Every year, October is Breast Cancer Awareness Month! For us at Mode, this is an important time for us – as breast reconstruction and breast cancer surgery is a core part of our practice – and thus this month is an opportunity to keep patients aware and up to date on the options available to them should they face this terrible disease.

In this post, we focus on DIEP flap or own tissue breast reconstruction.

What is DIEP flap reconstruction in Sydney? 

DIEP flap reconstruction involves reconstructing a new breast, from tissue in the lower abdomen. The surgeon removes only the fat, skin, and blood vessels, leaving behind the muscle that belongs to the abdomen (the six-pack or rectus muscle).

DIEP stands for Deep Inferior Epigastric Perforators, these are the specific blood vessels within the abdomen that supply blood to the lower abdomen or tummy area. Typically a special CT scan called a CT Angiogram will be organised prior to surgery to determine whether the blood vessels in your abdomen are of sufficient size for this type of surgery.

So, how’s it all work? Well, an incision is made along the bikini line, and a portion (the flap) of the lower tummy fat and skin is removed along with its blood supply. This block of tissue (the flap) is then transferred to the chest, and the patient is left with a scar similar to that of a C-section (but it is longer). It’s effectively similar to having a tummy tuck (the slight difference in the scar being that it can sit a little higher than that of a tummy tuck).

The flap is then transplanted to the chest – this is perhaps the most interesting and most crucial part of the surgery. Blood vessels in the chest are found, and then the tiny blood vessels in the flap are connected to these chest vessels under a microscope.

Think of suturing two tubes under a high magnification microscope, and placing delicate sutures that are 100 times finer than a human hair delicately around these tubes to reconnect them! The flap is then formed into a breast shape with sutures under the skin. If a patient is having a unilateral, meaning one-sided procedure, then this is done on the one side.

Any tissue that is not used is discarded. In a bilateral, meaning double side reconstruction, most of the tummy tissue is needed and split in half, with blood vessels from each side of the tummy connected to each side of the chest- this obviously means the surgery is longer than just a one-sided reconstruction.

It’s this microscopic element of the procedure which is what makes it so phenomenal and creates amazing results. Any surgeon performing this procedure requires specialty surgical training, particularly to become an expert at the microscopic element of reattaching blood vessels – this is taught to all surgeons who go through Plastic Surgery Training, but only a few surgeons choose to specialise in this area. Those who practice this area, like Dr. Aggarwal, do so after having completed rigorous overseas fellowship training in microsurgery.

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 prostheses

What are the advantages of DIEP flap reconstruction?

The patients who have successfully undergone this surgery ‘sing from the rooftop’ (hopefully!) as there are some huge benefits of this surgery which include:

• A natural look and feel to the breast
• Breasts that are in proportion to the rest of their body
• Breasts will respond to the body as normal, such as fluctuating in size depending on weight gain or loss
• No need to compromise any necessary muscle (although in some people we may need to take a small piece of muscle due to the size of their blood vessels).
• A permanent reconstruction unlike implants that need to be changed every 10-15 years
• Aesthetic appearance that is difficult to match using implants

Where do I start if I am considering DIEP flap reconstruction?

The best thing you can do before your DIEP flap breast reconstruction is research. If you are looking up things online use reputable websites and it is good to do some background reading before booking a consultation.

When you do book a consultation, speak to a specialist plastic surgeon who specialises in this area. When researching your surgeon, check what experience they have, have they done fellowship training in the area, is this part of their regular work, and what do patients say about them (check reviews).

During a consultation, the surgeon should explain all the details of the surgery including:

• How the surgery is performed
• What to expect after surgery
• All potential outcomes, including possible complications and their solutions
• Show you before and after photographs of their work
• Discuss relevant costs

Perhaps the most important way to judge your surgeon is how they handle complications – how will you be looked after, will you have direct access to them, and will it cost more to treat complications (it should generally not!).

Another excellent way to prepare is talking and connecting with women who have undergone the procedure and speaking to them about their experience. A fantastic resource is on our Mode Instagram platform where we have documented many past patients’ experiences.

Do I need any special scans in preparation for DIEP flap surgery?

Yes, after a consultation Dr Aggarwal will typically ask you to obtain a special CT scan called a CT Angiogram – usually, this is organised at a specific radiology practice familiar with this type of scan and also obtaining the information that Dr Aggarwal needs. This scan located the blood vessels traveling through the tummy area, and supplying the tissue that will be used for reconstruction. In short, it is used to determine whether the blood vessels in your abdomen are of sufficient size for this type of surgery.

What is the difference between a DIEP flap and msTRAM flap? Can I be guaranteed that I will have a DIEP flap?

Ultimately both surgeries involve a transplant of the tissue from the lower abdomen/tummy area to the chest to reconstruct a beautiful breast. The key part of this procedure is the surgeon finding the blood vessels in the tummy and delicately dissecting and removing them and transplanting them to the chest.

If the blood vessels in the tummy are too small to keep the blood flowing to the tissue, then doing a DIEP flap is dangerous and can result in part or all of the flap not surviving the transfer – in these situations a small amount of muscle may be harvested as this keeps more of the blood vessels traveling from the muscle to the skin and fat needed for reconstruction.

Dr Aggarwal, who is very experienced in this area, will explain during a consultation how the decision is made, but the aim is always to take the minimum or no amount of muscle during surgery, as long as the safety of the flap transfer is not compromised.

