Abdominoplasty is a commonly performed procedure. It usually is done for women after child bearing where the effects of pregnancy can result in stretching and laxity of the abdominal skin and muscles, sometimes with the presence of stretch marks. These problems are often compounded by the presence of a lower abdominal caesarean section scar or scars from pelvic surgery. It is not a suitable procedure for the grossly overweight in most cases and should be reserved for people of more or less normal weight who complain of laxity. It requires 3-5 days in hospital in most cases but can be done in day surgery for very small cases. The procedure involves the removal of a large amount of the lower abdominal skin and then tightening of the muscles beneath before closure over drains. The umbilicus is retained although it will have a suture line and scar around it. The recovery period is approximately one month. There is some pain after this procedure but usually this subsides adequately to allow normal activities such as driving a car and doing shopping in about ten days.

Liposuction is a common procedure. It must be understood that it is not an operation for weight loss. The ideal patient is of more or less normal weight who has genetically determined abnormal collections of fat particularly in the loins, buttocks and thighs. It can be of some use in patients who are in the last stages of weight loss after such procedures as gastric banding. The operation usually requires an overnight stay in a hospital if a volume greater than 3 or 4 litres is removed. The principle of the surgery is to prepare the areas previously planned by infiltration of a solution of local anaesthetic and a vaso constricting drug and then the use of fairly small cannulas (3 or 4mm) to remove an adequate amount of volume. Dr Lewis does not perform liposuction requiring more than 5 litres of fat removal in any given session. The area treated is compressed with a garment either in the form of leggings or arm bands or an abdominal binder depending on the site treated. This is worn for about six weeks post operatively, the first two weeks at night as well. Multiple small incision areas are needed and these are sutured. The scars never entirely disappear but are more or less are invisible in time. The time off work depends upon the volume treated but ranges from two to four weeks.

Gynaecomastia is breast enlargement, a common condition in young males as they reach their late teenage years. Most of the time it settles down spontaneously but in some it either remains or increases. It can affect one or both breasts. It is nearly always unrelated to any hormonal abnormality but represents an abnormal response by the breasts to the circulation of a normal amount of female sex hormone. Surgery requires just liposuction when the doctor deems that the amount of breast enlargement is caused by fat enlargement but most of the time there is a sufficient amount of glandular enlargement that a semi lunar incision made in the bottom part of the areola complex allows access for removal of the appropriate amount of gland. Drains are used. The patient can either stay overnight or go home the same day with drains in place. The drains remain in for 2 to 4 days. At 4 days all of the bandages are removed and the wound is checked for bleeding and accumulation of blood in the cavities and then the areas of treatment are compressed by the use of a body stocking or an elasticised vest which has to be worn for a month.

Recurrence can occur but is uncommon. Re operation is the only effective treatment for this.

Bat ears are common. They are a congenital abnormality and often familial. Certain races suffer from this condition more than others. The correction is best performed at around school age between the ages of about 5 and 7. The surgery requires admission to a day surgery and a general anaesthetic lasting about 1½ hrs. No hair is removed but the hair is taped out of the way. An incision is made on the back of the ear to allow access to the outside of the ear cartilages which are then modified to the correct shape. The skin is resutured with dissolving sutures at the back, the ears packed and bandaged.

The patient can leave hospital that day but will suffer from some pain when the anaesthetic wears off. Nausea and vomiting are also common after this procedure for 24hrs or so. At one week the bandages are removed and then the ears need to be kept in place with the use of a head band or bandage at night for a period of a month. Contact sport should be avoided for a month and such things as the use of a trampoline are ill advised in that period. Once corrected, the ears will remain in the correct position.

Skin cancer is common in Australia because of the sunshine and the Anglo Celtic and Irish nature of the majority of our population. Skin cancers vary enormously in severity from the more minor tumours like basal cell cancer through more serious tumours like squamous cell carcinoma and eventually manifest at their worst by malignant melanoma or Merkel cell tumour. The treatment of these lesions can involve a simple excision performed under L/A at Dr Lewis’ office right up to admission to hospital for excision with repairs of the defect produced by removal of tumour by the application of various forms of skin grafts which can be bought from near the ears or off the thigh in bigger cases. Other repair methods include the use of local tissues introduced from near by. This is called local flap surgery and is suitable for use in some cases.

Usually the recovery period from such procedures is a few weeks and recurrence is uncommon although the patients are followed up for an amount of time applicable to the particular type of tumour being treated.