(upbeat music) - Welcome to the Stiano Plastic Surgery podcast with plastic surgeon JJ Stiano, the only plastic surgeon in the UK who owns a clinic specializing in breast and body contouring. (upbeat music) (upbeat music) - Oh, we're on Facebook, we're on Facebook. Hi Facebook and indeed YouTube, Instagram. Sorry it is not working. I'm gonna say my live Q&A is not working. Join me on Facebook and you. And you. Tube. Right. Clearly I'm a threat to Instagram. And they're trying to shut me down. But, oh, of course, what's that? (screaming) Oh God, I'm ready. (upbeat music) - Nice. Right. (upbeat music) Okay. Yeah, I don't know. I don't know, my face, my, do you know what? Is it even the Facebook working? I don't know. Anyway, you know what? I'm gonna carry on because it. Share store is in a post or real. I'm gonna carry on because the show must go on. (upbeat music) Right, sorry, I'm just doing a video on Instagram, bear with me Facebook. This is a video to Instagram people. I am not able to do my live Q&A. I'm able to do a recording like this, but I can't do it live. Don't know why. It says my accounts are not available to. I often upset people, to be honest with you, with the sort of stuff that I post, although I try not to show, you know, body parts. But as, you know, due to my job, sometimes body parts do get shown. And maybe it's that, I don't know. Anyway, I'll do this video to say sorry, but I am on YouTube and Facebook if you are on those platforms. So I'll be doing the live on those. - Right, sorry, I'm just doing a video on Instagram, bear with me Facebook. This is a big video done. Right. Okay. Okay, right. (clapping) Professional rise above it, Q&A. Oh, I did it. And also I had a question on Instagram as well. So the question on Instagram was something on the lines of is the diastasis recti corrected during abdominal plastic procedure. So let me put it like this. You don't have to ask to have the diastasis recti. So if you don't know what diastasis recti is, it's the six-pack muscles, which are your rectus abdominis, which is one of them. And the recti is two of them, which actually goes straight down either side of your belly button. And they've got 10 in this intersection. They've got lines, which give them the six-packs or horizontal lines. The muscles go straight down. And when you are pregnant or when you put on weight, the whole abdominal cavity can stretch and those muscles can stretch apart. And that is called diastasis recti or diversification of the recti. It is just a fancy word for the same thing, which means that the muscles are a bit farther apart than we'd like. And you get a bit, sometimes you get a bit of a bulge, essentially. And so it is an integral part of doing a tummy tuck that you assess those muscles. And that you usually, I would say, not 100% of the time, but the majority of the time you have to bring them together. We call it repairing them. You're not really repairing them. You're just kind of bringing them closer together. So that is an integral part of a tummy tuck. You don't have to ask for it. It is there. So, but as I say, it's not 100% of the time. So if you didn't need to have it done, then we wouldn't do it. But the majority of patients do need to have it done. If your abdomen has been stretched enough for you to require a tummy tuck, in my experience, usually the muscles have been stretched to a degree. So we usually do do it. And as I say, it's an integral part. You don't have to pay extra. You don't have to ask for it. I mean, by all means, you can ask for it and we can talk about it, but some people don't really know it's there. The diversification. And we just might just quietly repair it and they might never have known. So, yeah, it's, the answer is yes, it is done. As part of that. So thanks for that question on Instagram. I'm sorry I couldn't answer it on Instagram. In fact, maybe I should have done that when I did the video. But anyway, I'll live and learn just a lot about just now. I've got a list of questions here, which are looking at them. I'm dominant plus, you were related quite heavily. I'm dominant last year. Easy for me to say related. So why don't I just kick off with this one? Can you have an abdominal plastic if you've had a previous open underlying incision or early repair with mesh? January 2017, it was due to complication from prior surgery, laparoscopy, and laparotomy in 2016. I answered this a little bit last week when someone was asking about, can you have an abdominal plastic or an umbilical incision or early repair? I don't know if it's the same question, but now this has given us a bit more information saying that they have a laparoscopy and laparotomy. So laparoscopy, no problem. Laparoscopy is a telescope, keyhole surgery. Laparotomy is actually having a cut in your abdomen and bowel, kind of open bowel surgery. And so that is potentially a problem. So the umbilical incision or early repair in itself is not a problem. But what might be a