COVID-19 and Plastic Surgery

COVID-19 and Plastic Surgery in Sydney

How is COVID-19 (Coronavirus) affecting plastic surgery in Sydney?

Coronavirus is changing the economic and social climate across Australia and the world. These are unprecedented times and the situation is evolving day by day, and week by week. As of 23rd March 2020, in Sydney, we are preparing to see a surge in Covid-19 pandemic cases across the city. Therefore our city, its care facilities, and its hospitals slowly go into lockdown.

At the time of writing this article, plastic surgery offices of most plastic surgeons are still open but that is about to change. Last week we were still performing surgery in the public and private health system sector although with some restrictions. However, both are likely to change by the end of this and next week.

This stage at Mode Plastic Surgery, we are only seeing URGENT consultations this week and early next week. We have made the difficult decision to almost completely stop our practice as of 1/4/20.

This will mean that until that time we are undertaking the following measures:

–       Strict handwashing or use of hand microbial gel for each patient, and staff member before and after any patient review

–       Strict wipe down of all surfaces between patients

–       Booking only URGENT consultations for new patients

–       Cancelling all non-essential follow up for patients (ie other than for drain or suture removal)

–       Cancelling our consulting at Chris O’Brien Lifehouse – this is our only consulting location within a hospital setting, and where patients share a common waiting room with other patients. Lifehouse is also across the road from RPA which is one of the major Coronavirus testing centres. To reduce exposure to the virus for our staff and patients, we have relocated this consulting to our other more private locations to increase social distance.

As of 1/4/20 :

·      We will not be conducting any private or public hospital lists as our hospitals will be faced with overwhelming demand

·      We will continue to see URGENT follow-ups in rooms ie those patients who are post-op and need drain or suture removal. We may see URGENT new referrals but these will be very restricted given that no hospital operating lists are going to be available for surgery.

·      We will have our office/ phones attended for 2 days a week only, at other times messages can be left on our voicemail and email. In case of emergency, private patients can contact Dr. Aggarwal on his mobile, and public patients may need to contact their GP. Or the plastics registrar on call at the hospital where they had their surgery.

·      At this stage, we do not know when our normal consulting and theatre lists will resume. The patients who had their consultations postponed this week, and those that may have contacted us will be contacted to schedule their appointment when it is safe to do so. This may occur in June or July (or later if things have not settled).

wash hands

 

 

How is COVID-19 (coronavirus) affecting plastic surgery in public hospitals?

Dr Aggarwal works at two major public and teaching hospitals in Sydney – Royal Prince Alfred and Prince of Wales/Royal Hospital for Women. RPAH has been designated as one of the key Coronavirus testing sites, although all public hospitals are running a Covid-19 check clinic.

Ultimately all public hospitals will be key in responding to the onslaught of coronavirus cases that NSW Health is predicting. These will require resources from all specialties and departments to be pooled to look after potentially sick patients on the ward, in ICU and possibly convert operating theatres to makeshift ICU beds.

In preparation for the possible catastrophic number of ill patients, our public hospitals have gone into lockdown. Cancelling all elective surgery (other than urgent cancer or trauma cases) to free up resources such as hospital beds, ICU beds, and operating theatres. RPAH took the decision 3 weeks ago to cancel all elective surgery, and Prince of Wales/Royal Hospital for Women has had to make the same decision last week.

The situation at both hospitals is unlikely to change until we are well past the coronavirus pandemic. Meaning many elective operations will be indefinitely postponed, and even more urgent things like skin cancer surgery may carry significant delays.

 

How is COVID-19 (coronavirus) affecting plastic surgery in private hospitals?

Last week and this week, the private sector is proceeding with activity as normal with very strict criteria on patients that have to be excluded from surgery (e.g. returning from overseas, ill-health or close contact of a COVID-19 patient).

However, this situation is likely to change by next week (commencing 30th March).  Dr. Aggarwal does a big part of his private operating lists at the Sydney Adventist Hospital, the largest private hospital in Sydney and New South Wales in general.

Given that the SAN has a significant infrastructure including ICU to manage sick patients it will be called upon by NSW Health, and the government to look after sick coronavirus patients needing ICU. Or alternatively performing urgent surgery lists from the public hospitals who may not have the capacity to do so. This is going to restrict private operating theatre time available to all the surgeons at the Sydney Adventist Hospital. We expect this to happen as early as 1st April 2020.

Currently, we are bringing forward patients due for urgent skin cancer surgery to this week and early next week, and anticipating that all lists as of 1st April will likely be cancelled. Any conditions or requests that are not pressingly urgent will be advised to wait for 3 to 6 months for their surgery.

