Mr Ross was chair of the breast special interest group.
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Month: November 2015
BBC Manchester Radio Interview
Oct 2012 Breast Master class Mentor
Held in Newcastle and hosted by Mentor with Mr Ross as a host and keynote speaker. A cadaveric workshop aimed at training consultants in breast surgery, and breast augmentation.
Time and Again: Revision Breast Augmentation
Even a successful breast augmentation can be affected by the ravages of time. Leading plastic surgeon Mr Gary Ross explains how he deals with revision breast augmentation, an often complex and difficult operation.
Breast augmentation is one of the most common aesthetic procedures with the aim being to provide a natural long-lasting result. However, over time both the skin and breast tissue and the implant itself can change and this can affect the overall result. Although this is uncommon and occurs infrequently the change can be devastating for the patient.
There are a number of possible aesthetic changes associated with the implant and its surrounding tissues; these include migration of the implant higher in relation to the nipple/ areola/breast tissue or migration of the implant lower in relation to the nipple/areola/breast tissue and loss of integrity of the implant/its capsule leading to a change in shape.
The migration of the implant upwards can lead to the nipple / areola and breast tissue lying lower than the implant. This Even a successful breast augmentation can be affected by the ravages of time. Leading plastic surgeon Mr Gary Ross explains how he deals with revision breast augmentation, an often complex and difficult operation time and leads to an unnatural aesthetic appearance that exaggerates any natural ptosis or drooping that occurs with age. The correction of this deformity requires a manipulation or removal of the capsule that surrounds the implant. It may be necessary to move the pocket of the implant from sub glandular to sub pectoral or vice versa and to close the original pocket (see patient one in PDF).
In severe cases where there is associated capsular contracture the natural definition of the breast inframammary fold can be completely lost and redefining the fold requires recruitment of abdominal wall skin and a recreation of the fold (see patient two). There may also be a requirement to change the pocket placement and removal of the previous pocket.
Migration of the implant downwards can occur due to relaxation of the inframammary ligaments. This results in the unnatural appearance of the nipples/areola sitting too high in relation to the implant. This bottoming out effect can be corrected by manipulation of the implant pocket to raise both the fold and the implant. In cases where the skin has not been stretched excessively there is no need to remove any further skin and the original inframammary scar can be used for the procedure (patient three).
Capsular contracture is probably the most common reason for change in shape and in severe cases can be associated with intracapsular and extracapular leak with seroma formation. The aesthetic results of this are unpredictable and any revisionary surgery is extremely difficult. In almost all cases the capsule must be removed in its entirety and the pocket changed to accommodate the new implant. Due to excessive expansion of skin it may be necessary to not only remanipulate the inframammary fold but also to elevate the areola with a combination mastopexy (patient four in PDF).
The main principals of breast surgery, namely size, shape and symmetry still remain, but the techniques to achieve an improved aesthetic outcome need to be altered to meet each individual requirement.
I aim to change and improve the patient’s appearance by concentrating on these individual expectations and needs. Preoperative consultations are crucial in developing the patient/ surgeon relationship and are a means to discuss any concerns and prioritise needs and expectations.
Nov 2012. British Association of Plastic Reconstructive and Aesthetic Surgeons Breast Reconstructive Course for nurses.
In Combination: Mastopexy Implant
Breast uplift and breast augmentation are two very different procedures but, for some women, a combination of these two procedures is necessary to produce the best aesthetic outcome. Leading plastic surgeon Mr Gary Ross explains.
Some women require a breast augmentation and some, particularly after childbirth or weight loss, require a breast uplift or mastopexy. However, for many women a combination of these two procedures is what is required and a skilled and experienced cosmetic surgeon will be able to determine the best option for you. As you age the skin stretches and breast tissue droops, which can result in the breast tissue lying lower on the chest wall and the breasts may become asymmetric in size and shape. A mastopexy is a fantastic procedure for recreating a more youthful shape, but another side effect of the ageing process, particularly post childbirth and breast feeding or weight loss, is that there is a loss in volume. Implants are therefore essential to increase volume. Different sized implants can also be used to improve symmetry. Women with a smaller bust can end up very disappointed if they have breast implants that then exacerbate a problem with sagging skin, so it is the plastic surgeon’s job to advise them that mastopexy implant procedure might be best for them. There are a number of different types of mastopexy implant that can be performed. Following breast augmentation one can lift just the nipple and areola by using a periareolar mastopexy, where the resulting scar is positioned only around the nipple and areola. This gives a small nipple/areola lift and does not require any other scarring. A vertical scar mastopexy implant requires the positioning of the scar around the areola and a line vertically on the breast. This allows the breast tissue to be lifted and redraped over the implant as well as lifting the nipple and areola. Nipples and areolae can be lifted as high as required aesthetically and this technique provides a very flexible means of lifting the breast. Where there is significant excess skin a mastopexy implant using a vertical scar, an inframammary scar and a periareolar scar can provide an excellent means of lifting the nipple, areola and breast tissue to a new position and also allows movement of the breast tissue upwards while finally allowing direct excision of any excess skin. Although more scarring is required it is sometimes the only method of creating an aesthetic result.
With so many different options, a consultation regarding each method of mastopexy implant is important to determine what your expectations of surgery are and what is achievable. The pros and cons of each need to be discussed and an informed decision made.