We feel it is therefore difficult for any surgeon to ‘guarantee’ that a DIEP flap will be performed, as the decision regarding muscle or no muscle harvest depends completely on the size of blood vessels found at the time of surgery.

Why should I come to Mode Plastic Surgery for my DIEP flap reconstruction?

Here at Mode, Doctor Shagun Aggarwal performs all major surgeries including DIEP flap reconstructions. Dr Aggarwal is one of few plastic surgeons who is trained in both cosmetic surgery as well as reconstructive microsurgery – DIEP flap reconstruction is one of the passions of Dr Aggarwal, who trained in Sydney, and then sub-specialised in this area through further fellowship training at the University of Pennsylvania (UPenn, Philadelphia USA), and University of Toronto (Canada).

We feel you could therefore not be in better hands! Additionally, the hand-picked nurses and support team, Dr Aggarwal works closely alongside with are what make the surgical experience seamless and successful.

Mode Plastic Surgery has a reputation for professionalism but what we hold most highly is our commitment to patient wellbeing and their desired results. We would welcome you to read our reviews on independent websites or talk to our previous patients about their results and experience.

If you would like to read more about the reconstruction procedures we provide you can read more here:

Breast Reconstructive procedures

Breast Reconstruction Cost 2022

North Shore Breast Reconstruction

 

 

 

Just how brand names like “Band-Aid” have become the colloquial term for any adhesive bandage, “Botox” is the term mostly used for anti-wrinkle treatments on facial muscles and skin care.

So What’s the Difference between Botox and Dysport? and what one should I choose?

Anti-wrinkle treatments are one of the most effective ways to instantly look younger, reducing glabellar lines, although more interestingly, these products can also be used to treat other medical issues such as jaw clenching or even cerebral palsy.

Each of these involves neurotoxin, Botulinum, it will cause temporary muscle relaxation by intercepting the nerve signaling pathway

So, if you’re thinking of receiving any form of anti-wrinkle treatment for moderate to severe wrinkles, one thing you will need to consider is which product your nurse will be using. Here at Mode Plastic Surgery, we choose to utilise Dysport / board certified. Essentially, the main differences are…

Firstly, both Botox and Dysport are approved by the Australian Therapeutic Goods Administration. Both also use the same mechanism to relax muscles and will last approximately 3-5 months depending on dosing and patient metabolism. That is really where the similarities cease and the two begin to differ.

Botox is made by Allergan, an American company, whilst Dysport is manufactured by Galderma, a Swedish company. Dysport is faster, in the sense it will start forming results in 2-3 days at the injection site, while Botox is 3-5 days. Additionally, they are measured in different units, Botox in international units and Dysport in Speywood.

This just means the two can not be interchanged. For example, in aesthetics, we use tiny doses in frown lines – 50 units of Dysport or 20 units of botox. Compared to medical uses such as cerebral palsy, 100 to 400 units of Dysport can be injected into hamstrings to relax spasticity.

Both are equally good products, with the same active ingredient to prevent the brain from sending a movement message to the muscle and both have the same risks.

Botox is one of the best ways to deal with wrinkles and fine lines. It is most commonly used for crow’s feet and lip lines. It is safe and effective, and if used correctly, you should notice the results very soon. However, it is best used for smaller areas like the lip and wrinkles around the eyes. If used correctly, you should see results within a week or so. However, it is best to use it sparingly. Too much Botox can cause hypotension, which is low blood pressure. Hypotension can be easily remedied by eating salty foods, drinking more water, and getting more rest.

Some patients who are a good candidates, after years of treatment may build up a resistance to one product and will need to swap to the other to get a therapeutic result.

The main difference we see is PRICE.

Botox is a household name and therefore clinics will charge accordingly. Some patients are brand loyal, some don’t know there is even an option with anti-wrinkle treatments or lines crow s feet and some patients don’t mind either brand. Do you have a preference?

Make a consultation today and we can discuss what is suited to you.

Liposuction is a popular cosmetic surgery procedure at Mode Plastic Surgery – sometimes performed alone, or often in conjunction or as an adjunct to another procedure. It is a safe and reliable procedure that aims to remove fat deposits that are difficult to shift with diet and exercise. Like any surgery, it’s important to ask as many questions as possible so that you can, with as much certainty as possible, understand what you are walking into. 

Dr Aggarwal will always ensure that he answers your questions during consultations, as well as make sure that your expectations of the surgery and the process are realistic. In order to help you in your decision making process, we thought it best to go through some common questions on the topic.

Am I a good candidate for liposuction?

Liposuction is an excellent procedure to remove stubborn areas of fat that are difficult to shift through diet and exercise. The patient must also be of excellent health (who maintains a healthy diet and regime of exercise), has realistic expectations and does not have significant other medical conditions (such as heart disease, being on blood thinners, breathing issues, and so on).

Liposuction however is not appropriate in the following circumstances:

• There is both excess skin and fat e.g. some patients requesting this for their abdomen actually need a tummy tuck that removes both skin and fat. If extra skin is present liposuction will remove the fat, and create even more loose skin, probably worsening the appearance.
• Cellulite – liposuction can reduce circumference of the thighs, but as a standalone treatment for cellulite it is not great as it can worsen the appearance
• Patient is significantly overweight, or someone who does not maintain a healthy diet/exercise – liposuction should not be seen as a quick fix. Firstly it can only target certain areas (whereas healthy eating and exercise achieves a more global reduction in weight), and the weight can simply rebound after liposuction.
• Patient has unrealistic expectations
• Patients who have lots of other medical problems such as heart, lung disease, diabetes, or other conditions that make them unsuitable for elective surgery.

