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Plastic and Reconstructive Surgery.... May 2023Nipple-sparing mastectomy is psychologically advantageous and can result in superior cosmetic outcomes. However, nipple position adjustment is challenging, and ischemic...
UNLABELLED
Nipple-sparing mastectomy is psychologically advantageous and can result in superior cosmetic outcomes. However, nipple position adjustment is challenging, and ischemic complications may arise. For patients who require timely mastectomies and reconstructions, concurrent mastopexy may prevent nipple malposition and reduce the risk for future corrections.
METHODS
A retrospective chart review of all patients undergoing immediate prosthetic reconstruction after nipple-sparing mastectomy were analyzed. Data regarding patient characteristics; surgical indications; reconstructive modality, including presence or absence of simultaneous nipple lift; and early and late complications were examined.
RESULTS
In total, 142 patients underwent 228 nipple-sparing mastectomies and prosthetic reconstructions. Correction of ptosis (lift) was performed in 22 patients and 34 breasts. The remaining 122 patients and 194 breasts did not receive mastopexy (no-lift). Two patients received bilateral reconstructions involving both lift and no-lift. Comparing the lift and no-lift cohorts demonstrated no differences in major complications (47.1% versus 57.7%; = 0.25) and minor complications (76.5% versus 74.7%; = 0.83). Control for plane of implant placement also did not show differences in major ( = 0.31) or minor ( = 0.97) complications. Similarly, control of application of acellular dermal matrix found major ( = 0.25) and minor ( = 0.83) complications uniform and not affected by lift status. Nipple lift distance was not associated with increased major ( = 0.10) complications.
CONCLUSION
Simultaneous correction of nipple position in immediate prosthetic breast reconstruction seem safe with uniform complications rates that are unaffected by acellular dermal matrix use or plane of implant placement.
PubMed: 37235135
DOI: 10.1097/GOX.0000000000005000 -
Plastic and Reconstructive Surgery.... Sep 2022Single-stage layered mastopexy with augmentation is a modification of muscle-splitting pocket that reduces risk of complications and revision rate.
UNLABELLED
Single-stage layered mastopexy with augmentation is a modification of muscle-splitting pocket that reduces risk of complications and revision rate.
METHODS
A retrospective chart review of all the consecutive cases, performed by a single surgeon, from March 2007 to August 2019, was conducted. All patients had surgery with superomedial pedicle in an approved facility. The patients were divided into group A whose implants were placed through the mastopexy incision, and group B whose implants were placed first and access closed prior to mastopexy.
RESULTS
Nonlayered group A included 116 patients and layered group B included 102 patients. Groups A and B had a mean age of 32.3 + 9.70 and 34.8 + 10.39 years (range, 20-66), respectively ( value 0.070). In groups A and B, 95 (81.9%) and 74 (72.5%) patients underwent primary and 21 (18.1%) and 28 (27.5%) patients underwent secondary procedures, respectively ( value 0.099). There were no hematomas in group A and two patients had hematoma in group B ( value 0.218). In group A, one patient experienced periprosthetic infection with none in group B ( value 0.41). Wound breakdown was observed in ten (8.6%) patients in group A and four (3.9%) patients in group B ( value 0.128). In group A, there was a partial or complete nipple loss in two (1.7%) and none in group B ( value 0.412). In group A, 15 (12.9%) underwent revision surgery and six (6.5%) in group B ( value 0.127).
CONCLUSION
Layered mastopexy with augmentation provides improved safety, fewer complications and revisions with adequate results.
PubMed: 36168613
DOI: 10.1097/GOX.0000000000004514 -
Plastic and Reconstructive Surgery.... Jun 2021Although a boxy breast is a common aesthetic problem following breast reduction and mastopexy, literature regarding this deformity is scarce. It is vaguely described as...
BACKGROUND
Although a boxy breast is a common aesthetic problem following breast reduction and mastopexy, literature regarding this deformity is scarce. It is vaguely described as a definitive postreduction deformity. To address this complication, it is important to fully analyze the problem, understand and predict its causes, and then try to prevent it.
METHODS
This study included two groups. Group 1 included 14 patients presenting with boxy postoperative breasts. Revision surgeries were conducted for all patients, and the first algorithm was created for quantifying breast surgery in revision cases. Group 2 included 37 cases of primary mammaplasty reduction/mastopexy performed between 2016 and 2019. All the patients in this group were treated as per the study algorithm.