problem is the scarring that you have. And often with a laparoscopy, it's a lower midline incision, which means it's below the belly button down from the belly button down to the pubic area, straight line. And if that's the case, happy days because that will all get removed. And that can cause quite a bit of distortion to the abdomen. So it's actually quite satisfying to remove those scars. The problem will come if there's any scar above the belly button. But if the skin scar is below the belly button, so if there's any scar above the belly button, either from the laparotomy or from the umbilical incision or hermy repair, that would be an issue and something we need to talk about. But if it's all below the belly button, then that would be okay. Do you need to know where the mesh is prior to abdominal surgery? If yes, is the scan done at your clinic or do I need to do the scan prior to the consultation? Which scan is best to see the abdominal mesh? No, is the answer to that? No, we don't need to see the mesh. The mesh is often becomes integrated in your tissues. It can be difficult to see it's on a scan. It's just basically a block of scar tissue. It's certainly good to know that it is there, but we don't need to know exactly where it is. We will find it when we do the surgery. The only issue with it is it might splint the abdominal rectus abdominis muscles. It might splint them so it might make it a bit more difficult for the repair to be done because there's a big block of mesh or a block of scar basically, which is what the mesh is doing. It's creating a big block of scar, which obviously reinforces the abdominal wall so you don't get the hernia, but it can be difficult if we're trying to apply Kate and contour the abdominal wall if there's a big block of scar tissue there. But we don't need to do a scan. We don't need to know where it is. We don't need to know where the mesh is prior to doing abdominal plastic surgery. Do you repair hernia in the epicastic region if one is found during the surgery? In my, I'm experiencing hernia like pain there, but no diagnosis of possible hernia yet. I had a clear CT of abdomen cavity and due to how an ultrasound of my abdominal wall, not sure if pain is in hernia or damage from previous surgery. I mean, yeah, hernia is not necessarily painful. I'm not sure what hernia like pain is. Hernia usually presents as a swelling or as a lump, which goes in and out. And if it gets incarcerated or strangulated, if it gets stuck basically, it can be painful. But the normally the sort of presenting symptom of hernia is a bulge that's coming in and out. So if someone has pain, I wouldn't necessarily go to thinking that's hernia first. It's probably more likely to be used previous surgery or what have you. But if we find an incidental hernia at the time of an abdominal plastic, then yes, it's not unusual to find little defects in the abdominal wall and to repair those during abdominal plastic. Obviously, if you've got a big symptomatic hernia, that's a different story that might need investigation and might need to be thought through differently because a big hernia might need some kind of reinforcement of the abdominal wall in the form of a mesh. Whereas a small hernia is often just a tiny little defect in the abdominal wall, which we can just stitch up and often kind of gets repaired with the plycation or the repair of the abdominal muscles. That small hernia is repaired just during that. So for sure, small hernias are fine to be repaired at the time. I've got abdominal plastic hernia central here. What are the pros and cons of carrying out abdominal plastic and epic has to do hernia repair at the same time? Epic gastric hernia repair. I don't, who said anything about doing an epic gastric hernia? So if you've got a small, usually peri-umbly called hernia, it will be repaired at the same time as an abdominal plastic because the overriding operation is the abdominal plastic and the hernia is just incidental. If you've got an epic gastric hernia, I think probably that should be looked at, certainly an opinion should be made about whether that needs to be repaired, whether that's causing problems, or whether that needs to be paid separately to an abdominal plastic. You can do that abdominal plastic and hernia repair at the same time, and the pro would obviously be that it's one operation rather than two, but the con is that if you have wound healing problems, if you have any issues with infection or anything, that can be bad with an abdominal plastic, and certainly if you're doing an abdominal plastic, your risks of wound healing problem and infection are significantly more than if you were just doing hernia repair on its own. So if you did get a wound healing problem, if you did get an infection, particularly if a mesh is used for the hernia repair, if that mesh becomes exposed or infected, it would have to be removed, which can be an absolute nightmare. So it's not something that is commonly