What is an abdominoplasty?

Abdominoplasty, which is also known as a tummy tuck, is a cosmetic surgical procedure that flattens the abdomen by surgically removing excess skin and fat from the middle and lower abdomen. This allows the abdominal wall muscles to be tightened. This is a major procedure that requires general anaesthesia. It is not an alternative to weight-loss.

Why have an abdominoplasty?

An abdominoplasty is suitable for men and women of a stable weight and in good health. Women might consider having an abdominoplasty to remove excess skin resulting from pregnancy. Additionally, men and women who have lost a lot of weight are often left with lots of saggy, excess skin which can be removed from the abdomen with a tummy tuck.

How is an abdominoplasty carried out?

To begin with, a large incision is made across the lower abdomen. Through this incision, the skin from the abdominal wall underneath the belly button is separated and the excess skin of the abdomen is cut away and the excess fat removed. The incision is then closed with stitches. An abdominoplasty can be either partial (mini tummy tuck) or complete, depending on how much excess skin and fat there is, and where it is mostly located. During a complete tummy tuck, it is likely that the belly button will need to be moved. Drainage tubes are placed in the incision to drain excess fluids following surgery.

Preparation for an abdominoplasty:

It is important to stop smoking for a period before surgery, usually at least two weeks. Days before the operation it may be necessary to stop taking certain medications. There will also be a period of fasting before surgery.

Aftercare:

The patient must keep in mind that the scar resulting from the operation is permanent, although its size will depend on the type of incision made according to the surgical requirements of each case. The days following the procedure, the patient will have a little pain and discomfort, so the doctor will prescribe painkillers. You will need up to six weeks off work and exercise whilst you heal. You won’t be able to drive either for a number of weeks. It may be necessary to wear a special elastic control support for a few weeks to encourage healing and to reduce swelling. After six weeks, you can stop wearing the elastic support and return to most normal activities.

Basal cell carcinoma is the most common form of skin cancer, it is non-melanoma. It can present as a shiny nodule or a patch similar to eczema. Most cases appear on areas that have been repeatedly exposed to the sun.

What is a birthmark?

A birthmark is a coloured mark that is visible on the skin, which can vary in size and colour. It often appears at birth or develops soon afterwards. A birthmark will either fade or get bigger over time and be permanent. It may appear anywhere on the body or face and is completely harmless in most cases.
 

What are the different types of birthmarks?

There are two main types of birthmarks:

1. Vascular birthmarks:

These are often red, purple or pink and are caused by abnormal blood vessels in or under the skin. They are likely to be found in the head and neck area and mostly on the face. The most common types of vascular birthmarks include:

• Salmon patches – flat red or pink patches on a baby’s eyelids, neck or forehead at birth. These are the most common type to occur in around half of all babies.
• Infantile haemangioma or ‘strawberry marks’ – are raised marks on the skin that are usually red. These are particularly common in girls. They increase in size for the first six months and eventually shrink and disappear by age seven.
• Capillary malformation or ‘port-wine stain’ – these are flat red or purple marks that affect a small number of newborn babies. They are sensitive to hormones and may become more prominent during puberty, pregnancy and menopause. Most are permanent.

2. Pigmented birthmarks:

These are usually brown and caused by clusters of pigment cells. Some of the most common types include:

• Café-au-lait spots – these are coffee-coloured skin patches. It is normal to have one or two but if they keep developing by the time your child is five, it could be an underlying sign of neurofibromatosis. You should have these checked by a doctor.
• Mongolian spots – these are blue-grey or bruised-looking birthmarks. They are more likely to appear on the lower back or buttocks and may last for months or years but usually disappear by the time a child turns four years old.
• Congenital melanocytic naevi or ‘congenital moles’ – are relatively large brown or black moles. They become less obvious with time but may become darker during puberty. The risk of it developing into skin cancer is low but it can still increase in size.
   

What causes birthmarks?

The underlying reason for the formation of a birthmark is unknown. Very occasionally, gene mutation may be a cause, for example, a rare condition Sturge-Weber syndrome appears as port-wine birthmarks. Birthmarks do not run in families, cannot be prevented and are not hereditary.
 

Are birthmarks dangerous?

Most birthmarks do not require removal. Some may lead to an increased risk for certain medical conditions such as skin cancer and should be monitored by a dermatologist.
 

How are birthmarks removed?

Treatment depends on which type of birthmark that the child has. Techniques for removing birthmarks can include laser therapy, which can significantly lighten and make some birthmarks less visible. The laser targets the abnormal blood vessels and breaks them up into tiny fragments that the body’s immune system will naturally dispose of.

Some birthmarks may be removed via surgery. These include strawberry marks and large moles. During the surgical procedure, the dermatologist uses a scalpel to remove the birthmark. Larger birthmarks may require several appointments and are removed section by section.

The purpose of body remodelling is to shape the silhouette, either by reducing cellulite or by attenuating flaccidity in a particular area. It is a treatment that can be done with or without surgery. It is performed under local anaesthesia and the patient can return to normal life the day after the procedure. The most common areas to be treated are the abdomen, waist, knees, inner thighs and the “love handles”.

What is brachioplasty?

Arm lift, also called brachioplasty, is the surgical procedure intended to eliminate unsightly excess skin in the arms, making them smoother and firmer while improving their appearance. In mild cases, the arm lift can be performed with less-invasive techniques and with local anaesthesia; in more advanced cases, surgery under general anaesthesia may be required.

Why is it done?

With ageing, particularly from the age of 40, the skin starts becoming flabby, especially in women. Arms are a part of the body in which flabbiness is highly visible and many women develop a complex about it. Several degrees of flabbiness in arm contours can be distinguished, and the specialist in Plastic, Aesthetic and Reconstructive Surgery uses different techniques for each degree.

What does brachioplasty surgery involve?

Brachioplasty involves making an incision in the inside of the upper arm, in order to eliminate excess skin. In the cases that are more serious, it may even be necessary to make an incision from the armpit to the elbow, always on the inside of the arm. Via this incision, all excess skin is removed. In cases in which the patient wants to remove excess fat from his arms, this intervention may be combined with liposuction. Brachioplasty usually takes around 2 hours.

How to prepare for the intervention

During the pre-surgery consultation, you will undergo an evaluation, the results of which will be taken into account in the specific instructions given to you about how to prepare for surgery: whether you have to stop smoking, take iron supplements etc.

Post-operative care

In the first few days after the brachioplasty, it is normal for your arms to feel more tender and be swollen; they revert to normal over time. You can resume your normal routine in around 15 days, and the final result will be visible after a few months. The result of the brachioplasty is permanent and leaves no visible scars.

What is breast asymmetry? 

Women with breast asymmetry have breasts that are different in shape, position or size. In fact, the great majority of women have mild breast asymmetry. However, when the asymmetry is significant, it may adversely affect the woman’s body image, her self-esteem and confidence.

Breast asymmetry can be classified into three types:

Anisomastia: a significant difference in the volume and size of the breasts.

Anisothelia: a difference between the nipples and areolas.

Combined asymmetry: anisomastia and anisothelia.

What are the symptoms?

The symptoms of breast asymmetry are essentially aesthetic, manifesting as a difference in, for example,  shape, size, developmental stage or fat percentage. In the most serious cases, there may even be a difference in osteomuscular structure or the breasts are completely different.

Causes of breast asymmetry

Significant breast asymmetry has several possible causes: it may be linked to a breast disease, a developmental problem, a hormonal problem, an unknown syndrome, an injury or periods of significant bodily change such as pregnancy or breastfeeding.

One of the diseases linked to breast asymmetry is breast cancer. Hence, all women with breast asymmetry are advised to perform breast self-examination to detect any warning signs in a timely manner.

Can it be prevented?

Breast asymmetry appears while the breasts are developing during puberty. It cannot be prevented, except if it occurs as a secondary effect of a growth disorder that is diagnosed early. There are no measures you can take to prevent breast asymmetry.

What is the treatment?

The only solution to breast asymmetry is plastic, aesthetic and reconstructive surgery. The surgical techniques used depend on the surgeon and on the patient’s characteristics. However in many cases, breast augmentation, breast reduction or a combination of both will be done.

Breast augmentation or mammoplasty is a surgical procedure aimed at increasing the size and volume of the breasts. Normally, surgery is recommended with implants in both breasts to make them more symmetrical. A breast enlargement operation is performed by making a small incision around the areola or in the fold under the breast or armpit. Through the incisions on each breast, breast tissue is lifted and breast implants are inserted under the chest muscle. The implants can be silicone or saline implants and they come in various shapes, generally round, oval or anatomical. Currently, there are prostheses with a rough textured surface to provide a more natural look. The incision scar for breast surgery is practically invisible.

Breast cancer is a form of cancer that develops in the cells of the breasts, mainly in women but men can also be affected. It is the most common type of cancer in the UK, with approximately one in eight women diagnosed with breast cancer during their lifetime, and around one in 870 men develop it. Although it is the most common form of cancer, the recovery rate is high if the cancer is discovered early.

