The review was prompted by the substantial concerns surrounding PIP silicone breast implants, which raised questions about the safety and regulation of cosmetic procedures. While many companies, ourselves here at BMI Healthcare included, dealt with the situation promptly – offering patients who had paid BMI Healthcare for their original PIP surgery the option to have their PIP implant removed and replaced at no cost to the patient - others’ responses were considered to be sorely lacking.

This issue highlighted wider concerns about the regulation of cosmetic interventions, including questions on the safety of products on the market, whether people felt pressured into cosmetic treatments and why it was so hard for some providers to trace those who had received the implants.

The cosmetic surgery industry is growing rapidly as use of both surgical and non-surgical procedures to enhance appearance becomes more ‘normalised’ and advances in technology mean that an ever-growing range of treatments are on offer. Existing regulations simply don’t encompass the shifts seen within the industry in recent years, meaning change is needed to ensure patients’ safety and wellbeing.

Findings

The review concluded that there is a “crisis waiting to happen” due to a lack of regulation in some areas and the fact that so many procedures such as dermal fillers, chemical peels and laser hair removal can be performed by anyone, anywhere, despite carrying significant risks.

Worryingly, there are no standards or accredited training courses for non-surgical cosmetic procedures in place at the moment, despite the fact that non-surgical treatments make up nine in 10 cosmetic procedures.

The review also found that there is a real lack of data on cosmetic procedures, meaning it is almost impossible to tell how many are being carried out and who by.

The marketing of cosmetic procedures was examined as part of the review, with the review concluding that while advertising has a legitimate role in providing awareness about cosmetic interventions, it can also trivialise procedures, target vulnerable consumers and mislead people about the outcomes of various procedures.

Recommendations

Based on the findings, the review committee made a number of recommendations, 40 in total, which provide a framework for both surgical and non-surgical interventions and are aimed at ensuring the safety and wellbeing of all patients.

These recommendations centred around three key areas: ensuring a high quality of care, informing and empowering the public and making resolution and redress accessible.

In terms of ensuring a high quality of care, the review suggested that anyone performing cosmetic interventions must be registered and that anyone providing dermal fillers should have a formal qualification. It was also recommended that the Royal College of Surgeons establish an Interspecialty Committee on Cosmetic Surgery to set standards for cosmetic surgery practice and training, and make arrangements for formal certification of all surgeons regarded as competent to carry out cosmetic procedures.

The review suggested that this cosmetic surgery committee would also play a role in informing and empowering the public by developing a multi-stage consent process for operations which would see the surgeon performing the operation obtaining the patient’s consent only once they were satisfied that the patient understood the risks and limitations of the procedure.

The review recommended that providers of non-surgical procedures should also have to obtain consent for all treatments and maintain records of the treatments given.

Regarding advertising, the review recommended that restrictions be updated to include a ban on the use of financial inducements such as BOGOF (‘buy one get one free’) and time-limited deals to avoid putting pressure on vulnerable people.  The review committee noted that existing restrictions also require updating and a better level of enforcement.

The review also made a number of recommendations aimed at making resolution and redress more accessible, including extending the remit of the Parliamentary and Health Service Ombudsman to cover the whole private healthcare sector, including cosmetic procedures of all kinds. An additional recommendation was that all individuals performing any type of cosmetic procedure, even overseas surgeons operating in the UK, be required to hold adequate professional indemnity cover. This would reassure patients that if anything did go wrong, appropriate compensation would be available.

Response

Response to the review has been overwhelmingly positive, with The British Association of Aesthetic Plastic Surgeons saying it was “thoroughly relieved” by the findings.

We here at BMI Healthcare welcome the report and believe that some of the recommendations are essential to ensure patients’ safety. Cosmetic surgery is often trivialised in the media; however it is important to remember that cosmetic procedures are just like any other medical procedure and should therefore be regulated in the same way.

Of course many providers, ourselves included, already incorporate many of the recommendations into our own working practices; however, it is reassuring to know that everyone will have to abide by them.

What’s next?

Sir Bruce Keogh has urged the Government to take swift action to implement the recommendations set out in the review as demand for cosmetic procedures shows no signs of waning. Health Minister Dan Poulter has pledged to consider the review carefully and issue a response in the summer.