RESULTS
Patient satisfaction was measured on a scale of one to 10, with one being extremely dissatisfied and 10 being extremely satisfied. The results indicated overall satisfaction, with average scores of 9.5 and 9.1 in groups 1 and 2, respectively; the scores of surgeon satisfaction were 8.2 and 8.6, respectively.
CONCLUSIONS
The proposed algorithm, preoperative markings, intraoperative techniques, and postoperative orientation may help achieve optimal results and prevent undesired deformities or asymmetry. Applying a flexible and simplified algorithm provided a more objective plan, which enabled surgeons to attain more satisfactory results. Following a preset quantified plan supported and shortened learning curves and objectively addressed the common postoperative complication, breast boxing.
PubMed: 34168940
DOI: 10.1097/GOX.0000000000003640 -
Plastic and Reconstructive Surgery.... Nov 2019Augmentation mastopexy is one of the most difficult challenges plastic surgeons face, especially concerning sustainability of upper pole fullness and lower pole ptosis...
UNLABELLED
Augmentation mastopexy is one of the most difficult challenges plastic surgeons face, especially concerning sustainability of upper pole fullness and lower pole ptosis correction. We describe our technique for augmentation mastopexy that provides inferolateral muscular support for the implant and standardizes a sequence of surgical stages to resolve multiple situations and present the outcomes of patients who underwent such an approach.
METHODS
Our technique proposes the following: (a) modified subpectoral pocket, with muscular inferolateral support for the implant; (b) independent approaches to the submuscular (implant) pocket and parenchymal resection/reshaping; and (c) pre-established 4-step surgical sequence. Data from office files of our private practice were collected for 266 patients who underwent the technique from October 2015 to January 2019. Patient perception about esthetic outcomes, photographs from multiple postoperative follow-ups, and surgical complications/reoperation rates were analyzed.
RESULTS
Overall mid-term and long-term results (39 months) were positive for lift and augmentation at single time mastopexy; >90% of patients reported satisfaction with their esthetic outcomes, including absence of ptosis. No major complications occurred. The total revision rate was 16%, but it became <5% in 2018 as the learning curve progressed.
CONCLUSIONS
Augmentation mastopexy is complex, and the myriad of approaches and possibilities may cause confusion when selecting the most suitable one. The 4-step sequence provides a reliable option, offering a predefined execution plan, whereas inferolateral muscular support prevents recurrence of lower pole ptosis. Other surgeons' experience with lift and augmentation at single time mastopexy and further studies are necessary to validate these findings.
PubMed: 31942312
DOI: 10.1097/GOX.0000000000002523 -
BMC Health Services Research Mar 2022Expansion of healthcare insurance coverage to bariatric surgeries has led to an increased demand from patients for post-bariatric contouring surgeries. This study...
BACKGROUND
Expansion of healthcare insurance coverage to bariatric surgeries has led to an increased demand from patients for post-bariatric contouring surgeries. This study examined the relationship between the use of contouring procedures on post-bariatric surgery patients, clinical need and sociodemographic factors.
METHODS
Data were extracted from the Healthcare Cost and Utilization Project (HCUP) Nationwide Ambulatory Surgery Sample (NASS) regarding hospital-owned ambulatory surgical centres in the US. Episodes without missing values relating to patients, 18 years old or above were the primary unit of analysis. Episodes were excluded if the field regarding expected payer was reported as "no charge." The primary outcome was the likelihood of panniculectomy, abdominoplasty, and mastopexy among post-bariatric surgery patients; and the degree to which uptake of these types of contouring surgery were associated with age, gender, median households' income, expected payer, patient's location, and comorbidity.
RESULTS
A total of 66,368 weighted episodes of care received by patients who had had bariatric surgery were extracted (54,684 female [82.4%]; mean age, 51.3 [SD, 12.1]; 6219 episodes had contouring surgeries [9.37%]). Panniculectomy was the most common post-bariatric contouring procedure (3.68%). Uptake of post-bariatric contouring procedures was associated with age, sex, payment type, area-based measures of median household income, and patient location. Compared to Medicare insured patients, the odds of receiving contouring surgery among self-payers were 1.82 (95% CI, 1.47 to 2.26) for panniculectomy, 14.79 (95% CI, 12.19 to 17.93) for abdominoplasty and 47.97 (95% CI, 32.76 to 70.24) for mastopexy. Rank order of comorbidity profiles also differed between insured and self-paying recipients of contouring surgery.