What are the symptoms of breast cancer?

The most notable symptom of breast cancer is the formation of a lump anywhere in the breast area from below the armpits to the centre of the chest. It may appear as a physical lump, or the thickening of breast tissue.

Other symptoms include changes in the size or shape of the breasts, dimpling of the skin of the armpits, a rash around the nipples, discharge from the nipples, or a sunken area in either of the breasts.

What are the causes of breast cancer?

The causes of breast cancer are not known, however it is understood that there are certain factors that can cause an increase in the risk of developing breast cancer.

People more at risk of breast cancer include:

• Those aged over 50 years old
• Those with a family history of breast cancer
• Patients who have previously had breast cancer
• Patients who have had a previous benign breast lump
• Tall people are slightly more at risk from breast cancer
• People who drink alcohol excessively
• People who are overweight or obese

What are the different types of breast cancer?

Cancer can develop in different parts of the breast and in different ways.

The most common types of breast cancer are:

• Non-invasive breast cancer (carcinoma in situ)

  
  Non-invasive breast cancer forms in the milk ducts within the breast. It does not grow to the normal surrounding tissues. This form of cancer is usually detected with a mammogram, and doesn’t usually show as a lump.

• Invasive breast cancer

  
  Invasive breast cancer is the most common form of breast cancer, and also the most dangerous. This form of breast cancer can spread to the surrounding tissues. It often shows as a lump or thickening of the breast tissue.

How is breast cancer treated?

It is important to detect breast cancer early, as early detection means that it can be treated more effectively before it is able to spread.

Treatment usually consists of three components: surgery to remove part or all of the breast tissue where the cancer is located, known as either a mastectomy to remove the complete breast, or a lumpectomy to remove the lump. Chemotherapy and/or radiotherapy to kill any remaining cancerous cells follows, along with the possibility of hormone or biological treatments.

To make an appointment with a breast cancer specialist, click here.

What is breast fat transfer?

Breast fat transfer, also known as fat grafting or an autologous fat transfer, is a fairly new breast reconstruction technique. In simple terms, a breast transfer involves removing fat from one part of the body, often the thighs, buttocks or abdomen, and injecting this fat into the breast area to reconstruct and recreate the breasts following breast cancer surgery. Whilst this is mostly an oncoplastic technique, it can be used as a means of ‘natural’ breast enhancement, without the need for implants.

Why is breast fat transfer done?

A breast fat transfer provides a means of both creating a more natural feeling and look breast enhancement. It is also a technique that can be used when reconstructing breasts that have undergone breast cancer surgery (e.g. a lumpectomy). If the breasts just need to have small differences fixed, a similar technique called lipofilling can be used. An advantage of this technique is that it can be safer than other means of breast augmentation or reconstruction because it is not major surgery, such as breast flap surgery, and it does not involve the risks of having a foreign object inserted (implants).

What does a breast fat transfer involve?

Fat is removed from another part of the body (buttocks, thighs or abdomen) using a thin tube which sucks out small amounts of fat. This process is similar to liposuction. Next, the fat must be prepared for insertion into the breast area. Specialist equipment spins the fat, separating the fat from the blood. Once the fat is prepared, it can be inserted into the breast area. Using a needle and syringe, fat is carefully transferred to the breasts. Stitches are usually not needed as the injections are inserted through very small holes.

A breast fat transfer can take up to two hours and sometimes it is done as a day case procedure, however, sometimes it may be necessary to stay in hospital overnight. It can be performed under either local or general anaesthetic, and whichever is used, there should not be any pain throughout the procedure. Sometimes, more than one session is required to achieve the desired results.

Preparation for a breast fat transfer:

Depending on the anaesthesia used, you may be required to fast before your procedure. Your health and suitability for breast fat transfer will also be determined before being scheduled for this procedure.

Aftercare:

After surgery, you should arrange for someone to take you home as you will not be able to drive initially. You can expect the breast area to be swollen and bruised for the first two weeks. Results are best observed a few months following breast fat transfer. Over time, it is normal for some of the transferred fat to be reabsorbed by the body, so some breast volume may be lost eventually. During your recovery period, it is advised that you do not sleep on your front and that you avoid strenuous activity.

What is mastopexy?

Mastopexy, or breast lift, is a form of plastic surgery that raises sagging breasts in order to correct ptosis. Throughout a woman’s life, her breasts will naturally sag as she ages, as breasts lack muscle tissue, meaning they cannot be strengthened. While it is not necessary to correct natural sagging, some women choose to in order to restore volume and fullness to the breasts.  

Why is mastopexy performed?

Mastopexy is performed to correct sagging breasts, which can occur as a result of gravitational pull, ageing (as fat and tissue decrease in the breasts), pregnancy, or weight loss. Smoking and sunburn can also affect the elasticity of the breasts. Sagging can occur in both large and small breasts. While sagging breasts do not affect physical health, they may affect self-esteem, and as a result women may wish to have the ptosis corrected.

What happens during mastopexy?

During the procedure, your surgeon makes several cuts on the breasts, depending on the technique that they are using. Skin can be removed from around the areola, and from under the breasts, or only one area. The breast is then reshaped, making it ‘tighter’, and the nipples are repositioned, with the areola being reshaped on some occasions to fit the new breast size.

Sometimes breast implants can be inserted during the same procedure, in order to perform a breast uplift and enlargement.

How to prepare for mastopexy

At consultations before your surgery, your surgeon will assess your breasts and take photographs for records. They will assess the size and position of your nipples and mark where the cuts will be made. They will discuss what you want to achieve from the procedure in-depth.

Before undergoing a mastopexy, your surgeon will explain what you must do in preparation. If you smoke, you will be asked to stop at least six weeks before the operation, as smoking increases the risk of infection and slows recovery.

You will be advised not to eat or drink anything for about six hours before the operation. The procedure is performed under general anaesthesia.

Post-operative care  

After surgery, you’ll need to:

• Wear a suitable bra (elastics, without underwire and with adjustable straps) and a bandage for a month
• Remove the bra only for showering
• Not wear an underwire bra for several months after the intervention
• Massage the area to reduce inflammation (if recommended by the specialist)
• Avoid lifting heavy things, strenuous exercises and sudden movements

Your surgeon will also give you advice on aftercare and how to clean the wound. Speak to your specialist if you have any questions or worries after the procedure.

What are breast lumps?

A breast lump is a mass in the breast that can vary in size and texture. They are sometimes painful and can feel like a knot, bulge or swelling around the breast or armpit area. Most of the time, breast lumps are benign (non-cancerous). It’s normal for breast tissue to feel lumpy but if you notice any new lumps, or ones that stay after a menstrual period, it’s very important to visit a doctor and get an examination.

What causes them?

There are many causes of breast lumps. These can include:

• Infections – the name given to inflammation of the breast tissue is called mastitis. Infection occurs most often in women who are breastfeeding. The skin around the nipple can become sensitive leading to the skin becoming injured or cracked. Bacteria can then enter and as a result cause infection in the breast. These infections can appear as a deep pocket of pus known as an abscess. Body piercings in the nipple can also cause infections and should be treated by a doctor.
• Injuries – if the breast is injured for any reason this can cause a lump to develop in the area. The small blood vessels can rupture and cause bleeding. This bleeding in the tissue can be noticed as a lump. These can vary in size and be painful.
• Non-cancerous growths & cysts – these normally occur in women aged over 35. Fibroadenomas is a type of tumour that’s non-cancerous. They are firm to touch and very common. They normally cause very little or no pain at all. Breast cysts are benign sacs filled with fluid. These can vary in size and can cause some pain.
• Cancer – most of the time, breast cancer causes no pain in the breast area. It may appear as a physical lump or the breast tissue may feel thicker. Other symptoms include changes in the size or shape of the breasts, dimpling of the skin of the armpits, a rash around the nipples, discharge from the nipples, or a sunken area in either of the breasts.

How are the types of breast lumps diagnosed?

The first step is a physical examination by a doctor. A manual examination by a doctor cannot always detect the cause of the lump. Since it is important to rule out breast cancer, a mammography is normally the next step. This is a screening tool that uses X-ray imaging to detect signs of breast cancer.

An ultrasound is also useful in determining the type of breast lump. This tool can be used to distinguish between a cyst filled with fluid, or a solid lump. Magnetic resonance imaging (MRI) scans are very effective and sensitive to small lumps in breast tissue. Often though, MRI is performed if the results of a mammography and ultrasound were not clear.

Treatments for breast lumps

There are various treatments available for breast lumps. After a doctor has evaluated and diagnosed the lump, the relevant treatment will be given:

• Infection – If the breast lump is caused by an infection then a combination of antibiotics and warm compresses are advised. Heat treatment is effective, so taking hot showers and applying warm washcloths are recommended.
• Abscess – Antibiotics are given, but depending on the size of the abscess, it might need to be drained by a doctor.
• Fibroadenomas – a surgeon will perform either a lumpectomy or excisional biopsy to check for cancer. There is also a procedure called fine-needle aspiration where a doctor uses a thin needle to withdraw fluid from the lump. Normally, fibroadenomas don’t require any treatment, but some women choose to have them removed for peace of mind.
• Cysts – these don’t normally need treatment unless they are causing constant pain and discomfort.
• Cancer – surgery is normally performed to remove the cancer. This depends on the stage and progression of the cancer but your doctor will evaluate your situation. Radiation therapy, hormone therapy or chemotherapy are also common treatments used to treat breast cancer.