To read the Review of the Regulations of Cosmetic Interventions in full click here

Data from the British Association of Aesthetic Plastic Surgeons (BAAPS)* shows that of the 43,172 surgical procedures carried out last year by its surgeons, 9.5% were performed on men, with nose reshaping (rhinoplasty) proving the most popular.

Other common procedures among men were male breast reduction, eyelid surgery, ear correction procedures, liposuction and face and neck lifts.

These figures show that men today are clearly more open to cosmetic surgery than previous generations, but what is behind this changing attitude?

Anything women can do…

The majority of men opt for cosmetic surgery for the same reasons women do; they want to enhance their features, rejuvenate their appearance by turning back the clock or ‘fix’ something they perceive as an imperfection. But now there is less stigma around taking steps to achieve this.

Attitudes towards grooming in general are shifting, with figures from Mintel showing that the male grooming market in Europe has boomed in recent years, suggesting it is no longer seen as ‘unmanly’ to want to look good.

A number of celebrities are leading the way here, with sports stars such as Jamie Redknapp and David Beckham known for taking pride in their appearance and a number of famous men, including Wayne Rooney and Gordon Ramsay, having undergone cosmetic procedures, demonstrating surgery is not just for women.

An element of competition

Experts have also suggested that men are increasingly becoming exposed to other men’s super-toned bodies in the media, with the likes of Matthew McConaughey and David Beckham regularly showing off their muscular chests, making men more aware of their own appearance. The widespread coverage of the Olympic Games is likely to have inspired many men to want to emulate the competitors’ athletic bodies with some turning to cosmetic procedures such as male breast reduction to aid them.

And it’s not only celebrities men are inspired by. Some want to turn back the clock to help them maintain an edge in youth-dominated workplaces while others returning to the dating scene after the end of a long-term relationship may turn to surgery to boost their confidence.

An addition to exercise

Another common reason for men turning to surgery is to address issues that exercise and healthy eating simply won’t help.

Gynecomastia or ‘man boobs’ for example, can prove almost impossible to shift, regardless of how hard you hit the gym, which is possibly why male breast tissue reduction is in the top ten procedures for men.

Surgical advances

Cosmetic surgery has come a long way in recent years, with procedures now more convenient and requiring less recovery time. This has made it more appealing to men who want to benefit from the advantages surgery brings, but with the minimum amount of fuss.

These advances have also made some procedures more affordable, making surgery an option for a wider audience than in previous years.

However, while men are increasingly open to surgery, this does not mean that it should be viewed as a ‘quick fix’. Cosmetic surgery is just like any other medical procedure and it is important to explore all of the alternatives open to you. If you’re thinking about seeking treatment, the first thing is to take your time. Do some research online about the possible treatments available to you. Also do your homework on the credentials of hospitals and surgeons who may be able to help.

If you’re interested in finding out more about cosmetic surgery with BMI Healthcare, contact us via one of the below methods. You can discuss any queries you may have or book an initial consultation with one of our cosmetic surgeons.

• Call us on 0800 015 2217
• Fill in an online enquiry form

*source: www.baaps.org.uk

We carried out a study* with www.ukbride.co.uk to investigate and found that 34% of women would consider having cosmetic surgery for their wedding.

Why do people have cosmetic surgery before the wedding?

David Crawford, Consultant Plastic, Reconstructive & Hand Surgeon at BMI Healthcare, explains: “These patients have usually been contemplating surgery for a long time for a specific concern. In this instance, their wedding, or a family member or friend’s wedding, prompts them to go ahead with the surgery they’d been considering.” However, Mr Crawford does add caution advising that “cosmetic surgery is not a solution for a general makeover and should always be given very careful consideration.”

The amount of planning and effort that goes into a wedding was a common reason quoted in our study for having cosmetic surgery. Many said that while they’re going to great lengths to ensure the rest of their wedding is perfect, they wanted cosmetic surgery to help them feel happy and confident with the way they look, both on their special day and in beachwear on their honeymoon. Others said that as they were paying for expensive photographers to capture their significant day and because these photos would be looked back on for years to come, they wanted to know they’d be happy with how they look in them.

