(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) Now, so this is a Tuesday night, trying to get the tech sorted out. Still can't go on Instagram, but I have reason to believe this is on Facebook and YouTube just tried to do it on TikTok as well, 'cause I saw a thing on TikTok that it said live. Apparently, you know the 1000 followers. I haven't got 1000 followers, so can't go live on TikTok. But YouTube and Facebook is active still, I believe. It just shows you it's not good to just go for one platform because this Instagram thing, there's no way of contacting them and no way of trying to find out why it no longer works. And I've googled it and apparently other people have had a similar problem. It just starts working one day, but it's not working today. So I've got to be happy with what we've got. It's one of life lessons that. So good evening. I've got some questions here to be tackled, which I will do presently. If you have got a question yourself, feel free to ask me. Happy to answer the live or you can post it somewhere on our answer it next week. Do this every Tuesday and presume I'll be doing it next week. I'll kick off if that's okay. In breast augmentation, do you have to have scars under your breasts? Perhaps you could put the scar on the side of your breast instead. Yeah, you're absolutely, you know, you don't have to have it on the under your breasts. You can have it kind of on the side. Ash in the armpit is relatively popular thing, certainly worldwide. It's a popular way of putting them in. It's called transaxillary. The other way you can put them in is infra ariola, which is like a U-shaped half moon-shaped incision on the bottom of the ariola. So those are the three kind of common roots to insert implants and they've all got pros and cons and understand why you might not want them in the under your breast in the fold because it can be visible. It's quite hard to see, you have to kind of lift up. You know, I understand it might be visible. So therefore the transaxillary approach is preferable in that regard because it's in your armpit. But if you, it really depends on the surgeon as to what you're familiar with. And I think most surgeons in the UK do do the, what's called the infra-memory approach, which is in the fold of your breast. And it's certainly the way I do it. And I don't do the transaxillary, the armpit one because I would struggle to create a cleavage. You're quite far away from the cleavage area, which is quite an important area to make a nice pocket when you're doing the surgery. And you're quite far away if your incision is in the armpit and it can be difficult to control the bleeding. There's some quite big blood vessels around the cleavage area. And that's what worries me. That's why I don't do it. But there are some very good surgeons who do do it. So I'm not saying it's bad. It's just, that's just me. Admittedly, most of the surgeons are overseas for whatever reason. I don't know why the UK doesn't do transaxillary, but I know people overseas in Europe who do a lot of transaxillary, it's popular there. So it's one of those ones which I guess it's like many things. If your surgeon is confident with that technique, then that might be the right thing for that surgeon to do. Certainly, when I've had patients come and see me in a transaxillary approach, I'd say no really, because it's not something I've done and it's not really something I'm confident doing. And so I feel like my expertise is the infrared memory approach. And you might find someone else who's got expertise in the transaxillary approach who maybe hasn't got expertise elsewhere. The infrared aerial approach is, I sometimes would do that, so it's a very common approach for accessing the breast in men. And sometimes you would put implants in from around the ariola, but I don't routinely use that one either. For some reason, America, that's popular. So why infrared aerial is popular in America, transaxillary is quite popular in Europe and in the UK. We do infrared memory, it just shows you there's no right way. We're all going to argue our corners, but I don't think any of us can say it's the best way, because if we could, then everyone would do it that way. So yeah, the answer is yes, you can put it on the side of your breast or at least in the armpit. So the trick that we find a surgeon who'll do it for you, certainly in the UK, I don't really know anyone who does it regularly, but I guess there's probably someone out there. Gabrielle Rebecca Charlene, Wetstone is the comment, "Is that tagging someone in?" Never know what that means, is that what tagging someone in means? It's Gabrielle tagged Charlene anyway. I'm assuming it's not a comment, Gabrielle, but thanks for the comment, it all helps. Holly's got a big one, what you got, Holly? "I have a pocket of fat under each armpit "that developed your own pregnancy understayed, "and back to my pre-pregnancy healthy weight, "how our pockets of fat have stayed. "I've inquired the two cosmetic surgeons "with both of us that they can't help. "I did leave milk from one of the pockets of fat "during pregnancy, so not sure if that's complicated things." I'm surprised that you've seen plastic surgeons who said they can't help Holly, because that sounds very much like what we would call accessory breast tissue, "bock-bockets of fat underneath your armpits," and I would have thought most plastic surgeons would kind of be okay with that. Mind you, you said two cosmetic surgeons. Were they plastic surgeons, Holly? Were they specialists in breast? Mm-hmm. Hey, now we're set to live from strangers how to find the best plastic surgeon for your cosmetic breast surgery written a book about it. So, yeah, certainly from what you've described, I mean, I might, it's difficult on this sort of stuff, because you're kind of like, you know, you're just doing it, you know, by over the ether. So, no, no, if you've seen, actually seen a surgeon, then maybe that's got more weight than what I'm going to say, but what I would say is what it sounds like is accessory breast tissue. It's unlikely the leaking milk, so has it got a nipple on it? Did the milk come from a nipple? So, but either way, they can be removed as the answer, and usually they are just fat, as you say, that the two options for treatment are liposuction or excision, if you're leaking milk from it, that suggests there's some breast tissue in there, breast tissue is a bit firmer than fatty tissue, and so it doesn't come out with liposuction. So, that would be like a mark against liposuction. The mark for liposuction is the scarring is a lot less than when you do excision. When you do excision, you actually literally make a scar, which can be visible, or as liposuction, there's no visible scarring, we sort of sort of hide it in the armpit, and there's usually little stab incisions. The other issue, so the other issue with liposuction is the potential for the skin to be left. So, it depends on how big they are and how much they've stretched the skin as to whether liposuction would be sufficient, because liposuction would just remove the tissue underneath the skin, and it wouldn't remove skin. So, it might be there be some redundant skin there. So, again, there's kind of pros and cons of liposuction and excision, and it kind of needs a discussion, but the thing you're describing is something that I think you know, there would be plastic surgeons out there who would be familiar with it. And it sounds like, as I say, accessory breast tissue is what we would call it, and it is not that unusual, Holly. You know, it's something you do see. I've certainly treated a couple of people in the last six months or so, although I'm not doing people any more, I've seen not seen you patients myself, but certainly in the last four years, probably that there's three to two or three, so it's not that common, but it's not that uncommon. Assuming that's what it is, Holly, because I might see it and think, oh, Christ, that's something pretty different or I don't know what that is or something, but it sounds like accessory breast tissue. Thank you for the comment, Holly. Gabriele, yes, I tagged her so she can watch right. Thank you, Gabriele, for explaining that to me. Where do we message for a price list? You can message here, Gabriele. You can also go on the website, SteinoPlasticSury.co.uk, and, oh, actually, for accessory breast tissue, is it? Oh, no, Gabriele, no, that's Holly, sorry, I'm getting mixed up. So if you go on the website, Gabriele, and you go to the page of the thing that you're interested in, and you say request code or something request a price, I think there's a button, and it will email you, email with information about the thing, whatever, you know, whether it's tummy tucks or breast reductions or more removal or whatever, with information about it. So we haven't got a price list, but we'll email you prices or the thing. Or you can message here. Amy, I'll get back to you tomorrow. Just, can you direct message? You have to be a friend to do that. Are you allowed to do that? If you, we'll just comment, I don't know, Gabriele, there's loads of places, websites, probably your best bet. This has been hard to go ahead with that one quite well. It's just from photos I've sent. I haven't seen anyone face to face. Okay, all right, well, okay. Not press specialists will note that. Yes, Holly, yes, thank you. Really knows what I'm really called, and I'll additional thanks so much. How does a price compare to breast surgery? Do you know? The price would be, how does it compare to breast surgery? So, it's a bit of a niche thing, Holly. It's not something that would be like, as I say, it's not that common, or we have treated it a few times, but it's not that common. So, I don't think it's kind of, it would be like, I think the thing to do is send us a photo, Holly, and we'll have a look at it. It's probably, you know, less than a bigger, less than a bigger op, more than a smaller op that's helpful in it. I mean, it's probably less than breast implants, or breast reduction, or something like that. It will be less than that, for sure. Don't know, Holly, I'm not going on prices. Gabrielle, can you remove