What is breast pain?

Breast pain, also known as mastalgia, is pain or tenderness around the breast area. It’s a common complaint among women and can appear as a dull, heavy andaching pain or a sharp burning pain. It can range from mild to severe and the duration varies. Pain may appear:

• Just before your period - two to three days before you may experience some form of mild to moderate pain in both breasts.
• During your menstrual cycle - the pain can be present for around a week or longer each month. The pain might be mild to moderate.
• During the whole month - this is usually not related to your menstrual cycle if it lasts the whole month.

Any breast pain that is persistent needs to be checked over by a doctor. It is normal for women to experience breast pain before and during both periods and menopause. Breast pain is not usually a symptom of breast cancer.

What are the symptoms?

Pain in the breast can be classified as either clinical or nonclinical.

Clinical pain means the pain is linked to your menstrual cycle. It usually appears two weeks before and subsides during or after the menstrual cycle is over. The pain can appear as dull, heavy and aching, affecting both breasts. Sometimes there is breast swelling and it can radiate around the armpit area.

Nonclinical pain is when the pain is unrelated to the menstrual cycle and is instead linked to an injury to the breast tissue or surrounding areas. This usually affects only one breast at a time. It can be a constant, sharp or burning pain and most likely to affect women after the menopause.

Extramammary breast pain is where the pain can feel like it is coming from the breast but in reality, it’s radiating from a different place close by. If you strain your chest muscles then the pain can feel like it is coming from your breast. It is treated using anti-inflammatory medication and rest.

What causes breast pain?

There are many reasons why a woman might experience pain in their breasts. The following list explains some of the various causes.

• Breast size – when a women has large breast this can put strain on the muscles around the chest, neck and shoulders. This would be identified as nonclinical breast pain.
• Hormone fluctuations – a change in the levels of oestrogen and progesterone during a menstrual cycle can cause the breasts to swell and feel lumpy and tender. These are likely when a women experiences puberty, pregnancy or menopause.
• Mastitis – This is an infection of the milk ducts. During breastfeeding, the nipple area sometimes becomes sensitive and the skin can break, allowing infections to occur. Doctors normally treat this with antibiotics.
• Diet – women that have a diet that is high in fat and refined carbs, may be more likely to experience breast pain.
• Breast cysts – as a women gets older, her breasts may replace tissue with fat. When this happens, cysts can occur known as fibrocystic breast tissue. They aren’t serious but they can sometimes cause discomfort.
• Trauma – surgery on the breast can cause pain around the scar tissue. Injuries to the breast can also cause pain.
• Medications – some medications such as anti-depressants, antibiotics and hormone therapy can cause breast pain.

Medical tests & diagnosis

If the pain is constant, localised or is getting worse then a visit to the doctor is necessary. If your doctor feels like it needs to be checked further, they may offer various tests. A clinical breast exam is often performed where the doctor will check for any changes in the breast, listen to your heart and lungs and check for any muscular pain around the area.

If there is a focused area of pain and a lump or swelling present, then you may need to have a mammogram and/or an ultrasound to evaluate the cause. Sometimes, the doctor might need to perform a biopsy if the images from the mammogram and ultrasound aren’t clear. During this process, the doctor will take a very small sample of breast tissue and send it to a lab for testing.

Treatment

Treatment for breast pain varies depending on what’s causing the pain. Sometimes the pain can resolve on its own, other times you may need some treatment.

Changing your diet and eating less fatty foods can help if the pain is related to your diet. Sometimes, reducing caffeine and taking vitamin E can help too. If medication is needed, a doctor might prescribe some hormone supplements or hormone blockers to correct any hormonal imbalance. Anti-inflammatory pills and painkillers can be used to ease the discomfort.

Each treatment depends on the individual case, so you must consult a doctor to find the correct treatment for you.

What is breast reconstruction?

Breast reconstruction is performed after a mastectomy or a lumpectomy; in some cases, the reconstruction is delayed a few months or years after the breast cancer surgery.

The surgery is performed under general anaesthesia and takes about 8 hours.

Why is it done?

Breast reconstruction is primarily done for aesthetic reasons, and leads to marked improvement in the patient’s self-image. The decision to have breast reconstruction surgery is as valid as the decision to not have it — in all cases, the decision is a personal one.

What does it involve?

There are two ways of performing breast reconstruction: with an implant or with the patient’s own tissue (autologous or “flap” reconstruction).

• Breast reconstruction with an implant: only requires surgery in the chest, hence requires fewer interventions than flap reconstruction. The implant is usually filled with a saline solution, silicone gel or a combination of both, with vegetable oil or silicone on the outside and a saline solution inside. The implant is placed under the pectoralis major muscle. The approximate duration of the implant is between 10 and 20 years.
• Autologous or flap reconstruction: in this type of reconstruction, skin, fat and even muscle tissue is used to recreate the shape of the breast. The tissue, called a flap, is taken from the abdomen, back, thighs or breast. In “free flap” techniques, the tissue is completely separated from its original blood vessels, moved to the chest then combined with blood vessels in its new location. In “pedicled flap” techniques, the tissue remains attached to its original blood vessels and is moved under the skin to the chest. The surgical result lasts for the patient’s lifetime, and this constitutes an advantage of flap reconstructions over implants. There are different types of flap and the one used depends on the patient’s body type, the size of her breasts and whether she wants to become a mother in the future.

How to prepare for it

It is important that you follow the surgeon’s instructions, e.g. to stop taking medications such as ibuprofen or aspirin. You will have to stop smoking; you will have to dress as comfortably as possible; and you will have to arrange in advance how to return home after surgery and how to manage during the first few days of recovery.

Post-operative care

You will feel tired for a few days after the intervention, and so you should arrange for someone to help you during this time. After the first week, you will be able to take care of yourself.

What is breast reduction? 

Breast reduction is a surgical procedure to reduce the size of the breasts. The operation is performed under general anaesthesia by a specialist in plastic, aesthetic and reconstructive surgery.

Why is it done?

Breast reduction may be done for aesthetic reasons, in women who feel that the size of their breasts is not proportional or in harmony with the rest of their body. However, in many women, the procedure also alleviates neck and back pain caused by the excess weight.

What does it involve?

The plastic surgeon will recommend the most suitable breast reduction technique for you. However the operation usually involves making incisions around the areola to remove excess fat, skin and breast tissue and to shape the whole breast to achieve the desired position and size. This results in smaller, firmer breasts that are less prone to sagging. For an optimal outcome, a mastopexy (breast lift) is always performed as part of breast reduction surgery.

How to prepare for breast reduction surgery

Before surgery, a medical examination is necessary to determine whether you can undergo surgery under general anaesthesia. If you are a smoker, you will have to stop smoking from at least 4 weeks before surgery. You may also have to stop taking certain medications.

Post-operative care

After the operation, you may have to stay in hospital overnight, possibly longer. Recovery at home can take 1 to 2 weeks, after which you can gradually resume your usual routine. Breast pain during recovery is normal, so painkillers are usually administered. Oedema and mild bleeding may also occur. During recovery, you will have to avoid lifting, driving, exercise and sunbathing. Furthermore, you will have to sleep with your head and back elevated.

There are many types of breast surgery, including reconstructive surgery, augmentation (breast implants), and reduction. Undergoing surgery is a major decision which should be reflected upon and discussed in detail with a specialist before surgery is decided upon. People may seek cosmetic breast surgery for many reasons, and nowadays there are many options to choose from, meaning the procedure can be truly tailored to the patient. 

What are cysts?

Cysts are closed sacs in the body’s tissue that may be filled with fluid, air, or other substances. They have a membrane, or “shell”, to divide them from the surrounding tissue, and the cells that make up this membrane are abnormal compared to the surrounding cells.

Cysts can appear almost anywhere on the body, including on bones, organs, and the skin. There are hundreds or types of cyst and many possible causes.

Most cysts are benign and some resolve on their own; others may require surgical removal and a small proportion are cancerous.

Types of cysts

There are many types of cyst, including:

• Cystic acne
• Ganglion cyst
• Ingrown hair cyst
• Kidney cysts (e.g. polycystic kidney disease (PKD))
• Liver cyst
• Mucus cyst (mucocele)
• Ovarian cyst
• Pancreatic cyst
• Sebaceous cyst
• Tarlov cyst

Prognosis

The vast majority of cysts are benign (non-cancerous) and cause few problems for the patients. Many cysts simply go away on their own. However, if a cyst fails to resolve by itself, if it is causing particular discomfort or pain, or if its size and appearance bother the patient, it may require surgical removal, although this may also depend on the location of the cyst in the patient’s body.