On the whole, those in favour of cosmetic surgery before their wedding were doing it for their own self-esteem, rather than the benefit of their partners or anyone else. Those considering surgery, for whatever reason should remember that cosmetic surgery is no different to any other medical procedure, so you must feel comfortable that it’s the right decision for you. At BMI Healthcare your first consultation will always be with a consultant surgeon, which is a chance for you to ask any questions you might have so you can make a fully informed decision whether surgery is the right option for you.

What kind of cosmetic surgery do brides choose?

When looking at the types of cosmetic surgery favoured by brides, it’s possible that the recent increase could be linked to the trend for getting married, or re-married, later in life.

“Typically we find those who are getting re-married perhaps later in life or will be the mother of the bride want to look younger for the wedding photos, so will come in for a lower face or neck lift, or eyelid surgery”, said Mr Crawford.

Common procedures before a wedding include liposuction, tummy tucks and breast augmentation – often related to wanting to turn back the clock to times before having had children.

What other procedures have become popular?

Mr Francis Peart, Consultant Plastic & Reconstructive Surgeon, at BMI Healthcare, has noticed Rhinoplasty procedures (nose alterations) have increased over the past few years. On nearly every occasion the patient has been dissatisfied with their nose for nearly all their adult life.

“We get people of all ages wanting to change the shape of their nose. We certainly do have the occasional groom or best man wanting their nose done before the big day.”

Reasons for not having it

A major reason for not undergoing cosmetic surgery before a wedding was the concern of visible scars and bruising on the wedding day. However, careful planning with your BMI Consultant means these risks can be minimised and overcome. In many cases, the area that has been operated on can heal far quicker than you may expect, so even if your wedding is fast approaching there may still be time to have the treatment you’d been considering. Just make sure you take time to consider all the information and different choices you have. An alternative option is non-surgical treatment, such as dermabrasion and dermal fillers, which can be less invasive and often have quicker recovery times.

If you’re interested in finding out more about cosmetic surgery ahead of your wedding day, contact us via one of the below methods to discuss any queries you may have or to book an initial consultation with one of our cosmetic surgeons.

• Fill in an online enquiry form
• Click here to live chat with an advisor
• Call us on 0800 015 2217

Mr David Crawford, Consultant Plastic, Reconstructive & Hand Surgeon, MBChB FRCS(Ed) FRCS (Plast)
Mr Francis Peart, Consultant Plastic & Reconstructive Surgeon, BSc MBBCh FRCS FCS, BAAPS, BAPRAS

*80 people were surveyed by [UK Brides] in [November 2012]

Covering 34 categories, from allergies to vascular surgery, the guide’s introduction from its editor, Jessie Hewitson, states: “Our aim was to make it simple to find the leading, most experienced consultants.  To do this Tatler assembled a panel of respected GPs and top-of-their-tree surgeons and physicians, and asked them who are the best in their fields.  Which doctors, in short, they ask to treat their own families.  For anyone searching for the right doctor who wants to start at the top, this is the guide for them.”

The list of consultants recognised in the guide for their work in the field of cosmetic and reconstructive surgery are:

• Consultant Plastic, Reconstructive and Aesthetic Surgeon Mr David Gault at BMI Bishops Wood Hospital
• Consultant Cosmetic Surgeon Mr Jan Stanek at BMI Fitzroy Square Hospital
• Consultant Plastic Surgeon Dr Jesper Sorensen who practices at BMI Weymouth Hospital
• Consultant Plastic Surgeon Mr Douglas Harrison at BMI Bishops Wood Hospital
• Consultant Plastic, Reconstructive & Hand Surgeon Mr Walid Sabbagh at BMI The King’s Oak and Cavell Hospitals

For more information on the full list of BMI Healthcare consultants in the ‘Tatler Doctors Guide 2013’ please visit: www.bmihealthcare.co.uk/tatler

Women with excessively large breasts may complain of having constant neck and back pain, painful grooves where bra straps have cut into the shoulders and skin irritation/rashes in the crease beneath the breast. People say that they cannot find clothes that fit, have poor posture and find many activities difficult due to the size of their breasts.  In addition, unusually large breasts can make a person feel extremely self-conscious and embarrassed.

What does the breast reduction surgery involve?

There are a number of techniques that can be used for breast reduction.  The one selected depends in part upon the amount of breast tissue that has to be removed and the quality of the skin.