What Should I Know Beforehand?

In order to prepare for liposuction it’s important to:

• Cease fish oil, and other supplements such as Ginkgo, Ginseng etc. 
• Discuss with Dr Aggarwal if you are on blood thinning medications as to when you should stop and recommence those.
• If you are smoking you need to cease this well in advance of surgery

What does liposuction involve? 

Liposuction is typically performed under general anaesthesia, given by an accredited anaesthetist in a fully accredited and licensed facility (usually one of the North Shore’s premier private hospitals). It can take from one to three hours, and patients will be discharged either the same day or stay overnight.

Before liposuction is performed, the area is infiltrated with a solution containing local anaesthetic and adrenaline – this increases the safety of liposuction by significantly reducing bleeding.

Liposuction is then performed using a variety of liposuction cannulas and the end point is the desired contour. We record the amount of infiltration and the amount of deposit that have been removed. Patients who have more than 5L removed during liposuction will need to stay in hospital. This is because there is good evidence that fluids can shift around the body after large volume liposuction, and monitoring you in the hospitals is the safest option.

It is however common to have some fluid leak through the closed liposuction incision sites – this is usually remnants of the liposuction infiltration fluid injected at the start of the procedure. Other than being a nuisance it does not do any harm.

What do I need to do after my liposuction procedure?

Dr Aggarwal will place waterproof dressings over the incisions. You will also be placed in a liposuction garment at the end of the procedure before you wake up. This helps to reduce swelling, pain and discomfort in the early post-operative period as the area heals. This garment needs to be worn for approximately 6-8 weeks. 

You will be given a script for antibiotics by Dr Aggarwal which you must continue until the box runs out. You will also be given pain relief medications, although most patients only report minor amounts of postoperative pain that is responsive to simple oral analgesia. 

You should not drive for at least 24 hours after having an anaesthetic, so you will not be allowed to go back home on your own – you must have someone accompany you home, and it is best to have someone look after you for the first few days as you recover. You will be given instructions how to look after the wounds as they continue to heal, and you will be able to ask questions about what you can and cannot do.

How painful is liposuction?

While liposuction does not involve large incisions, it can be sore. This is because the cannula used to remove the fat is creating a zone of injury under the skin, that the body then needs to heal.

It is common to get extensive bruising and swelling (which is the zone that is sore after surgery) and it is for this reason that compressive liposuction garments are used for 6-8 weeks after surgery as they minimise bruising and swelling and therefore comfort after surgery.

Depending on the extent of surgery, and also where it is being performed, patients will need around 1 to 2 weeks off after surgery.

How long does it take to recover after a liposuction procedure? 

The bruising and swelling after liposuction is worst at day 2-3, and subsides rapidly over the first 2 to 3 weeks, but takes 6-8 weeks to completely disappear. Patients have to wear a compressive garments for 6-8 weeks. It is best to be off work for the first 1 to 2 weeks depending on the extent of surgery.

The small incisions heal over 2 weeks, and patients are not allowed to swim in these first 2 weeks. Gym exercise can be resumed at around 6 weeks.

Are the results of liposuction permanent?

Yes, provided the patient is selected carefully – meaning if it is performed for stubborn fat areas in a person who exercises regularly and maintains a healthy diet then it is permanent.

However if it is used as a quick fix, or someone does not maintain their healthy diet and exercise they can certainly put the weight and volume back on negating the effects of liposuction.

What does liposuction cost (Sydney)?

As a rule of thumb around $4000 per treatment area (at Jan 2021) which usually includes surgeon fee, anaesthetist and hospital, plus GST. However hospital and theater fees are subject to change.

The beginning of October marks the beginning of Breast Cancer Awareness Month! This is an important month on our calendar, as it’s a time that we dedicate to breaking down stigma and questions around breast health.

Breast cancer continues to be one of the most common cancers Australian women face, but survival rates continue to reach phenomenal highs! Mode Plastic Surgery is dedicated to the women that have battled breast cancer and face the new challenge of regaining the life they knew before diagnosis.

 

 

Monitoring your Breasts

Common breast cancer signs and symptoms include:

• A lump or thickening in the breast, upper chest or armpit (you might feel the lump but not see it)
• Swelling of all or parts of the breast  
• ‘Dimpling’ or a change in your breast’s skin texture.
• A change in the colour of the breast – ( it may look red or inflamed)
• A change to the nipple, for example it has become inverted.
• Rash, colouring or crusting around the nipple
• Any unusual liquid (discharge) from your nipple(s)
• Changes in size or shape of the breast

On its own, pain in your breasts is not usually a sign of breast cancer, however be one the look out for for constant pain. 

Noticing an unusual change doesn’t necessarily mean you have breast cancer, and most breast changes are not because of cancer, HOWEVER it’s important to get checked by your GP. 

 

Diagnosis and Resources 

Being diagnosed with breast cancer can be a shocking and confusing experience for many people and their loved ones. However, the support and information that has been provided by reputable Australian institutions can provide you comfort in knowing that there is assistance out there for coping with cancer and its following recovery. 

