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Plastic and Reconstructive Surgery.... May 2024Three-dimensional (3D) imaging using computer simulations is an evolving technology. There is a lack of strong data on the use of this technology for oncoplastic (OP)...
BACKGROUND
Three-dimensional (3D) imaging using computer simulations is an evolving technology. There is a lack of strong data on the use of this technology for oncoplastic (OP) and reconstructive surgery.
METHODS
A prospective, randomized, single-center trial including breast cancer patients undergoing OP or mastectomy with immediate breast reconstruction with implant (IBR) enrolled from November 2019 to October 2021 at the Hospital Nossa Senhora das Graças, Breast Unit in Curitiba, Brazil. Both patients undergoing OP and those in the IBR group were randomized to undergo 3D imaging and simulation of postoperative results (intervention group) or 3D imaging without simulation (control group). All patients were invited to complete a patient-reported outcome (BREAST-Q) expectations module and breast reconstruction or reduction/mastopexy module before and 6 months after surgery.
RESULTS
A total of 96 patients were enrolled. Sixty-nine patients (45 OP and 24 IBR) completed the pre- and postoperative questionnaires and were randomized for the simulation. Women in the OP group had higher expectations for breast appearance when clothed than those in the IBR implant group (93.4 ± 16.3 versus 82.9 ± 26.5; = 0.03). The intervention group was more satisfied with information than the control group ( = 0.021). Both patients who underwent OP and IBR believed that the 3D simulation helped them understand the surgical process (86.6% and 75%, respectively).
CONCLUSIONS
Preoperative 3D simulation significantly improved patient's satisfaction with information and did not decrease postoperative satisfaction with the outcomes. The incorporation of preoperative 3D simulation may be a valuable tool in breast reconstruction.
PubMed: 38752215
DOI: 10.1097/GOX.0000000000005804 -
Cureus Apr 2024Pyoderma gangrenosum is a rare ulcerative skin disease of uncertain etiology, which in some cases can be misdiagnosed as an infectious process. In even more unique...
Pyoderma gangrenosum is a rare ulcerative skin disease of uncertain etiology, which in some cases can be misdiagnosed as an infectious process. In even more unique cases, this can occur in the postoperative period. Termed postsurgical pyoderma gangrenosum, this type of inflammatory skin condition requires a high index of suspicion to be able to appropriately treat and reduce complications. We present a 55-year-old female who presented with multiple wounds following mastopexy and abdominoplasty. With a prompt diagnosis and a multidisciplinary approach, we could accurately care for the patient and minimize poor aesthetic sequela.
PubMed: 38738036
DOI: 10.7759/cureus.58060 -
JPRAS Open Jun 2024Simultaneous breast augmentation with mastopexy is growing in popularity. It is a complex procedure that can lead to post-operative complications, patient...
Simultaneous breast augmentation with mastopexy is growing in popularity. It is a complex procedure that can lead to post-operative complications, patient dissatisfaction, and increased risk of litigation. The aim of this study is to describe an approach for the inverted-T augmentation-mastopexy technique, which limits intraoperative modifications, minimizes errors, and decreases post-operative complications and patient dissatisfaction. The study included 107 patients with Regnault's grade I and II ptosis and severe pseudoptosis. All patients were marked according to our novel technique, Mastopexy Augmentation Made Applicable and Safer (MAMAS), and operated by a single surgeon. All patients underwent simultaneous breast augmentation with Siltex Mentor Round Silicone Gel breast implants and mastopexy. Pre-operatively and post-operatively, patients filled the BREAST-Q. The mean follow-up was 24 months. Hundred and seven women received treatment in this study. Sixteen presented with post-operative complications, eleven in the early stage of recovery, and five in the late stage. There were eight cases of minor wound healing complications, all treated conservatively. Two cases of infection were noted, both were treated with oral antibiotics. One patient experienced post-operative bleeding after 13 days, which required surgical revision. In the late stage of recovery, five cases of implant displacement occurred and required revision surgery. No cases of capsular contracture and seromas were reported. According to Breast-Q, all patients were satisfied. MAMAS surgical technique, focusing on precise pre-operative marking for augmentation-mastopexy, is simple and easily reproducible. The procedure has a low complication rate and high patient satisfaction. It provides predictable and stable results over time.
