londonplasticreconsurgery

londonplasticreconsurgery Dariush Nikkhah FRCS (Plast)

Consultant Plastic and Reconstructive Surgeon
The Royal Free Hospital, London

09/06/2026

TUG vs PAP Flap Reconstruction (Quick Summary)

Both TUG (Transverse Upper Gracilis) and PAP (Profunda Artery Perforator) flaps are breast reconstruction options that use tissue from the upper thigh.

🔹 TUG Flap

* Uses skin, fat, and a small portion of the gracilis muscle from the inner thigh.
* Suitable for women with limited abdominal tissue and smaller breast reconstruction needs.
* Leaves a scar hidden in the groin crease.

🔹 PAP Flap

* Uses skin and fat from the upper thigh but preserves the muscle.
* Can provide a larger volume of tissue and may reduce donor-site weakness.
* Scar is usually hidden in the crease beneath the buttock.

The main difference: TUG includes a small muscle transfer, while PAP uses only skin and fat, preserving muscle function. Both are excellent options for patients who are not candidates for abdominal-based reconstruction.

09/06/2026

Thankyou to my patient for allowing me to share her long term outcome after thumb base stabilisation .The Eaton–Littler ligament reconstruction is a hand procedure used to treat instability of the thumb carpometacarpal (CMC) joint—the joint at the base of the thumb. It is most often performed when the thumb base is unstable because of ligament injury ( as in this case ) , hypermobility, or early degenerative changes that have not responded to splinting, therapy, or other conservative treatments. Goals of the operation

* Reduce pain
* Improve thumb stability
* Improve pinch and grip function
* Potentially slow the progression of arthritis caused by chronic instability Images shared with patient permission

27/05/2026

A DIEP flap (Deep Inferior Epigastric Perforator flap) is often considered one of the best options after a failed implant-based breast reconstruction because it replaces the implant with living tissue from your own body, which can solve several problems that implants cannot.

Here’s why it’s commonly recommended after implant failure:

1. It brings in healthy, well-vascularized tissue

A DIEP flap uses skin and fat from the lower abdomen along with its blood vessels. The tissue is reconnected microsurgically to chest vessels.

That healthy blood supply can:

* improve healing in damaged or radiated chest tissue
* reduce tightness and pain
* help after infection, wound breakdown, or implant exposure
* soften severe scar tissue/capsular contracture

2. Better option after radiation

Radiation often causes:

* poor skin quality
* fibrosis/stiffness
* higher implant complication rates
* recurrent capsular contracture

Implants tend to perform poorly in radiated tissue, while DIEP reconstruction usually tolerates radiation damage much better because it adds new healthy tissue.

3. Lower long-term failure and maintenance

Implants may eventually need:

* replacement
* revision surgery
* treatment for rupture or contracture

A successful DIEP flap is living tissue and usually ages more naturally with the body, often requiring fewer future operations.

4. More natural feel and appearance

Compared with implants, DIEP flaps often:

* feel softer and warmer
* move more naturally
* can better recreate breast shape after scarring or tissue loss

This matters especially after a difficult implant course.

5. Can salvage difficult situations

DIEP is frequently used when implants fail because of:

* infection
* implant exposure
* repeated capsular contracture
* radiation damage
* chronic pain
* thin skin or poor tissue coverage

In many of these cases, simply replacing the implant has a high chance of failing again. For patient enquiries email 📧 [email protected]

Mr Nikkhah runs a weekly minor ops list .london . Many plastic surgery procedures can be performed under local anaesthet...
23/05/2026

Mr Nikkhah runs a weekly minor ops list .london . Many plastic surgery procedures can be performed under local anaesthetic from mole biopsies to skin cancer removal and reconstruction. Email 📧 for appointments : [email protected]
Call ☎️ for enquires : 02045403903

For more info visit my website www.plasticreconsurg.co.uk

Working together as a team in complex microvascular surgery can help us through challenging cases and to help patients t...
22/05/2026

Working together as a team in complex microvascular surgery can help us through challenging cases and to help patients through otherwise difficult operations.

21/05/2026

Ni**le reconstruction is a surgical or tattoo-based procedure used to recreate the appearance of a ni**le and ar**la, most commonly after a mastectomy and breast reconstruction for breast cancer treatment. It can also be done after trauma, burns, gender-affirming surgery, or congenital conditions.