Cancer Council and Breast Cancer Network Australia have great resources to provide emotional and practical support for people affected by cancer, such as transport to treatment services, helplines and much more. 

Cancer Australia also has fantastic information on managing the physical and emotional changes following cancer, as well as information about finding support for people that have been impacted by cancer. 

 

Below are the links to some of these resources, so that you can copy and paste the link and find the services that speak to your needs. 

 

https://www.cancer.org.au/support-and-services

https://www.bcna.org.au/metastatic-breast-cancer/coping-with-metastatic-breast-cancer/where-to-find-support/

https://www.canceraustralia.gov.au/affected-cancer/living-cancer

https://www.canceraustralia.gov.au/affected-cancer/living-cancer/finding-support

 

Reconstruction.

Dr Aggarwal is fellowship trained in the world’s best plastic surgery centres in both autologous (own tissue) and implant based reconstruction. In fact Dr Aggarwal was selected as the first Australian plastic surgeon to complete the University of Pennsylvania Microsurgery Fellowship, the best microsurgery fellowship in USA and perhaps the world. During his time there he completed over 200 free flaps as primary operator, many of these in breast reconstruction. Dr Aggarwal brings his experience from low morbidity high volume world centres to Sydney, and since returning from overseas has reconstructed many women after breast cancer surgery. This is why a large number of our patients are cancer survivors, all pursuing a surgeon with extensive knowledge and experience in breast reconstruction.

Dr. Aggarwal specializes in what is called a DIEP flap reconstruction; where the fat, skin, and blood vessels are cut from the wall of the lower belly and moved up to your chest to rebuild your breast. Breast reconstruction using DIEP or msTRAM flap can be:

 

• immediate (at the time of mastectomy); or
• delayed (after mastectomy and other treatment such as chemo and radiotherapy)

This is considered the Rolls-Royce of Breast Reconstruction. Patients who have had it want to tell the world about it, because it offers advantages unmatched by other forms of reconstruction:

• The reconstructed breast feels soft and natural like a normal breast because it is built from your own tissue
• If you were to put on weight the reconstructed breast will add on weight and vice versa.
• The reconstructed breast will sag with age mimicking a normal breast
• It is possible to mimic the shape of a larger, ptotic (saggy) breast which is impossible with implant based reconstructions
• There are no long term risks and complications of implants, and no future repeat operations to exchange implants.
• No risk of BIA-ALCL
• Immediate autologous reconstruction can be difficult to tell from a breast lift or reduction when completed.

 

Dr. Aggarwals knowledge in the field combined with the passionate care that our team provides ensures that the women that put their trust in us to reconstruct their breast move past this hiccup in their lives with a regained confidence. Dr Aggarwal offers breast reconstruction at the SAN, Chris O’Brien Lifehouse and also at RPAH and POWH/RHW. 

 

If you would like to read more about the reconstruction procedures we provide you can read more here: 

https://www.modeplasticsurgery.com.au/breast-reconstructive-procedures/

https://www.modeplasticsurgery.com.au/2020/03/11/breast-reconstruction-cost-2020/

https://www.modeplasticsurgery.com.au/2019/02/20/breast-reconstruction-north-shore-sydney/

 

Final Words

Breast cancer is a difficult experience to go through, but is no longer the death sentence it used to be. With the right support, information, and recovery plan, you will be able to get back to living the life that you love. The team at Mode have heard it countless times that reconstruction gives you back a piece of yourselves. Our work is one of recreating confidence and giving women back the lives they deserve

“Once I had the breast reconstruction it gave me my life back.. I can go and do my passions that I love. I love to dance, and I couldn’t do that before.” – Denise 

 

Tummy tuck vs Liposuction (vs mini tummy tuck): What operation do I need?

This is a common question asked by our patients at Mode Plastic Surgery. Some patients come requesting liposuction when what they need is a tummy tuck. Doing the wrong operation can yield worse results, and sometimes worse than where the patients originally started. Undergoing surgery, recovering and spending money to have the incorrect procedure is not an ideal situation. So we thought it best to go through some common questions on the topic.

What’s the difference between liposuction and a tummy tuck?

Liposuction involves removal of the fat under the skin. It uses a cannula that passes in and out, sucking the fat through a tiny hole. It does not remove the skin. Therefore this is an ideal procedure for those who are fit and healthy (not overweight) and do not have loose skin. It is suitable for people with areas of fat (such as love handles, upper or lower tummy, thighs, etc.) that they cannot shift through diet and exercise.

 A tummy tuck is a procedure involving the removal of excess skin and fat. Usually, the skin from the belly button down to the groin crease, and the hip bones at the sides, is removed. Some liposuction is always used as an adjunct to this procedure, especially out the sides (flanks, love handle area). The skin is then pulled down tight. Tummy Tucks are the ideal procedure for patients who have loose skin and excess fat. If these patients have liposuction alone, it can create more loose skin.

 

What is the difference between a tummy tuck and a mini tummy tuck?

A mini tummy tuck involves a short scar in the groin crease, mainly as a way for the surgeon to get access to the rectus (six-pack) muscles. Women (and men) who have muscle separation can have this corrected via this approach, and this is the main part of the procedure. It is not a replacement for a full tummy tuck as it does not remove much in the way of the skin of the tummy.

