Is it safe to combine multiple plastic surgery procedures into one operation?

Following on from the Mummy Makeover piece I recently posted, I have been asked whether it is really safe to combine multiple procedures in one lengthy operation.

My advice is that, for fit and healthy patients, combining plastic surgical procedures is very safe, despite the extra length of a combined operation, and offers the advantage of only requiring one general anaesthetic.

Naturally, there are still risks and complications relating to both the surgery and the anaesthetic and any particular risk factors, such as smoking, excessive weight, diabetes and the prescribed use of steroids for medical conditions, may lead to the decision that surgery would be more wisely carried out in stages.

However, there are some definite benefits in combining multiple procedures, particularly in regard to only undergoing one general anaesthetic, as there are a number of potential risks attached to this aspect of the operation and prospective patients often identify this as one of their chief concerns.

Getting everything done in one surgical operation also means just one hospital stay, which is also very appealing to prospective patients.

My patient consultations are exhaustive, considering the presenting problems carefully, including thorough examination, in the presence of a chaperone if desired, before moving on to talk about realistic solutions by way of surgery.

Do’s and dont’s after surgery are carefully talked through in terms of lifestyle and occupation, particularly with regard to length of recovery and I also discuss potential risks and complications, as well as cost to round things off. This is all backed up by a detailed letter covering all these aspects of the consultation, inviting further queries if anything is unclear or if a further point arises. A second consultation can take place if desired. There is no pressure on my part for surgery to proceed, this decision being entirely up to the patient booking a date through my secretary.

What exactly is a Mummy Makeover?

Over recent years, I’ve seen an increasing number of female patients seeking plastic surgical solutions to the effects of pregnancy on their bodies. This is an acknowledged trend worldwide and plastic surgeons in the USA first coined the phrase ‘Mummy Makeover’ to describe the phenomenon of body contouring procedures aimed at both the abdomen and breasts.

Pregnancy has a profound impact on a woman’s body – some of my patients have described it as “devastating” – particularly the abdomen and breasts. As the womb expands to accommodate the baby, the central, vertical abdominal wall strap muscles stretch and separate to a greater or lesser degree. This may cause irreversible fullness of the tummy and even, at its severest, a ventral hernia, the tummy contents pushing through the central weakness to lie just under the skin. The overlying skin, of course, also stretches at the same time.

The breasts are also affected by the pregnancy as they generally increase in size and their tough, supportive, connective tissue fibres stretch as the breasts become more heavy and full. Breast feeding, whilst absolutely the best thing for the new baby, causes collateral damage to the breast tissues through continued engorgement with milk. Often the stretched effect on the skin and connective tissues does not recover when breast feeding is stopped, causing many women dissatisfaction as their breasts feel loose and empty. Loss of cleavage is also a popular complaint as fullness is principally lost in the upper part of the breast.

Turning to the tummy, age, the amount of weight put on during pregnancy, the size of the baby, multi-birth pregnancy, multiple pregnancies and inherited genetic make-up are all factors in how your body shape will change during and after pregnancy.

Although it is possible for the body to snap back to its pre-pregnancy shape, many women are left with the ‘battle scars’ of pregnancy, long after the baby is born. Skin stays stretched and the abdominal muscles fail to knit back as tightly as before, meaning it is impossible to regain a toned abdomen, however stringent a diet and exercise routine is followed.

Although plastic surgery post-partum is nothing new, the increase in women seeking plastic surgery procedures to reshape and restore the body seems to be down to a change in attitude. Reflecting the times in which we live, many women, more aware, empowered and self-confident than ever before, are not prepared to simply shrug their shoulders and just accept these changes as their permanent lot.

So, what are their surgical options?

A ‘Mummy Makeover’ is a marketing term and doesn’t describe an actual surgical procedure. It is a loose term that covers a number of different surgical procedures that can be combined into one lengthy operation. The main procedures are aesthetic breast surgery aimed at restoring breast shape, tone and, often, volume and a ‘tummy tuck’ that will improve abdominal appearance and tone.

