Part two: Plastic surgery during the COVID-19 pandemic

Aesthetic and reconstructive plastic surgery, like various other medical specialist treatments and operations, slowed down – or depending on urgency – stopped altogether when the COVID-19 pandemic was at its’ height.

In part two of this double article, prominent consultant plastic and reconstructive surgeon, Mr Kelvin Ramsey, discussed the changes to plastic surgery procedures during the pandemic and what happens if patients experience COVID symptoms close to their operation date.

How has the process of surgery changed during COVID?

The pandemic has changed the health service, both the private and the NHS sectors, permanently, I would suggest. Not only are patients consulted about the risks from the virus pre-operatively, but also the patient pathway in the hospital setting includes appropriate PPE measures to ensure the safety of the patients and the staff. They are routine measures now.

Unless coronavirus completely disappears, I think these measures are going to be with us for many years to come. Essentially from a patient point of view, we will lead them through every step of the way so they don’t need to worry about remembering anything. They will be guided throughout the process and they should be reassured that they should be no more likely to be exposed to coronavirus within a hospital environment than they will walking down the street with the measures that have been put into place.

Will I be able to have surgery if I have symptoms of COVID-19 around the time of my procedure?

This is a very important question. The early data that came out of China in Spring 2020, and then further data that came from the entire international surgical community in the early stages of the pandemic did show, that if you have coronavirus at the time of an operation, this is dangerous. You were likely to get much worse symptoms from coronavirus if you were recovering from an operation, because your immune system is slightly impaired.

Therefore, we take many precautions to make sure that patients are isolated pre-operatively. At the moment, in the vast majority of hospitals this is between three days and a week. And there are testing procedures to ensure that you don’t have coronavirus when you come into hospital for your surgery.

There are a number of questionnaires that patients are asked to complete to ensure they don’t have any symptoms at the time of their surgery, just to make sure we don’t let anyone slip through the gaps and expose a patient to an operation when they have the virus.

A further follow-on question is, ‘If I have COVID, and I’m testing positive but I’m asymptomatic, can I still have the operation?’, I’m afraid the answer is no, because you may be asymptomatic at present but once you’re in the postoperative period you may become symptomatic and more unwell.

Another consideration from that, is ‘How long do I have to wait, if I’ve got COVID, for my next surgery.’ And in my practice, the answer to that question is at least seven weeks. This is because we know that, from the long-term data, you will have fully recovered. Also, you aren’t as likely to have an adverse outcome from your surgery especially if you’ve waited seven weeks from the resolution of your symptoms and have a negative test result. Of course if the surgery is more urgent and cannot be delayed by such a period, then an individual patient tailored decision is made.

To discuss your options at this time further, call 020 3764 0399 to arrange a consultation with Mr Kelvin Ramsey.

Part one: Plastic surgery during the COVID-19 pandemic

Aesthetic and reconstructive plastic surgery, like various other medical specialist treatments and operations, slowed down – or depending on urgency – stopped altogether when the COVID-19 pandemic was at its’ height.

In part one of this double article, prominent consultant plastic and reconstructive surgeon, Mr Kelvin Ramsey, talks how the pandemic initially affected plastic surgery and how healthcare providers have expertly resumed operations in a completely different landscape.

How did the COVID-19 pandemic affect plastic surgery?

The coronavirus pandemic has been a challenge for everybody, both patients and doctors alike, as you can imagine. Right at the beginning, in the spring of 2020, the health service both for private and NHS patients changed dramatically overnight. In the early stages of the hard lockdowns, we were only looking after patients who needed urgent or life-saving procedures. And appropriately, we did not perform any other operations that could safely be delayed because we were trying to minimise the exposure of patients to coronavirus.

Over the last two years, the world – and health services – have changed. Pathways have been put in place to make it safer for patients to come through the hospital environment for treatment. At times, when the coronavirus pandemic has been at its height and when we’ve been in lockdowns, we’ve been adjusting the procedures to make sure that we’re not exposing anybody, patients or staff alike to an unnecessary risk from the virus.

Fortunately, in the UK, with the assistance of the vaccine programme, we seem to be on the way out, I would hope. We’ll be living with coronavirus for many years but from a healthcare point of view, things are looking much more favourable. We have safe pathways for urgent and non-urgent procedures to make sure that everybody is protected but also, to make sure that patients get their much-needed operations.

