Breast Implants and Anaplastic Large Cell Lymphoma (ALCL). Only recently described, breast implant–associated ALCL (BIA-ALCL) usually presents as an effusion-associated fibrous capsule surrounding the implant and less frequently as a mass.  To the best of my knowledge, this is the first video to demonstrate the unexpected diagnosis of BIA-ALCL.

Little is known about the natural history and long-term outcomes of such a disease. What we do know so far is that BIA-ALCL occurs at a mean of 8 years post implantation and is most commonly a T-cell lymphoma, is CD30 receptor protein positive and does not have an anaplastic lymphoma kinase gene translocation (ALK -). The exact cause of BIA-ALCL is still unknown and not possible to determine if it’s specific to any manufacturer or breast implant type. What we do know is that it may involve a combination of genetic predisposition, biofilm and textured implants

Current recommendations for the diagnosis, treatment and monitoring of BIA-ALCL include:

  1. Any patient presenting with late peri-implant seroma (>1 year), consider U/S (if inconclusive do PET CT or MRI) to rule out effusion, mass +/- lymph nodes and send seroma for culture, flow cytometry and cell block. Note 1 in 8 cases present with lymphadenopathy. There is no role for mammography.
  2. Send tissue samples for CD30 and ALK to haematologist experienced with ALCL.
  3. Confirmed localized BIA-ALCL requires explantation and total capsulectomy (surgical oncologist recommended). Consider removal contralateral breast implant as several bilateral cases detected incidentally. Monitoring by oncologist for surveillance every 6 months for 5 years with annual U/S +/- PET CT for 2 years. Advanced disease requires surgery (mass, lymph nodes), chemotherapy (CHOP: cyclophosphamide, doxorubicin, vincristine, prednisolone), targeted immunotherapy (Brentuximab vedotin) and chest wall radiation for unresectable tumours or positive margins. BIA-ALCL has a more favourable prognosis than systemic forms of ALCL. BIA-ALCL with mass has higher but significant disease recurrence and progression.
  4. Reconstruction suggested >1 year surveillance. Replacement with smooth implants has been performed without reported progression or recurrence of disease but ongoing safety of this strategy is still being investigated. Autologous reconstruction favoured when possible.

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Breast Reduction using the Wise skin pattern. DrTim demonstrates a breast reduction using the Wise pattern, often referred to as an “anchor” or “inverted-T” technique. This is the skin pattern outlined on the breast. The blood supply or “pedicle” to the nipple is supplied superomedially in this case.

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This middle aged lady underwent a Body Lift following massive weight loss of 70kg with diet and exercise alone. DrTim demonstrates the 2 phases of the operation- starting on the back by removing excess tissue and lifting the buttock region and finishing on the front by further excising tissue, performing a lateral thigh lift, tightening the separated rectii muscles and reconstructing the belly button. The B & As show a much better contoured torso with an improved waistline.

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CoolSculpting by DrTim: Fat Reduction Without Surgery. During the CoolSculpting procedure, a non-invasive applicator delivers precisely controlled cooling to the treatment area to specifically target underlying fat, leaving surface skin tissue unaffected. When fat cells are exposed to extreme cold, a process of natural removal is triggered, which gradually reduces the thickness of the fat layer. The result is a visible reduction in fat bulges.

It involves no needles, surgery or downtime. It’s safe, convenient and the results are dramatic.

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Body Lift following massive weight loss (MWL). While there are many benefits of losing weight, there’s also a significant problem: patients are often left with a large amount of loose skin that inhibits them from fully enjoying their lean figures. Fortunately, there are effective surgical options like a Body Lift to remove the unwanted skin. You can see the dramatic improvement in the B & as of this patient.

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Tummy Tuck for Stretch Marks & Rectus Diastasis. DrTim demonstrates a tummy tuck for the removal of stretch marks and repair of rectus diastasis (muscle separation). The before & after photos at 3 months show a nice flat and contoured abdomen.

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Tummy Tuck For Excess Skin, Stretch Marks, Umbilical Hernia & Scars. DrTim demonstrates how a tummy tuck, also known as abdominoplasty, can be performed to remove excess or loose skin, stretch marks (usually from the umbilicus down to the pubis) and abdominal scars from appendicectomies, caesarians, laparotomies etc. If there is an incidental umbilical hernia present, then this can be easily repaired at the same time as shown in this video.

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Breast Reduction using Superomedial Pedicle. DrTim demonstrates a breast reduction using a Superomedial Pedicle for the blood supply of the nipple-areola complex. A Wise skin pattern is used, also known as, the “anchor” or “inverted-T” technique.

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Brachioplasty for “Bingo Arms’. DrTim demonstrates a brachioplasty (aka arm lift) procedure on a young female patient following massive weight loss. Loose skin hanging from the arms tends to make patients self-conscious and limits their clothing options. It can even cause people to avoid certain activities, like swimming. The before and after photos show an amazing transformation which is truly life changing for the patient.

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Tummy Tuck for Excess Skin & Muscle Separation. DrTim demonstrates a tummy tuck (aka abdominoplasty) for loose, excess skin on a background of significant muscle separation (rectus diastasis). The procedure involves 4 stages:

  1. Liposuction
  2. Mobilisation tissues
  3. Removal excess skin & fat
  4. Reconstruction of the umbilicus & closure of wound

The B & A photos at 3 months show a trim, taught and well contoured abdomen, as well as, a rejuvenated mons pubis region.

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