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Aesthetic Surgery Journal. Open Forum 2023The ideal breast implant does not exist and the choice of implant for breast augmentation is largely based on what surgeons think will be best for their patients.
BACKGROUND
The ideal breast implant does not exist and the choice of implant for breast augmentation is largely based on what surgeons think will be best for their patients.
OBJECTIVES
To evaluate the preliminary results of a new, smooth, round, and opaque breast implant (PERLE, GC Aesthetics; Dublin, Ireland) from a single-center UK aesthetic practice.
METHODS
Retrospective cohort study of all patients undergoing breast implant surgery with PERLE at the authors' center between January 2021 and December 2022. Outcomes data such as rates of capsular contracture, infection, revision surgery, and synchronous mastopexy were analyzed.
RESULTS
Of the 385 patients identified, 374 (97.1%) had PERLE implants placed by 3 surgeons for primary ( = 290) and secondary breast augmentation ( = 21), and augmentation-mastopexy ( = 63). Capsular contracture occurred in no cases, infection in 1 (0.2%), and revision surgery in 21 patients (5%). The incision used was always submammary, unless a synchronous mastopexy was performed; implants were placed in the subglandular/subfascial plane in the majority of cases (85.3%), and the rest were dual plane (14.7%). Eight revisions were performed in patients undergoing breast augmentation (due to implant displacement in 6 patients, and hematoma and infection in 1 patient each). Fourteen revisions were performed in those undergoing augmentation-mastopexy. The average follow-up time was 18 months.
CONCLUSIONS
The authors' early, single-center experience with PERLE implants suggests a safety profile and overall complication rate that is comparable with other modern implants. They will continue to monitor the safety and effectiveness of PERLE and discuss the reasons and evolution in the choice of breast implant.
PubMed: 38828093
DOI: 10.1093/asjof/ojad090 -
Plastic and Reconstructive Surgery.... Feb 2023We report on a rare case of primary varicella infection manifestation in the early postoperative period after mastopexy with simultaneous breast augmentation that caused...
We report on a rare case of primary varicella infection manifestation in the early postoperative period after mastopexy with simultaneous breast augmentation that caused dehiscence of surgical wound edges and spread of infection to a subcutaneous fat layer, leading to unaesthetic scarring. Whether such dehiscence in the background of varicella occurred coincidentally or was specifically triggered by the infection is unknown. The treatment is comprised of oral antiviral therapy, surgical wound debridement, and topical application of antiseptic solutions and ointments. We would like to raise awareness of the existence of such a rare case of chickenpox in an early postoperative period of a plastic surgery patient. Thereby, physicians can recognize it, test for it, and treat it promptly and appropriately. Also, we recommend taking a detailed history of infectious diseases.
PubMed: 36751506
DOI: 10.1097/GOX.0000000000004807 -
Plastic Surgery (Oakville, Ont.) Aug 2022The Dermabond (2-octyl cyanoacrylate) is a commonly used skin adhesive in plastic surgery. There are some reports in the literature regarding Dermabond associated...
The Dermabond (2-octyl cyanoacrylate) is a commonly used skin adhesive in plastic surgery. There are some reports in the literature regarding Dermabond associated contact dermatitis. In this retrospective cohort study, we evaluated the incidence and characteristics of contact dermatitis (type IV hypersensitivity reaction) post application of Dermabond (Trade name PRINEO manufactured by ETHICON) in patients who underwent plastic surgical breast procedures in our hospital. Sixty patients had undergone plastic surgical breast procedures (mastopexy and reduction mammoplasty) with Dermabond application over the period of last 3 years in our hospital. The records of these 60 patients were studied retrospectively. Four patients (6.6%) out of the 60 patients taken for study had developed type IV hypersensitivity reaction to Dermabond. All of these patients presented with pruritus and skin rash in the second week of their post-operative period and none of them had any known past allergic history. We conclude that the incidence of type IV hypersensitivity allergic reaction post application of Dermabond (2-octyl cyanoacrylate) is significantly high and its possibility should be explained to the patients prior to its application.
PubMed: 35990393
DOI: 10.1177/22925503211015448 -
Eplasty 2022Medially positioned nipple areola complex (NAC) is an anatomic configuration common in women who have undergone significant weight loss. The superomedial pedicle (SMP)...
BACKGROUND
Medially positioned nipple areola complex (NAC) is an anatomic configuration common in women who have undergone significant weight loss. The superomedial pedicle (SMP) technique is thought to have excellent long-term outcomes but is considered unsafe in patients with a medially positioned NAC. In a patient with a medially positioned NAC, the SMP technique can be challenging to achieve sufficient arc of rotation of the NAC.