If a cyst becomes infected, it can become sore and red, and may develop into an abscess (filled with pus).

A small proportion of cysts are cancerous, with the sac being formed by the body as an immune response to try to contain the cancerous cells and prevent them from spreading. However, if the cancer already has its own blood supply, the cyst will be ineffective. It is important to have any cyst that does not disappear quickly checked out by a doctor and monitored to make sure it is not cancerous.

Cysts symptoms

Cysts on the skin or close to it may be visible as lumps on the body. Cysts on the internal organs may be more difficult to spot, unless they cause symptoms such as pain in that area or affect the function of the organ. For example, kidney cysts caused by polycystic kidney disease (PKD) can lead to frequent urination or blood in the urine.

What causes cysts?

A number of things can lead to cysts, including blocked ducts or glands, infections, inherited conditions, chronic inflammation, parasites, injuries, and tumours.

Treatments for cysts

The treatment will depend on the type, size, and location of the cyst. Some common treatments include:

• Draining the fluid or other material from the cyst using a syringe
• Medication to reduce inflammation in the cyst
• Surgery to remove the cyst (usually as a last resort for persistent cysts or if the cyst is cancerous)

Which type of specialist treats cysts?

Cysts can be treated by doctors and surgeons from a number of different specialties, depending on the type and location of the cyst. For example, sebaceous cysts and other cysts affecting the skin may be treated by a dermatologist, while ovarian cysts may be treated by an obstetrician/gynaecologist.

What is DIEP flap reconstruction?

Women who have a mastectomy performed as part of breast cancer treatment may later decide to have reconstructive surgery to rebuild the breast which was removed. DIEP (deep inferior epigastric perforator) flap reconstruction is a type of reconstructive breast surgery which uses tissue taken from the patient’s abdomen.

Why is it done?

DIEP flap reconstruction is done in order to reconstruct the breast which was removed during mastectomy. While there are many reconstructive procedures available nowadays, with different surgical techniques producing different results, the DIEP flap reconstruction procedure can offer a natural-looking and feeling breast, as it uses the patient’s own tissue.

Implants can sometimes produce an uneven result, as of course the implanted breast may look slightly different to the natural breast, and implants can also distort and be uncomfortable years after the initial surgery. DIEP flap reconstruction rarely requires significant retouching, and the result is both natural and ‘softer’ looking, as the reconstruction should age naturally along with the patient, and change depending on your weight.

DIEP reconstruction can also be used to improve the appearance of the breast and relieve symptoms of a tight or distorted implant.

The result of DIEP flap surgery is generally lifelong, although occasionally a second smaller operation is needed after the initial one, to adjust the reconstruction, or to remake the nipple.

What does it involve?

The procedure is performed under general anaesthetic, using microsurgery to disconnect some of the tissue and blood vessels from the lower abdominal area. Once the ‘flap’ of tissue has been removed, it can be connected to a new blood supply in the chest. The operation itself is complex and can take between 6 to 8 hours. As it is performed under general anaesthetic, you should expect to be in the hospital for several days.

How do you prepare for DIEP flap surgery?

Your surgeon will assess if you are eligible for DIEP flap surgery, as those who are underweight or significantly overweight may not be considered for the procedure. If you have enough spare tissue around the abdomen, you may be able to have DIEP flap surgery. In your consultations with your surgeon, they will discuss the options available to you, and if you decide to choose DIEP flap surgery, you will have a CT angiogram performed.

A CT angiogram checks the blood vessels in the abdomen and can tell the surgeon if any type of injury to the abdominal muscle is likely to happen during surgery. Other tests may be ordered to check you are suitable for surgery.

Aftercare

As the procedure is relatively complex, you will have to stay in hospital for a few days after surgery. A scar, similar to that of an abdominoplasty, sits on the abdominal area, but this generally fades well over time. Scarring on the breast depends on the surgery performed. If the procedure is performed at the same time as the initial mastectomy, scarring can be reduced. If performed at a later date, the scar may be a little more visible, but it generally fades well over time too.

After surgery, you will need to avoid strenuous activity for around 6 weeks and some discomfort may be felt in the abdomen for this time. You can expect to be back to normal after about three months.

Alternatives to this treatment

Various forms of reconstructive surgery can be performed after a mastectomy, including implant surgery, where an implant filled with saline, silicone gel, or a mixture of the two is used to reconstruct the breast. Tissue can also be taken from other areas of the body in similar ‘flap’ procedures, such as from the thigh or back. Your surgeon will explain your options and you can decide on the best course of action after exploring them together.

What is gynaecomastia?

Gynaecomastia, occasionally referred to as ‘man boobs’, is the medical term for enlarged male breasts. It is a common hormonal disorder that only affects males, making their breasts larger than normal due to an excess quantity of male breast tissue. It usually occurs more in teenage boys and older men.

The extent of gynaecomastia symptoms varies from person to person. Some males find they have a small amount of excess breast tissue around their nipples, whilst others may have noticeably larger male breasts. In some cases, gynaecomastia may cause discomfort or tenderness in the breasts.

What are the causes of gynaecomastia?

There are several causes of gynaecomastia. One of the main causes is believed to be hormone imbalance, when more oestrogen is produced than normal and less testosterone. Oestrogen causes male tissue to grow at an abnormal rate. Although all males produce a certain amount of oestrogen, they also produce bigger quantities of testosterone which prevents the growth of breast tissue. In some cases, the reason for this hormonal balance is not known.

Obesity can also cause gynaecomastia, as being overweight may increase oestrogen production making the breasts larger. For this reason, patients who have dieted and done exercise to lose weight may find that they still have enlarged breasts.

Gynaecomastia in newborn babies occurs due to oestrogen passing from the mother through the placenta and to the baby. The breasts usually return to a normal size a few weeks after the baby’s birth. During puberty, some male adolescents may also find that their breasts grow as their hormone levels vary, but this usually stabilises as they grow older. Gynaecomastia in older men is caused by decreased production of testosterone. As older men often have more body fat, their oestrogen production increases thus causing the breasts to enlarge.

Other possible causes of gynaecomastia include drinking too much alcohol, and consuming illegal drugs or prescribed medications, among others.

Can gynaecomastia be prevented?

Although the condition is not always avoidable, there are some measures one can take in order to prevent gynaecomastia. These include following a proper diet, exercising, drinking less alcohol, avoiding certain drugs and medications such as steroids and marijuana (which has been linked to increased levels of oestrogen production).

What is the treatment for gynaecomastia? 

In some cases, treatment for gynaecomastia may be recommended. Gynaecomastia treatment includes breast reduction surgery to remove the excess male breast tissue, or medication aimed at correcting the hormonal imbalance behind enlarged male breasts. 

What is hyperhidrosis? What are the types?

Hyperhidrosis is a condition characterized by excessive sweating. Sweating, also called perspiration, is a skin function that helps to maintain body temperature constant. However, uncontrolled unpredictable excessive sweating , i.e. hyperhidrosis, can adversely affect social and professional relationships.

People with hyperhidrosis have overactive sweat glands. Their uncontrolled sweating can become problematic, from an emotional as well as physical viewpoint, and interfere with their everyday life as the condition develops. Hence, many people with hyperhidrosis want to avoid situations that involve physical contact, e.g. greeting somebody with a handshake. Similarly, they tend to restrict their arm movements and adopt rigid postures to hide sweating in their armpits. Among the habits that people with this condition develop, a common one is changing clothes several times a day.

Hyperhidrosis may affect only specific parts of the body such as the armpits (axillary hyperhidrosis), palms of hands and soles of feet (palmoplantar hyperhidrosis) or the face (gustatory hyperhidrosis), or the whole body (generalized hyperhidrosis). It may be focal, affecting an area ≤ 100 cm², or generalized, affecting an area > 100 cm².

Symptoms of hyperhidrosis

The symptoms are readily apparent: excessive, uncontrolled sweating in different parts of the body with no apparent cause.

What are the causes of hyperhidrosis?

Hyperhidrosis may be primary or secondary. Primary hyperhidrosis is usually more localized, and the cause is unknown; it is obvious however that the sympathetic nervous system is overactive and the sweat response is excessive. Feeling tense or nervous can make the symptoms worse. In many patients, a positive feedback loop develops: they become nervous when they realize that they have started sweating, which makes them sweat more, which makes them more nervous….

Secondary hyperhidrosis is the result of an underlying clinical situation and it tends to affect the body in a more generalized manner: it can appear at different stages of the patient’s life in association with different habits, illnesses or problems (e.g. menopause, certain drugs or medications, thyroid gland problems, tumours, etc).

Can it be prevented?

Primary hyperhidrosis cannot be prevented. Secondary hyperhidrosis is associated with another clinical problem and if the underlying problem is controlled, hyperhidrosis may be better controlled.

What is the treatment?