A mini tummy tuck seems appealing to many patients, as patients feel they would like to keep the scar of their tummy tuck as short as possible. In general, the longer the injury, the more skin the surgeon can remove. So if you have a tummy tuck to remove the skin, then you remove as much of it as you need to get a good result. The scar will be hidden in clothes and improves with time. However, if there is excess skin left behind, and the contours not corrected, this will be difficult to hide in clothing.

So what is the ideal procedure?

Each patient is assessed by Dr Aggarwal at Mode Plastic Surgery to determine if they are a candidate for liposuction, or a mini tummy tuck, or a full tummy tuck. In general, there is one procedure that each patient is the most suitable for, and we would counsel patients to do one that will achieve the outcome they want.

What happens during a tummy tuck surgery?

The skin of the tummy between the groin crease and up to just above the belly button (and out to the sides, roughly to the hip bones) is removed. The skin above this is lifted to the rib cage and is ‘window-shaded’ down to close the tummy. Before this is done, the underlying muscles (the rectus or six-pack muscles) are tightened to produce a flat contour. The belly button is usually kept by cutting around it, and when the skin is pulled down, it takes a new position on the surface of the belly, although its real position has not changed.

 

What are the signs of a good tummy tuck candidate?

In general, you need to be fit and healthy. Unfortunately, this is not a procedure for patients who are grossly overweight. They carry weight both inside the tummy near the organs (Visceral fat), as well as on the outside under the skin. There is no way to reduce the fat around the organs other than diet and exercise. Therefore being an ideal weight (or achieving your healthiest and stable weight) is essential so the flattest contour of the tummy can be achieved.

The procedure is also not offered to patients actively smoking, and those with multiple medical problems who are at risk under an anaesthetic.

Those who are; a healthy weight, maintain a balanced diet, do not have many medical problems, and overall have realistic expectations, are the ideal candidates for a tummy tuck.

 

Do I need to lose weight before my tummy tuck procedure?

Absolutely, this reduces the amount of fat around the organs, as well the fat under the skin. This allows the flattest contour to be achieved during surgery and the most amount of skin to be removed. Not to mention your recovery will be smoother; it is known to reduce both anaesthetic complications and also surgical complications like wound healing problems.

 

How long is the recovery time for a tummy tuck?

The first 8 weeks you are restricted from heavy lifting and heavy housework and are wearing a binder. Between 8 to 12 weeks you progress to regular activity and by 3 months you can go to the gym to do most if not all exercises.

 

How long will I need off work following a tummy tuck?

For most desk type jobs you’ll need around 4 weeks. If you are someone who does heavy lifting at work, that would not be allowed in the first 8 weeks.

 

Will the results last?

Absolutely – once the skin has been removed, it does not come back. However, one has to maintain a healthy lifestyle, including a balanced diet and exercise. Significant weight gain and loss will change the appearance as will a pregnancy for women.

 

Does insurance/medicare cover a tummy tuck?

A cosmetic procedure does not carry any insurance or Medicare rebates. The item number for abdominoplasty/tummy tuck was removed in November 2018 and restricted mostly to those with a significant weight loss (BMI drop of greater than 5 points). If someone has lost a lot of weight (5 BMI points) and can demonstrate interference with activities of daily living, and the excess skin causing issues/breakdown of skin that has not improved with conservative measures, then they qualify for a Medicare item number. Similarly, if the procedure is being done for a (significant) hernia repair, the procedure may also be covered by an item number.

Medicare Item number coverage, combined with appropriate health insurance, can mean the hospital and theatre costs are covered, a rebate possible for the surgical and anaesthetic fees, and that no GST is applicable (which is applied to cosmetic procedures). In general, this can halve the cost of surgery.

 

Will a tummy tuck help/remove my stretch marks?

While there is no excellent solution to removing stretch marks, a tummy tuck will often remove many of the tummy stretch marks. This is because the skin of the lower tummy is being removed during surgery. Given the lower belly is where most of the stretch marks occur, these are almost entirely removed in surgery. However, stretch marks in the upper tummy will usually remain after surgery.

 

 

For more information on the abdominal procedures we perform at Mode Plastic Surgery, click here.

June is an important month on our health awareness calendars, as it’s time for Men’s Health Week, and the time to incite conversations around what it means for men to be healthy. 

Figures show that men are less engaged with their health and are less inclined to seek professional help for issues that they may face, which contributes to the fact that men die at disproportionately higher numbers throughout the stages of life. We as a community must reflect on how we can create positive and healthy environments for men and boys. We need to challenge perceptions – masculinity and self-maintenance are not antonyms. 

We at Mode Plastic Surgery primarily see male patients for skin health concerns (including skin cancer treatment) and cosmetic concerns. With this in mind, we believe it would be beneficial to share information on these health concerns that we treat every week. 

Skin Health- Cancers & Melanomas

Australia and New Zealand have the highest rates of melanoma in the world, and men are at higher risk of developing both non-melanoma and melanoma skin cancer than women. This could be because men are more reluctant to have their skin checked. Skin cancer risks include:

• Excessive exposure to ultraviolet (UV) radiation from the sun (or from solariums)
• Fair skin
• Blonde hair
• Multiple moles
• Having a depressed immune system: People who are immunosuppressed, such as solid organ transplant recipients, have a higher risk of non-melanoma skin cancer and melanoma.
• Family history: this is questionable but there is some higher risk amongst families of a person with melanoma – some of this could be genetic or growing up/living in a similar environment.
• Previous personal diagnosis: People who have been diagnosed and treated for melanoma or non-melanoma skin cancer have a greater risk of additional diagnoses.

