<![CDATA[anitahazari - Blog]]>Thu, 10 Sep 2026 06:36:38 +0100Weebly<![CDATA[The UK National Flap Registry: First Report 2019]]>Mon, 10 Feb 2020 20:51:28 GMThttps://www.anitahazari.co.uk/blog/the-uk-national-flap-registry-first-report-2019It has taken six years from inception of the registry to delivery of this first report, with over 5750 cases from 97 hospitals across the UK. This registry, and certainly the first report, would not have been possible without data entry by flap reconstruction colleagues from various surgical specialties. Often these cases are long and physically demanding. 

UKNFR is the first national registry of its type in the world to collect data on all major pedicled and free flap operations. Data entry is voluntary, and it is acknowledged that unit data in this first report may not be a true representation of the case load of each participating unit.
 
An overview
• This is the first report of the UK National Flap Registry.
• The first patient record was added to UKNFR on 1 August 2015.
• Up to 8 August 2019, 5,751 operation records had been added to UKNFR, with over 180 registered consultant users actively adding data to the registry.
• Cases have been included from 97 private and NHS hospitals in England, Wales, Northern Ireland and Republic of Ireland. Surgeons in Scotland are awaiting permission from the Public Benefit and Privacy Panel (PBPP) for Health and Social Care.
• Participating speciality associations include the British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS), British Association of Oral and Maxillofacial Surgeons (BAOMS), British Association of Head and Neck Oncologists (BAHNO), Association of Breast Surgery (ABS) and British Society for Surgery of the Hand (BSSH).
 
Outcomes
Interpretation of the data has taken into account that some records may be incomplete and that not every case from each unit will have been included. The key outcomes were as follows:
• Overall total flap survival: breast 97.6%, head & neck 94.2%, limbs 94.5%, trunk and perineum 94.2%.
• Unplanned re-operation rate: breast 8.6%, head & neck 12.1%, limb 15.5%, trunk and perineum 12.0%.
• Average length of stay in days: breast 4.7days, head & neck 18.6, limb 12.9, trunk and perineum 11.5.
• Patency rates: Anastomotic patency of blood vessels is an objective measure of surgical outcome in free tissue transfer. More couplers were used in breast microsurgical reconstruction, constituting 81% of end-to-end vein anastomoses with over 98% patency rates.
• Outcomes were also analysed according to other groupings, such as specific risk factors or comorbidities: smoking, diabetes and an ASA score >3 were all associated with a significantly increased flap failure rate.
• The majority of flaps were from a single donor site to single recipient site (85.0% of operations)
• The most common donor flap in breast reconstruction was the deep inferior epigastric perforator flap (77.5%)
• The majority of breast reconstructions were delayed (49.0%) i.e., after completion of cancer treatment, compared to immediate (45.2%) i.e., mastectomy and reconstruction performed at the same time.

Breast-Q PROMs
After breast reconstruction, Patient Reported Outcome Measures (PROMS) were measured using the Breast-Q questionnaire at 6 months. Using a benchmark of a Breast-Q score of ≥70 (range 0-100) to define satisfaction, 72.5% of patients were satisfied with the breast reconstruction, 83.5% were satisfied with the outcome and 87.8% were satisfied with the information they were given. Though a further questionnaire was sent out at 18 months after reconstruction, the numbers of returned questionnaires were inadequate for this report and will be presented in future reports.
 
Surgeon dashboard
One of the big successes of the registry has been the surgeon dashboard. The registry displays the surgeon’s own data on a dashboard which allows easy visualisation of it in real time. This includes the number of procedures performed, case-mix, flap survival, unplanned return to theatre and length of hospital stay. The dashboard is very useful during appraisal and revalidation as it produces evidence of the surgeon’s performance in the form of a real time audit. 
]]><![CDATA[Breast Reduction Surgery]]>Sun, 26 May 2019 16:32:29 GMThttps://www.anitahazari.co.uk/blog/breast-reduction-surgery
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Breast reduction surgery brings about significant benefits: backache, neckache , bra-strap shoulder indentations and intertrigo (redness under the breast in the creases) are vastly improved after surgery. It also becomes easier to find clothes that fit. In this You-Tube video, I have outlined the benefits, recovery and complications from surgery. 