There are currently many varied treatments for hyperhidrosis:

• Treatment of hyperhidrosis with botulinum toxin: this is a straightforward treatment that can be applied to the armpits, the palms of the hand and the soles of the feet. The toxin, injected using very fine needles, blocks the function of the sweat glands, such that sweat production in the area is lowered. The treatment usually takes about one hour and it is effective for around 6 months.
• Medico-dermatological treatments: aluminium chloride is often used as an antiperspirant, but it may cause skin irritation. Anticholinergic substances are also used, but they may have side effects.
• Surgical treatments: one technique is to eliminate the sweat glands using one of several methods. Another procedure is endoscopic thoracic sympathectomy, in which the principal thoracic ganglia of the paravertebral chain innervating the skin region that requires treatment are rendered useless. Although this technique is highly effective, compensatory sweating may develop whereby sweating starts to occur in areas that did not sweat before surgery.

What is inverted nipple correction surgery?

The purpose of inverted nipple correction surgery is to place inverted nipples, also called flat or umbilicated nipples, in their natural position: protruding, rather than retracted. This is a simple operation of short duration, and it can be performed under local anaesthesia.

Why is the operation carried out?

In some women, the nipple does not point outwards, as it normally should. This abnormality becomes apparent after puberty and although there is no reason why it should be a health problem, many women find that it affects their self-image and confidence and so want to correct it. Although this abnormality primarily affects women, men may also have inverted or retracted nipples.

The abnormality has varying degrees of seriousness: it may be that the nipple inverts only occasionally; or it may be that the nipple is positioned inside the breast because the muscle filaments that should maintain the nipple in the correct position do not exist or are too short.

What does the operation entail?

During corrective surgery for mild cases, an incision is made around the base of the umbilicated nipple, making it point outwards and separating it from the muscle filaments. In other more serious cases, the lactiferous ducts, through which milk passes during lactation, must be eliminated; the woman must take this into consideration when deciding whether to proceed with the intervention.

Presurgical precautions

Before surgery, the breast must be examined in order to rule out a malignant process. Depending on the patient’s particular health situation, the surgeon may require that additional medical assessments be done before the intervention. 

Postsurgical precautions

In most cases, the patient can return to their normal routine immediately after the operation. She only needs to avoid physical activity for 10 days after the operation.

Keloid scars are formed during the healing of a wound. In the process, too much scar tissue is formed and causes abnormal growth, which is usually large and red. Keloid scars and hypertrophic scars are different. These are less thick and deformed.

Lipofilling is a type of facial rejuvenation without surgery, using fat as facial fillings. It is a treatment for the elimination and correction of wrinkles in different areas of the face, such as cheekbones, chin or cheeks. The fat is extracted from the patient by liposuction, from areas where there is excess fat (such as thighs, abdomen or hips), and undergoes a purifying treatment in the laboratory. The purified fat is then infiltrated into the facial area to be corrected for a smooth and younger looking skin. This treatment for wrinkles gives more natural results compared to the ones made with other materials that the organism could reject.

A lipoma is a benign lump that forms under the skin, usually made from fatty tissue. They usually grow slowly and are situated between the skin layer, and the muscle layer beneath.

Lipomas are more common in middle age, are usually painless, and most commonly appear on the upper back, shoulders and abdomen.

What causes a lipoma?

The cause of lipomas is unknown. It is believed that they may be genetic, so if your parents or other members of the family had lipomas, then you may also be prone to developing them. They can often appear after an injury, though the reason they form is unknown.

What are the symptoms of a lipoma?

As previously mentioned, lipomas are usually painless, though can cause some pain if they press on nearby nerves. They appear as soft, doughy lumps ranging in size from around the size of a pea to as big as a grapefruit. The lumps may move slightly if pressed.

Who is more at risk of developing lipomas?

Although people of any age can develop lipomas, they are more prevalent in adults aged between 40 and 60 years of age.

People with the following conditions are more at risk of developing one or more lipomas:

• Madelung’s disease
• Gardner’s syndrome
• Cowden syndrome
• Adiposis dolorosa

What is the treatment for lipomas?

Lipomas don’t usually cause any problems if left alone, however they can be treated if required.

The most common way of treating lipomas is to have them surgically removed. This can be done by either a dermatologist, or by a plastic surgeon.

Surgery involves making an incision to remove the fatty tissue, before suturing the opening. Though there is a risk that the lipoma may return, it is uncommon.

Another treatment option to reduce the size of the lipoma is liposuction, where a needle is used to remove some of the fat from within the lipoma.

Finally, steroid injections may be used to treat the lipoma. The steroid injection works to shrink the lipoma, though this treatment doesn’t completely remove the lipoma.

Lipo-transference is a technique that involves removing fat from one part of the body and putting it in another. Everything takes place in one operation. This type of treatment is used to fill or add volume to some areas of the body like the lips, breasts, etc., and avoid the use of synthetic or semi-synthetic materials.

Melanoma is a type of skin cancer that forms from the skin cells called melanocytes, which give the skin its pigment. This type of skin cancer can also be called malignant melanoma and is the most dangerous form of skin cancer, with a mortality rate of around 20% if the cancer goes undetected.

What causes melanoma?

Melanoma is most often caused by over-exposure to the sun’s harmful ultraviolet (UV) rays. It is more common in older people due to the cumulative effect of years of exposure to the sun, and is especially common in areas of the body that are more exposed to the sun such as the face, back of the neck, hands and arms. Due to this, melanoma is also more common in people with a fair complexion, and with people that have been sunburnt as a child.

Having said that, it is a myth that people with darker skin are not affected, as they also carry a risk if not protected from the sun. Where they commonly develop in areas that receive a lot of sun exposure in fair coloured skin, in darker skin types they more commonly develop on the soles of the feet, palms of the hand and in the finger nail beds, and can easily go unnoticed.

Melanoma can also be genetic, with around 5% of cases of melanoma thought to be genetically passed on.

What are the symptoms of melanoma?

Melanomas are often noticed by the person rather than diagnosed by a doctor. A sign of a melanoma is a mole that changes shape or size, or that the border of the outline changes and becomes more blurred.

Another symptom is when a new mole, or pigmented section of skin appears where there was nothing before.

The key for checking a mole to look for signs of melanoma is the ABCDE acronym for the characteristics of melanoma:
 

• Asymmterical shape such as two halves of a mole having a different shape
• irregular Border when the mole has a ‘notched’ outline
• Change in colour such as uneven colours or multiple colours
• Diameter when the size changes, or when a mole is bigger than 6 millimeters in diameter.
• Evolving If the mole changes overtime, or develops other symptoms such as itchiness or bleeding.

Melanoma treatments

The treatment of the melanoma depends on the type of melanoma, the severity and the position on the body, and whether the cancer has spread.

Some of the options available to your doctor include surgery, with different methods available to remove the melanoma.

Radiotherapy may be considered if the cancer has spread, or it may be decided that a melanoma vaccine is the best option, which aims to kill the cells using the body’s own defence mechanisms. This form of treatment is still being developed.

If you are concerned you may have a melanoma, and would like to be diagnosed. Make an appointment with a specialist here: https://www.topdoctors.co.uk/melanoma

This is a type of cancer that appears as a nodule on the skin, usually on the face, head or neck. It is a rare form of cancer, more common in the elderly.

What are moles?

Moles are pigmented spots which appear on the skin. They can often appear during childhood or adolescence without a known cause. Most moles are nothing to worry about and only become a concern when they change colour, size, or shape. In some cases people prefer to have them removed for aesthetic reasons, but this is largely done through the private sector as the NHS do not offer cosmetic mole removal. It is also worth noting that moles may also fade or disappear over time, and sometimes can darken during pregnancy. If you see noticeable changes in a mole, it is always best to have it checked by your doctor or dermatologist.

What do moles look like?

Moles can be varied in size, shape, and colour. They can be flat or raised, and most moles are oval or round-shaped. They may also have a smooth or rough texture, and have hair growing from them. Moles should be checked out by a doctor if you notice the following:

• A change in shape
• A change in colour or a separation of colour
• Bleeding
• Itching
• Crusting of the skin
• An increase in size
• The mole becoming more ‘raised’

What are the causes?

Moles or nevus occur when melancocytes, the pigment-producing cells of the skin, grow in clusters. Exposure to the sun influences their appearance, shape and size. Those who are fair-skinned are more likely to develop moles.  

Can it be prevented?

Monitoring sun exposure can prevent the appearance of some types of mole.

What is the treatment?

The dermatologist should keep track of the patient's moles, checking all those which change colour and shape or cause pain, or itch or bleed. If any of these symptoms present, the dermatologist may suggest mole removal as a precaution, in order to prevent melanoma developing. This operation is performed on an outpatient basis.

Oncoplastic & reconstuctive surgery rebuilds the breast after breast cancer surgery, with the aim of reducing scarring and preserving as much of the existing breast tissue as possible. There are various surgical techniques and procedures available, and the treatment usually requires the input of a multidisciplinary team, including plastic surgeons and surgical oncologists. 

What is otoplasty?