July 2012. Surgical skills event for GP’s in Greater Manchester. Course Organiser and Key note speaker
Uplifting Surgery: Mastopexy
Leading plastic surgeon Mr Gary Ross explains the options available once gravity takes its toll.
Gravity is the enemy of us all and as well as causing the face to sag it can also have an effect on our breasts. The breasts age due to a combination of tissue changes in the skin, breast tissue, the ligaments within the breast and the position on the chest wall.
Changes to these tissues occur most acutely with fluctuation in weight and the impact that pregnancy has on the body.
Mastopexy is a technique used to lift the breast. Each component of the breast can be lifted and each component needs to be addressed individually by a surgeon experienced in this operation.
The consultation regarding vertical scar mastopexy must take into account the patient’s ideal size and a discussion needs to be had regarding previous shape and the desired outcome. Often breasts are slightly different both in terms of size and shape and the position of the nipples. Sometimes the nipples need to be lifted a considerable distance in combination with the breast tissue (patient one – see PDF).
The ideal position of the breast on the chest wall is the key and will dictate whether a small amount of tissue needs to be raised and repositioned into a new inframammary fold or in some cases removed (patient two). The overall size needs to be tailored to the individual using methods to minimise risk to the blood supply to the tissues. The breast mound is then designed in order that the breast can be lifted into a new position. Finally the skin is redraped over the breast.
A single vertical scar can be used in the majority of patients (patient three). Occasionally if there is too much skin a small inframammary scar is required alongside a vertical scar. If only a small skin lift is requested a scar around the areola can be used to give a small lift without altering the inframmary fold or lifting the breast tissue.
Finally, the vertical mastopexy technique can also be used in combination with an implant to give superior fullness to the breast.
Recovering from a mastopexy
Patients undergoing vertical scar mastopexy should be aware that the breast will sit high on the chest wall and will drop over time, which will usually take three months (patient four). It is important following surgery that a well-fitted non-wired bra is worn at all times.
Often patients can go home on the night of surgery and recovery is usually quick with the wounds healing in a week (bruising and swelling is relatively common and can take a couple of weeks to settle). In conclusion Women no longer have to accept the hand that time has dealt them and it is possible to regain the shape they have lost. A consultation regarding the pros and cons of mastopexy will help to clarify the expectations of patients and provide results that are achievable to meet these expectations.
In conclusion
Women no longer have to accept the hand that time has dealt them and it is possible to regain the shape they have lost. A consultation regarding the pros and cons of mastopexy will help to clarify the expectations of patients and provide results that are achievable to meet these expectations.
May 2012. Weight Loss Surgery and the development of a multidisciplinary team at the Bmi Alexandra. Key note speaker on weight loss surgery.
On The Face Of It: Face lifts
Face lifts often get a bad press, but techniques have changed and these days, if you pick the right surgeon, it is possible to achieve a very natural looking result. In this article, Mr Gary Ross explains his approach to face and neck lifting.
Many non-surgical treatments and minimally invasive face and neck lifting techniques have been introduced into cosmetic practice over recent years. A consultation regarding facial rejuvenation must involve the pros and cons of these alongside the pros and cons of classic face lifting and neck lifting procedures.
The aim of facial rejuvenation is to change and improve appearance and produce a long lasting, natural looking result, with as little down time as possible. Although non-surgical treatments and minimally invasive face lifting is effective in slowing the ageing process within our formative years, as we get older classical face and neck lifting is often the only procedure that can address the ageing lower face and neck adequately.
The classic signs of jowl formation, prominence of the nasolabial angle, blunting of the jaw line and fullness under the chin are best addressed by modern face and neck lifting techniques using the classic approach.
Modern techniques in face lifting address mainly the layer underneath the skin and above the muscle, which is called the SMAS layer. Minimal skin excision is required with an emphasis on redraping of the skin following the SMAS lift.
The windswept look, with change in earlobe position and stretched scarring as a result of skin face lifts only still occurs in very rare and unfortunate cases and is easily avoidable.
The effects of ageing lead to an increase in subcutaneous fat deposition in the jowls and the nasolabial creases. These descend in a vertical fashion and for face lifting the SMAS needs to preferentially lifted in a vertical fashion.
Because we lose tissue with age, the SMAS layer should be remoulded rather than removed to improve facial contour. Autologous fat may also be required to improve the volume of the face.
The neck is one of the most difficult areas to address and must be considered in all patients consulting for facial rejuvenation, as an ageing neck can let down a youthful face. To lift the neck, one must consider not only the repositioning of the SMAS layer but also the repositioning of the platsyma layer that is a continuation of the SMAS layer in the neck.
As the platysma ages and weakens the fat under the chin becomes more prominent – often this fat needs to be removed by either an open approach or by liposuction. Where liposuction is required to reduce fat in the jowls, under the chin and on the neck, the fat can be redistributed into other areas such as the cheek, lips or chin to provide an overall rejuvenated effect.
As previously mentioned, the platysma layer is a continuation of the SMAS layer and therefore the platysma also needs to be lifted in a vertical plane via suspension methods. Finally one must also consider the chin and the angle of the jaw and where required a genioplasty, or chin augmentation, may be required.
The face/neck interface must be addressed in all consultations regarding facial rejuvenation. Although non-surgical treatments and minimal access face lifting provide a useful adjunct in the fight against the ageing process, the pros and cons of classic facelifting using modern techniques provide a long lasting result with minimal downtime and may be more likely to achieve the expectations of the patient.