Incisions are made in order to sculpt the breasts into a smaller shape.  The incisions may include one or more of the following;-

• Around the areola (the dark skin surrounding the nipple)
• Vertically down from the areola to the breast crease
• Horizontally in the breast crease

Excess breast tissue and skin is removed and the entire breast is reshaped with the nipples moved to a higher and more youthful position. The incisions are stitched up in a way that reduces scarring to a minimum. The surgery takes between two to four hours to complete.

A breast reduction is usually performed under a general anaesthetic (you will be asleep during the procedure).  The operated area may be swollen for a few days and you will experience some pain. Simple painkillers are all that is normally required although aspirin should be avoided for the first few weeks following your operation. Providing all is well, you can expect to go home the day after surgery.

What are the risks and side effects of breast reduction surgery?

Having cosmetic surgery can be a very positive experience. Complications are infrequent and usually minor.  However, no surgery is without risk and it is important that you are aware of possible complications.

Rarely a haematoma (collection of blood in the wound) can occur.  This is most likely to occur within 24 hours of surgery.  Large haematomas may need to be drained in the operating theatre, under a general anaesthetic.

Infection may occur but again this is rare.  Infections can usually be treated successfully with antibiotics.

Everybody heals differently, and this is not always predictable. Poor or delayed healing occasionally occurs. These healing difficulties can range from minor problems, such as small areas of wound separation, to major issues, such as skin or nipple loss.  Although very rare, this situation may require a skin graft to close the wound, meaning more surgery. People who have diabetes, smoke, are obese or elderly are at an increased risk of delayed healing.

There is always permanent scarring where the incisions are made.  Breast reduction surgery is a trade off between large, uncomfortable breasts and smaller ones with scars.  Although these usually fade and soften up to a year after surgery, scars can occasionally thicken and stretch. Darker skinned people have more of a chance of forming thick scars (hypertrophic or keloid scars). The scars are positioned so that they lie under the average bra or bikini top

Permanently reduced nipple sensation is not uncommon after this procedure. The ability of the nipple to go erect may also be affected.

Future breast feeding may not be possible as the surgery does involve removing some of the milk ducts that lead to the nipple area.

Breast asymmetry/shape irregularities can occur following this operation.  In rare cases, further surgery is needed to correct this.

Sometimes, areas of fat and breast tissue within thebreast form hard lumps called fat necrosis.  Usually, no specific treatment is required and the problem settles down over about 12 months.

There are general risks associated with all operations.  Very occasionally a blood clot can form in the leg (deep vein thrombosis or DVT) which wouldrequire medical treatment. Part of these clots can also break off and move up to the lungs, causing acute shortness of breath and pain in the chest. This is known as a pulmonary embolus (P.E). Developing a chest infection is uncommon but more likely to happen to people who smoke.

All the risks will be discussed in detail at your consultation.  However, if you have further questions or concerns, do not hesitate to discuss these with your surgeon.  Decisions about cosmetic surgery should never be rushed.

How do I prepare for surgery?

Having had your initial consultation, if you decide to proceed, a mutually convenient date for your operation will be made. Prior to your admission, you may be invited to attend the hospital for a pre-operative assessment with a nurse.  Depending on your age and general health, routine blood tests, a heart tracing (ECG) or mammogram may be taken.  You will be given the opportunity to ask any questions you may have or raise any concerns.

You will be admitted to the hospital on the day of your operation.  If you are having a general anaesthetic, you will be asked not to eat anything six hours before surgery.  Chewing gum should also be avoided six hours before your operation.

It is important to inform your surgeon, anaesthetist and nurse of any medicines (self or GP prescribed) or recreational drugs you take.  Medicines containing aspirin should be avoided for two weeks before the operation since they increase the risk of bleeding during surgery. If there are any other medications that may affect surgery then this will be discussed with you at your first appointment.

You will not be able to drive yourself home from hospital and ideally, you should have someone to stay with you for a few days to lend a hand.

What happens after the operation?

Once you have recovered from your anaesthetic, you will be encouraged to sit up in bed.

The dressings are usually removed after one to two weeks.  You will be advised to wear a sports bra day and night for the next six weeks to give support and help to mould the breast tissue to its new shape.  After this time, a bra should always be worn during the day.  Avoid wearing an underwired bra for at least the first four weeks.