done, hernia repair and abdominal plastic. And usually, if it was done, it's usually people who are often not very well, they've got a huge abdominal apron, and they're just trying to do it for comfort, rather than doing a formal cosmetic abdominal plastic. It's not a common combination. So usually, I would, personally, I would say, let's, you know, obviously good to have a discussion if you're gonna have an abdominal plastic in the future, but I would have a discussion regarding the hernia repair, what needs to be done, and perhaps this discussion between the plastic surgeon and the general surgeon, prior to doing the hernia repair, just to ensure that maximizing your ability to have an abdominal plastic, in terms of the skin scarring that you get from the hernia repair. Is that all right? If I get diagnosed with a hernia, epigastric, wow, is this right? Okay, can the hernia repair, wow, these are, this is some, okay. If I get diagnosed with a hernia, epigastric, can the hernia repair at the same time as your abdominal plastic? Can this be done at your clinic? Who should I need to see? Right, no, none of this stuff we do at the clinic, we see patients at the clinic, but this would be done at a hospital. So tummy tucks, abdominal plastic is not done at the clinic, but obviously the doctors are based at the clinic. I don't do any of this stuff anymore. I've had enough, I don't do any more of these sorts of things, but if you do get diagnosed with a hernia, can this be done at your clinic? No, it'd be done at the main hospital. Who should I need to see, plastic in general? Yeah, exactly. So plastic surgeon at the clinic, general surgeon would not be at my clinic. We don't have any general surgeons working there, so you'd need to talk about the hernia repair with a general surgeon, and certainly plastic surgeons could talk to the general surgeon, but you would need to see two different people at different places, and the general surgeon would be at a different place. So yeah, it would need to, well, I want the hernia to be prepared using suture or human biomass only. Is that possible at your clinic? Well, it's cost of hernia on top. So hernia repair is done by general surgeons. We don't have any at the clinic. We wouldn't do anything. We wouldn't do anything regarding the hernia repair. The hernia repair would be the remit of the general surgeon, and we would be just talking about abdominal plastic. So in terms of what's whether you're using suture or human biomass only, or whatever, that's completely the general surgeon. We would have no input on that. That would be a discussion between yourself and the general surgeon as to how the hernia was repaired, and what would there be the cost of the hernia repair? We'd talk about cost of abdominal plastic, but the cost of the hernia repair would be up to the general surgery and his or her teeth. Since having the plastic mesh repair, I've been having information in my body, and I've been diagnosed with fibromyalgia and lupus. Can the mesh be removed by general surgeon and repaired with suture or human biomass, cranky? Don't know. You'd have to talk to the general surgeon. Very difficult to remove meshes, but as I say, it's not my specialty. Hernia is not my specialty. It's a general surgeon who you'd have to talk to about that. So I don't know if the mesh can be removed or repaired. Well, if you're interested in meshes and hernias, this is the one for you. Will the abdominal plastic help prevent recurrent hernias? Will the abdominal plastic help prevent recurrent hernias? No. No. If you've got recurrent, so what? No. So hernia is basically a defect in abdominal wall. Well, it can be in different areas, but let's just say abdominal wall hernias are the defects in the abdominal wall. And no, not really. No, if you're prone to them or if you can still get one even if you haven't had one in the past few years. Oh my God, we've got comments. We've got comments, guys. Where am I after the ball? An enemy. Hello, the anterior abdominal ultrasound I had today showed small defect in my wall muscle above belly button. Is this repairable by suture during an abdominal plastic? Is this going to be an extra cost? What's the weighting of the type of concentration? The only thing I would be concerned about is, so on balance, if there was incidentally a discovered that there was a small defect in the abdominal wall muscle above the belly button, that would be integrated into the donor plastic with no extra cost. The only thing that worries me a bit is that you say you've had an ultrasound, which presumably means you've got some symptoms there. So if you've got a symptomatic hernia, that will be a slightly different issue, which again, I'll go back to the general surgeon thing. That would need to be having a opinion from a general surgeon, I think. As I say, the sorts of hernias we repaired during an abdominal plastic are normally incidental, i.e., you are asymptomatic, you don't know they're