Otoplasty, which is also known as ear correction surgery or cosmetic ear surgery, is a surgical procedure to change the size, shape or position of the ears. Otoplasty is often associated with pinning ears back that appear as very protruding, so this is a common form of otoplasty carried out, but it is also known as pinnaplasty. Depending on the age of the patient, the intervention can be performed under general or local anaesthesia. Otoplasty can be carried out on children, but after the age of 5 years is recommended, as any younger and the ears will still be growing and developing. It is important to understand that otoplasty does not alter or affect your hearing, just the appearance of your ears.

Why is otoplasty done?

Otoplasty will be considered if your ears stick out a lot, if they appear as very large in proportion to your head, if you need to correct previous ear surgery, or if your ears have been damaged due to injury or congenital malformations.

What does otoplasty consist of?

Otoplasty can usually be carried out with local anaesthetic and is performed by either an otolaryngologist (ENT surgeon) or a plastic surgeon. A small incision is made behind the ear to gain access to the ear cartilage. Next, small sections of cartilage and skin are removed, depending on what results are being aimed for. Once done, the ear is positioned into place using scoring and stitching techniques. The whole procedure takes up to two hours. Newer techniques use special clips placed under the skin to reshape and reposition the ears.

Preparation for otoplasty:

Once you have been deemed healthy and suitable for surgery, your surgeon will advise you on any fasting required, which medications have to be stopped and any other requirements for having otoplasty. You will not be able to drive home after surgery, so making alternative arrangements beforehand will be necessary.

Aftercare:

Otoplasty is often carried out as a day-case procedure, meaning the patient can return home on the same day. You will have bandages around your ears after the procedure for protection. You may experience some itching and discomfort, but painkillers can manage this. It is important to avoid putting pressure on your ears, so try not to sleep on your side or rubbing your ears. Wearing loose-fitting collars is also advised for comfort. Bandages should be worn during the day for the first few days, and afterwards just when sleeping for a couple of weeks. You should avoid swimming and other sports for several weeks to protect your ears. Stitches can be removed after 5-10 days, children can usually return to school after 1-2 weeks. Return to normal activities, such as swimming and contact sports can resume after 12 weeks.

What is pinnaplasty?

Ear correction surgery, where the ears are pinned back, is known as pinnaplasty or otoplasty. The cosmetic surgery procedure is used to change the size or shape of the ears, or to pin them back if they stick out. It is usually carried out on children and teenagers but some adults may opt to have the procedure too. Children under the age of five are unable to have pinnaplasty as their ears are still developing and growing.

What happens during a pinnaplasty?

Pinnaplasty is performed under local or general anaesthetic, depending on the age of the patient. The operation usually takes about one to two hours. The surgeon will make a cut to the back of the ear and peel off some skin from the cartilage. The shape of the cartilage is changed so that the ear is closer to the head. The doctor can also correct the symmetry of the ears too. The wounds are then closed with stitches and a dressing is applied.

There is a newer technique known as incisionless otoplasty to treat prominent ears, which involves scoring the cartilage through the ear skin using a needle. No incision is made. There is not a lot of evidence about the long-term quality of this procedure.

What happens after pinnaplasty?

Following surgery, the ears may be sore, tender or numb for a few days and the patient may need to wear a bandage around their head. They will not be able to wash their hair for a few days whilst leaving the dressing on to protect the ears from infection. It is useful to sleep upright for a few nights following surgery.

There may be bruising for a few weeks and it is recommended taking the time off school or work to let these heal. The stitches may come to the surface and cause the ear to feel sore, which can be treated with over the counter pain medications. After 10 days the stitches are removed.

What are the possible complications of pinnaplasty?

Complications are unusual. There can be a collection of blood between the skin and the cartilage, which creates 'cauliflower ear'. On some occasions, the skin may scab and the patient must be very careful with their dressings to ensure that underlying cartilage is not exposed, dried out or infected. If it does dry out then it can cause a misshapen ear and another procedure will be needed to repair the hole with a skin graft. If the area is red, swollen or painful post-operation, this may be a sign of infection and the patient should consult their doctor.

What is rhinoplasty?

A rhinoplasty, more commonly referred to as a ‘nose job’, is an operation performed to change the shape or size of the nose, whether for aesthetic or functional purposes (functional rhinoplasty).

Why is rhinoplasty performed?

Rhinoplasty may be performed on those who are unhappy with the appearance of their nose, those who have experienced trauma to the nose, or on those who have functional problems (e.g breathing/sinus difficulties). The rhinoplasty procedure can improve the aesthetics and function of the nose, depending on the goal the patient wants to achieve.

Rhinoplasty can make the nose smaller, larger, change its shape, or change the angle that exists between the nose and the top lip.

What happens during rhinoplasty?

Currently, two types of surgery are generally performed:

• Open rhinoplasty: a cut is made in the middle of the nose to better access the bones and cartilage.
• Closed rhinoplasty: accessing the nose through the nostrils so no scars are left (though this operation is not always able to be done, and it depends on the skillset of the surgeon).

The operation is carried out under general anaesthetic, meaning you won’t be awake for the surgery. The procedure can take anything from one hour and a half to three hours. You may also need to stay in hospital or at the clinic overnight, or for a couple of days.

Preparation

Before the operation, you will need to attend an initial consultation with your surgeon. This may be either a facial plastic surgeon (an ENT surgeon, who has trained extensively in the anatomy of the face and the functionality of the nose) or a plastic surgeon (who performs various types of plastic surgery on the body). They will conduct a thorough examination, discuss your expectations with you, and determine if you are eligible for surgery.

Before your operation, if you decide to go ahead, the surgeon will take pictures in order to provide a photo analysis and discuss expected outcomes. They will also explain the risks of the surgery in detail, and ask you to sign a disclosure form.

Post-operative care

After the operation, you’ll have to take about two weeks off work in order to recover. However, results of the procedure may not be visible until a few months later. Immediately after the procedure, and a short stay in the clinic, arrange for a friend to take you home, as you will not be able to drive for a couple of days.

Your stitches can usually be removed after a week, if they are not the dissolvable kind. If you are wearing a splint, this may be able to be removed at this stage too. After three weeks, bruising and swelling should be significantly reduced. You can expect return to playing sports and higher intensity activity at about four to six weeks.

There will be some aftercare which you can follow at home with your doctor’s recommendation, including:

• Avoiding hot baths
• Avoiding dust and smoke
• Getting your splint wet
• Making sure to sneeze through your mouth rather than your nose
• Avoiding blowing your nose until your split is removed
• Propping your head up with pillows while resting (this helps the swelling go down)

Your doctor can prescribe you pain medication such as paracetamol to help with any pain. You may experience nosebleeds for the first few days after surgery, and there will be some swelling and bruising which will go down after time.

What are scars?

Scars are marks left on the skin after a wound or injury has healed. Visible scars remain on the skin when the deeper layers of your skin has been injured. The vast majority of minor lesions, such as lacerations, cuts, abrasions or burns, will not leave a scar.

How does scarring happen?

After a lesion or injury, the healing process consists of three phases: inflammation phase, proliferative phase and maturation phase.

1. The inflammation phase takes place 48-72 hours right after a wound is made. The wound starts closing on its own with a blood clot and the new tissue starts growing.
2. In the following three to six weeks, during the proliferative phase, the connective tissue builds up to close the wound.
3. During the maturation phase, which can last a few months or a few years in the most severe cases, the deepest layers of the epidermis keep on repairing themselves.

What influences the scar formation process?

Scar healing is a highly individual process which can be influenced by several factors, so you should not take into account only the size and severity of a wound.

For instance, age is really important: the older you are, the longer the wound healing process will be. However, even if you are in the age range of 10 to 30 years, an overproduction of connective tissue can compromise the wound healing process. Furthermore, people with a really pale or darker skin type may have more evident scars, as well as people suffering from a hormone imbalances, such as teenagers and pregnant women. The scar formation process is also influenced by the location of the wound: scars tend to form in parts of the body where the skin is tenser.

Should there be any complications after a wound, such as chronic inflammation (acne), the risk of getting a scar will be much higher.

Types of scars:

Scars can be divided into hypertrophic scars, keloid scars and atrophic scars.

• Keloid and hypertrophic scars are mainly caused by an overproduction of connective tissue, which makes the scar grow outside of the original wound area. Keloid scars are much bigger than the original wound size and tend to be more invasive and persistent than hypertrophic scars. They tend to grow in areas where the skin is tense. People with a genetic predisposition and people with darker skin types can have much more visible scars.
• Atrophic scars or pitted scars are caused by a lack of collagen in the wounded area, creating a sunken recess on the skin. In this case, there is not enough connective tissue to repair the wound. They are particularly common in individuals with acne or chickenpox.

What is a second medical opinion?

A second medical opinion is when you consult with a doctor that is not your regular doctor about a potential diagnosis and/or treatment plan. There is no legal right to a second opinion, however, it is rare for a doctor to refuse.

Why would you get a second medical opinion?

Patients may consider a second medical opinion if they are facing a new diagnosis or recommended treatment because sometimes this can feel confusing and a second opinion can put their mind at ease.

