Hybrid Breast Augmentation: A Reliable Formula for Preoperative Assessment of Fat Graft Volume Based on Implant Volume and Projection

2020 ◽  
Vol 40 (8) ◽  
pp. NP438-NP452 ◽  
Author(s):  
João Maximiliano ◽  
Alexandre Mendonça Munhoz ◽  
Mirian Pedron ◽  
Antonio Carlos Pinto de Oliveira ◽  
Daniele Walter Duarte ◽  
...  
Keyword(s):  
Breast Augmentation ◽  
Low Cost ◽  
Preoperative Assessment ◽  
Fat Grafting ◽  
Fat Graft ◽  
Level Of Evidence ◽  
3 Dimensional ◽  
Clinical Series ◽  
Fat Removal

Abstract Background Autogenous fat grafting (AFG) is an established technique used as an adjunct to breast augmentation (BA) to redesign breast shape. Surgeons often use experience and intuition to estimate AFG volume, which can result in incorrect assessment of donor areas and unnecessary fat removal. Objectives This aim of this study was to develop a method based on a mathematical formula, which utilizes implant volume and projection to predict AFG volume. Methods Thirty patients (60 breasts) underwent primary hybrid BA. A software package (SketchUp) was used to simulate 3-dimensional AFG and implant volumes, which in turn were used to develop an equation for estimating AFG volume according to 3 different implant projections. The results for each group were compared, via Pearson’s correlation coefficient, with the results of the clinical series. Results All patients received Motiva Ergonomix SmoothSilk/SilkSurface implants, ranging in volume from 175 to 355 cc (mean, 265 cc), as well as an average AFG volume of 79.2 cc/breast (range, 50-110 cc). Twenty-nine patients (96.6%) were either very satisfied or satisfied during a mean follow-up of 18 months (range, 6-28 months). A high correlation was observed between the AFG performed in the cohort and predictions obtained from the formula (r = 0.938, P < 0.001). Conclusions The AFG volume in hybrid BA procedures can be estimated utilizing measurements based on implant volume/projection. This low-cost method can be applied to guide surgical decision-making in patients who are candidates for BA. Level of Evidence: 4

Citation Analysis in Breast Reconstruction Publications Between 2000 and 2010

2021 ◽  
pp. 229255032110499
Author(s):  
Rebecca Miller ◽  
Sheina Macadam ◽  
Daniel Demsey
Keyword(s):  
Breast Reconstruction ◽  
Citation Analysis ◽  
Case Series ◽  
Acellular Dermal Matrix ◽  
Fat Grafting ◽  
Fat Graft ◽  
Level Of Evidence ◽  
Dermal Matrix ◽  
Number Of Patients ◽  
Acellular Dermal

Introduction and Purpose: Breast reconstruction is an active area of plastic surgery research. Citation analysis allows for quantitative analysis of publications, with more citations presumed to indicate greater influence. We performed citation analysis to evaluate the most cited papers on breast reconstruction between 2000 to 2010 to identify contemporary research trends. Methods: The SCI-EXPANDED database was used to identify the 50 most cited papers. Data points included authorship, publication year, publication journal, study design, level of evidence, number of surgeons/institutions, center of surgery, primary outcome assessed, implant/flap/acellular dermal matrix/fat graft, acellular dermal matrix brand and use with implants/flaps, fat graft use with implants/flaps, unilateral/bilateral, one-/two-stage, immediate/delayed, number of patients/procedures, complications. Descriptive analysis of trends was performed based on results. Results: 20% of papers were published in 2006, 16% in 2007 and 12% in both 2004/2009. 66% were published in Plastic and Reconstructive Surgery. The majority were retrospective or case series, and of Level III or IV evidence. The one Level I study was a prospective multicenter trial. 21 and 7 papers discussed procedures by single/multiple surgeons, respectively. Results from single/multiple centers were discussed in 18 and 6 papers, respectively. 30 papers discussed implant-based reconstruction, 22 papers flap-based (19 microsurgical), 15 papers acellular dermal matrix, and five papers fat grafting. The primary focus in the majority was complications or outcomes. Conclusion: Our analysis demonstrates continually evolving techniques in breast reconstruction. However, there is notable lack of high quality evidence to guide surgical decision-making in the face of increasing surgical options.