Click on the  YouTube ICON to watch the video.

Though this recording has been made by One Ashford Hospital, I perform the procedure at Chaucer Hospital, Canterbury; Spire Tunbridge Wells, and the Mcindoe Centre, East Grinstead.
]]><![CDATA[Update on Breast implant ALCL and Breast Implant Illness]]>Tue, 04 Dec 2018 23:07:05 GMThttps://www.anitahazari.co.uk/blog/update-on-breast-implant-alcl-and-breast-implant-illness​BIA-ALCL
A rare type of immune system cell cancer called Anaplastic Large Cell Lymphoma (ALCL) is linked to silicone breast implants. ALCL is a lymphoma and not cancer of the breast tissue. In women with breast implants, ALCL was found adjacent to the implant itself and contained within the fibrous capsule. The condition presents usually with a late onset seroma (fluid collection around the implant) some years after surgery, and is usually treated with capsulectomy alone, though some cases require chemotherapy. The first case was reported in 1997, yet it is important to note that breast implants have been used since 1962, with current numbers showing there are over 10 million women in the world with breast implants. The current risk of developing ALCL associated with breast implants is placed at 1:24,000.
 
As of September 30, 2017, the FDA in USA had received a total of 414 medical device reports (MDRs) of BIA-ALCL, including the death of nine patients. 272 of the 414 reports included information on the surface information of the implant at the time of the report, including 242 with textured surfaces and 30 with smooth surfaces. 413 of the 414 reports included information on implant fill types. Of these, 234 reported implants filled with silicone gel and 179 reported implants filled with saline.
https://www.fda.gov/medicaldevices/productsandmedicalprocedures/implantsandprosthetics/breastimplants/ucm239995.htm
 
As of September 2018, MHRA  in the UK has received 57 reports of ALCL in patients with breast implants, 45 of which meet the WHO diagnostic criteria for BIA-ALCL. In cases of ALCL in women with breast implants reported to MHRA there have been 3 deaths. Only 1 of these is confirmed to meet the diagnostic criteria for BIA-ALCL. The other two deaths did not meet the diagnostic criteria. https://www.gov.uk/guidance/breast-implants-and-anaplastic-large-cell-lymphoma-alcl
 
There is increasingly accepted hypothesis that bacterial contamination introduced at the time of implant surgery may over time lead to a biofilm that triggers an inflammatory and immune response which in conjunction with a patient’s genetic pre-disposition may lead to BIA-ALCL. The creation of a biofilm can be reduced with the use of the 14-point plan. Texturing may contribute to increasing an inflammatory response by increasing the surface area.
 
Breast implant related Anaplastic Large Cell Lymphoma (BI-ALCL) remains a rare condition that has been identified in 650-700 patients worldwide. It appears that there are at least 57 cases identified in the UK. All of the information to date suggests that women with breast implants have a very low but increased risk of developing ALCL compared to women who do not have breast implants.

​
Breast Implant Illness (BII)
Breast Implant Illness is a condition that consists of a very broad range of non-specific symptoms such as hair loss, brain fog, general fatigue, fibromyalgia and other associated conditions such as ME, irritable bowel syndrome, various skin conditions and autoimmune conditions such as lupus, rheumatoid, SLE and Raynaud’s.
 
Many of these patients have tried a range of strategies to overcome their ailments, including nutritional advice, changes in diet and a variety of lifestyle changes. Most of them have reached the conclusion that their breast implants are responsible for their malaise and requesting explantation.
 
