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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Mommy Makeover with Body Lift & Breast Reduction. The Mommy Makeover is a term for a group of cosmetic procedures that many mothers seek following pregnancy. After multiple pregnancies and breastfeeding, many women find it impossible for diet and exercise alone to restore their figures. Fortunately, mothers with permanently altered figures find that a Mommy Makeover is an excellent solution just like this patient found after having a Body Lift and Breast Reduction. The B & A photos at 3 months show a much more youthful figure and perkier, more shapely breasts.

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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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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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