there. If you are symptomatic, which presumably you are, if you're having an ultrasound, then that would need to be discussed with a general surgeon and the costs. The extra costs would be due to the general surgeon and seeing what they want or need, and there might be costs around hospitals, et cetera, if needs to be done, that's a certain place. So it sounds a little bit more, a little bit more involved. What's the waiting time? What for? I mean, for a consultant without one of us, so it wouldn't be me, just to be clear, it would be a costus. So a consultation with costus, I'm not sure. A month, Amy knows, you can ring the clinic, Amy. I guess that, I don't know, I know idea what his waiting time is, but it sounds like you wouldn't, if this, I wouldn't imagine this would be done quickly if you need to get involved with a general surgeon as well. That would probably be quite a, well, I don't know, actually you might be able to get an opinion from the general surgeon, I don't know. No hernia was found. Well, small defects in the wall muscle. Okay, well, I don't know, it's hard to get into. I mean, technically speaking, a defect. I guess it depends on the depth. A defect in the abdominal wall is a hernia. So I guess it's getting a bit semantic there, but I think, anyway, yeah, okay, I don't know. This is a complicated case. Still got more questions here though. How dangerous, no way up to, how dangerous is it to have abdominal plasti plus possible, after you go, if you have an excisional umbilical, I don't have with my mesh. Not, well, I guess the danger is infection. So any time you have an abdominal plasti, there's a risk of infection. And if you all either already have a mesh in place, which is your incisional umbilical hernia repair, or if a mesh is going to be placed with a possible epigastric hernia repair, that increases your risk of getting an infection in the mesh, which is a nightmare to be quite frank. So that is the danger, I guess. If you've got a mesh in place or are having a mesh in place, it would be dangerous to have an abdominal plasti on top of that, because if you get a wound infection and that infection gets to the mesh, that's a serious complication. So something to think about, quite a lot to think about here. Would you offer to perform the abdominal plasti if I'm experiencing pain in my wall muscle, but can't see what the cause is on scan or ultrasound? I'm not sure, it doesn't sound great, to be honest with you. It's not sounding great. And I think abdominal plasti is an elective procedure, it's a planned procedure. So you normally do it when people are in sort of good, optimal condition. If you're getting pain, if you're having undiagnosed abdominal pain, I probably wouldn't advise going down the route of having an abdominal plasti, which is quite a big elective procedure, whilst there's still something hanging in the balance that there's something going on, potentially in your abdomen, that we don't really know what it is. So that would probably mean, look, general surgeons are the ones who deal with abdominal pains and intra-abdominal problems. So I would probably say, look, it's probably best to get that sorted, and it wouldn't be ideal to be having a cosmetic tummy choke while you're having undiagnosed abdominal pain. I would like my muscle wall to be repaired ASAP, but if I still have a little bit of weight to lose after surgery, would that be okay? Let's say one stone. So again, muscle wall repair would be the general surgeon, rather than ask the plastic surgeon. So whether they do it when you've still got bit of weight to lose, would be up to their discretion. But in general term, surgery is better when your weight is less. The tension will be off things. The repair will be tighter. So it is generally speaking better to do it when you have lost weight. And certainly the tummy tuck, if you're having a tummy tuck, for sure that is better to have once you've lost the weight, because if you have the tummy tuck and then you lose weight, you can get a bit redundant skin. Not to mention the fact that your risk of complications, or you talk about hernia, or hernia on the mind, talk about infection and what have you, risk of infection is higher, risk of room breakdown is higher. So the complication rate is higher if you have a, if your weight is higher. So the ideal, ideally you would lose the weight. First, I guess it depends a bit on what your weight is and what sort of timescales you're looking at. I don't know, you're saying you want it ASAP, but yeah, in general terms, this sort of elective surgery, these, you want it being your best condition. So having your weight right first, and as I say, undiagnosed abdominal pain is probably not great. So it sounds like there's a few issues here, which need a bit of thought and a bit of input, possibly from other surgeons, other than plastic surgeons. To be frank, the thing that we do is usually pretty straightforward, you know, the tummy tuck side of