Though BII has been recognized as a condition that affects some patients with breast implants, currently  there is lack of good data and no causal association has been demonstrated in literature so far. The variety of generalised symptoms reported have made it difficult to ascertain the ‘true’ features of the illness and hence an objective diagnosis can be difficult. It is believed that a in some patients, a psychological pre-disposition may lead to development of symptoms. Explantation (removal of implants) appears to only work for 50% patients.
]]><![CDATA[Textured vs Smooth Breast Implants]]>Wed, 14 Feb 2018 22:14:25 GMThttps://www.anitahazari.co.uk/blog/textured-vs-smooth-breast-implants
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Across most of the world including Europe and Australia, the preference is for the use of textured implants in 90% patients, with only 10% smooth being used. The current breakdown of implant usage in the USA is 87% smooth and 13% textured. This discrepancy is due to the moratorium imposed by the FDA in USA in 1992, which led to US surgeons almost exclusively using smooth saline and of late, silicone smooth implants; whereas the rest of the world progressively continued to use textured implants.

Capsular contracture continues to be the leading cause of breast implant re-operations. The key benefit of using textured implants is reduced capsular contracture. As textured implants provide frictional resistance to movement, they also help to stabilise the implant pocket and reduce skin stretch and ‘bottoming out’ in the lower part of the breast over time.
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Smooth implants, on the other hand, can feel softer, are more easily placed with smaller incisions, however, will have greater movement with some drift to the sides of the breast (lateral slip). They tend to settle in the lower part of the breast, stretching the lower breast skin envelope.

Though textured implants have been pre-dominantly been used in the UK and Europe, the concern for the rare occurrence of BIA-ALCL (Breast Implant Associated ALCL) has started to influence the discussion regarding the use of textured vs smooth implants. You should discuss with your surgeon what is best for your body shape, chest wall shape and breast skin envelope.

*Longterm safety of textured and smooth breast implants
Calobrace et al. Aesthetic Surgery Journal 2018, Vol 38(1) 38-48.
 
]]><![CDATA[Breast Implant-Associated Anaplastic Lymphoma (BIA-ALCL)]]>Tue, 08 Aug 2017 20:23:55 GMThttps://www.anitahazari.co.uk/blog/breast-implant-associated-anaplastic-lymphoma-bia-alcl
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A rare type of immune system cell cancer called Anaplastic Large Cell Lymphoma (ALCL) occurs in association with breast implants. ALCL is a lymphoma and not cancer of the breast tissue. In women with breast implants, ALCL has been found adjacent to the implant itself and contained within the fibrous capsule. The condition usually presents at an average of 7-8 years following breast implant surgery with a late onset seroma (fluid collection around the implant), and is treated with capsulectomy alone, though some cases require chemotherapy. The first case was reported in 1997, yet it is important to note that breast implants have been used since 1962, with current numbers showing there are over 10 million women in the world with breast implants. As of February 1, 2017, the FDA in USA received a total of 359 medical device reports (MDRs) of BIA-ALCL, including nine deaths. Out of 231 reports that included information on the implant surface, 203 were reported to be textured implants and 28 reported to be smooth implants. 312 of the 359 reports included information on implant fill types. Of these, 186 reported implants were filled with silicone gel and 126 reported implants filled with saline. In the UK, at least 23 cases have been identified .
 
Though we do not know what causes BIA-ALCL, there is increasing evidence to support an infective trigger. The time frame for its development fits with a chronic bio-film infection. In addition to the implant surface acting as a passive conduit for bacteria, it is believed that patients with genetic susceptibility and with an abnormal immune response, over time may contribute to the eventual development of BIA-ALCL. The 14 point plan (www.saferbreastimplants.org/about/the-14-point-plan/) has strategies that can be incorporated into surgical practice to prevent implant contamination and may be a useful tool in reducing the risk of BIA-ALCL.
 
To summarise, Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) remains a rare condition that has been identified in 360 patients worldwide. All of the information to date suggests that women with breast implants have a very low but increased risk of developing ALCL compared to women who do not have breast implants. Most cases of breast implant-associated ALCL are treated by removal of the implant and the capsule surrounding the implant, however, some cases may require chemotherapy.
]]><![CDATA[Stopping natural supplements before surgery]]>Thu, 04 May 2017 17:53:20 GMThttps://www.anitahazari.co.uk/blog/stopping-natural-supplements-before-surgery
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​Evening primrose oil (EPO) is taken by many women for breast pain. Though it may help with premenstrual breast discomfort, it is one of a long list of natural supplements that must be stopped atleast 2 - 4 weeks prior to surgery.
 