Our recommendation is a 6 monthly skin check with your GP or dermatologist. Even if you are not due for a skin check, you should be vigilant and watch for:

• New moles and spots.
• Existing moles which increase in size, change colour or become irregular. 
• Any mole or spot that becomes raised, lumpy, scaly or ulcerated.
• Red moles that are firm and enlarging.
• Any mole or spot that itches, bleeds or weeps. 
• Any spot that looks different from the others.

Both GPs and dermatologists will undertake non-surgical management of simple sunspots and some skin cancers such as superficial BCCs. However, SCCs and most BCCs will require surgical excision and it is best to pick these up as early as possible to limit the size of excision and surgery needed. 

Prevention is certainly better than cure and one of our best tips for prevention is year-round use of sunscreen, making sure that you reapply when spending prolonged time periods in the sun. When in direct sun you should use a sunscreen with the highest SPF (SPF 50+). If you are staying largely indoors a moisturiser with sunscreen is ideal. Other than preventing skin cancer, this is actually the best way to have your skin looking youthful for as long as possible as the number one cause of aging is photoaging related to sun exposure. 

Cosmetic Surgery for Men – Gynecomastia and Abdominoplasty

Gynaecomastia is one of the most frequently discussed procedures with our male patients. Gynecomastia is an enlargement of breast tissue in males,  most commonly caused by hormonal imbalances. It is very common – more than half of all boys develop the condition during puberty, and it normally disappears as they grow older. About 1 in 3 older men will develop it. 

The condition causes enlarged breasts that feel rubbery or firm. It can be mild where it is easily concealed in clothing to dramatic sizes where patients feel embarrassed in social settings as they find it difficult to conceal. We normally treat gynecomastia with liposuction and direct gland removal via an incision placed around the nipple. Patients in the past have stayed in the hospital for a night, and the surgery is performed under a general anaesthetic. 

The other most common discussed procedure is Abdominoplasty and Liposuction frequently around the tummy or torso region. These procedures are best in patients who maintain a healthy lifestyle with a balanced diet, and exercise. We can then target surgical solutions – liposuction being good for difficult to move fat deposits, and abdominoplasty or body lift being the solution when there is excess skin. Dr Aggarwal would guide you through this decision making if you have had massive weight loss or wish to discuss your concerns.

What we are doing at Mode for men 

Mode Plastic Surgery is committed to engaging with men’s health and their maintenance, and this month we will be offering a variety of specials and information. 

Injectable treatments 

Throughout June, Mode Plastic Surgery will be offering men anti-wrinkle treatments at $180 for one area, and $350 for two areas. Please note that standard quantities per site apply and that treatments all take place under the supervision of Dr Aggarwal, Specialist Plastic Surgeon.

Hydrafacial Special. 

Throughout June, we will be offering Hydrafacial Treatments for $150. HydraFacial is an amazing technology that delivers the results of an advanced facial in under 30 minutes. It uses a patented technology that can simultaneously cleanse, exfoliate, clear congested pores and deliver nourishing serums. Vouchers can also be purchased in June for the special price for use at any time over the next 12 months. 

Men’s Health Skin Care Bundle 

In this new Men’s Basic Bundle deal, we will be providing the essentials for improving skin’s overall health, giving any man a refreshed look. The pack includes three products:

• Foam Cleanser
• Moisturiser with sunscreen OR AHA/BHA Exfoliator 
• Hydrating moisturiser.

These products would normally be valued at a combined value of $310, but this new Bundle is being sold at an astounding price of $199. 

Mode Skin Protection Pack 

For all our patients who have had excisions of any moles or skin cancers, or alternatively any surgery, we suggest this pack as a way to maintain the best scar, and for general sun protection. 

The pack includes three products:

• SPF 50+ sunscreen
• Moisturiser with sunscreen 
• Silicone Gel 5g.

These products would normally be valued at a combined value of $145.95, but this new Bundle is being sold at an astounding price of $100. June only; for our regular pricing, please refer to our online store.

 

Contact Us

Throughout Men’s Health Month, we will be highlighting that Mode Plastic Surgery is practice for all, and that we are committed to the health and positive results of all clients, no matter their gender. We want to commit to showing men that it’s okay to seek help. If you would like to find out any more information on our offers, services or health concerns that we specialise in treating, contact us on 1300 80 9000, or email at info@modeplasticsurgery.com.au.

The federal government has announced an easing of elective surgery restrictions – this will allow a graduated return of elective surgery from 50%, then 75% and finally to 100% of normal operating in a staged plan outlined by the Prime Minister.

It is then up to the individual states how quickly to progress through these stages. Given that NSW had the most number of coronavirus cases, it is wise for the NSW government to be more cautious in the relaxing of elective surgery as this means some capacity in all hospitals is reserved in case a ‘second wave’ of Covid-19 occurs. This is also important to carefully protect the precious supply of personal protective equipment (PPE), and other resources such as ICU beds needed to manage any outbreak.

The NSW Health department has advised elective surgery will resume up to 75% capacity by the end of June 2020. While the types of surgeries were restricted previously, all restrictions have now been relaxed. This means that cosmetic surgery can safely resume. However it is now up to the individual hospitals to manage their resources, including beds and PPE, and therefore it is at their discretion what they will and will not allow up to 75% of their total capacity.