Before you leave the hospital, you will be given a follow up appointment to see either the surgeon and/or nurse. This is to check on your progress and also the wounds.  If non dissolvable stitches have been used, these will be removed about 10 days after surgery.

What is the estimated time for recovery, absence from work and return to usual activities?

Recovery times vary from one person to another so use the times given below as a guide only.  If you have any concerns during this period, do contact the hospital team for advice.

In the first two days after your operation, it is important for you to be out of bed and walking every two hours during the day and early evening. Staying in bed too long increases your chances of developing clots in the legs. Gradually increase your activity over the next few days.

Avoid sunbathing topless for up to a year after the operation and certainly for the first few months.  The scars are more sensitive to sunlight and burn more easily.

Breast reduction post surgery timeline

This article has been written by one of our consultants.  Each consultant differs in their practice and therefore this article does not reflect the standard approach or practice of all BMI consultants.  It is important that you talk to your treating consultant about your own situation and any surgery you may undertake.

Article by Miss Anne Dancey, MBChB(Hons), MRCS, FRCS(Plast), MmedSci(Hons), Consultant Plastic Surgeon, BMI The Priory and Edgbaston Hospitals.

Following the recent PIP scandal with an estimated 50,000 women affected by having industrial grade silicone implants used for their procedure, it is no surprise that the majority of women considering breast augmentation want to be as educated as possible before making this potentially life changing decision.

Anne Dancey, consultant specialist plastic surgeon at Queen Elizabeth Hospital, Birmingham shares her thoughts on breast augmentation and her advice to anybody considering having this procedure. Alongside her full-time NHS post dealing with advanced breast reconstruction techniques and trauma, Miss Dancey consults and treats private patients at BMI The Priory Hospital in Birmingham.

Who is suitable for Breast Augmentation?

“Breast augmentation\enlargement is indicated for anybody in good health who wishes to have fuller or larger breasts. My patients range from 18 years old until well into their 60s. Breast implants can be used to increase or restore volume and fullness in the breasts or correct asymmetry, if this has been a concern for the patient. Although, it is worth noting that the correction of nipple asymmetry or sagging of the breast will have limited results by using implants alone.”

What implants should I choose?

“Since the beginning of the modern era of silicone breast implants in 1963, technology and quality has improved dramatically in recent years. Undoubtedly the recent PIP scandal has shaken faith in breast implants as a whole. I would suggest that the patient does their research and makes a decision based not on price, but on quality and reputation of the manufacturing company.
For a patient having a secondary breast augmentation due to severe capsular contracture – I would recommend using a polyurethane implant which has a different type of shell to the standard textured implant and data suggests this would be more effective at stopping the capsular contracture recurring.”

Should I go over or under the muscle?

With any kind of surgical procedure, there is no “one size fits all” method to achieving the best result possible. The position of the implant will depend on several factors, including how much breast tissue the patient already has, the size and shape of the implant itself, and the degree of sagging present already in the breast. It is a misconception that going under the muscle will give a more “natural” result but it is sometimes necessary due to variables with the patient and her anatomy. The implant can be placed in a sub glandular, sub muscular, or indeed a dual plane position where the implant is only partially under the muscle.

What are the risks and complications of breast augmentation?

There are risks associated with any kind of surgical procedure, and your surgeon will inform you of these at consultation. In terms of complications specific to breast augmentation, the main concern is with capsular contracture. After any breast augmentation the body’s natural healing process will form a capsule of scar tissue around the implant, this becomes a complication when the capsule constricts the implant, leading to possible discomfort, rippling, or misshaping of the implant.

In a study I carried out with Paul Levick on 1400 breast augmentation patients treated over a 16 year period, there was no significant link to alcohol consumption or smoking post-operatively increasing the incidence of severe capsular contracture. However it is extremely important to note, I would recommend stopping smoking as a general health concern and indeed smoking has been proven to have a detrimental effect on the healing process. The study also established a link between post-operative pregnancy and capsular contracture and I would counsel any patient considering breast augmentation on this link if they were unsure as to whether they would be having any children post-operatively.

