perfect size

and shape, the new approach cuts costs by 40% because t

here is no need for an anaesthetist.

The procedure, to be revealed at a conference in America, is the latest in what has become known as “extreme plastic surgery” .

Other operations include Botox breast lifts and “cleavage rejuvenation”, which is designed to remove wrinkles from sun-damaged skin between the neck and breasts.

Dr David Morrison has treated 50 patients with “awake breast augmentation” at his clinic in Washington, US, where he charges about £2,750 — about £1,200 less than with a full anaesthetic.

He said: “Since the patient

is awake you can sit her up so she can look in a mirror and decide if they are too big or too small. We use saline implants so you can alter the size of them. You really bring the patient into the decision-making.”

Related techniques are already being introduced to Britain with several clinics offering “awake surgery” in which a substance called Macrolane is injected into the breasts to enlarge them.

Douglas McGeorge, ex-president of the British Association of Aesthetic Plastic Surgeons, said UK cosmetic surgeons would be cautious about offering permanent resculpting under local anaesthetic.

Cleavage rejuvenation is, however, about to hit the British market with the Oaklands medical centre in Middlewich, Cheshire, already advertising the procedure in which a filler is injected under the skin to reduce the appearance of wrinkles.

Perhaps the most radical

of these treatments is the Botox breast lift where toxins are injected into the chest muscles, paralysing them

and forcing the back muscles to lift the shoulders to compensate. This causes the breasts to appear lifted — but the effect lasts only about six months. According to the market researcher Mintel, cosmetic surgery in Britain was worth £143m in 2002 but this year the figure will touch £1.2 billion.

However, John Harris, of The Journal of Medical Ethics, warned against the Botox breast lift. “There is always a danger if you are knocking out bodily systems like breast muscle and getting the back to compensate, you get damage resulting from them doing things they were not expecting to have to do,” he said.

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