CONCLUSIONS
Insurance status of bariatric surgery patients and their sex were strongly associated with receipt of a range of contouring procedures. Self-payments were associated with a doubling of the odds of having panniculectomy and an increase in the odds to approximately 14 times for abdominoplasty and 48 times for mastopexy. Thus, access to contouring surgery by post-bariatric patients may be disproportionately dependent on personal preference supported by ability to pay rather than clinical need. Further research is needed to examine the impact of contouring or delayed/denied contouring on health status.
Topics: Abdominoplasty; Adolescent; Aged; Bariatric Surgery; Comorbidity; Female; Humans; Insurance Coverage; Medicare; Middle Aged; Obesity, Morbid; Retrospective Studies; United States
PubMed: 35255893
DOI: 10.1186/s12913-022-07692-1 -
Plastic and Reconstructive Surgery.... Feb 2020The treatment of breast ptosis and gland hypoplasia in a single surgery is a challenging procedure and the result is less predictable. In this surgery, the complications...
BACKGROUND
The treatment of breast ptosis and gland hypoplasia in a single surgery is a challenging procedure and the result is less predictable. In this surgery, the complications mainly concern the prosthesis, such as implant deflation, capsular contracture, palpability, or malposition. We, therefore, propose a different and new technique that avoids breast prosthesis, combining mastopexy and autologous augmentation with fat grafts.
METHODS
Combined mastopexy and autologous fat graft augmentation (lipopexy) was performed in women affected by breast ptosis and asymmetric breast or hypomastia. The breast lift technique was determined due to the ptosis level. The process of fat grafting was executed according to the PureGraft and, in some cases, to GID System, to Celution System or Carraway's techniques.
RESULTS
Thirty-four patients affected by breast ptosis and hypomastia underwent lipopexy from January 2010 to May 2017. The mean volume of adipose tissue injected for each breast was 225.98 ml. After surgery, the patients were followed for an average of 22.8 months. A mild ptosis relapse with partial fat absorption was observed in 4 cases (11.76%) and the presence of oily cysts was diagnosed in 2 patients (5.88%). One severe complication was recorded (hematoma drainage). All the patients healed uneventfully in 2 weeks.
CONCLUSIONS
This technique allows the surgeon to distribute the desired fat volume along the breasts, avoids implants, and displayed stable results. This treatment has been demonstrated not to interfere with follow-up breast imaging. We, therefore, consider lipopexy a valuable and safe alternative to mastopexy and mild to moderate breast volume augmentation.
PubMed: 32309065
DOI: 10.1097/GOX.0000000000001957 -
Journal of Cutaneous and Aesthetic... 2023Ptosis and volume atrophy of the breasts are common symptoms for various ages of women and may induce a considerable amount of stress in daily life. Periareolar...
BACKGROUND
Ptosis and volume atrophy of the breasts are common symptoms for various ages of women and may induce a considerable amount of stress in daily life. Periareolar augmentation mastopexy is an effective procedure for such conditions, and planning the new nipple position is very important.
AIM
To provide a simple, straightforward planning and walkthrough of this operation in a journey to find the ideal level of breast lifting for natural upper fullness.
MATERIALS AND METHODS
From January 2019 to December 2021, a total of 193 patients with volume deflation and ptosis of the breast received periareolar augmentation mastopexy in our institute. We retrospectively reviewed data on demographics, surgical procedures, outcomes, and complications.
RESULTS
All operations were done with periareolar incisions, and the mean follow-up period was 29.48 ± 9.11 months. The Likert scale of outcome satisfaction scored 9.02 ± 0.61. Complications were minimal, and no symmastia or bottoming out occurred.
CONCLUSION
We present our basic strategies of periareolar augmentation mastopexy with a slight modification of the design. We believe that lifting the nipple to 3-4 cm above the inframammary fold (IMF) (making the top of the areola about 5-6 cm above the IMF) yields satisfactory aesthetic results.