I would urge patients considering a breast augmentation or any other elective cosmetic surgical procedure to be as informed as possible before making their decision, check your surgeon’s credentials, the implant used and ask anything you feel unsure of. Having plastic surgery can be a wonderful experience and give you new-found confidence however always remember to put your trust in somebody genuinely interested in giving you the best result possible.

Article by Miss Anne Dancey, MBChB(Hons), MRCS, FRCS(Plast), MmedSci(Hons), Consultant Plastic Surgeon, BMI The Priory and Edgbaston Hospitals.

This article has been written by one of our consultants. Each consultant differs in their practice and therefore this article does not reflect the standard approach or practice of all BMI consultants. It is important that you talk to your treating consultant about your own situation and any surgery you may undertake.

The cosmetic surgery review is critical in challenging the trivialisation of cosmetic surgery – both in the media and in some areas of the medical and healthcare sectors.

A ComRes survey on attitudes towards cosmetic surgery showed that only half of people considering cosmetic surgery take the qualifications of a practitioner into consideration – 54% for surgery and 50% for non-surgical procedures.

In the same survey, two thirds, 67% for surgery and 66% for non-surgical procedures, said cost is a factor for them when deciding whether to have surgery.

At BMI Healthcare, we believe it is vitally important that patients take into account a number of factors including the choice of surgeons on offer at their chosen provider, the qualifications and experience those surgeons have as well as where the surgery will take place and the quality of the facilities.

Making the decision to have cosmetic surgery should not be taken lightly, nor be determined purely by cost.

Time should be taken to understand the process. Only when an individual is comfortable and has all the facts should a decision be made about going ahead with surgery or not.

BMI Healthcare understands the decision to undergo cosmetic surgery can be complex and at times, confusing. We have developed a guide prompting people to consider the important factors about cosmetic surgery. Read our top 10 tips here.

Further information about the Sir Bruce Keogh led Department of Health review can be found here.

Breast reduction or reduction mammoplasty is a surgical procedure that involves the reduction of the size of the breasts. It involves the excision of excess fat, skin and glandular tissue and the reshaping of both the remaining breast tissue and the breast skin and the repositioning of the nipples.

Worldwide, the size of the average breast is increasing and younger women are requesting breast reduction surgery, aiming towards a natural, long lasting result. Patients opting for breast reduction surgery, complain that their breasts hinder their mobility, impair them functionally and often they experience back and neck pain. The additional weight on the shoulders may lead to skin irritation  due to the pressure of the bra straps. Patients are also frequently concerned with the shape of the breasts and an inability to find bras and clothes to fit. Sometimes the size of the breasts causes emotional as well as physical discomfort with a detrimental affect on self confidence.

Breast reduction is a surgical procedure that may be combined with other cosmetic procedures such as breast lift and liposuction. These techniques vary depending on the individual requirements of each patient. These requirements dictate the number and length of incisions. The most important aspects of breast surgery are in relation to size and shape. I aim to change and improve appearance by concentrating on the expectations and needs of the individual patients. Preoperative consultations allow the development of the patient/surgeon relationship and a means to discuss any concerns and prioritize your needs and expectations.

Changing techniques

Breast reduction is usually combined with lifting of the nipple to a new position (mastopexy) and often liposuction. A combination of procedures are tailored to the individual to provide the optimal result.

Providing a natural long lasting result is paramount and the procedure involves careful consideration of the different elements of breast surgery and addressing each component individually. Excess breast tissue can be removed and the remaining tissue moulded to create an enchanced shape. The nipple is moved to a position relative to the stature and chest width of the patient and the excess skin is adjusted to redrape over the new breast in such a way that the blood supply to the nipple and the skin are not compromised. Final touches can be applied to remove fat by liposuction or place fat via a lipomodelling technique to give a symmetrical aesthetic result.

Newer techniques such as the vertical scar only technique prevent the need for a scar underneath the breast and all three examples shown have been performed using this method. Drains are not required and minimal dressings are applied immediately postoperatively. The results of surgery are therefore immediately apparent and patients are able to see the results instantaneously. Patients can mobilise on the day of surgery and are encouraged to wear a sports bra day an night for the first 4 weeks following surgery. Bruising and swelling does occur although this has almost subsided by one week postoperatively when the minimal dressings are removed. All stitches are dissolvable thus minimising discomfort and maximising outcome

Results.