In addition, there are certain situations where a second medical opinion is sought after:

• Potential treatment is risky and could be life-changing or the diagnosis is possibly life-threatening
• The diagnosis is not clear-cut
• If you are considering a new treatment approach that is experimental

The aims of obtaining a second medical opinion are:

• To confirm whether a diagnosis is correct and/or appropriate.
• To confirm whether a suggested treatment is correct and/or appropriate.
• To compare information received from each doctor so that you can make an informed decision – sometimes a second medical opinion can rule out the need for a potentially unnecessary invasive procedure.

Possible disadvantages of seeking a second medical opinion include:

• The process can delay the start of treatment.
• Logistically, seeing another specialist might be difficult and possibly time-consuming.
• It might be stressful to hear the same diagnosis again.

How would you seek a second medical opinion?

You can request a second medical opinion from your GP or consultant, but before doing so it is recommended that you ask for as much clarification and explanation about the initial diagnosis and treatment, before seeking a second opinion.

Obtaining a second medical opinion does not mean that the second doctor will then take over – if that is what the patient decides, then this needs to be agreed formally between doctors and hospitals. 

What is it?

Rhinoseptoplasty is a type of plastic surgery performed to correct and reconstruct the nasal septum (bridge) for aesthetic and medical purposes. This is what makes the difference between rhinoseptoplasty and a simpler rhinoplasty (which only aims at aesthetically enhancing the nose) or a septoplasty (which only corrects and reconstructs the nose for medical purposes). This procedure yields better results when doing a mild remodelling and reconstructing.

What is it for?

From a strictly medical angle, rhinoseptoplasty is usually done to treat any problems arising from a deviated septum. Other potential issues include:

• respiratory impediments, caused by an obstruction due to the deviated septum
• trouble falling asleep
• dry mouth from breathing with your mouth
• rhinorrhoea (getting frequent nosebleeds)

From an aesthetics angle, any kind of defect can be corrected; there are several different types of aesthetics enhancements to the nose available.

How does it work?

Before the surgery, you will be given either local anaesthetics or general anaesthetics.

During the septoplasty phase, the surgeon will make an incision on your septum. If the remodelling is simple enough, the surgeon will be able to reposition the septum without needing to move it first. Otherwise, the surgeon will have to remove the septum, straighten it up and place it back within the nose. After that, the surgeon will suture the nose up.

The rhinoplasty can be either a closed procedure (by making an incision within the nose) or an open procedure (by making an incision at the base of the nose). After the surgery, an external cast will be placed on your nose, which will be removed less than a week after the procedure.

How can I prepare for it?

Before the surgery, you need to:

• Schedule a visit with the surgeon to talk about the procedure, what results you expect and to go through your medical history;
• Have an ECG, blood pressure measurement, blood test and urine test;
• If you smoke, quit smoking and stop taking anticoagulants and platelet aggregation inhibitors, to avoid any complications (such as epistaxis) during the procedure.

Post-operative progress

You will be in hospital for one day after the surgery. However, complete recovery may take several months (from three months to a whole year in some cases). It is fairly common to feel pain in your nose and have some nosebleeds in the week immediately after the surgery.

You should avoid smoking in the days after surgery. You should also avoid any strenuous physical activity, keep your head lifted up while sleeping and make sure you don’t blow your nose for some time after the procedure.

You can go back to work roughly one week after the rhinoseptoplasty. The plastic surgeon will generally recommend periodic check-ups to monitor the recovery process.

What is skin cancer?

Skin cancer is one of the most commonly occuring types of cancer. There are certain types of skin cancer. There are non-melanoma skin cancers which are a group of cancers that are slow-growing and develop on the upper layers of the skin. Basel cell carcinoma (BCC) is the most common type of skin cancer and start in the cells of the lower epidermis. Squamous cell carcinoma (SCC) accounts for around 20% of skin cancers and starts in the upper layers of the epidermis. 

Melanoma skin cancer is more serious and can spread to other parts of the body. 

What are the symptoms of skin cancer?

Basal cell carcinoma:

• smooth and pearly
• may be firm and red 
• may sometimes bleed or develop a scab
• never completely heal 
• itchy

Squamous cell carcinoma:

• tender to the touch
• sometimes bleed
• can have a hard cap
• the skin surrounding the mole is raised

Melanomas will usually start with a change to normal skin or can develop on a mole already present.

You can use the ABCDE mole checklist to help determine if a mole has become a melanoma.

• A – Assymetrical moles
• B – Border of a mole is blurred
• C – Colour of a mole varies
• D – Diameter of the mole is irregular and larger than 7mm
• E – Evolving (melanomas will often change over time)

What causes skin cancer?

Non-melanoma skin cancers are caused by too much exposure to ultraviolet (UV) light, which comes from the sun, as well as tanning beds.

There are also a number of risk factors that can increase the chances of non-melanoma developing:

• family history of skin cancer
• pale skin that burns easily
• people with lots of moles and freckles
• medication of a medical condition that suppresses the immune system
• previous non-melanoma skin cancer

Melanoma is caused by exposure to UV light from the sun or tanning beds. Melanomas are caused by very intense exposure to UV light, such as bad sunburn on holiday.

The following risk factors increase your chances of developing melanoma:

• pale skin
• blonde or red hair
• family history of melanoma
• people with lots of moles and freckles

How can skin cancer be prevented?

It is possible to reduce your chances of developing skin cancer by reducing exposure to sunlight and avoiding sunburn. You can do this by avoiding tanning beds, covering up outdoors and wearing high SPF sunscreen. You can also avoid the sun during the hottest part of the day. It is also important to check your skin regularly and notice any changes as early diagnosis increased the chances of treatment.

What is the treatment for skin cancer?

Non-melanoma skin cancer can be treated firstly by surgically removing the cancerous tumour and surrounding skin. Non-melanoma skin cancer can also be removed to using cryotherapy (freezing). They can also be treated with radiotherapy and photodynamic therapy (PDT). Treatment option depends on the size of the skin cancer, the type and the location. Non-melanoma skin cancers are often treated successfully as the risk of the cancer spreading to other parts of the body is much lower than with melanomas.

Melanoma skin cancer is treated surgically most of the time, however, treatment depends on the circumstances of your diagnosis. Early detection and treatment can successfully treat melanoma. Advanced melanoma treatment aims to slow down the spread of the cancer and improve the symptoms. Melanoma can return once treated, so regular check-ups are essential.

What is skin cancer?

Skin cancer is one of the most commonly occuring types of cancer. There are certain types of skin cancer. There are non-melanoma skin cancers which are a group of cancers that are slow-growing and develop on the upper layers of the skin. Basel cell carcinoma (BCC) is the most common type of skin cancer and start in the cells of the lower epidermis. Squamous cell carcinoma (SCC) accounts for around 20% of skin cancers and starts in the upper layers of the epidermis. 

Melanoma skin cancer is more serious and can spread to other parts of the body. 

Can skin cancer occur on the face?

Skin cancer can occur anywhere on the body, and is more common on parts of the body exposed to sunlight more often, which the face certainly is. Although moles on the face are very common, many of which are harmless, some can become cancerous. Benign moles on the face are non-cancerous and have often been present for a long time.

What are the symptoms of skin cancer?

Basal cell carcinoma:

• smooth and pearly
• may be firm and red 
• may sometimes bleed or develop a scab
• never completely heal 
• itchy

Squamous cell carcinoma:

• tender to the touch
• sometimes bleed
• can have a hard cap
• the skin surrounding the mole is raised

Melanomas will usually start with a change to normal skin or can develop on a mole already present.

You can use the ABCDE mole checklist to help determine if a mole has become a melanoma.

• A – Assymetrical moles
• B – Border of a mole is blurred
• C – Colour of a mole varies
• D – Diameter of the mole is irregular and larger than 7mm
• E – Evolving (melanomas will often change over time)

What causes skin cancer?

Non-melanoma skin cancers are caused by too much exposure to ultraviolet (UV) light, which comes from the sun, as well as tanning beds.

There are also a number of risk factors that can increase the chances of non-melanoma developing:

• family history of skin cancer
• pale skin that burns easily
• people with lots of moles and freckles
• medication of a medical condition that suppresses the immune system
• previous non-melanoma skin cancer

Melanoma is caused by exposure to UV light from the sun or tanning beds. Melanomas are caused by very intense exposure to UV light, such as bad sunburn on holiday.

The following risk factors increase your chances of developing melanoma:

• pale skin
• blonde or red hair
• family history of melanoma
• people with lots of moles and freckles

How can skin cancer be prevented?

It is possible to reduce your chances of developing skin cancer by reducing exposure to sunlight and avoiding sunburn. You can do this by avoiding tanning beds, covering up outdoors and wearing high SPF sunscreen. You can also avoid the sun during the hottest part of the day. It is also important to check your skin regularly and notice any changes as early diagnosis increased the chances of treatment.

What is the treatment for skin cancer?

Non-melanoma skin cancer can be treated firstly by surgically removing the cancerous tumour and surrounding skin. Non-melanoma skin cancer can also be removed to using cryotherapy (freezing). They can also be treated with radiotherapy and photodynamic therapy (PDT). Treatment option depends on the size of the skin cancer, the type and the location. Non-melanoma skin cancers are often treated successfully as the risk of the cancer spreading to other parts of the body is much lower than with melanomas.