things, bit of muscle repair, hernias, abdominal pain, all these sorts of things need a bit more thought and a bit more input from a different type of specialist, which would be a general surgeon. So it sounds like you need a bit of input from your general surgeon. And as I say, the sort of stuff that we do, the tummy tuck side of things is usually relatively straightforward. This one clearly isn't straightforward. This one's not straightforward at all with all this hernia shenanigans going on, but a kind of inverted commas, normal tummy tuck is relatively straight. I mean, I don't want to say it's not a big arp, it's a big arp and the risks, et cetera, et cetera. But the actual, you know, the actual sort of not dynamics, the sort of like the mechanics of what you do sort of thing is kind of relatively, bit of a skin removed, bit of muscle tightening, contouring to the abdomen, getting the shape right. You know, it's kind of sort of superficial surgery, you know, it's all kind of, you know, relatively, relatively straightforward. But I guess I'm saying that 'cause that's the sort of thing we do and everything that you do is straightforward, I think. What we've got, Davina, hello, Mr. Diana. I had my bilateral mastopexic, canceled on the 12th April due to asthma attack. Please advise how long I have to wait to have surgery. Well, so typical one with Davina, but I would say to Davina, asthma is a serious condition and, you know, you gotta be careful with asthma 'cause it can be even in this day and age, it can be a serious thing. Two aspects that spring to mind, one aspect of it is how are you? If you are still, you know, did you have treatment? Did you have, what was the sort of an exacerbating cause? Was it infection or was there something that created your asthma, in fact, attacking which case? How is that? Is that settled or are you back to normal? That's the number one aspect. So how are you? And the number two aspect is really gonna be down to you, Davina, to be honest with you. To be honest, and the person who would have canceled you would be the amisest, really. Because, I mean, obviously, I would agree that it should be canceled if you have an asthma attack, but it's not really a surgical problem, if you like. It's an anesthetic problem, the asthma, and it's something the amisest needs to manage. So that would need a discussion with the amisest. So first of all, we need to make sure you are over the issue. If there was an issue, as I say, if there was an infection or a reason for the exacerbation of your asthma. And secondly, it will be a discussion with the amisest, but I don't think we'll be rushing in, number one. And number two, we'd have to look at the hospitals, well, to see where the amisest is happy at all. I am personally finding that the, actually, not so much the amisest, it's more the hospitals are becoming a lot more, I don't know if risk averse is the right word, because I'm not saying they were sort of okay with risk before, but it's getting a lot more difficult people with things, not the asthma's a minor thing, asthma's not a minor thing, but things which previously I was doing kind of no problem at all, didn't really even bat an eyelid. Now, the hospital's like, oh no, we can't do it, 'cause patients is, patients that, patients diabetic, patients is, patients who have this witness, patients do. So, you know, whereas before, we're like, well, we did, you know, seven, seven, seven, so. So, and it's difficult in those circumstances, because at the end of the day, you begin to realize that you or, you know, as in we are surgeons who operate at hospitals, and the hospital says no, we haven't got a hospital to work at, so I think they are getting more and more, what sort of select or more and more anxious about patients with medical conditions. I think there's also, maybe it was more so in COVID, but there was also sort of like feeling that they are worried about people potentially having a problem, maybe getting transferred to NHS, putting burden on the NHS. I think that was more of an issue on the ground COVID. Very rarely happens anyway in anyone, but I think, you know, I think there was a big concern about that. So, if anyone had a medical condition that they were worried, we don't really want to put pressure on the NHS, certainly around the COVID time when the NHS was in real, you know, real capacity sort of thing. Oh, hello. Thank you. I'm well now, GP Happy Recovery was called by bad cold and received nebulizers, antibiotic steroids, good news. He could have my foot, oh, surgery before I finished my maternity, yes, Davina, that's very common. Totally understood. Message received and understood. Davina probably Amy or Nicholas or something like that would be looking at that. And they would be, I guess, the next stage is, when was it 12th of April? It wasn't that long ago, Davina, was it 12th of April? I mean, that's 11 days ago. Yeah, anyway, it needs to stay in, but I'm glad you're feeling