The results of breast reduction are immediately apparent although it does take 6 weeks for all bruising and swelling to settle. Results can be dramatic with immediate relief of the pain associated with excessive breast tissue. The scarring following breast reduction can take longer to settle and scars remain pink for the first few months before usually fading into fine white lines. Change in mobility and functionality combined with the dramatic improvement aesthetically allows breast reduction patients a substantial improvement in quality of life

Advantages of Mr Ross’s Care

Optimising outcomes without compromising safety is paramount. By practising and operating aesthetically in one hospital Mr Ross is able to provide patients with a dedicated service. Preoperative consultations and all post operative visits are with Mr Ross and provision of 24 hour perioperative anaesthetic cover with dedicated intensive facilities ensures that every eventuality for all patients can be provided for on a single site.

BEFORE

AFTER

Article by Mr. Gary Ross   MBChB, MD, FRCS(plast), Consultant Plastic Surgeon, BMI The Alexandra Hospital.

This article has been written by one of our consultants.  Each consultant differs in their practice and therefore this article does not reflect the standard approach or practice of all BMI consultants.  It is important that you talk to your treating consultant about your own situation and any surgery you may undertake.

BMI Healthcare’s commitment to patient care remains its core priority and, whilst at some stage there will need to be a financial reckoning with those responsible for putting these implants into the UK market, we do not believe patients should be kept waiting whilst this is resolved.  We will continue to follow updates from both the Department of Health and the MHRA and act according to their guidance.

Neither the MHRA nor the Department of Health recommend the routine removal of PIP implants.  However, BMI Healthcare believes that patients with these implants should not be left worrying about a real or perceived risk.  We will continue to treat any patient who paid BMI Healthcare for their PIP implant surgery who now wishes to have their PIP implant removed and replaced at no cost.  In support of the wider objective of helping all affected patients of other providers, BMI Healthcare will continue to offer the same rapid and clinically robust service to those providers or direct to their patients on a guaranteed fixed price package.

If you would like further information, please contact our national helpline on 0800 533 5087.

What if I don’t know what implant I had?

If you paid BMI Healthcare for your surgery and do not know the specific details of the implants that were used in your surgery and would like confirmation, you should contact the BMI Hospital where you had your surgery and the Hospital will endeavour to retrieve your records to confirm the type of implant used.  Please be aware that records are normally kept for a period of seven years and we may not be able to provide the information for records dating beyond seven years.

Are there problems with other implants?

No; the concerns relate only to those provided by Poly Implant Prothèse (PIP).  [1]

The purpose of a tummy tuck is to therefore remove excess skin and tighten the muscles of the tummy wall.  The latter is usually achieved with permanent internal stitches.  The exact operation required to give the best results depends on the type of tummy problem  Liposuction may be cautiously used with this technique in certain cases.

What will happen during the consultation?

A medical history is taken to detail the cosmetic, functional and psychological symptoms caused by the abdominal problem. Any history of weight change, previous pregnancies or abdominal surgery is documented together with a discussion regarding your general health.

Your tummy is then examined to identify exactly what needs correcting. You will be checked for skin and fat excess, muscle weakness, hernias and skin quality.

The surgeon will then discuss the options for you in detail including the pros and cons of the proposed procedure(s).

I personally find it very useful to give patients the option for a second consultation (free of charge). Many patients are grateful for the opportunity to have the operation explained again and have questions answered.   It is important that patients are given sufficient time to think through what has been discussed.

Who is suitable for this operation?

Patients must be medically fit for this operation as it requires a full general anaesthetic. You should stop smoking 4 weeks prior to this operation (to reduce the risks) until at least 2 weeks after surgery or when the wounds have healed.

Abdominoplasty is not a procedure to help achieve weight loss and indeed obese patients (body mass index>30) should be advised to lose weight prior to surgery. This advice is given to minimize potential risks and to optimize cosmetic results.

Where will the scars be situated?

For a standard abdominoplasty, there will normally be a curved scar located in the bikini line running from hip to hip.  Sometimes a small vertical scar above the pubic hair region is required particularly when patients have had umbilical (belly button) piercings. There will also be a scar running around the belly button.  In patients who have lost a lot of weight a long vertical scar may also be used.

How long will I be in hospital for?