Melanoma skin cancer is treated surgically most of the time, however, treatment depends on the circumstances of your diagnosis. Early detection and treatment can successfully treat melanoma. Advanced melanoma treatment aims to slow down the spread of the cancer and improve the symptoms. Melanoma can return once treated, so regular check-ups are essential.

What are skin lesions?

Skin lesions are abnormal lumps, bumps, ulcers, sores or coloured areas on the skin. There are two different categories: primary and secondary skin lesions. Primary skin lesions are present from birth or are acquired during a person’s lifetime. Secondary skin lesions appear as a result of irritated primary skin lesions. They occur if someone were to, for example, scratch a mole until it bleeds. Many different conditions such as acne, herpes simplex, allergic eczema and impetigo can cause a skin lesion.
 

What causes skin lesions?

The commonest cause of a skin lesion is an infection on or in the skin, such as a wart or the herpes simplex virus that causes cold sores and genital herpes. Some skin lesions are hereditary, such as moles and freckles. Other causes of a skin lesion can be an allergic reaction or conditions such as diabetes, which causes skin sensitivity.
 

What are the types of primary skin lesions?

The most common types are:

• Moles
• Rashes
• Acne
• Blisters
• Freckles
• Nodule
• Pustule
• Rash
   

What are the types of secondary skin lesions?

The commonest types of secondary skin lesions are:

• Crust
• Ulcer
• Scale
• Scar
• Skin atrophy
   

How are skin lesions diagnosed?

A doctor will examine the skin lesion and ask if there any other symptoms. They may take samples of the skin, perform a biopsy or take a swab of the lesion, which is to be sent for analysis in a lab.
 

How are skin lesions treated?

Treatment of skin lesions is determined by the underlying cause. Topical medications can help treat the inflammation and can stop pain, itching or burning. Some skin lesions, which may become infected, can be drained for relief. There are also home remedies that are recommended such as using lotions for relief from itching and absorbent powders if the skin lesions rub against clothes. Suspicious moles or lesions that may be precancerous are to be removed surgically.
 

How are skin lesions removed?

Lesions can be cut out of the skin, frozen off or removed using heat, laser or light therapy. If a patient has a surgical procedure, it can take up to three weeks for the wound to heal. It takes a few weeks for a lesion to scab and comes off after having cryotherapy.

This is usually a type of skin cancer but squamous cells can also be found on some other parts of the body. When it presents as skin cancer it begins as a small nodule and can develop into a larger ulcer. It is more common in lighter skin tones which have had sun exposure, and it is also more common in later life.

What is surgical tattoo removal?

Having a tattoo may seem like a good idea at the time but some people may later regret their decision. Tattoos can be removed surgically as a quick and immediate alternative to laser treatment, which usually requires many treatment visits and still does not guarantee complete removal of the image.
 

What are the reasons to have a tattoo surgically removed?

There is a high demand in surgical tattoo removal as people tend to regret being inked in the first place, or because a tattoo could potentially hinder job prospects. Some employers will not hire staff who have visible tattoos.

Other patients may have had a few unsuccessful sessions of laser removal surgery previously, whereas surgical tattoo removal is definitive.
 

What happens during the procedure?

Surgical tattoo removal works best on small tattoos. The skin that contains the image is completely removed, which leaves a gap that is stitched. The tattoo is replaced by a neat surgical scar. This procedure guarantees the complete removal of the tattoo.

In some cases, larger tattoos can be removed with serial excision, where parts of the tattoo are removed sequentially over a period of time. Dissolving stitches can be used and the procedure is carried out as an awake day case operation.

Larger tattoos may need a skin graft, where the skin is taken from another part of the body, which may cause an additional scar. The skin graft leaves a patch of skin in place of the tattoo that will be a slightly different colour and texture to the surrounding skin.
 

What happens during recovery?

Post-surgery the skin is covered with sutures and a pressure pad or skin-coloured surgical tape for two weeks to support the scar. It will then be checked by the surgeon and if it hasn’t healed, the graft will be redressed for another week. The scar will need to be massaged and moisturised for the final results. Showering is allowed but the dressings are to be kept dry.
 

How long does it take for the scar to disappear?

Compared to laser removal, which leaves the imprint of the tattoo, surgical excision will only leave a thin line. The surgical wound takes approximately two weeks to heal and the scar will take several months to fade.
 

Who is suitable for surgical tattoo removal?

The best candidates for tattoo removal surgery include those who can pinch their tattoo easily into a fold of skin. If this is difficult to do, then a serial excision or skin graft is required instead.
 

How much does surgical tattoo removal cost?

In the UK, private clinics may charge from £150 for removal of a small tattoo, to up to £800 for a larger one per session. It depends on the individual case: the size of the tattoo, the location on the body and how many sessions are required for removal. Prices vary in different clinics.

What are tendon injuries?

Tendon injuries, also known as tendinopathies, happen when there is an overload that causes small fibres to tear. When the affected muscles or joints are put under pressure, it causes tendon inflammation which reduces blood flow and can lead to nerve compression. When there is a mild inflammation it is referred to as tendonitis. It is called tendinosis if there is tendon degeneration.

Tendon injuries are common in sports. Injury location will depend on the sport. Some common tendon injuries include:

• Achilles tendon: in the heel, it is common among professional athletes. It causes inflammation, pain, and swelling.
• Patellar tendon: in the knee, it is more common in women. Exercising is important to avoid discomfort.
• Supraspinatus tendon: in the shoulder, as it is a fragile area, and recovery tends to take longer. This is usually the tendon affected in rotator cuff injuries.
• Lateral epicondyle tendon: in the elbow, most commonly known as tennis elbow. It is common amongst tennis players, but can happen in other professions too.

Prognosis:

Tendon injuries do not tend to be a serious condition, providing adequate treatment is given.

Tendon injuries may be:

• Acute: less than two weeks
• Subacute: between three to six weeks
• Chronic: more than six weeks

What are the symptoms?

The symptoms of tendon injuries vary according to their location. There are several common symptoms, including:

• Pain and tenderness when moving the tendon or joint
• Stiffness at night or upon waking
• Inflammation
• Heat and redness
• Hearing or feeling a crack when moving the tendon
• Thickening of the tendon (in some cases).

Medical tests:

A physical examination is normally enough to identify the affected tendon and the seriousness of the injury. However, in some cases the specialist may carry out other tests to have a closer look, these may be an ultrasound or an MRI scan.

What causes tendon injuries?

Some of the most common causes include:

• Not warming up before exercise
• Sports injuries
• Repetitive movements or overexertion
• Physical changes (such as postural dysfunction and many more)
• A bad movement, especially when exercising
• Inadequate training equipment
• Metabolic dysfunctions or poor hydration

How can tendon injuries be prevented?

There are different tips that can be followed to avoid this kind of injury. It is important to take care when lifting heavy loads to avoid pushing the tendon beyond its limit.

A massage or stretching after lifting a heavy load is one way to prevent a tendon injury.

Other things to bear in mind are:

• Improving sports techniques
• Lessening loads
• Using appropriate footwear

What is the treatment for tendon injuries?

Treatment tends to be conservative, and includes rest and anti-inflammatory measures, depending on the severity of the injury. This may include medications, nutritional supplements, dietary changes, using bandages and manual therapy.

The methods used will depend on the injury location, severity, and how long it has affected the patient. Although there are many different treatments, the most common ones are:

• Rest
• Stretching
• Anti-inflammatories
• Physiotherapy

When treatment doesn’t work, surgery may be resorted to instead.

What specialist should I see?

Tendon injuries are normally treated by a sports medicine specialist, an orthopaedic surgeon or a physiotherapist.

What are tuberous breasts?

Tuberous breasts, also known as tubular breasts, are breasts which are tube-shaped instead of rounded and which have a larger space of separation between the breasts. The areolae are also usually large, and the lower part of the breast lacks development. There are various degrees of malformation.

What are the symptoms?

The characteristics of tuberous breasts are:

• Conical shape instead of rounded
• Too much space between the breasts
• Lack of growth or development of the lower part and inside of the breast
• Large and dilated areolae
• Asymmetrical breasts

What causes tuberous breasts?

Tuberous breasts are caused by the existence of a genetic alteration of the tissue that covers the mammary gland, which is abnormally rigid, preventing the harmonious development of the breasts during adolescence.

What is the treatment?

Tuberous breast surgery is performed to correct a malformation in the breasts which causes them to have a shape similar to tubes instead of developing a rounded shape.

The surgical technique used varies depending on the case, to give the bust volume and a more rounded shape, placing the areola and the nipple in the correct position. Generally, if it is a mild abnormality, it can be treated with the implantation of a prosthesis, without need for any complete glandular reshaping, as is the case in serious malformations. In these cases, the diameter of the areola would be reduced, and incisions would need to be made around it and/or at the base of the breast to relax the rigid area of the chest and to be able to redistribute the gland.