PubMed: 38708383
DOI: 10.1016/j.jpra.2024.03.007 -
Scientific Reports Apr 2024In this article, we present a modification of the NS/SRM technique in which the mastopexy design for skin reduction is undertaken with a wide-base bipedicled (WIBB)...
In this article, we present a modification of the NS/SRM technique in which the mastopexy design for skin reduction is undertaken with a wide-base bipedicled (WIBB) flap. The WIBB flap can be applied in both autologous and implant-based breast reconstruction. Our reconstructive algorithm is also presented. The clinical data of patients operated on from June 2017 to November 2022 were collected: 51 patients for a total of 71 breasts. Personal data, BMI, type and volume of implants used, and major and minor complications were analyzed by descriptive statistics. The mean age was 48.3 years. BMI ranged between 21.5 and 30.9 kg/m. Thirty-one patients underwent unilateral mastectomy, while twenty patients underwent bilateral surgery. In 25 breasts, immediate reconstruction was performed with implants and ADM. In 40 breasts, reconstruction was performed with a subpectoral tissue expander, and in 6 breasts, reconstruction was performed with a DIEP flap. We observed only one case (1.4%) of periprosthetic infection requiring implant removal under general anesthesia. Minor complications occurred in 14.1% of patients. The use of both the WIBB flap and our algorithm maintained a low complication rate in our series, ensuring oncological radicality and a good aesthetic result at the same time.
Topics: Humans; Female; Middle Aged; Surgical Flaps; Mastectomy; Mammaplasty; Nipples; Adult; Breast Neoplasms; Aged; Postoperative Complications
PubMed: 38649704
DOI: 10.1038/s41598-024-52396-7 -
Journal of Clinical Medicine Feb 2024The medicinal leech has been used in plastic surgery to resolve venous congestion that can threaten the viability of tissue transfer. Within the context of breast... (Review)
Review
The medicinal leech has been used in plastic surgery to resolve venous congestion that can threaten the viability of tissue transfer. Within the context of breast surgery, venous congestion is a pertinent consideration for reconstructive and non-reconstructive breast surgery such as mammoplasty and mastopexy. However, leeching is closely associated with complications such as infection, pain, and anaemia. This is the first systematic review that examines the methodology, efficacy, and post therapeutic outcome data across all existing studies on medicinal leeching in breast surgery. A systematic search of PubMed and Embase databases from their inception to November 2023 was conducted. Inclusion criteria included studies reporting on the use of leeches to resolve venous congestion in any breast surgery. The JBI Critical Appraisal Checklist for Case Series tool was used for bias analysis. Descriptive statistics were undertaken in Microsoft Excel. A total of 18 studies with a combined sample size of 28 were examined, including 4 case series and 14 case reports. Patients mostly underwent reconstructive breast surgery (75%). The median number of leeches used was two, with a median number of three leeching sessions per day and 3 days of leeching. Medicinal leeching successfully prevented the loss of 75% of all tissue transfers. The complication rate was high at 81.14% and mainly included infection and anaemia. Medicinal leeching is an effective method to relieve venous congestion in breast surgery but must be judiciously used within the clinical context of the patient to maximise efficacy and mitigate harm from complications.
PubMed: 38592085
DOI: 10.3390/jcm13051243 -
Aesthetic Surgery Journal Jun 2024
Topics: Humans; Female; Mammaplasty; Learning
PubMed: 38517285
DOI: 10.1093/asj/sjae063 -
Indian Journal of Plastic Surgery :... Feb 2024Biointegration of polyurethane (PU) implants providing their stable position years after surgery ensures predictable results of breast augmentation and...