METHODS
Medial canting of both vertical limbs of the Wise pattern as well as broadening the base of the pedicle are 2 key modifications to the standard SMP technique that create sufficient arc of rotation of the NAC. Demographics (age, body mass index), operative details (weight of tissue excised from each breast), and outcomes (perioperative complications, incidence of partial or total NAC loss, and aesthetics) were recorded for each patient. A modified superomedial pedicle breast procedure was performed on 8 women with medially positioned NAC (16 breasts); 6 underwent breast reduction, and 2 underwent mastopexy. Mean age was 38.0 years (range 21-50), mean BMI was 28.1 (range 23-35). The mean weight of tissue removed was 509 grams (range 245-889 grams) in patients undergoing a reduction and 105 grams (range 83-131 grams) in patients undergoing mastopexies.
RESULTS
There was 1 perioperative complication (hematoma) and no instances of partial or complete NAC loss. All patients had satisfactory breast shape and NAC position.
CONCLUSIONS
Modifications to the standard SMP design that include medial canting of the vertical limbs and lateral extension of the base of the pedicle allow SMP breast reduction or mastopexy to be safely and successfully performed in women with medially positioned NAC.
PubMed: 35811642
DOI: No ID Found -
Aesthetic Surgery Journal Aug 2022Breast Implant Illness (BII), as described in recent medical literature and by social media, describes a range of symptoms in patients with breast implants for which...
BACKGROUND
Breast Implant Illness (BII), as described in recent medical literature and by social media, describes a range of symptoms in patients with breast implants for which there are no physical findings or laboratory results that explain their symptoms.
OBJECTIVES
Part 2 of this study aims to determine whether heavy metals are present in the capsules around saline and silicone implants and if there are statistical differences in the type or level of these metals between women with or without symptoms. Demographic data was collected to investigate potential alternate sources of metals: inhaled, absorbed, or ingested.
METHODS
A prospective, blinded study enrolled 150 consecutive subjects divided equally into in three cohorts: (A) women with systemic symptoms they attribute to their implants who requested implant removal, (B) women with breast implants requesting removal or exchange who do not have symptoms they attribute to their implants, and (C) women undergoing cosmetic mastopexy who have never had any implanted medical device. Capsule tissue was removed from Cohort A and B for analysis of 22 heavy metals. Additionally, breast tissue was obtained from a control group with no previous exposure to any implanted medical device.
RESULTS
The study was performed between 2019-2021. Heavy metal content was compared between the capsule tissue from Cohort A and B. The only statistically significant differences identified in Cohort A were higher levels of arsenic and zinc, and lower levels of cobalt, manganese, silver, and tin. There were no elevated levels or statistically significant differences in the other metals tested between Cohorts A and B.
CONCLUSIONS
This study analyzes the metal content in capsules surrounding both saline and silicone breast implants. Heavy metals were also detected in the non-implant control group breast tissue, with some metals at numerically higher levels than either breast implant cohort. Smoking, gluten free diets, dietary supplements, and the presence of tattoos were all identified as statistically significant sources of arsenic and zinc in Cohort A. The risk of heavy metal toxicity should not be used as an indication for total capsulectomy if patients elect to remove their breast implants.
Topics: Arsenic; Breast Implants; Female; Humans; Metals, Heavy; Prospective Studies; Silicones; Zinc
PubMed: 35474526
DOI: 10.1093/asj/sjac106 -
Plastic and Reconstructive Surgery.... May 2023Breast reductions, including oncoplastic breast surgery (OBS), have high postoperative wound healing complication (WHC) rates, ranging from 17% to 63%, thus posing a...
UNLABELLED
Breast reductions, including oncoplastic breast surgery (OBS), have high postoperative wound healing complication (WHC) rates, ranging from 17% to 63%, thus posing a potential delay in the onset of adjuvant therapy. Incision management with closed incision negative pressure therapy (ciNPT) effectively reduces postoperative complications in other indications. This retrospective analysis compares postoperative outcomes and delays in adjuvant therapy in patients who received ciNPT on the cancer breast versus standard of care (SOC) after oncoplastic breast reduction and mastopexy post lumpectomy.
METHODS
Patient demographics, ciNPT use, postoperative complication rates, and time to adjuvant therapy were analyzed from the records of 150 patients (ciNPT = 29, SOC = 121). Propensity score matching was used to match patients based on age, body mass index, diabetes, tobacco use, and prior breast surgery.