Dr Aggarwal works at a number of private hospitals. Hunters Hill Private Hospital has advised they will resume cosmetic surgery, while the Sydney Adventist Hospital (being a larger hospital with ICU beds) is likely to be more cautious.

What surgery can we now offer?

We are pleased to announce that we can now resume our full range of surgeries normally offered at Mode Plastic Surgery. We were already offering our full range of skin cancer and reconstructive
cancer services over the past few weeks, and we can now resume offering cosmetic surgery, and other more elective (non-urgent) plastic surgery. However for any cosmetic surgery, or more elective plastic surgery it is up to the discretion of the hospitals where Dr Aggarwal works if they will allow the operation to go ahead. We therefore request patients to take this into account when booking and flexibility may be needed as to your preferred date.

Please also note that in the event of a ‘second wave’ of Covid-19 restrictions may resume, and therefore elective surgery (including cosmetic surgery) may be postponed at short notice. In these unprecedented times, if this was to occur (as we did in March and April) any deposits for surgeries cancelled due to government restrictions will be refunded or if preferred held for a future date of
surgery.

My surgery was cancelled when the government restrictions were announced – what happens now?

We will be in contact with patients soon who had their surgeries cancelled in late March, April and early May. We will prioritise these patients for new dates – depending on the type of procedure and the hospital at which it was going to take place.

What about public hospitals?

If you are a patient waiting for surgery at one of the public hospitals at which Dr Aggarwal works (RPA, POWH, or RHW) it will depend on what the surgery is for. More urgent plastic surgery needs such as skin cancer treatment has been allowed throughout the Covid-19 period. However, since Dr Aggarwal’s regular operating lists have been cancelled surgeries such as this have been booked using ad-hoc operating time depending on the urgency of the surgery needed. Most patients for this type of surgery are on a 90 day wait list at the hospital and will be accommodated on the basis of urgency. Patients needing urgent breast cancer surgery, and immediate reconstruction are also priortised and booked on an ad-hoc basis.

For other less urgent requests, the public hospitals are yet to open the usual elective plastic surgery operating lists. Till that time, we are not able to resume these other types of surgeries.

What about cosmetic injectable treatments?

We are now able to safely resume these – please see our other blog on this topic for more information by clicking here.

Surgical Consultations – Resumption of face to face consulting.

While we have been offering telehealth services throughout this COVID -19 period, we always prefer to see patients face to face as this allows a physical examination, more accurate assessment and
therefore more individualised, considered plans for surgery to made.

There is a new normal in our clinic since the reintroduction of face to face consulting. We are continuing to follow strict protocols to provide social distancing within our office, encouraging use of
hand sanitiser on entry, questionnaire and temperature screening of all patients, regular disinfection of all surfaces, and spacing our appointments. As for face to face consulting, all patients are requested to come alone for appointments. We also recommend that you do not attend if:

• You have been overseas in the last 14 days
• You have had contact with someone who is unwell, has confirmed coronavirus or is confined due to possible coronavirus
• You are unwell in any way, including with a sore throat, fever, shortness of breath, loss of smell or cough.
• We recommend patients drive to our Gordon office, with undercover parking dedicated to our clinic available for patients. In this environment, we recommend against using public transport wherever possible although we are only a short walk from Gordon and Pymble stations if you did need to catch the train.

Are there any services not offered at the moment?

At this stage we are unable to offer medispa services such as Hydrafacial and peels. But we continue to offer skin care advice and our skin care products are available for purchase in the clinic or via phone (and they can be shipped to you, or be ready for collection from our office).

Contact us

We are back to normal clinic hours of 9am-5pm Monday to Friday. You may wish to call us on 1300 80 9000 or email us at info@modeplasticsurgery.com.au to enquire further.

The Australian Society of Plastic Surgeons (ASPS), the Australasian Society of Aesthetic Plastic Surgeons (ASAPS) along with NSW Health have advised that cosmetic injecting can now recommence provided these are delivered in clinics operated by medical practitioners. ASAPS in conjunction with the Australian Society of Cosmetic Dermatologists have introduced safety guidelines for the safe introduction of cosmetic treatments in the time of Covid-19.

We are able to now offer both returning and new patients cosmetic injectables with our Nurse, Karyn, under the supervision of Dr Aggarwal.

 

Antiwrinkle treatments

We are pleased to announce that we have resumed taking bookings for antiwrinkle treatments. At Mode we offer these treatments most commonly for frown lines, forehead lines, crows feet, and other indications such as for teeth grinding/masseter slimming, and hyperhidrosis.

All of these locations are away from the mouth and nose, which means they are considered the safest sites with respect to Covid-19 exposure for our staff and patients. These are also not considered Aerosol Generating procedures and take less than 15 minutes of close contact therefore also reducing exposure.

Our standard fees apply, which you can find in the non-surgical section of our website, or alternatively call or email us to find out more.

Dermal Fillers

Hyaluronic acid based dermal fillers are used for many indications – at Mode Plastic Surgery we use these predominantly for cheeks, and lips. Filler can also be used for the chin, and jaw line definition. We do not offer fillers for nose (liquid rhinoplasty), forehead, temples or tear-troughs.

