Lockdown 2.0

So, we are in lockdown again.

We are much better prepared this time and over the last few months, we have put measures in place to ensure the safety and protection of everyone at the clinic and we have robust measures which are over and above what you might expect in other public environments.

  • because we offer a boutique, bespoke service, we have never been about high volume and so we can limit access to the clinic to one patient at a time. This ensures that you will not be entering a busy waiting room and passing other patients in the corridors
  • we have screening measures in place that ensure that if you have had any contact or any symptoms, then we will ask you not to attend clinic. In this way, we can ensure as much as possible that we are what is known as a ‘clean site’.
  • we offer virtual consultations that can be held by phone or video call with the facility for a screen share to go through before and after photographs and talk about your goals or your progress. This avoids the need to attend clinic in many cases and saves on the stress of having to drive in to Birmingham!
  • because we are a medical clinic, we are used to using PPE and it is second nature for us to wear surgical face masks, gloves and gowns to ensure that we keep you safe. We will also ask you to wear shoe coverings and face coverings when at the clinic.
  • we are very lucky to have our own minor operating suite on site, and so we can offer procedures under local anaesthetic which can even be done on the same day as consultation by prior arrangement
  • the Private Hospitals that we normally work at are being used by the NHS, so we have not had access to the main operating theatres since March. However, we have not rested on our laurels and we have formed relationships with facilities that are not being used by the NHS and so we are one of the few clinics in the country that are still able to offer surgery under both general anaesthetic and local anaesthetic with sedation (twilight anaesthesia).

We are confident that we can continue to work safely and would be pleased to welcome you to the clinic.

However, we appreciate the need to avoid unnecessary journeys and encourage you to stay at home when possible.

If you can have a virtual consultation rather than an in person one, then we can arrange this and if you do have a consultation or a procedure booked and you prefer to cancel it or postpone it, then we completely understand and will be happy to reschedule or offer you a full refund.

Furthermore, if you were to have any sort of treatment with us and we were to go into a more restrictive lockdown period, we want you to be reassured that we would still be able to look after you.

Even during the previous lockdown when we had to close the clinic for 3 months, we were still doing virtual consultations and if anyone had a clinical problem, we would have been able to see & treat them at the clinic because that would be considered an urgent matter.

The lockdown involves the closure of non-essential shops and services and medical clinics can remain open.

We feel comfortable with our safety measures to be able to work effectively and maintain our levels of service and hope that you will feel comfortable too.

We are trying to do the right thing and I am very conscious about striking the balance between maintaining a service to our patients and containing the spread of the virus.

As ever, if you have any concerns or questions, you can get in touch or find me on Facebook and Instagram every Tuesday night at 7pm where I will be available for a live Q&A.

View our COVID guidance for patients

If you would like more information, please leave a comment and we will get back to you or call us on 0121-454 3680 or contact us here.

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Twilight Anaesthesia – A Change For Good?

The Coronavirus Crisis is likely to have a long lasting effect on many aspects of our lives – both good and bad.

  • Remote working has taught us that we perhaps don’t need to use our car as much and there can be benefits in reducing commuting and carbon emissions.
  • Regular hand washing and hygiene can help to reduce the spread of many infections, not just the coronavirus.
  • Spending more time at home has been welcome especially for those of us with young families.

“It is what it is, as my son would say”

…and so we have to try to see if we can take some positives from it.

It has certainly forced me to look at the way I operate.

The Private Hospitals have been taken over by the NHS in and are not accepting any Plastic Surgery patients until the New Year.

This has meant that I have had to look for other facilities to treat patients (either that, or shutting up shop for 6 months – or more!).

There are still some smaller Private facilities that are not big enough to be of use to the NHS, but are able to offer surgery under General anaesthetic and Twilight anaesthesia (local anaesthetic with sedation).

Until now, I had only done a small proportion of my cases under Twilight anaesthesia and only in those patients who specifically requested it.

…but I have to admit that it has been an eye-opener.

We have done quite a few cases under Twilight anaesthesia now and it works amazingly well.

The sedation is such that you are not really aware and usually quite relaxed with little or no memory of the procedure.

In fact, for most of the surgery, it is similar to a General anaesthetic.

The main difference comes in the postoperative recovery.

…it is a lot smoother following Twilight anaesthesia and you are pretty much ready to get up and walk out within an hour of finishing the surgery.