 

Can I still have my skin cancer surgery during the COVID-19 (coronavirus) pandemic?

Unlikely. We are still consulting URGENT patients this week. However, due to the public and private hospital response in the health care system to the coronavirus, and general safety of the public we will not be doing any regular lists as of 1/4/20.

 

Can I still have my breast reconstruction surgery during the COVID-19 (coronavirus) pandemic?

Unlikely. We are still consulting URGENT patients at our clinic locations.

However due to the public hospital restrictions on what is allowed during the pandemic we are likely to only see breast cancer patients proceed to surgery. With all patients requesting prophylactic mastectomy and reconstructions placed on hold indefinitely. Even patients with breast cancer may face some delay in getting to surgery due to lack of theatre time in the public hospital and the need to coordinate breast and plastic, surgery teams.

In the private sector, theatre time is likely to be restricted as well due to overflow from the public sector, and also the ICU needing to look after coronavirus patients. The planning may be slightly easier in the private sector at the time of writing this article – 23rd March 2020.

 

Can I still have my cosmetic plastic surgery during the COVID-19 (coronavirus) pandemic?

No. We have had to make the decision for the safety of our patients and staff to postpone seeing new cosmetic patients until the pandemic has settled.

If you are a patient of ours, that had booked elective cosmetic surgery with us in the near future it is our opinion that anything that can wait until the situation settles, should. Our staff will be in contact this week to discuss postponing your elective surgery to 3 to 6 months later when hopefully the coronavirus situation is under control.

 

Which plastic surgeons’ offices are still open during the COVID-19 (coronavirus) pandemic?

Until last week Mode Plastic Surgery was hoping to stay open. But as of March 23rd, we have taken the difficult decision to wind down our practice until the coronavirus pandemic is over. After 1/4/20 we will move to very restrictive contact hours with patients, and run a virtual office for 2 days a week without patient contact.

 

What do I do in the case of an emergency and my plastic surgeon’s office is closed due to the COVID-19 (coronavirus) pandemic?

Mode Plastic Surgery will move to restricted opening hours as of 1/4/20 during the coronavirus pandemic. If it is not immediately urgent, you will be able to contact us via phone or email if you have any concerns but you may need to leave a message. If you are a private patient of Dr. Aggarwal’s you will also have his mobile number in case of any emergencies.

If we are closed, you will need to contact your GP. You could visit your local hospital emergency department – however, you should only do so in the case of an absolute emergency as they are likely to be attending to unwell coronavirus patients, and their resources will already be stretched.

 

Stay safe everyone.

wash hands

Breast Reconstruction Cost 2020

What is the cost of breast reconstruction in Sydney?

Breast reconstruction comes in a wide variety of forms and the cost in the private sector is dependent on the stages of surgery, and type of reconstruction. Different types of breast reconstruction have different complexity and therefore different amount of time and effort required by the surgeon for your surgery.

 

It also depends on whether it is performed at the same time as the mastectomy or in a delayed fashion, and may also include costs for an anaesthetist, surgical assistant, hospital excess, and other fees. Usually, in the private sector, all fees are quoted inclusive of follow up both in hospital and in rooms after the surgery.

 

What is the cost of breast reconstruction in a public hospital?

In Australia, it is possible to have all forms of breast reconstruction in a public hospital free of charge, covered entirely by Medicare. Read what it means to be a public patient section of our website for more information. The main limitations of this option are:

 

–      Possible increased wait time

–      Less say of when and where your surgery will be performed with limited flexibility

–      Registrars or fellows may be doing all or part of the procedure

–      Follow up is generally in public hospital clinics, and wait associated with these

–      Your date of surgery or supervising surgeon may be changed

 

Why is there is an out of pocket cost for breast reconstruction in a private hospital?

Despite having ‘top’ level of cover many patients ask why there is an out of pocket for procedures done in the private sector. This also applies to breast reconstruction. This is because the reimbursement or what Medicare and Health Funds pay is dependent on the schedule fee as listed for each Medicare item number. Unfortunately, the government has frozen this for decades meaning the reimbursement for each procedure is way behind what the actual cost of the procedure.

The Australian Medical Association each year publishes what it considers the fair value to be charged for each procedure and this is what many surgeons, including plastic surgeons, use to guide their fee structure. This means there is usually a ‘gap’ between the AMA fee and the Medicare schedule fee, and this constitutes the out of pocket cost. This often applies to both surgeon’s fees and anaesthetist’s fees.

