The Plastic Surgery Room

Episode 29: Asymmetric Breast — Diagnosis, Planning, and the Operation Where You Are Fixing Two Different Problems at the Same Time

One breast is bigger. One is smaller. It sounds simple — it almost never is. Tuberous breast deformity, Poland syndrome, IMF asymmetry, the augmentation-mastopexy blood supply problem, radial scoring of the constricted lower pole, and the intraoperative sit-up that reveals every mistake before you close. Episode 29 — asymmetric breast, from the diagnosis that changes everything to the periareolar purse-string suture that holds it together.

Episode 28: Excisions and Oncological Skin Surgery — Margins, Melanoma, and the Reconstruction That Follows Every Cut

Same operation. Different tumour. Completely different margin. Get it wrong and the patient either loses their face or their life. Breslow thickness, surgical margins by tumour type, Mohs micrographic surgery, sentinel lymph node biopsy, specimen orientation, frozen vs. paraffin histology, and the positive margin that arrives after you have already reconstructed the cheek. Episode 28 — excisions and oncological skin surgery, from the punch biopsy to the paraffin report.

Episode 27: Sternoplasty — Chest Wall Deformity, the Funnel Chest, and the Operation That Straightens What Was Bent Since Birth

He won't take his shirt off. His right ventricle is being compressed. And the treatment is a steel bar passed blindly through the mediastinum anterior to his beating heart. Haller index, the Nuss procedure, the modified Ravitch, perichondrial sleeve preservation, bar displacement, and the cardiac perforation that happens when the introducer goes one centimetre too deep. Episode 27 — sternoplasty, from the echo to the bar removal two years later.

Episode 26: Osteoma and Benign Skull Tumours — The Lump Nobody Takes Seriously Until It Isn't Benign

It feels like a lump. It looks like a lump. It has been there for years. And then the CT comes back and it isn't what you thought. Differential diagnosis of the hard skull lump, CT bone windows, osteoma excision technique, frontal sinus involvement, mucocele formation, and the missed malignancy that no imaging could have predicted. Episode 26 — osteoma and benign skull tumours, from the GP referral to the burr on the outer table.

Episode 25: Cranioplasty — Rebuilding the Skull, Protecting the Brain, and the Implant That Has to Last a Lifetime

The skull is missing. The brain is pulsating through the scalp. The patient flinches every time someone walks past him.Stored bone vs. PEEK vs. titanium mesh, dural adhesion release, temporal muscle re-suspension, bone resorption, infected implant removal, and the syndrome of the trephined that nobody teaches in medical school. Episode 25 — cranioplasty, from the 3D CT plan to the drain at 48 hours.