EPO increases the risk of bleeding during and after your surgery. The gamma-linolenic acid in evening primrose oil can slow blood clotting, so it should not be taken along with medications intended for the same purpose, as this can cause a bleeding and bruising risk. Often after surgery, you will be given an injection to prevent Deep Vein Thrombosis and Pulmonary Embolism (clots in legs and lungs), along with other measures such as TED stockings and Flotron boots. EPO can interact with blood thinning medication. EPO has also been known to cause seizures under general anaesthetic, even though you may not normally have fits.
 
Other natural supplements that have been implicated in an increased risk of bleeding during surgery are garlic, ginger, ginkgo, ginseng, danshen, omega-3 fatty acids, St John wort…… Always tell your doctor about supplements you are taking if you are considering surgery. 

​Just because supplements may be natural, it does not mean that they are safe for surgery.
]]><![CDATA[Breast Implant Registry- a track and trace facility ]]>Wed, 18 Jan 2017 17:01:17 GMThttps://www.anitahazari.co.uk/blog/breast-implant-registry-a-track-and-trace-facility
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The Breast Cosmetic Implant Registry (BCIR) was launched in the UK in Oct 2016 and is managed by NHS Digital  http://www.hscic.gov.uk/clinicalauditplatform. It is track and trace system- in the event of another failure such as PIP implants, patients can be traced and actively managed. It follows the example set by similar breast implants registries in Australia and Netherlands. The data-set has been shared by the Australians and the Dutch via 'icobra' (International Collaboration of Breast Registry Activities) and is embedded in the UK BIR.

However, unlike the other registries which favour mandatory participation, in the UK, a patient has to give consent for her data to be entered into the registry. All patients are actively encouraged to participate in the registry.
]]><![CDATA[The card that reminded me why I care so much for the NHS.....]]>Mon, 02 May 2016 19:17:37 GMThttps://www.anitahazari.co.uk/blog/the-card-that-reminded-me-why-i-care-so-much-for-the-nhs
28 years ago, I decided to do medicine to make a difference.
And then along the years, got caught up in surgical training, Royal College exams, getting a consultant post, establishing a breast reconstruction service, having a family and getting that balance right......and it slipped from the conscious mind. The tremendous changes to the NHS in the last few years started to take their toll. This year's constant oppressing bureaucracy made me question whether I wished to continue.......
And then I got THE CARD. With so many happy faces. I cried. For it has reminded me again why I chose to be a doctor and a surgeon. And I would do all those years all over again and put up with almost anything, just to get such a card and make a difference to so many of 'my ladies'.  
Will I feel the same in years to come if the spirit continues to be crushed? I do really hope so and that I continue to be strong and resilient. Because collectively, as a profession we care and we always will, especially if we all stand together.
]]><![CDATA[First Toe to Thumb transfer in the West by John Cobbett 1968. Queen Victoria Hospital, East Grinstead (video copyright QVH)]]>Mon, 21 Mar 2016 16:01:59 GMThttps://www.anitahazari.co.uk/blog/first-toe-to-thumb-transfer-in-the-west-by-john-cobbett-1968-queen-victoria-hospital-east-grinstead-video-copyright-qvh
Video of the first toe to thumb transfer to reconstruct a missing thumb in a woodcutter, performed in the West in 1968 by John Cobbett in East Grinstead. The video is from the QVH archives and has been released to mark John Cobbett's great contribution to microsurgical reconstruction.
]]><![CDATA[The UK National Flap Registry (UKNFR): a National database for all pedicled and free flaps in the UK (JPRAS Editorial)]]>Sat, 23 Jan 2016 18:33:20 GMThttps://www.anitahazari.co.uk/blog/the-uk-national-flap-registry-uknfr-a-national-database-for-all-pedicled-and-free-flaps-in-the-uk-jpras-editorial
uk_national_flap_registry_jpras_editorial.pdf
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