While the main disadvantage of private treatment is an out of pocket cost, there are many advantages of private treatment:

–      Total flexibility over time: often surgeons work with the patient’s time commitments and availability as to when to schedule the surgery

–      Complete say over where your surgery will be performed

–      Complete choice over surgeon and the main consultant surgeon performing your surgery

–      Follow up is in private rooms with direct contact with the main surgeon who makes all the decisions

–      Your date of surgery is usually fixed and won’t be changed (Unless negotiated with you)

 

What are the aims of breast reconstruction?

The aim of breast reconstruction is to:

–      Create a breast mound

–      Look great in clothes (even tight-fitting dresses)

–      Achieve symmetry with the opposite breast (in cases of one-sided or unilateral reconstruction)

–      Avoid the use of a prosthesis

 

What types of breast reconstruction are there?

There are 3 main categories:

  1. Implant or expander based breast reconstruction (i.e. using foreign tissue)
  2. Autologous breast reconstruction (using your own tissue only)
  3. Combination of autologous and implant or expander reconstruction – usually reserved for patients who have required radiation in their cancer treatment and do not have enough own tissue to make an entire breast

In general breast reconstruction is always a staged operation. This is often the case with implant reconstruction, which is often performed in 2 stages. Own tissue reconstruction is usually performed in a single stage but there may be a second stage for nipple reconstruction.

 

 

 

What is the cost of DIEP flap surgery in Sydney?

The approximate out of pocket cost for DIEP flap surgery (as at February 2020) in the private sector is:

 

–      Approx. $25000-30000 for a bilateral procedure (double reconstruction) – this includes the cost of 2 plastic surgeons, surgical assistants, an anaesthetist and all follow-up. In case of any complications, no further fees apply.

–      Approx. $17000-22000 for a unilateral procedure (single reconstruction) – this includes the cost of 2 plastic surgeons, surgical assistants, an anaesthetist and all follow-up. In case of any complications, no further fees apply.

–      These fees assume appropriate health insurance coverage and do not include fees for a breast surgeon (where needed) or the hospital excess.

 

 

What is the cost of implant breast reconstruction in Sydney?

The approximate out of pocket cost for breast implant-based reconstruction (as at February 2020) in the private sector is:

–      Double reconstruction

o  Approximately $7000-8000 for stage 1 – this includes the cost of a plastic surgeon, surgical assistant, an anaesthetist, prosthesis, and all follow-up. In case of any complications, no further fees apply.

o  Approximately $5000-6000 for stage 2

–      Single reconstruction

o  Approximately $3000-4500 for stage 1 – this includes the cost of a plastic surgeon, surgical assistant, an anaesthetist, prosthesis, and all follow-up. In case of any complications, no further fees apply.

o  Approximately $7000-8000 for stage 2 (often including an opposite breast reduction or breast lift, of the non-reconstructed breast)

 

What is the cost of latissimus dorsi reconstruction in Sydney?

The approximate out of pocket cost for latissimus dorsi based reconstruction is calculated on an individual basis and it depends on if this is being performed alone on one side or combined with reconstruction on the opposite side.

 

Who is the best breast reconstruction plastic surgeon in Sydney?

This is a difficult question to answer and often the answers are all inherently biased. Rather than giving you a specific answer the things you should look for when choosing a breast reconstruction surgeon, ask or research the following:

o  Does the surgeon perform breast reconstruction regularly in the private sector?

o  Have you had direct contact with patients who have been operated on by your nominated surgeon? What were their experience and outcome? What are the patient reviews specifically regarding breast reconstruction?

o  How many breast reconstructions has the surgeon performed and specifically the type of reconstruction you are interested in?

o  It is important to ask does your surgeon if he/she performs both own tissue reconstruction (such as DIEP flaps) as well as implants (as if they don’t do own tissue reconstruction, they will not be in a position to offer you the whole range of options).

o  What training have they had in breast reconstruction and specifically own tissue reconstruction (which involves complex microsurgery)? Have they done a fellowship in this area?

o  Does your surgeon work in a public hospital? (Public hospitals only employ safe and reputable surgeons and being part of a busy tertiary hospital may give you confidence the surgeon is of a certain standing)

o  Does your surgeon perform breast reconstruction in a public and private hospital? (This will allow them to offer you reconstruction regardless of cost, and also advise you as to the volume and difficulty of work they may be doing)

 

To read about Dr Aggarwal’s qualifications, hospital appointments and bio click here.