glands before placing implants? Do you say you like to have breast reduction there? Gabrielle, like remove the breast, and then place implants? Is that what you say? That is a thing that some people do, because they don't want to be bigger. They don't want their breasts to be bigger, but they want the fullness that you get with implants, and particularly, even if they want to be smaller sort of thing, because that, for me, I would say, would be a lift, but a lift, you don't get it as full as you do with implants. So, some people will actually reduce some of the breast tissue, if that's what you mean by the gland, some of the gland unit tissue, and then replace it with an implant to get a more fullness in the upper pole. I don't like that. I'll be honest with you, Gabrielle. I don't like removing breast tissue and replacing the implants, but it's something that people do, I don't call it the plus, minus, technical thing, but no, the Montgomery gland or something, I'm having issues with. Montgomery's tubercles, are you talking about the Montgomery's tubercles, the little kind of dots on the areola? Is that having issues with that? So, can you remove? You can remove my guests, Gabrielle. If you're having issues with it, like blocked darks or problems like that nature, it might be a breast surgeon, Gabrielle. Having said about choosing a plastic surgeon that specializes in breast, this is why it's so confusing. That's why, because you might think what he's written a book on it, what is there to talk about? It is quite confusing because there are plastic surgeons who specialize in all different areas, head and neck, hands, burns, cleft lip, cranial facial, skin, breast. So, there's all sorts of areas. So, you should find one that specializes in breast. And so, people who treat breasts, there's two types of surgeons. There's plastic surgeons and general surgeons. And general surgeons do things like breast lumps and breast cancer. And so, if you're having problems with the darks, with the Montgomery's tubercles or something like that, that might actually be a breast surgeon rather than a plastic surgeon. So, a breast surgeon is a general surgeon who specializes in breast, who does cancer treatment and removes lumps and what have you. So, there are general surgeons that specialize in breast, who are called breast surgeons, and then there are plastic surgeons who specialize in breast who are called plastic surgeons. They don't change their names. The general surgeons who specialize in breast sometimes do some reconstruction as well as the mastectomy. So, when I was in the NHS, the general surgeons did the mastectomy and then we would do the reconstruction. But there are some general surgeons who are now trained to do the reconstruction and they're calling themselves ancoplastic surgeon's ancobene cancer. So, see, it's a bit of a bit of a mind field, I'll be honest with you. Yeah, so it might be Holly. Thanks, I really appreciate it. I'll contact your client. Yeah, good, Holly, please do. Gabrielle, yeah. Scene one, is that a breast surgeon? Okay, see, breast surgeon's useless, is it? Oh, dear. Scene three through NHS. They're useless, honestly. So, thinking private and get the glands done, then the implants, yeah. Yeah, I mean, the glands thing is not a common thing. I mean, set up treated a few people with accessory breast tissue. I can't remember treating someone with problems with their mangomberies. Glans, they're mangomberies tubercores, they're little dots on the ariola. So, that is even more than Holly's thing. But for sure, yeah. All right, well, if we got here, got another question. Or are all the scars hidden if you have a full tummy tuck or breast enlargement? So, breast enlargement, yes. So, as I say earlier, we normally put them on the in the infirmary fold. So, I say they're hidden, they're kind of hidden on the infirmary fold. So, from the front, you can't see them at all. But if you put your arm up, or if you sort of lie down, do that, you can see them. Certainly in the first few months, then they do fade. They can take six or 12 or even 18 months to properly fade. But they are kind of hidden in a bra, I put it like that. And even one. So, if you go back 10, 15 years later, if it's changed the implants or anything, they're actually quite hard to see. So, they usually fade really well. So, that's the breast enlargement. Tummy tuck. So, full tummy tuck's got two scars, one big long scar from hip to hip, and one round the belly button. So, we're always aiming to hide the one from hip to hip in your underwear. And it's always difficult to, you know, 100% guarantee that. And certainly, you know, you're helping us out. If you wear wider underwear, you know, wonder where with a wider band, if you like. If you wear quite a thin band, it's, you know, we might not get it all spot on. Hidden in your underwear. So, it might be visible in kind of skimpier underwear. If that's important to you, you can always bring the sort of pants you want to wear. And we can mark them to try and get the scar to lie in that area, although there's still no