There are still the bigger cases that need General anaesthetic like tummy tucks or bigger breast reductions but even these can be done with twilight anaesthesia and so I think it is probably a matter of time before it becomes the standard.

We are very lucky to have access to surgical facilities during these challenging times and I can’t tell you how pleased I am to be operating again.

If you are thinking of having surgery, whether it is under General anaesthetic or Twilight, then please get in touch because we are lucky to have access to some really great surgical facilities.

If you would like more information, please leave a comment and we will get back to you or call us on 0121-454 3680 or contact us here.

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Is it safe to have surgery during Coronavirus?

Surgery During Coronavirus Crisis

If you are planning to have surgery, you may have some concerns about all of the measures in place around COVID-19 and might be wondering if it is safe to have surgery during coronavirus.

The risks of contracting the virus relate to the spread in an aerosol form hence the requirement for face masks and visors.

This means that you will find measures in place when you come to the clinic to reduce transmission in the same way that you would when visiting other shops and services.

However if you are considering surgery during this time you may have further concerns.

There are risks to the healthcare professionals delivering the surgery as well as risks to yourself having the surgery.

Risks to healthcare professionals

In my field of breast and body contouring, I do not do surgery that would be classed as high risk in producing aerosol which would be more related to surgery around your mouth such as ENT or dental surgery.

There is however a risk during intubation and extubation at the beginning and end of a general anaesthetic, however there are robust measures to protect everyone around these times.

Private hospitals aim to be COVID-free environments which is why you will be asked to self isolate, fill in a questionnaire and have a COVID test before admission.  It is also why, for the time being, visitors are being discouraged.

Unlike NHS Hospitals, Private Hospitals do not have an A&E Department and so do not accept direct admissions.   This means that they have much more control over their environment as all admissions are planned.
Everything is being done to make the hospital environment a safe environment to be in for both the staff and the patients during these challenging times.

Risks to you

In relation to the risk to yourself if you are considering surgery then this is by no means clear.

There was a study which suggested that if you have surgery and go on to develop COVID-19, then your outcome may be worse than if you hadn’t had surgery.

This study seemed to affect patients who are in higher anaesthetic risk category rather than the sort of patients who have elective cosmetic surgery . It also seemed to be in patients having longer and more complex surgery. which is why this has been discouraged at the moment.

The Royal College of Surgeons has produced this information leaflet.

It has not been suggested that we should stop during surgery during coronavirus and the guidance is that for most elective cosmetic surgery, it is safe to proceed although we will ask you to fill in a COVID-19 specific consent form before your operation.

Following surgery, you will also be given a specific postoperative instruction sheet for COVID-19.

The main issue that we have at the moment is with accessibility to theatres as all of the major private hospitals in the UK have been taken over by the NHS and are offering limited access to plastic surgeons.

However we like to solve problems and overcome challenges and so have adapted and there are more and more clinics in the UK who are offering local anaesthetic and sedation which is suitable for many plastic surgery procedures.

My clinic is not set up for local anaesthetic and sedation at the moment, but we have access to other clinics to use their facilities.

This is something that we have been doing on a small scale before the coronavirus outbreak and will be doing more of moving forward and I think it is actually a positive step.

The recovery after local anaesthetic and sedation is much quicker and it can be extremely well tolerated by patients.

However it is not for everybody and there will still be some larger operations that require a general anaesthetic and we have some access to general anaesthetic theatres.

The information that we are getting from the hospitals is that we will be back to normal capacity after Christmas although this is of course dependent on how things progress with the coronavirus pandemic.

We are trying to keep everyone updated as well as we can but unfortunately, we are getting theatre lists on an ad hoc basis, so it is difficult to plan and give you a lot of notice if you are on the waiting list for surgery.

These are challenging times for all of us all,  but I think it is important to recognise the significant benefits that can come from cosmetic surgery and I believe that it is safe to continue to perform surgery during coronavirus and still maintain our high levels of service given the limitations and restrictions imposed upon us.

If you have any questions or would like to talk about any of the issues around this please feel free to get in touch or join me on my Facebook and Instagram live Q&A every Tuesday at 7pm.

Resources:

The Royal College of Surgeons information leaflet
Specific guidance sheet for COVID-19
COVID-19 specific consent form

Why does breast reduction cost so much?

If you think that breast reduction costs a lot then it is important to put it into perspective.