Biointegration of polyurethane (PU) implants providing their stable position years after surgery ensures predictable results of breast augmentation and reconstruction almost eliminating implant factor as a cause of complications. However, in rare cases PU implants appear to be not connected to the surrounding tissues. The aim of the study was to determine the incidence of PU implant nonadherence after primary breast augmentations and augmentation mastopexies with dual plane implant position, to analyze possible causes, and to propose preventive measures and treatment possibilities of this complication. The results of primary aesthetic surgeries in 333 patients with dual plane PU implant placement were analyzed. Patients were evaluated clinically, and pictures and videos taken in different periods after the surgery were compared. Particular attention was given to the changes in implant position and the appearance of asymmetries over time. PU implant nonadherence was found in seven patients. It can be divided into primary and secondary and may be complete or partial. Primary nonadherence was found in two cases (0.6%), and secondary in five (1.5%) cases. Possible influencing factors could have been traumatic surgical technique, seroma, hematoma, or physical trauma. The average follow-up was 33 months (1 month-15 years). Biointegration is mandatory for the long-term predictable results with PU implants. PU implant nonadherence leads to implant malposition and may cause typical complications connected to non-PU implants. Improvements in surgical maneuvers, manufacturing process, and weight reduction of the implant may be beneficial for the stability of the results. V.
PubMed: 38450018
DOI: 10.1055/s-0043-1778644 -
Plastic Surgery (Oakville, Ont.) Feb 2024The popularity of aesthetic surgery is on the rise, as is patients' expectations towards excellent surgical results. In order to meet these expectations, risk factors... (Review)
Review
The popularity of aesthetic surgery is on the rise, as is patients' expectations towards excellent surgical results. In order to meet these expectations, risk factors that hinder desired outcomes, such as smoking, need to be identified and addressed. To that end, the present study summarizes an updated systematic review focused on the effects of smoking on cosmetic surgical procedures and outcomes. A systematic review of studies comparing aesthetic surgical outcomes by procedure, between tobacco smokers and non-smokers was carried out, querying PubMed, Embase and the Cochrane databases. Data regarding surgical outcomes were extracted and meta-analyzed by a random effects model in conjunction with the Mantel-Haenszel statistical method. Eighty-two studies were included in the final synthesis. Abdominoplasty/panniculectomy (n = 19 cohorts) and breast reduction (n = 27 cohorts) were the most common types of procedures included in this review. Other than mastopexy and rhinoplasty, smoking conferred a statistically significant increased risk of overall complications for all studied aesthetic procedures. The data demonstrates that smoking is a clear risk factor for the vast majority of aesthetic plastic surgeries studied. Although our meta-analysis suggests that smoking is not a risk factor for complications in mastopexies and rhinoplasties, these two specific analyses may have been biased, and should therefore be re-evaluated with future additional evidence. The results of this systematic review confirm the importance of smoking cessation and education relative to the outcomes of common cosmetic surgical procedures.
PubMed: 38433792
DOI: 10.1177/22925503221085083 -
Annals of Medicine and Surgery (2012) Feb 2024Lipomas are benign tumours composed of adipocytes surrounded by a thin fibrous capsule. Although they make up 16% of mesenchymal tumours, the occurrence of breast...
INTRODUCTION AND IMPORTANCE
Lipomas are benign tumours composed of adipocytes surrounded by a thin fibrous capsule. Although they make up 16% of mesenchymal tumours, the occurrence of breast lipomas is uncertain. Giant lipomas, measuring 10 cm or more in diameter or weighing at least 1000 g, commonly occur in the upper back, neck, and thigh, and are rare in the breast. Given its rarity, accurately diagnosing a giant breast lipoma is crucial to prevent potential overtreatment, as it might otherwise be mistaken for a malignant tumour.
CASE PRESENTATION
A 40-year-old woman presented with a painless, gradually enlarging left breast mass. Physical examination and imaging studies revealed a lipoma-compatible mass. Surgery was performed, and the 5 kg mass was enucleated and identified as a lipoma on histopathology. The patient had an uneventful postoperative recovery and was satisfied with the outcome of the surgery after 2 months of follow-up.
CLINICAL DISCUSSION
Breast lipomas are more common in the 40-60 years age group, with giant lipomas occurring more frequently in the latter half of this age range. They can mimic various breast conditions, including neoplastic and non-neoplastic conditions, and are often treated with surgical excision to avoid recurrence. The location of the lipoma in the breast can be subcutaneous or intramuscular, and preserving the future pedicle of reduction mammoplasty/mastopexy is essential.
CONCLUSION
Giant breast lipoma is an infrequent condition that can manifests as progressive enlargement of the breast, posing a diagnostic challenge due to its resemblance to various benign or malignant pathologies.
PubMed: 38333323
DOI: 10.1097/MS9.0000000000001683 -
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