Common approaches include:

* Surgical ni**le reconstruction: A surgeon reshapes small flaps of skin on the reconstructed breast to form a raised ni**le.
* Ar**la tattooing: Medical tattooing adds color and shading to create the ar**la (the darker skin around the ni**le) and can also create a realistic 3D ni**le effect.
* Ni**le grafting: Tissue from another body area or part of the opposite ni**le may be used in some cases.
* Prosthetic ni**les: Removable silicone ni**les are another non-surgical option.

The procedure is usually done after the reconstructed breast has healed and settled into its final shape, often several months after breast reconstruction surgery.

Results vary, but important considerations include:

* Reconstructed ni**les may flatten somewhat over time.
* Sensation is often reduced or absent compared with a natural ni**le.
* Tattoo pigment may fade and need touch-ups.
* Risks include infection, poor healing, asymmetry, or loss of projection.

Some people choose ni**le reconstruction because it helps them feel more “finished” after reconstruction, while others prefer to skip it entirely. Both choices are common and valid. **lereconstruction Mr Nikkhah founded the London Microsurgery Group in 2021. He is a leading UK specialist in reconstructive microsurgery after cancer and trauma. His private practice is located in North London at St John and Elizabeth Hospital and The Royal Free Private Patients unit.

Email for appointments : [email protected]
Call for enquires : 02045403903

For more info visit my website www.plasticreconsurg.co.uk

we specialise in microsurgical breast reconstruction with the DIEP flap (tissue transplant from the abdomen) for :* fai...
19/05/2026

we specialise in microsurgical breast reconstruction with the DIEP flap (tissue transplant from the abdomen) for :

* failed implant reconstruction
* capsular contracture,
* radiotherapy deformity,
* asymmetry,
* animation deformity,
* previous failed flap reconstruction . Mr Nikkhah founded the London Microsurgery Group in 2021. He is a leading UK specialist in reconstructive microsurgery after cancer and trauma. His private practice is located in North London at St John .london and Elizabeth Hospital and The Royal Free Private Patients unit.

Email 📧 for appointments : [email protected]
Call ☎️ for enquires : 02045403903

For more info visit my website www.plasticreconsurg.co.uk

Patient reviews

The DIEP flap involves an abdominal free tissue transplant for breast reconstruction. The donor site can be closed like ...
17/05/2026

The DIEP flap involves an abdominal free tissue transplant for breast reconstruction. The donor site can be closed like a tummy tuck. DIEP flap provides a like for like reconstruction of the breast after cancer. He accepts referrals from both the U.K. and international ✈️ patients. We offer dual consultant operating and work with all major insurers . What makes us unique we perform Co Surgeon operating , minimal access techniques by hand 🤚 or lap/robot , imaging systems such as ICG.

Email 📧 for appointments : [email protected]
☎️ for enquires : 02045403903

For more info visit my website www.plasticreconsurg.co.uk

Patient reviews
.london illustration by .ruston

We are one of the few centres in the UK that offer private orthoplastic services for hand 🤚 surgery . This includes all...
16/05/2026

We are one of the few centres in the UK that offer private orthoplastic services for hand 🤚 surgery . This includes all aspects of complex extremity reconstruction, hand trauma and elective hand surgery . I work closely with my colleagues Yazan Al Ajam and to achieve the best outcomes . fixation Call ☎️ for enquires : 02045403903 or email 📧 [email protected]

09/05/2026

During your DIEP flap breast reconstruction, we may also perform procedures to help treat or prevent lymphedema. Two common techniques are lymphovenous bypass and lymph node transfer.

Lymphovenous bypass, or LVB, is a microsurgical procedure where tiny lymphatic vessels are connected directly to nearby veins. This creates a new pathway for lymphatic fluid to drain, helping reduce swelling in the arm.

Lymph node transfer involves transplanting healthy lymph nodes — often from the lower abdomen during the DIEP flap procedure — into the underarm area. These lymph nodes can help restore lymphatic drainage and improve long-term function. Mr Nikkhah founded the London Microsurgery Group in 2021. He is a leading UK specialist in reconstructive microsurgery after cancer and trauma. His private practice is located in North London at St John and Elizabeth Hospital and The Royal Free Private Patients unit.

Email for appointments : [email protected]
Call for enquires : 02045403903

For more info visit my website www.plasticreconsurg.co.uk

Patient reviews

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Hospital Of Street John And Elizabeth, Royal Free Private Patients Unit
London
NW89NH

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