Some patients put breast reduction into the category of cosmetic breast surgery and think of it in the same way as other operations like breast augmentation.

Any cosmetic surgery is a major undertaking both physically and psychologically because you are changing the way you look.

However when it comes to the extent of surgery, breast reduction can be a significantly bigger procedure than breast augmentation.

When taking in to account breast reduction cost, you have to realise what is involved.

Breast augmentation surgery takes about an hour in theatre whereas breast reduction takes three hours in theatre.

If you have ever seen the inside of an operating theatre (check out my video), you will see that there are 5 to 10 members of staff at all times all of whom have specific areas of training and expertise.
Not to mention what goes on in the background to keep a hospital running with all the administrative costs and overheads.

There is usually at least a one night stay in hospital and this will all be covered in the one-off cost that you pay.

I sometimes notice that my colleagues think that we as plastic surgeons get paid a lot because they see the headline rate that we receive when doing surgery.
However there is a big difference when working in the self-pay market compare to the insured market.

Whilst the cost of breast reduction is significant, it is a one off payment and all aftercare, outpatient visits and follow-up appointments are included in the price.

My colleagues who do insured work get paid for every intervention.

If they see you in the clinic, if they perform an x-ray or other tests, or if they have to perform any other procedures “ they will be paid at every stage.

After performing a breast reduction, we will see you in the clinic on a regular basis to ensure that your wounds heal, your scars soften and the shape of your breasts settles.

We want to make sure that you are happy with everything.

Furthermore, we will continue to see you in the clinic if you ever have any problems or concerns at any time.

There may be some patients who need very little input from us but there are others for whom this will be invaluable.

It comes down to how much value you get from a procedure as to whether it is worth the cost.

Breast reduction can be life changing on several levels:

  • on a physical level by removing the weight from your chest, reducing back and neck strain and not having your bra straps digging in.
  • on a practical level by allowing you to shop on the High Street for bras and be able to wear the clothes that you want to wear.
  • and on a emotional level by feeling in proportion and more comfortable with your body and improving self esteem and self-confidence.

 

It is hard to put a price on this.

I understand that breast reduction cost is a major determinant when someone is choosing surgery but I don’t think it should be the only one.

Here at The STAIANO Clinic, we are very aware that many other clinics offer the same procedures and we need to be competitive.

I have built the clinic so that we can compete on a worldwide scale when it comes to the qualifications of us as plastic surgeons, the level of care and treatment that we give and the time and space that we give you as an individual patient.

Not to mention the aftercare that we offer.

It is hard to do this and still be able to compete on price and so I realise that if you shop around, you will be able to find surgery cheaper elsewhere.

Whilst we can’t always compete on price, I know that we can compete on quality.

If you want to find out more you can download our guide with some frequently asked questions here or call us on (0121) 454 3680

You can also read more by visiting our Breast Reduction page.

If you want to know what a breast reduction costs at The STAIANO Clinic, then click here and we will send you not only how much it costs but also what we offer for that cost.

As always feel free to comment and if you have any questions you can find me on Facebook with a live Q&A every Tuesday at 7 pm

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What is a Tummy Tuck with Muscle Repair?

We often talk about performing a tummy tuck with muscle repair and I would like to clarify what we mean by that.

The muscle in question is the rectus abdominis muscle which is the six pack.

Although the six-pack looks like horizontal lines across your abdomen, it is actually a vertically orientated muscle that goes from your rib cage straight down to your pubic bone.

There are two rectus abdominis muscles which sit side-by-side.

At intervals along the length of the muscle there are ridges called tendinous intersections.  It is these that create the appearance of the six-pack.

These muscles can be spread apart when the intra abdominal contents increase and swell up.

This commonly occurs during pregnancy and when putting on weight.

When the swelling goes down, sometimes the muscles don’t come back together again leaving a gap between them.

This is known as divarification of the rectus muscles.

It is not that the muscles actually need to be repaired but more that they need to be brought back together.

If you are wondering whether you need to have your muscles repaired or not then you can demonstrate divarification of the rectus muscles by lying flat on your back and performing a straight leg raise.

This will tense the rectus muscles and if they are not sitting next to each other, you will be able to see a bulge or feel a gap between them above your belly button.

It is routine to repair the rectus abdominis muscle when performing a full tummy tuck or a fleur-de-lis tummy tuck.

