It's strange to think that when it comes to product recalls, there's more regulation and process for items like electronics, furniture, machinery and even food than there are for breast implants. In fact, there is no universal process for notifying breast implant patients of faulty products, putting hundreds if not thousands of women in potential danger if their implants were to rupture. That's why here at the Good Surgeon Guide we decided to be part of the solution and launch the Breast Register, the first centralised resource for breast implant patients, doctors and industry leaders. This means, if ever there is another major breast implant recall (such as PIP in Dec 2011), you'll be notified quicker, given actionable steps and hopefully help save lives. So, if you are a recipient of a breast implant procedure or a breast doctor, please take a moment to register the procedure today on the Breast Register and help the Good Surgeon Guide be the starting point for any future implant issues.

Patient Details

Surname :

Forename :

Date of Birth :

Email :

Address :

Hospital :

Medical Record :

Breast Implant Details

Left Side

Manufacturer :

Size :

Reference/ catalogue no:

Lot/batch no :

Serial No :

Hospital :

Medical Record :

Right Side

Manufacturer :

Size :

Reference/ catalogue no:

Lot/batch no :

Serial No :

Hospital :

Medical Record :

Operation Details - Implantation

Other - please describe :

Operation Details - Removal

Date of Operation :

Left Side

Right Side

Reason :

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Specialist Surgery
Breast Enlargement		Eyelid / Eyebag Surgery
Breast Reduction		Tummy tuck / Abdominoplasty
Breast Uplift		Labia Reduction
Rhinoplasty / Nose Job		Macrolane Breast Shaping
Facelift / Cheek Lift		Male Chest Reduction
Specialist Non-Surgical
Acne, Acne Scar treatment, Acne Treatment
Brow Lift, Plastic Surgery Brow contouring in London
Cheek Implants, Cheek Augmentation, Cosmetic Cheek Enhancement Plastic Surgery in London
Cheek Lift, Mid-Face Lift Endotine, Mid-Face Rejuvenation
Chin Augmentation, Chin Implant, Chin Enhancement Plastic Surgery in London
Chin Reduction, Chin shaping Plastic Surgery, Reduction Genioplasty in London
Dermaroller skin treatment for acne scarring, lines and wrinkles and stretch marks in London
Evolence, Collagen Injection
Eye bag Removal, Blepharoplasty, Eyelid Plastic Surgery
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Facial Feminization Surgery, FFS to transform male face to normal female features
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Hair Removal, Non-Surgical IPL
Laresse, Dermal Filler, Injectable Product
Laser Resurface
Lip enhancement, Lip augmentation, Lip implants, Fillers
Medical Skin Care, Treatment, Rejuvenation
Non Surgical Cheek Enhancement, Dermal Filler Injections, Cheek shaping
Non Surgical Chin Augmentation, Chin shaping Dermal Filler, Plastic Surgery
Non Surgical Nose shaping, Nose Job with Fillers Non-Surgical Eyelid Lift & Eyebag Correction
Non-Surgical Face lift, Liquid Lift
Non-Surgical Neck Lift, Ribbon Lift
Non-Surgical Wrinkle, Scar Release, SurgiWire Incisionless Procedure
Plastic Surgery Lip Lift, Lip Feminization Plastic Surgery
Restylane, Perlane, Restylane SubQ, Restylane Vital
Revitalize Eyelashes, RevitaLash, Longer, Thicker Eyelashes
Rhinoplasty, Nose Job, Nose Reshaping Plastic Surgery
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with BOTOX, Botulinum toxin injections, muscle relaxing injections
Female Surgical Procedures
Breast Enhancement, Breast Implant Surgery, Plastic Surgery Breast Augmentation
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Breast Reduction Surgery, Reduce large breasts in London, Revision Breast Surgery Specialist
Breast Uplift, Mastopexy, Breast Reshaping Specialist Plastic Surgery
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Buttock Implants, Buttock Augmentation, Buttock Reshaping Plastic Surgery
Chin Reduction, Chin shaping Plastic Surgery, Reduction Genioplasty
Facial Feminization Surgery, FFS to transform male face to normal female features
Fuller Breast, Shaping, using Macrolane, Non Surgical Breast Enhancement
Labia Reduction, Labiaplasty, Labia Surgery, Specialist Plastic surgery of labia, female genital surgery