Is all plastic surgery going ahead post lockdown?

At the moment, the answer to that question, is fortunately yes. So, whether it’s a reconstructive procedure for cancer surgery or whether it’s subsequent adjustments, or even aesthetic procedures, both myself and the vast majority of my colleagues are carrying out such operations at the moment.

If the pandemic deteriorates and the hospitals become overwhelmed, then we may need to adjust the patient pathways and start postponing their surgery. I think that is unlikely to happen from now on because of the success of the vaccine programme.

Will there be a long wait to be able to have a procedure?

There is always a short wait to have an operation from the time that you’re seen in the outpatient clinic to the operation date. From a logistical point of view to arrange appropriate pre-operative assessment, arrange theatre time and ensure that sufficient consultation and consent processes have been completed.

Within the NHS there are some significant waiting lists at the moment, unfortunately because of the backlog after the pandemic. Within the private sector the waiting lists are much less.

Obviously, patients are still prioritised within both sectors if they have urgent problems such as cancer but within the private sector for non-urgent procedures, the waiting lists are very manageable at present.

Call 020 3764 0399 to arrange a consultation with Mr Kelvin Ramsey.

The vaccine rollout at Royal Marsden

Alongside his plastic and reconstructive work at the Royal Marsden, Mr Kelvin Ramsey has been helping out in the hospital’s vaccine clinic in his spare time, to ensure that as many of our patients and staff are offered a vaccine as soon as possible.

Cancer patients, specifically those receiving active treatment in the form of chemotherapy, immunotherapy or bone marrow transplant, have been categorised since the start of the pandemic as extremely vulnerable. These cancer treatments can lower normal immunity, and this can be a problem with administering certain types of vaccines, known as ‘live’ vaccines. The COVID vaccines that are currently available are not live vaccines and have all been deemed safe for cancer patients.

As a frontline healthcare working, Mr Ramsey received his first COVID-19 vaccine at the end of December. He strongly encourages his patients to take up the offer of vaccination when offered. For more advice, call 020 3764 0399 to arrange a consultation with Mr Ramsey.

 

 

Mr Kelvin Ramsey discusses breast reduction surgery for Top Doctors

London cosmetic breast specialist, Mr Kelvin Ramsey writes an article for Top Doctors, entitled ‘Am I eligible for breast reduction surgery?’.

Plastic surgeon Mr Ramsey covers the factors that he takes into account when assessing breast reduction patients and what you should know before you make the decision.

“Any woman who has issues with the size of her breasts can be eligible for breast reduction surgery. If the size of their breasts is affecting their everyday life, then reduction surgery may be an option.”

He then discusses the timing of the breast reduction surgery, particularly in relation to whether you should lose weight prior to the operation. “If a patient is planning to lose weight,” Mr Ramsey explains, “it’s recommended that they get to their ideal weight before the surgery. This is because if a patient loses weight after a breast reduction, it will cause the breasts to droop more quickly.”

For more advice on the breast reduction procedure, call 20 3764 0399 or email pa@kelvinramsey.co.uk to book a consultation.

Mr Kelvin Ramsey appears in this year’s Tatler Beauty and Cosmetic Surgery Guide

Mr Kelvin Ramsey was delighted to appear in the Tatler Beauty and Cosmetic Surgery Guide 2019 in the category of UK’s best breast surgeon. Alongside five other plastic surgeons, Mr Ramsey was recommended for his meticulous breast reconstruction work, explaining to the publication his aim is to “put these ladies back to where they were before they had cancer, both physically and emotionally”.

His experience in breast reconstruction and background in microsurgery also informs his cosmetic breast surgery work and he advocates “a gentle, natural-looking augmentation”.

Mr Kelvin Ramsey publishes lymphoedema article in British Journal of Surgery

Lymphoedema specialist Mr Kelvin Ramsey and colleagues recently had an article published in the British Journal of Surgery.

Following treatment for breast cancer, damage caused by surgery or radiotherapy to the lymph nodes under the arm can result in a build-up of lymph fluid causing a swelling of the tissues known as lymphoedema. Treating breast cancer-related lymphoedema presents a significant cost to the healthcare system and the symptoms – swelling, discomfort, a sensation of tightness, dry skin and possible infection – all adversely affect the quality of life of patients.