PubMed: 38314368
DOI: 10.4103/JCAS.JCAS_42_23 -
Seminars in Plastic Surgery Feb 2020The role of fat grafting to the breasts has evolved in the recent past, gaining several new applications within both reconstructive and aesthetic surgery. Initially used... (Review)
Review
The role of fat grafting to the breasts has evolved in the recent past, gaining several new applications within both reconstructive and aesthetic surgery. Initially used for reconstructive purposes to fill lumpectomy defects or to correct residual contour deformities after breast reconstruction, it has since made its way into cosmetic breast surgery and has grown to encompass a wide variety of new indications. Fat grafting in aesthetic breast surgery may be performed as a form of primary autologous breast augmentation or as an adjunct to implant-based breast augmentation to disguise implant edges. It may also be used to provide added volume after explant surgery or to provide improvements in breast contour alongside mastopexy techniques. In this article, we will review the current applications of fat grafting in aesthetic breast surgery and provide an up-to-date summary of its reported outcomes, safety, and complications.
PubMed: 32071576
DOI: 10.1055/s-0039-1700958 -
Plastic and Reconstructive Surgery.... Feb 2022The muscle splitting technique is a submuscular pocket used for augmentation mammoplasty. Its use and results following primary and secondary procedures are presented.
BACKGROUND
The muscle splitting technique is a submuscular pocket used for augmentation mammoplasty. Its use and results following primary and secondary procedures are presented.
METHODS
A retrospective study that analyzed complication and revision rates following primary and secondary mastopexy with augmentation in a muscle splitting pocket performed between April 2007 and March 2020 was carried out. Data were divided into two groups: primary and secondary single-stage mastopexies with augmentation.
RESULTS
A total of 169 patients had a primary procedure and 49 had secondary procedures. The mean ages of patients in the primary and secondary were 32.3 ± 9.89 and 38.2 ± 9.63 years, respectively. Five (3.0%) patients had periprosthetic or wound infections in the primary group when compared with 0% in secondary surgery group. Wound breakdown was seen in 13 (7.7%) patients with a primary procedure compared with one patient (2%) with a secondary procedure. One patient had partial nipple loss and another had total nipple loss in the primary group (1.2%) when compared with one patient (2.0%) who had partial nipple loss in the secondary group. Revision surgeries were carried out in 16 (10.1%) of the primary procedures compared with five (10.2%) of the secondary procedures.
CONCLUSION
Even though there was a higher prevalence of complications in the primary procedures group than in the secondary procedures group, the overall complications following muscle splitting mastopexy with augmentation are within an acceptable range.
PubMed: 35242490
DOI: 10.1097/GOX.0000000000004138 -
Plastic and Reconstructive Surgery Feb 2022Because of the multiplying number of patients undergoing breast augmentation, nonprimary augmentation mastopexy will be increasingly requested in the future; this...
BACKGROUND
Because of the multiplying number of patients undergoing breast augmentation, nonprimary augmentation mastopexy will be increasingly requested in the future; this operation represents an even more significant challenge than primary augmentation mastopexy. The authors describe a standardized approach for subglandular-to-subpectoral implant pocket conversion in mastopexy that provides a tight neopocket with inferolateral muscular support, which minimizes implant displacement complications and allows operative strategies to reduce the risk of bacterial load on implants.
METHODS
The authors' technique proposes the following: (1) modified subpectoral pocket, with muscular inferolateral support for the implant; (2) independent approaches to the submuscular pocket and subglandular (preexisting) pocket; and (3) preestablished four-step surgical sequence. The authors collected data from their private practices for 46 patients who underwent the technique from March of 2017 to April of 2020. Patient perception about aesthetic outcomes, photographs from multiple postoperative follow-ups, and surgical complications/reoperation rates were analyzed.
RESULTS
Overall results were positive; 89.1 percent of patients reported satisfaction with their aesthetic outcomes. No major complications occurred. The total revision rate was 15.2 percent, but only 2.1 percent in the last year, as the learning curve progressed.
CONCLUSIONS
Secondary augmentation mastopexy is a complicated procedure. The four-step sequence approach is one reliable option for subglandular-to-subpectoral pocket conversion, once it produced high levels of patient satisfaction while producing low complication rates. Other surgeons' experiences with the technique and further studies are necessary to validate these findings.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Therapeutic, IV.
Topics: Adult; Breast Implantation; Female; Humans; Mammaplasty; Mammary Glands, Human; Middle Aged; Pectoralis Muscles; Retrospective Studies; Young Adult
PubMed: 35077413
DOI: 10.1097/PRS.0000000000008775