RESULTS
In the matched cohort, the overall complication rate of ciNPT-treated cancerous breasts was 10.3% (3/29) compared with 31% (9/29) in SOC-treated cancerous breasts ( = 0.096). Compared with the SOC-treated cancerous breasts, the ciNPT breasts had lower skin necrosis rates [1/29 (3.4%) versus 6/29 (20.7%); = 0.091] and dehiscence rates [0/29 (0%) versus 8/29 (27.6%); = 0.004]. In the unmatched cohort, the total number of ciNPT patients who had a delay in adjuvant therapy was lower compared to the SOC group (0% versus 22.5%, respectively; = 0.007).
CONCLUSION
Use of ciNPT following oncoplastic breast reduction effectively lowered postoperative wound healing complication rates and, most importantly, decreased delays to adjuvant therapy.
PubMed: 37250834
DOI: 10.1097/GOX.0000000000005028 -
Aesthetic Surgery Journal. Open Forum 2023Instagram (Menlo Park, CA) has become a popular means of advertisement for aesthetic surgery procedures, influencing patients' likelihood of undergoing a procedure. In...
BACKGROUND
Instagram (Menlo Park, CA) has become a popular means of advertisement for aesthetic surgery procedures, influencing patients' likelihood of undergoing a procedure. In this study, the authors aim to explore public interest in aesthetic procedures before and after the Instagram platform started gaining in popularity through Google Trends (Google, Mountain View, CA), a platform with previously demonstrated utility for tracking interest in surgical procedures.
OBJECTIVES
The authors hypothesize that as a result of increased medical marketing on Instagram, there is an increase in public interest in elective procedures of plastic surgery.
METHODS
Trends in the United States for given search terms and volumes were gathered through Google Trends between April 2004 and January 2022. Search terms included popular aesthetic procedures based on the 2020 Aesthetic Plastic Surgery National Data Bank Statistics. The search volumes were normalized, and a bivariate regression analysis of panel data was then applied to the aggregate trendlines to determine whether a statistically significant change in search volume occurred following the increase in user traffic of the Instagram platform.
RESULTS
The authors found significant variations in search volume for plastic surgery procedures before and after April 2012. Blepharoplasty, Botox, brachioplasty, breast implant removal, breast reduction, brow lift, butt lift, hair transplantation, lip augmentation, male breast surgery, mastopexy, mentoplasty, otoplasty, platysmaplasty, rhinoplasty, and thighplasty ( < .000) had statistically significant increases in search volume, whereas buccal fat removal ( = .003) had a statistically significant decrease in search volume after April 2012.
CONCLUSIONS
The authors observed a significant increase in public interest in both surgical and nonsurgical aesthetic procedures after Instagram gained popularity in the April of 2012.
PubMed: 36789103
DOI: 10.1093/asjof/ojad004 -
Cureus Oct 2021Radiation-induced sarcoma of the breast is a rare complication that is primarily treated with surgical resection but in patients with advanced disease, a multimodality...
Radiation-induced sarcoma of the breast is a rare complication that is primarily treated with surgical resection but in patients with advanced disease, a multimodality treatment approach is often required. This case report discusses a 37-year-old female with a history of a pT3N3M0, estrogen receptor (ER)+, progesterone receptor (PR)+, human epidermal growth factor receptor 2 (HER2)+, right breast cancer, and a germline tumor protein (TP) p53 mutation who underwent right modified radical mastectomy, adjuvant systemic therapy, and radiation therapy, and subsequently developed a radiation-induced sarcoma. The patient is a 37-year-old female who has a history of pT3N3M0, ER/PR+, HER2+, and right breast cancer diagnosed in 2014. At the time of diagnosis, she had locally advanced disease and underwent right modified radical mastectomy followed by adjuvant chemotherapy, radiation, delayed right breast implant-based reconstruction, and left breast augmentation with mastopexy. Upon completion of adjuvant chemotherapy, she was started on hormonal therapy. In February 2020, she underwent genetic testing given her early onset of breast cancer and was found to have a germline TP53 mutation. Routine MRI for breast implant evaluation showed two irregular enhancing masses with an additional satellite lesion in the right breast. Right breast ultrasound (US)-guided biopsy revealed two separate foci of high-grade pleomorphic fibroblastic/myofibroblastic sarcoma. Further staging workup with a whole-body MRI was negative for evidence of metastatic disease. Her case was discussed in multidisciplinary sarcoma tumor board and consensus was for surgical resection. She underwent radical resection of the right chest wall masses and subcutaneous tissue, removal of right breast implant and capsulectomy, and left breast mastectomy with left breast implant removal and capsulectomy. The final pathology revealed two separate foci of high-grade pleomorphic fibroblastic/myofibroblastic sarcoma, 1.2 cm and 1.1 cm in their greatest dimensions with negative margins. Her case was re-discussed in multidisciplinary sarcoma tumor board and due to T1 size of the tumors and the negative resection margins, close surveillance with annual whole-body MRI and quarterly chest MRI imaging was recommended. In patients with a germline TP53 mutation and breast cancer, the utilization of adjuvant radiotherapy should be considered cautiously given the increased risk of radiation-associated sarcoma.