better, Davina. And the way I look at it, Davina, if I was you, is we're trying to do the right thing for you. And sometimes it can be frustrating, especially when you've got things like your maternity leave and what have you, it can be frustrating. Oh, Christ, you just get on with it. Come on, all right. But in fact, you know, everyone, and, you know, as I say, will be driven by the anesthetist and the hospital, this rather than the surgeon. If they do say, oh, you know, we're not comfortable, then they're doing it kind of feel good, although I completely understand that it can be frustrating. But anyway, yeah. So I'm going to specifically answer to Davina, but I'm saying to you, 11 days is not that long ago. And that's most serious thing, not to be taken lightly. I think sometimes people have this image of asthma as being like, frouble pitch, bit of a puffer, bit of a breathlessness, but it can be serious. So we do take asthma quite seriously. Oh, wait, not a hernia thing. How much do you trust to repair the hernia with hernia? So, Lynn, if you have got a hernia, it's probably best to get that kind of investigated and looked at by a general surgeon. If you're going to have a tummy tuck, 'cause general surgeons or abdominal surgeons, they treat hernias, if you're going to have a tummy tuck, it's good for the general surgeon to liaise with the plastic surgeon about incisions and placement of scars and stuff, it's such a way, because you've got to be careful if you're going to have a hernia repair followed by a tummy tuck. But personally, as I said earlier, I wouldn't be that keen about doing a tournier pair and a tummy tuck at the same time if it's a significant hernia. Sometimes we discover small incidental hernias, and we just repair them as part of the tummy tuck. No extra charge, it's just part of the tummy tuck, there's just small defects in the abdominal wall, which we repair. So, if it's one of those, it's no extra charge. But these people have not got symptomatic hernias, these people didn't know they were there, and we just found them while doing the tummy tuck. If you know you've got a hernia, then that suggests it's going to be bigger than these ones that I'm talking about, which are very, very tiny of these ones I'm talking about. So, if it's a significant defect in the abdominal wall, it might need more than just to sort of stitch up. It might need some investigation. It might need things like mesh. They often do mesh repairs now. It might need some more involved surgery, which A, might make it potentially not suitable to have at the same time as a tummy tuck, but the surgeon should talk to the plastic surgeon about incision replacement. And B, if it was, it may require a general surgeon to be with a plastic surgeon to do the surgery, and that would obviously require extra costs. How much? I don't know, 'cause it would be the general surgeon who would be charging for that. So, I don't know how a general surgeon would be. I was gonna say, I know how much your tummy tuck is. To me honestly, I don't even know how much your tummy tuck is, but, you know, we know, if you were a contact anemia, and stuff, she'll say this is how much your tummy tuck is, but if it's a tummy tuck joint procedure with general surgeon, different level of complexity, you can expect it to be a lot more, to be frank, because there'll be two surgeons during your operation, so that will increase the cost of that. Wow, that was a theme, that, wasn't it? That was a tummy tuck hernia theme. That's a theme of the day. Lynn, thank you. 'Cause that was, that was Jolly Guru, Lynn, Davina, and Nemeny. Thank you for participating. Thank you for putting your oars in. Oars, I'm grateful, I'm received. So, that was, that was that, that was good on. I think we, I think we've done hernia in a, a dollar plastic. Hope, I hope, I hope, I hope you've, I hope you've clarified that. And Nemeny, thank you, thank you for your questions. And, I do think I need to lie down after that, to be quite honest with you. So, I don't know about you, I don't have a lie down. If you do have any questions about hernias, about tummy tucks, or about anything else, then message on the YouTube or the, or the Facebook, or the Instagram, although this isn't working on Instagram, but I, you know, we've composed on Instagram, but for some reason the live's not working on Instagram. So, by all means, if you do any of those things, then you message on there. And, I've got a reason to be Mopi Batman X Tuesday. Will I, is there anything you have in my life? I don't know, I'll probably be Batman X Tuesday. So, I will see you all then. Thank you all for the questions. And, the participation is very, very gratefully received. So, go up your feet up, and have a good evening. I bid you, good night. (upbeat music) Have a question not covered in today's show? Then send it over to info@stionoplasticsurgery.co.uk, using the hashtag #AskJJ. We'd love to hear from you. [MUSIC PLAYING] [BLANK_AUDIO]