The most likely breast procedures are augmentation and/or uplift (medically known as a mastopexy). Occasionally some degree of reduction is appropriate. During the consultation for my patients from Warwickshire, Coventry and beyond, I perform a thorough physical examination to identify, and then discuss with them, what procedure would best suit their needs.

The correct procedure choice is crucial. Often a woman will feel she needs a breast augmentation because of lost fullness in the upper pole of the breast. However, if she also has more than just slight sagging, inserting an implant will only make the appearance of the breast worse with time, the implant dragging the breast downwards by gravity and resulting in the breast volume being too low down. A mastopexy, utilising and lifting her own breast tissue to a more natural position, higher on the chest, whilst also tightening the skin ‘envelope’ a lot, will often produce a much better result more nearly fulfilling her hopes and expectations, although sometimes some degree of augmentation will also be required.

A ‘tummy tuck’ (known medically as an abdominoplasty) will vary in extent depending on how much needs to be done. If a ventral hernia is present, a complex repair is required to try and prevent it ever happening again. I carefully stitch stretched and separated abdominal muscles together again, before removing any excess skin and fat to produce the final result. A small but definite sector of my patients are women who are otherwise very slim and toned but are unable to strengthen the area below the belly button because of muscle looseness post-pregnancy. A mini-tummy tuck is an ideal procedure for these women as it focuses on this area alone.

As with all the plastic surgery procedures I offer, prospective patients can speak to former patients, who have had a particular procedure or combination of procedures done, so they can get a clearer idea of the results that are achievable and what the experience will be like from the patient’s perspective.

Dermal Fillers: the next scandal waiting to happen?

“It is our view that dermal fillers are a crisis waiting to happen.” These are the chilling words that appeared in Sir Bruce Keogh’s Review into cosmetic interventions, published six months ago.

Non-surgical treatments, including dermal filler injections, account for nine out of ten procedures in the UK and, although they may be enticingly described as ‘non-invasive’, ‘lunchtime’ or ‘walk-in, walk-out’ procedures, this is false reassurance: they should be treated very seriously as they can have an irreversible impact on your long-term health and/or appearance.

Yet, there is little regulation covering dermal fillers and the British consumer is at risk.

Understanding legislation

The PIP breast implant crisis happened in part because an implant is categorised as a medical device rather than a medicine. As a result, implants are only monitored as closely as a wheelchair, yet these are products that are inserted into the body, with all the potential complications that entails.

Amazingly, dermal fillers aren’t even categorised as a medical device as their use is deemed cosmetic and so there is little control over product quality. That’s not to say they are unsafe, but it means that you’re entirely reliant on the manufacturer enforcing strict safety controls.

USA versus UK

The PIP crisis didn’t happen in the USA because they have stricter guidelines. Implants and dermal fillers are all classified as medicines which must undergo rigorous testing before receiving approval.

The Food and Drug Administration in the US have only approved fourteen dermal filler brands – compare that to the UK where there are 160-plus temporary and permanent dermal fillers certified for use.

Anyone can inject

As well as concerns about the actual products that are being injected, what is even more worrying is that there is no legislation covering who can inject these dermal fillers. Anyone can set themselves up as an ‘aesthetic practitioner’ and, legally, there is no requirement for them to have knowledge, training or previous experience.

Obviously, no one like that has the necessary experience to be able to deal with complications if something does go wrong, leaving their patients worryingly adrift.

At my Leamington-based practice, I have become increasingly concerned about poor practice in the unregulated dermal filler market, particularly through patients seeking correction of botched dermal filler ops.

Sir Bruce Keogh’s recommendation in the review is that beauty therapists and aesthetic practitioners should simply receive more training and have to pass certain qualifications, but I, along with many of my plastic surgery colleagues, believe that only specific medical professionals should provide injectables.

So, in the absence of government legislation, how can patients protect themselves? Check your practitioner’s qualifications and, to ensure your safety and that you’re being offered the right treatment for you, only see an adequately trained medical professional such as a Plastic Surgeon who offers the full range of cosmetic surgery and non-surgical procedures. Membership of BAAPS (The British Association of Aesthetic Plastic Surgeons) is a good starting point.