Male to Female Gender reassignment surgery, Specialist GRS, SRS
Plastic Surgery Lip Lift, Lip Feminization Plastic Surgery
Revitalize Eyelashes, RevitaLash, Longer, Thicker Eyelashes
Silhouette Lift Face, Brow and Neck
Male Surgical Procedures
Brow Lift, Plastic Surgery Brow contouring
Buttock Implants, Buttock Augmentation, Buttock Reshaping Plastic Surgery
Chin Reduction, Chin shaping Plastic Surgery, Reduction Genioplasty
Gynaecomastia, Male chest Reduction, Man Breasts Plastic Surgery
Silhouette Lift Face, Brow and Neck
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Acne, Acne Scar treatment, Acne Treatment
Body Contouring, Non-Surgical Reshaping, UltraShape
Buttock Reshaping, Macrolane, Non-Surgical Enhancement
Dermaroller skin treatment for acne scarring, lines and wrinkles and stretch marks
Elastiderm Decolletage Treatment
Evolence, Collagen Injection
Facial Rejuvenation, Anti-Aging Treatment
Fuller Breast, Shaping, using Macrolane, Non Surgical Breast Enhancement
Hair Removal, Non-Surgical IPL
Hyperhidrosis, Excessive Sweating Treatment
Jet-Tox, supersonic jet treatment, no needles for sweat control
Laresse, Dermal Filler, Injectable Product
Laser Resurface
Lip enhancement, Lip augmentation, Lip implants, Fillers
Medical Skin Care, Treatment, Rejuvenation
Non Surgical Cheek Enhancement, Dermal Filler Injections, Cheek shaping
Non Surgical Chin Augmentation, Chin shaping Dermal Filler, Plastic Surgery
Non Surgical Nose shaping, Nose Job with Fillers
Non-Surgical Eyelid Lift & Eyebag Correction
Non-Surgical Face lift, Liquid Lift
Non-Surgical Neck Lift, Ribbon Lift
Non-Surgical Wrinkle, Scar Release, SurgiWire Incisionless Procedure
Restylane Vital, Rejuvenate Sun-damaged, Aging skin
Restylane, Perlane, Restylane SubQ, Restylane Vital
Revitalize Eyelashes, RevitaLash, Longer, Thicker Eyelashes
Silhouette Lift Face, Brow and Neck
Square Jaw Reduction, large Masseter Muscle reduction with BOTOX
Thread Veins
Treatment of Active Facial Lines with BOTOX, Botulinum toxin injections, muscle relaxing injections
Your Hands, Hand Rejuvenation, Youthful Hands
Other Surgical Procedures
Abdominoplasty, Tummy Tuck, Abdominal Reshaping Plastic Surgery
Buttock Implants, Buttock Augmentation, Buttock Reshaping Plastic Surgery
Fat Grafting
Liposuction, Liposculpture, Plastic Surgery Body Shaping
Lower Limb Reconstruction
Male to Female Gender reassignment surgery, Specialist GRS, SRS
Mini Abdominoplasty, Mini Tummy Tuck, Abdomen Reshaping
Prominent Ear Correction, Pinnaplasty, Otoplasty Plastic Surgery
Scars, Treatment and Scar Revision Plastic Surgery

	1. My details can be entered on the Registry
	2. I agree that my medical notes may be examined by a researcher approved for the purpose of carrying out any research study relating to breast implants. Although identifiable information will remain anonymous.
	3. I agree to allow a researcher to contact me to discuss my participation in any study related to breast implants.
If the answer to 3 is 'YES', I would prefer to be contacted:
	a) Through the hospital where I received my implants
	b) Directly to my home address
	c) To my email address

Breast Register

Patient Details

Consent to Application

Breast Implant Details

Operation Details - Implantation

Operation Details - Removal

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