Patients are normally kept in hospital for 2 nights following a full abdominoplasty.  This is to allow you to recover to a safe level. Temporary drains are usually inserted at the time of the operation. These are plastic tubes about the size of a drinking straw, which come out of the skin close to the abdominoplasty scar. The drains are kept in for the first 48 hours usually to take away any excess blood or fluid from the wound.  If drainage is very excessive these tubes may be kept in slightly longer

What other aftercare will I need?

You will need to have follow-up appointments to check your wounds. I use dissolving sutures in my practice that do not need to be removed. I would normally see you at about 9-10 days after surgery then 1 week, 6 weeks and 6 months later.

A pressure garment is usually advised following this procedure. I normally recommend “control pants” which can be bought over the counter fairly cheaply.  These garments should extend right up to the rib cage and are normally applied when the drains are removed.  I recommend that this garment is worn for 6 weeks to reduce the risk off fluid accumulating under the skin.

What are the possible risks of this operation?

All operations carry some degree of risk. Most potential problems with abdominoplasty surgery are minor, but it is important that potential risks are discussed with patients. This is to allow them to decide whether the operation is right for them and so they are well-prepared.  The exact risks of a procedure depend on the type of abdominoplasty performed and factors related to an individual’s health.  Below is a list of some possible complications. This list is not exhaustive and is intended only as a guide:

• Lumpy, raised scars (keloid or hypertrophic scars)
• Infection,
• Bleeding (may require return to the operating theatre during the admission),
• Wound breakdown (dressings may be required for longer than expected)
• Fluid collection under the skin (seroma) – usually absorbs itself or can be removed using a needle and syringe
• Numbness of the skin of the tummy (normal for this procedure), upper thighs (occasional)
• Asymmetry of scars or abdominal skin
• Small areas of excess skin at either end of the scar that can sometimes can require revision
• Very rarely, blood supply of the belly button may be compromised by this procedure,. This process can lead to loss of the belly button.
• Deep vein thrombosis – to try and prevent this, special stockings are worn and a small injection of a blood-thinning agent is given after surgery.

What is the recovery time from this operation?

Recovery from any abdominoplasty, as with any operation, depends on a number of factors including the patient’s fitness level before surgery and the extent of the surgery required. Likewise, time off work depends on these factors and also the demands of the job.

Although you should be able to start walking about on the first day after surgery, during the first 1-2 weeks you will not be able to stand up completely straight. Pain after surgery is usually very well controlled with tablet painkillers. It is advisable that you have somebody at home to help look after you during the first week after surgery.

Wound dressings are normally required during the first 2 weeks, although this can occasionally be longer. I advise patients to apply Micropore^TM tape to the wounds during the subsequent month to support the scars.

Most patients need 3-4 weeks off work.  You may tire easier in the first few weeks after surgery. Heavy lifting or strenuous exercise should be avoided during the first 6 weeks. Swelling, particularly in the lower abdomen and pubic hair region may persist for many weeks.  Most people are back to normal within 2-3 months of their surgery, however. Scars usually fade month by month but can take 1-2 years before they are maximally faded.

When will I be able to drive?

You will be able to drive when you are able to comfortably move your legs around whilst sitting in the car and when you can perform an emergency stop.

For most people, this is in the region of 3-4 weeks after surgery.  It is important to raise this with your surgeon after your abdominoplasty and check with your car insurance company.

A final note…..

Abdominoplasty is a very popular and effective operation. Having this surgery is a big decision, but when patients are properly informed and an operation is tailored to their needs they are usually extremely satisfied with the results. The patient can normally expect to have a flatter tummy with a boost given to their confidence both in and out of clothes.

Pre-operative photographs (patient of Mr. Darren Chester, Consultant Plastic Surgeon at BMI Droitwich Spa Hospital)

12 months following full abdominoplasty

“It was a big decision to go ahead with an abdominoplasty but throughout I was made to feel positive and was kept well informed. It was the best decision I made”

Article by Mr. Darren Chester FRCS(Plast.), Consultant Plastic Surgeon, BMI Droitwich Spa Hospital.

This article has been written by one of our consultants.  Each consultant differs in their practice and therefore this article does not reflect the standard approach or practice of all BMI consultants.  It is important that you talk to your treating consultant about your own situation and any surgery you may undertake.