Category: Tummy Tuck Info

Stopping natural supplements before surgery

4/5/2017

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.

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Quilting reduces fluid formation in tummy-tuck (graphic surgery video - viewer discretion advised)

22/11/2015

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Abdominoplasty or tummy-tuck is one of the most frequently performed cosmetic operations. And seroma or fluid collection, when you return to the clinic with a feeling of 'water-bed' under the skin layer, is one of its commonest complications. In my blog in 2013, I wrote about quilting the tummy skin down onto the rectus sheath to obliterate the space with a Quill / Stratafix knotless barbed dissolving suture in my DIEP breast reconstruction patients, wherein tummy tissue is used to reconstruct a breast. The closure of the tummy is very similar to that of a cosmetic tummy tuck.

I am about to publish in a plastic surgery journal the results of quilting in 76 patients compared to 26 who did not have quilting. The seroma in tummies with quilting was 2.2% whereas those without quilting was 7.4%. The contour is much more pleasing, as the tension across the tummy skin is more evenly distributed. The only downside is that in some slimmer patients, the quilting can show up as puckering or dimples in the skin; however, these disappear by 10 weeks when the suture is absorbed by the body. Needless to say, I have also been using quilting in my cosmetic tummy-tuck patients too.

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Everyday Surgical Heroes: The BairHugger

4/10/2014

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Invented in 1987, forced-air warming technology, the Bair Hugger™shown in the photo, looks like a plastic blanket with warm air inside, has become standard in hospitals around the world, safely warming 165+ million patients. It keeps anaesthetised patients warm and maintains 'normothermia' - normal body temperature. This makes the operation safer for the patient and as it is single-use, reduces infection. Maintaining normal body temperature is crucial in long operations, especially breast reconstructions which I do every week; when a large part of the body such as the chest and abdomen are exposed for surgery, thereby losing heat and cooling down further from the use of damp swabs and saline in the surgical field.

My breast reconstruction patients benefit tremendously even after the operation. The BairHugger is kept on overnight- it keeps the 'breast flap' warm and hence keeps the connected blood vessels which are 2-3mm in diameter flowing nicely. My reconstruction patients do feel a little 'roasted', though I prefer to say 'cosy'!.

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Quilting in tummy-tucks reduces seroma

3/11/2013

Abdominoplasty or tummy-tuck is one of the most frequently performed cosmetic operations. And seroma or fluid collection, when you return to the clinic with a feeling of 'water-bed' under the skin layer, is one of its commonest complications. For over 3 years, I have been quilting the tummy skin down onto the rectus sheath to obliterate the space where seroma forms with a Quill knotless barbed dissolving suture in my DIEP breast reconstruction patients, where the tummy tissue is used to reconstruct a breast. The closure of the tummy is very similar to that of a cosmetic tummy tuck.

With quilting, I noticed that the seroma rate was significantly reduced and since incorporating the same technique for cosmetic tummy-tuck patients, I have not looked back. The contour is much more pleasing, the tension across the tummy skin is more evenly distributed and the seroma rate is almost negligible. The only downside is that in some slimmer patients, the quilting can show up as puckering or dimples in the skin; however, these disappear by 10 weeks when the suture is absorbed by the body. There have been several scientific studies in plastic surgery journals which have demonstrated the reduction in seroma with quilting in tummy tucks compared to the use of tissue glue or patients with no quilting.

Does Quilting suture prevent seroma in abdominoplasty? Plastic Reconstructive surgery March 2007.
Suction drains, quilting sutures, and fibrin sealant in the prevention of seroma formation in abdominoplasty: which is the best strategy? Aesthetic Plastic Surgery April 2012

Looking after your Surgical wounds

18/5/2013

I almost always use tan coloured micropore tape for surgical sites as a dressing both for my cosmetic and reconstructive surgery patients. Once the first dressing change has been done, you will be advised to re-apply the micropore tape without tension to support the scar for 3-4 weeks after surgery. In the first 2 weeks, the tape can be left on. However, after showering (no baths!), dab the tape dry with paper towel and then using a hair-dryer on a cold setting, blow dry the tape until 'bone-dry'. Do not leave it damp as this can make the underlying wound/ scar soggy. The tape is latex-free, hypoallergenic and kind to fragile skin. It is microporous, which means it is not occlusive and hence the need to ensure the tape is dry after showering! When changing the tape, start off at one end and peel off, low and slow back over itself, supporting the fragile skin underneath with your fingers.

There is anecdotal evidence of surgical wound cross infection from household pets. Ensure you have clean bedsheets when you return home after surgery and do not allow pets in your bedroom and no cuddles for the first 3-4 weeks!

Once you have stopped using the tape 4 weeks after surgery, massage the scar with pressure using a non-perfumed cream or bio-oil (do not use an old pot or bottle incase it is harbouring bugs, buy a new one!) for several weeks to months, and always use high sun-block for the first year in the sun. Remember scars do take a year or so to fade.

Getting the Transverse Abdominus muscle into shape

25/4/2013

For years after the birth of my son, I had 'bulging' of my tummy, one so often gets when doing sit-ups. My Rectus Abdominis muscle or 'six-pack', which often separates in the midline during pregnancy, was the root cause. Performing crunches had infact kept this separation open. One of my Plastic Surgery male colleagues who has been doing Pilates for the last 15 years for back pain, recommended it.

I started Pilates 6 months ago with one of my hospital physiotherapists who is also a qualified instructor, and the difference is already quite noticeable! The gap between the two parts of my rectus abdominis has reduced to a finger breadth. The back pain which I got after a long day of operating, is gone. What has changed?

I have trained the transverse abdominis muscle and decreased the separation, medically known as 'Diastasis' or 'Divarication'.The transverse abdominis muscle is a key stabilizing muscle often used as part of core stability. As seen in the diagram above, it is the deepest of the tummy muscles and acts as the 'internal girdle'. I firmly believe that all women after pregnancy should learn to strengthen their Transverse Abdominis. Postural or rehabilitation programmes such as Pilates concentrate on building core stability and actively work on the transverse abdominis. Always do Pilates with a trained instructor and never continue if you have pain.

For medical evidence on the effect of Pilates on Transverse Abdominus:
click on: The influence of Pilates training on the ability to contract the Transversus Abdominis in asymptomatic individuals Journal of Bodywork and Movement Therapies 2005, Elsevier

Useful sites for more information are given below, please click on the link:
Wikipedia Pilates
NHS Choices: A Guide to Pilates

Stopping natural supplements before surgery

Quilting reduces fluid formation in tummy-tuck (graphic surgery video - viewer discretion advised)

Everyday Surgical Heroes: The BairHugger

Quilting in tummy-tucks reduces seroma

Looking after your Surgical wounds

Getting the Transverse Abdominus muscle into shape

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