guarantee. But certainly, with a wider pair of underwear, we would aim for it to be hidden. But there is a scar also around the belly button. And that's not hidden in your underwear. So, that can be visible. Although, again, we try and hide it kind of inside the belly button. So, it's not kind of visible from the skin. So, we do our best to make it so that you can't see that you've had a tummy tuck. But the belly button scar is potentially the kind of one that would be a giveaway if you're in a bikini or if you're in your underwear. And we try and hide the other two as best we can. Gabrielle, you're back. Yeah, it's around the outside. The milk does get infected every couple of weeks. That does sound like a general surgeon, Gabrielle. I've got to be honest. If you've got kind of recurrent infections around the milk ducts, that's more of a general surgeon issue, and I think they do. They would treat that rather than a plastic surgeon, especially if I was impressed. Do we offer skin grafts instead of tattoo excision? Can I just, I've got something. So, I think we're all right, we're all right for a minute. Do we offer skin grafts instead of tattoo excision? Well, I am one of the few, can you see that part of my hand just now? I am one of the few, it seems plastic surgeon that does tattoo removal. For reasons I don't know, patients say they've seen lots of people who not who say they weren't removed tattoos. As far as I'm concerned, it's like removing any piece of skin really. So, we do quite a lot of tattoo excision at the clinic. This is a personal kind of view. My personal view is that I don't like doing skin grafts. So, I'm not sure if people realize what a skin graft looks like. It doesn't look like skin, it's not pliable, it's kind of stuck there. There's often a bit of a contour irregularity. It's cosmetically, it's not a good thing. And I know that people just want their tattoo removed, but we've got to be very aware of the cosmetic outcome. So, personally, I don't like doing that. And my preference for a large tattoo that couldn't be cut out and stitched up, obviously, it can be cut out and stitched up, then we do that. So, this question is talking about ones that you can't cut out and stitch up. So, once you can't cut out and stitch up because they're too big, my preference would be what's called serial excision, which means cutting out as much as we can, and then leaving it for months, and then cutting a little bit more out, and then cutting a bit more out. It's a little bit, well, it's more tedious, not a little bit more tedious, quite a bit more tedious, but the end of the day, it just leaves you one scar, and it's a better way of doing it than a skin graft. Not all tattoos are suitable for it, and you know, if you've got a big thing on your shoulder or something like that, you know, it's often just a no from me. I wouldn't put a big skin graft on. I just think it would not look good at all, and so it's a no from me. But people do, as I say, not only plastic surgeons, do you even do the excision? So, I'm sure there are people out there who would, but I'm not one of them. So, I think I'm going to have to take stuff out of the oven. Sorry, I'll do this in a sec. Sorry, I'll take that thing out of the oven. You can talk about it, put it on the top. Sorry, sorry, just going to have the oven. I've heard it already. What implants, as in the material, make do you use? So, the material is, to be honest, there's not a huge option. So, the material of the implants, in terms of the contents, you can have saline or silicone. In this country, we mainly use silicone implants, which are silicone gel, and there's one company in America that makes that silicone. So, all the implants have got the same silicone inside. There are different materials of the shell. So, they've usually got a different silicone shell, and then some have got a polyurethane coating around the outside of that shell. The polyurethane is one company, again, in the world, called Polytech. So, if you have polyurethane implants, they're polytech, the only company that makes them. If you're having a silicone shell with a silicone gel implant, there are several companies. I'm not particularly tied to any company, so can use any of them. Polytech, I use a lot of, simply because I use them for the polyurethane implants. I'm familiar with the range, and I think they're a good company. Nagel, Motiva. There's lots of companies I don't really use. Seba, EuroSurgical. Mentor, mentor, a big company. So, there's lots of companies out there, but personally, it's usually polytech. The main one's a bit of Motiva. Nagel as well, use Nagel as well. So, those are the ones that I use, but as I say, if a patient's got a view about it and the hostel can get, oh my god, I'm not tied to any particularly implant company. So, yeah. What anesthetic do you use when having breast implants? These days, UGA, general aesthetic. Around the lockdown, we were doing a lot of local installation, and we can still do local installation, but what I'm finding is when I'm working in the hostels that can do both, they