This is because the operation involves releasing the skin and fat all the way up to the rib cage, so the whole length of the rectus abdominis muscle is exposed.

This is not the case with a mini tummy tuck because the belly button is left in place and we can only access the lower abdomen below the belly button.

This means that we cannot repair divarification of the rectus muscles when performing a mini tummy tuck.

Patients sometimes ask specifically to have the muscles repaired when requesting a tummy tuck but this is something that we will assess and repair routinely for anyone having a full tummy tuck or a fleur-de-lis tummy tuck.

If you are having your rectus abdominis muscles repaired, it can be a little bit uncomfortable and so do not be surprised if you wake up after surgery with discomfort centrally above your belly button and it can be uncomfortable to cough because this will put tension on the muscle repair.

Sometimes people think that they have a hernia but divarification of the muscle is not strictly a hernia in itself.

A hernia is a defect in the abdominal wall whereas divarification is a weakness in the abdominal wall.

Most plastic surgeons will be comfortable repairing hernias or divarification of the rectus muscles and so whatever the cause of the weakness or bulge in your abdominal wall, we should be able to fix it for you.

If you have any questions about tummy tuck with muscle repair or tummy tucks in general, you can comment below or email me at info@staianoplasticsurgery.co.uk.

I perform a live Q&A every Tuesday at 7pm on Facebook and so you can catch me there if you want to ask a question.

If you want to come to the clinic for a consultation then you can contact us here or phone (0121) 454 3680. We would love to see you.

You can download my tummy tuck guide here.

 

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How to treat Breast Asymmetry

We specialise in breast reshaping here at the STAIANO Clinic and can perform breast lifts, breast reductions, breast implants and breast lift with implants.

There are many cosmetic clinics which offer breast implants but not all will treat patients with more complicated problems.
Patients with breast asymmetry will often present for surgery.

The first question we would ask is:

Are you happy with either of your breasts or do you want them both changed?

If we can just operate on one side then this will lower the risk of complications and be beneficial for all.

It may not always be possible to just operate on one side, particularly if one breast is sitting lower than the other one with uneven heights of the nipples.

It is possible to lift the nipple, but it is not possible to lower a nipple (at least not without leaving a scar where the nipple was). So we can raise the low one, but is extremely difficult to lower the high one.

The next question to ask is:

Is there a problem with the shape, the volume or both?

In general terms, problems with the shape involve a breast lift and problems with the volume involve breast implants or breast reduction, (depending whether you want them bigger or smaller).

Surgery for breast asymmetry usually involves a combination of breast implants, breast lift and sometimes breast reduction.

Different things need to be done to each breast and so there is always a risk that they will settle differently and you may have to accept some degree of asymmetry.

Everybody is born with a degree of asymmetry and this is quite natural.

What we aim to do with surgery for breast asymmetry is to bring your breasts and your frame back into balance and make it easier for you to wear clothes and bras without needing to use a chicken fillet or external prosthesis in one side.

If you have different size breasts with one sitting lower than the other (usually the bigger one), you could have them made the same size by using different size implants.

The implants come in set volumes and so we would be unlikely to make them identical and would usually need to use a sizer in theatre to work out the best match.

The implants would not do anything about the shape of your breasts and so one would still be sitting lower than the other.

This would probably not be in issue when wearing clothes but may be an issue out of clothes.

In order to correct this you would need a lift of the breast that was sitting lower, which is usually the bigger one and so it would also be possible to perform a reduction at the same time as the lift to balance out the volume.

Then we could use the same size implant in each side.

This is something that we could discuss in the clinic and there is no right or wrong answer.

Some patients would prefer not to have breast tissue removed and then replaced with an implant and would prefer different sized implants.

Others would rather have a reduction to match the size and the same size implants so as you age or undergo weight fluctuations, it is more likely to have a symmetrical change in your breasts.

Treatment of breast asymmetry is complicated and requires a bespoke approach and a partnership between the surgeon and the patient so that a plan can be made that can produce a realistic expectation with acceptable risks and an acknowledgement of the limitations of what we can do.

If you have a breast asymmetry and have any specific questions then I do a live Q&A every Tuesday at 7pm on Facebook and I would be happy to give my opinion.
If you want to come to the clinic for a consultation then you can contact us here or phone (0121) 454 3680. We would love to see you.

You can download my breast implant guide here.

You can download my breast reduction and breast lift guides.

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