Cheek fillers

These are considered safe injecting sites, as they are also far away from the nose, mouth and lips. These will be offered at our regular price and standard quantities apply – you can ring or email us to enquire further.

Lip fillers

Any filler around the mouth, or nose is considered an aerosol generating procedure, and can put at risk (mainly) the injector if the patient was positive for Covid-19. Our governing societies have now allowed these treatments to commence in medical clinics provided appropriate safety precautions are taken. Given that these are higher risk for exposure (especially to staff) we will screen you with questions and temperature check (just like all our patients), and in addition we may ask you to use a mouthwash prior to the procedure. Furthermore you will see our staff wearing special masks for protection of everyone. Lip fillers will also be offered at our standard pricing – you can call or email us to find out more.

Fillers for other sites

We can also offer chin, and jaw line treatments. Pricing will depend on individual treatments and requirements, and can be discussed with our practice nurse Karyn.

 

Your Safety For Cosmetic Injectables

There is a new normal in our clinic since the reintroduction of face to face consulting. We are continuing to follow strict protocols to provide social distancing within our office, encouraging use of hand sanitiser on entry, questionnaire and temperature screening of all patients, regular disinfection of all surfaces, and spacing our appointments. You will also see us wearing masks during your cosmetic treatment.

As for face to face consulting, all patients are requested to come alone for appointments. We also recommend that you do not attend if:

• You have been overseas in the last 14 days
• You have had contact with someone who is unwell, has confirmed coronavirus or is confined due to possible coronavirus
• You are unwell in any way, including with a sore throat, fever, shortness of breath, loss of smell or cough.

We recommend patients drive to our Gordon office, with undercover parking dedicated to our clinic available for patients. In this environment, we recommend against using public transport wherever possible although we are only a short walk from Gordon and Pymble stations.

All cosmetic treatments take place with the supervision of Dr Aggarwal, as has always been the policy at Mode Plastic Surgery. 

 

What about other non-surgical services?

At this stage we are unable to offer services such as Hydrafacial and peels. But we continue to offer skin care advice and our skin care products are available for purchase in the clinic or via phone (and they can be shipped to you, or be ready for collection from our office).

Contact us 

We are back to normal clinic hours of 9am-5pm Monday to Friday. You may wish to call us regarding specific products and pricing that we are not able to advertise, and you may ring us on 1300 80 9000 or email us at info@modeplasticsurgery.com.au to enquire further.

The Government Eases Ban on (Some) Elective Surgeries during COVID-19
The Prime Minister today outlined a plan to wean back the restrictions on elective surgery.
Combined with the surgeries that were allowed during the shut-down period we are now in a
position to be able to offer the following operations:

• All skin cancer surgeries
•  Breast Reconstruction Surgery – both DIEP flaps and also implant based breast
  reconstructions
• Medically necessary breast implant removal e.g. For rupture, pain or concern regarding
  cancer or ALCL
• Medically necessary procedures on those under 18 (such a breast reductions).
• Trauma surgery such as hand injuries, facial trauma (fractures, lacerations) and other
  wounds such as skin loss/tears or burns
•  Any other trauma or cancer reconstructions
  The situation will be assessed by the government again on 11 May, and hopefully this will further relax the remaining restrictions on elective surgery.

Face to Face Consultations at Mode Plastic Surgery
For all the services listed above we are now offering face to face consultations but social distancing
rules strictly apply in our practice and patients will be screened via a questionnaire and temperature
check on arrival. We also ask kindly that you arrive alone for any appointments, please see our
previous blog for further information on what we are doing in our office during times of Covid-19.
Our standard consultation fees and Medicare rebates apply to all appointments. Our current office
hours remain Tuesday to Friday 9am to 5pm – outside these hours feel free to leave us a voicemail
or an email.
We also continue to consult primarily at our flagship office at Gordon. However, as restrictions ease,
we may very soon be in a position to resume consulting at our other locations. At this stage we
tentatively aim to begin consulting at our other locations from May 11.

Are there any operations or services you are unable to offer?
Unfortunately at this stage cosmetic plastic surgery and medispa services such as fillers and
anti-wrinkle treatments are still unable to be offered. However we are able to consult with patients
via phone or video, and will be in touch as soon as the restrictions on these services are lifted.

Changes to tele-health consultations
Telehealth consultations are offered via phone or video for all plastic surgery concerns including
cosmetic surgery. The government has now allowed Medicare rebates to be offered for private
tele-health consultation fees and therefore we have moved to charging the same fees for tele-health
consultations as we do for our face to face consultations. The same amount of time will be dedicated
to your virtual visit, as it would be for a face to face visit. The Medicare rebate you receive is also the
same as what applies to a face to face visit.

When will there be more information?
After the next national cabinet meeting on May 11 regarding elective surgery. If the remaining
restrictions are relaxed, we may seen a near return to normal practice, with more hospitals also able
to open their normal operating list allowing us to offer tailor made solutions for our patients like we
have always done.

Finally we wish to say that now more than ever, we are proud of our community and people for
doing the right thing, flattening the curve, and leading the world in controlling Covid-19 cases. Four
weeks ago we thought the situation would escalate quickly with our hospitals full of sick patients
requiring ICU and ventilator treatment. Fortunately this has not happened, and the return to (some)
elective surgery marks the beginning of returning to some sense of normality.
Well done Australia! We will get through this!