default to general aesthetic. Because they say the local installation is quite highly stated, and yeah, it's not protected. So, it's like anything, there's pros and cons of them, but the most places that do a lot of local installation seem to be places where they can only do local installation, and in places where you can do both, they seem to go prefer GA. And I'm kind of guided by these, just unless someone's got a strong view about it and they want local installation that's fine, we can offer local installation, no problem at all. But if you kind of leave it and discuss it with your nieces, they often go for GA. But again, like anything, pros and cons, I don't think there's any best way of doing it, otherwise we'd all do it that way all the time. And the fact of the matter is, some people do it GA, some people do it local installation. So, this pros and cons are both. But yeah, the person is just mainly GA. Although, as I say, I have done quite a few under local installation, and it's been fine. So, I'm happy to do it under local installation. I had a press production surgeon eight weeks ago. I was trebledy, trebledy before surgery, but now I'm still a D, double D. The surgeon agreed B, but he removed only one pound in total. What should I do to reduce the size? Well, this is why I never agree the size. So, you know, you say I'm a trebledy and I want to be a B, I'll be like, I'll take that on board, but I cannot guarantee the cup size. Because the first question is, what about a back size? Has the back size changed? Because if your back size has gone down and your cup size has stayed the same, well, then they're smaller. Because your back size shouldn't change, just to be clear, your back size should not change when you're having a press reduction. But often people are wearing the wrong back size pre-op and they get measured post-op with the right back size. And they go to a smaller back size and a bigger cup size. And all of a sudden they think they haven't had a reduction because the cup size hasn't gone down much. I don't know how I'm making sense there. So if they stayed the same size, so if you were something like a 34 double, a treble D, and now you're a 32 D double D, well, pre-op, instead of being a 34 treble D, you'd have been a 32 E or F. So you've gone from an E or an F to a D double D. Have any sense? I don't know if I'm making sense here, but the point is it's very difficult to be too accurate about cup sizes. The bottom line is whether you feel like you're smaller and whether you're happy with the size of your breasts, not what size you are. It doesn't matter what cup size you are. It matters whether you're happy with the size. If you're happy with the size, great. If you're not happy with the size, not great. So I always try and get patients not to be too fixated on the cup size, because it's very hard to predict. So that's the first thing. I think you're on a, it's not good to agree with patients of cup size, because it's impossible in my experience to to predict the cup size. That's the first thing. So only one pound in total. One pound is not too fair, fair amount, I would say. Or you mean in total from both breasts, or anyway, whatever. What should I do to reduce size? So, you know, often it's skin, it's a skin tightening process as well as a reduction of volume procedure. So often the lift is the main part of it, as well as reducing volume. So, you know, the only thing I guess you can do now to reduce the size is weight loss. But I would always say to people, you need to really try and lose weight before surgery. So it's not ideal losing weight after surgery, because they could droop. So it's not, it's not great. But that's the only thing I could say that you could do to remove more volume. Well, non-surgically, obviously surgically, you could have liposuction. But again, they could, they could droop, because that would just taking out some of the heaviness. Or another breast reduction, I guess, must be extreme. So, you know, there's the surgically option, but non-surgically, yeah, weight loss. The other thing is, you know, good well-fitting bra and things. And again, these sorts of things are things that it's probably best to look at pre-operatively, but a well-fitting bra can help with a lot of problems people get, you know, depressed a bit big and heavy. So that's one option. Again, it's not reducing your breast, but it might make things a bit more comfortable for you. Right, so hopefully the dinner's not burned. I've got to go and check on it. I hope that's been helpful. Much love to Gabrielle and Holly, and Charlene, who she's tagged in. So I hope you find this Charlene and probably helpful. If you've got any questions, just call me or message me. Well, those are the main ones, really. Call me or message me. And I will do my level best to answer them. I'll be back next Tuesday for more of the same. So we'll wish me luck with the dinner. See you soon. Bye. Have a question not covered in today's show? Then send it over to info@styanoplasticsurgery.co.uk using the hashtag #AskJJ. We'd love to hear from you.