PubMed: 34765345
DOI: 10.7759/cureus.18563 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... Oct 2021To summarize the difficulties and key points of free deep inferior epigastric artery perforator flap (DIEP) transplantation in breast shaping of two-staged breast...
OBJECTIVE
To summarize the difficulties and key points of free deep inferior epigastric artery perforator flap (DIEP) transplantation in breast shaping of two-staged breast reconstruction with vertical scar.
METHODS
The clinical data of 32 postoperative breast cancer patients after mastectomy who underwent free DIEP transplantation for breast reconstruction between October 2015 and October 2019, whose original surgical incisions were all vertical and longitudinal, were retrospectively analysed. All the patients were female, aged from 31 to 42 years, with an average of 34.6 years. The disease duration of breast cancer ranged from 9 to 48 months (mean, 22.8 months). Free DIEP pedicled with contralateral vessels were used in all cases, and the recipient vessels were intrathoracic vessels. Among them, 17 flaps were placed longitudinally, 15 flaps were placed obliquely; Z-shaped flaps were used in 18 cases to adjust the chest wall skin contracture, and contralateral breast reduction and mastopexy were accomplished at the same time in 23 cases.
RESULTS
All DIEP survived completely, and all donor and recipient sites healed by first intention. Internal thoracic lymph node metastasis was found in 1 case and treated with radiotherapy. All 32 cases were followed up 9-48 months, with an average of 19.4 months. The appearance and texture of all flaps were satisfactory, and only linear scar was left in donor site. Eleven patients underwent further autologous fat transplantation and nipple reconstruction. All patients had no effect on abdominal wall activity, and no local recurrence and metastasis was found.
CONCLUSION
It is difficult to use free DIEP for two-staged breast reconstruction in patients received mastectomy with vertical longitudinal scar left. Combined with different breast shaping techniques, the outcomes can significantly improve.
Topics: Breast Neoplasms; Cicatrix; Epigastric Arteries; Female; Humans; Mammaplasty; Mastectomy; Neoplasm Recurrence, Local; Perforator Flap; Retrospective Studies
PubMed: 34651488
DOI: 10.7507/1002-1892.202105016 -
Plastic and Reconstructive Surgery.... Nov 2019Mastopexy is one of the most performed cosmetic surgery procedures in the United States. Despite the numerous mastopexy techniques that were published in the past...
UNLABELLED
Mastopexy is one of the most performed cosmetic surgery procedures in the United States. Despite the numerous mastopexy techniques that were published in the past decades, preventing pseudoptosis to ensure longer lasting results remains the principal challenge.
OBJECTIVES
This paper describes a new mastopexy technique developed for moderate to severe ptosis/pseudoptosis associated with upper pole deflation. Considering some of the commonest risk factors generally considered predictive of worse outcomes (massive weight loss, multiple pregnancies, skin quality, smoking, age), we aimed to assess whether this technique could be beneficial in the support of the desired breast shape over time.
METHODS
Twelve patients, all featuring 1 or more of the abovementioned preoperative risk factors, were operated on by the same senior surgeon with the hammock mastopexy technique using dermal flaps as a support for the glandular reshaping (6 bilateral mastopexies and 6 unilateral mastopexies for contralateral symmetrization after breast reconstruction). Patients' characteristics, such as smoking, weight loss, or multiparity with consequent inelastic skin, age, and lengthy nipple-areola complex lift, were considered as independent risk factors for ptosis recurrence and bottoming out. Patients were divided into 3 subgroups according to the number of their risk factors. Aesthetic results were assessed at 12 months postoperatively. Changes in postoperative were assessed for each patient by breast measurements and a superposition of the standardized breast photographs. Long-term outcomes were compared with a control group of 6 patients who benefited from mastopexy without "hammock technique."
RESULTS
Satisfactory maintenance of shape and stable nipple-areola complex position was seen at 12 months regardless of the number of risk factors. However, a statistically significant difference was found in lower pole lengthening between patients with more than 3 risk factors compared to other groups. Aesthetic measurement results were consistent between the patient and surgeon reporting a satisfying cosmetic result, regardless of the number of risk factors. In the control group, we found a significant increase in breast lower pole measurements at 12 months when compared with the hammock group.
CONCLUSIONS
This mastopexy technique improves projection and reinforces the lower pole support with lateral and medial dermal flaps. The technique is safe and reliable and provides easily reproducible results for patients with risk factors for postoperative pseudoptosis.
PubMed: 31942285
DOI: 10.1097/GOX.0000000000002473