Mr Ramsey and his colleagues conducted a feasibility study into the use of combined dynamic imaging and lymphaticovenous anastomosis surgery for the treatment of breast-cancer related lymphoedema.

Using near-infrared spectroscopy with indocyanine green lymphatic mapping to identify suitable lymphatic channels, patients were then treated with end-to-end anastomoses to subdermal venules. After surgery, compression garment therapy (CGT) was recommended. Excess volume reduction was assessed at regular intervals and an excess volume reduction of -33·2 per cent was recorded at 12 months.

The authors concluded that this combined approach could result in sustained volume reduction, but further work would be required to identify biomarkers that would allow practitioners to predict who would best respond to this treatment.

Chosen as the front cover article for this month’s journal, the editor tweeted his excitement at the study’s findings.

Advice on breast implant safety

On Monday, BBC Panorama’s programme focused on medical implants, after working with the International Consortium of Investigative Journalists and a large number of media organisations around the world including the British Medical Journal, who had highlighted what they feel to be regulatory deficiencies in bringing medical implants to the healthcare sector and their subsequent surveillance in patients.

In light of this programme, the British Association of Aesthetic Plastic Surgeons (BAAPS), of which I’m a member, has released a statement focusing on breast implant safety and giving advice to any previous or prospective patients: “As a result of the media attention regarding medical devices, many of our patients will be understandably concerned and we publish a statement by our partners, the International Collaboration of Breast Registry Activities (ICOBRA), to clarify some questions around the safety of breast implants.”

Please click here to read the full BAAPS statement on breast implant safety.

Groundbreaking surgery developments at the Royal Marsden

The Royal Marsden continues to lead the way in groundbreaking surgery internationally, as surgeons perform a UK-first in robotic surgery. Using pioneering da Vinci robotic technology, a patient underwent a robotic total pelvic exenteration to treat advanced rectal cancer. This procedure entails removing all the organs from the pelvic area and the traditional approach would have required a large incision being made from the chest down to the pubic bone.
With robotic technology, however, surgeons at the Royal Marsden were able to perform the procedure through a minimally invasive approach. Robotic surgery potentially has a number of benefits; less blood loss, less pain experienced, a quicker recovery and a much quicker return to home.

Mr Kelvin Ramsey published in the British Journal of Surgery

Breast cancer‐related lymphoedema (BCRL) presents a significant healthcare burden and adversely affects the quality of life of breast cancer survivors. Mr Kelvin Ramsey has just had his series of lymphaticovenous anastomosis surgery for breast cancer-related lymphedema published in the British Journal of Surgery.

This is the first UK series of this type of technique and is paving the way to a randomised controlled trial which will start in 2019.

Important information for patients considering breast implant surgery

Breast implant surgery is a very popular cosmetic surgery procedure and is typically very successful, with a high patient satisfaction rate. However, any surgical procedure carries a degree of risk and potential complications and it is essential that patients are fully aware of the implications of their decision to go ahead with surgery at that time.

Last month, a joint statement was released by the Association of Breast Surgeons (ABS), the British Association of Aesthetic Plastic Surgeons (BAAPS) and the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS), who have been working in close collaboration with the Medicines and Healthcare products Regulatory Agency (MHRA) to evaluate the risk factors associated with Breast Implant Associated – Anaplastic Large Cell Lymphoma (BIA-ALCL).

Click here to read the statement in full.

Mr Kelvin Ramsey always offers a comprehensive consultation where all aspects of the surgical procedure are discussed in depth to ensure that patients are fully informed. If you have further questions, then please call 020 3764 0399 to arrange a consultation.



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Mr Kelvin Ramsey is a myHealthSpecialist recommended Plastic Surgeon


THE CONSULTING SUITE



Mr Kelvin Ramsey at the Consulting Suite

84 Harley Street
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W1G 7HW

020 3764 0399


THE ROYAL MARSDEN



Mr Kelvin Ramsey at the Royal Marsden Hospital

203 Fulham Road
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SW3 6JJ

020 7352 8171
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THE LISTER HOSPITAL



Mr Kelvin Ramsey at the Lister Hospital

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www.thelisterhospital.com


THE LONDON CLINIC



Mr Kelvin Ramsey at The London Clinic

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020 7935 4444
www.thelondonclinic.co.uk

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