Does Transection of the Superficial MCL During HTO Result in Progressive Valgus Instability?

2021 ◽  
pp. 036354652110591
Author(s):  
Joo-Hwan Kim ◽  
Dong Jin Ryu ◽  
Sung-Sahn Lee ◽  
Seung Pil Jang ◽  
Jae Sung Park ◽  
...  
Keyword(s):  
Case Series ◽  
Preoperative Assessment ◽  
International Knee Documentation Committee ◽  
Clinical Results ◽  
Osteotomy Site ◽  
Tibial Osteotomy ◽  
Level Of Evidence ◽  
Valgus Stress ◽  
Valgus Instability

Background: During high tibial osteotomy (HTO), the superficial medial collateral ligament (sMCL) is cut or released at any degree to expose the osteotomy site and achieve the targeted alignment correction according to the surgeon’s preference. However, it is still unclear whether transection of sMCL increases valgus laxity. Purpose: We aimed to assess the outcomes and safety of sMCL transection, especially focusing on iatrogenic valgus instability. Study Design: Case series; Level of evidence, 4. Methods: Seventy-two patients (89 knees) who underwent medial open wedge HTO (MOWHTO) with transection of the sMCL between October 2013 and September 2018 were retrospectively investigated. Clinical evaluations, including the International Knee Documentation Committee (IKDC) score, Knee injury and Osteoarthritis Outcome Score (KOOS), and Tegner and Lysholm scores, were performed preoperatively and at 2 years postoperatively. The radiographic parameters hip-knee-ankle (HKA) angle, joint line convergence angle on standing radiographs (standing JLCA), and weightbearing line (WBL) ratio were assessed preoperatively and at 3 months, 6 months, 1 year, and 2 years postoperatively. To evaluate valgus laxity, we assessed the valgus JLCA and medial joint opening (MJO) at the aforementioned time points using valgus stress radiographs. Results: All clinical results at the 2-year follow-up were significantly improved compared with those obtained at the preoperative assessment ( P < .001). The postoperative HKA angle significantly differed from the preoperative one, and no significant valgus progression was observed during follow-up (preoperative, 8.5°± 2.7°; 3 months, –3.5°± 2.0°; 6 months, –3.2°± 2.3°; 1 year, –3.1°± 2.3°; 2 years, –2.9°± 2.5°; P < .001) The mean WBL ratio was 62.5% ± 9.0% at 2 years postoperatively. The postoperative valgus JLCA at all follow-up points did not significantly change compared with the preoperative valgus JLCA (preoperative, –0.1°± 2.1°; 3 months, –0.2°± 2.4°; 6 months, –0.1°± 2.5°; 1 year, 0.1°± 2.5°; 2 years, 0.2°± 2.2°) The postoperative MJO at all follow-up points did not significantly change compared with the preoperative MJO (preoperative, 7.1 ± 1.7 mm; 3 months, 7.0 ± 1.7 mm; 6 months, 6.9 ± 1.9 mm; 1 year, 6.7 ± 1.8 mm; 2 years, 6.8 ± 1.8 mm). Conclusion: Transection of the sMCL during MOWHTO does not increase valgus laxity and could yield desirable clinical and radiographic results.

scholarly journals Pyrocardan Trapeziometacarpal Joint Arthroplasty—Medium-Term Outcomes

2020 ◽  
Vol 9 (06) ◽  
pp. 509-517
Author(s):  
James Logan ◽  
Susan E. Peters ◽  
Ruby Strauss ◽  
Silvia Manzanero ◽  
Gregory B. Couzens ◽  
...  
Keyword(s):  
Case Series ◽  
Postoperative Outcome ◽  
Preoperative Assessment ◽  
Pinch Strength ◽  
Level Of Evidence ◽  
Original Series ◽  
Surgery Outcome ◽  
Trapeziometacarpal Osteoarthritis ◽  
Patient Reported

Abstract Objective Pyrocardan trapeziometacarpal interposition implant is a free intra-articular spacer composed of pyrocarbon. This biconcave resurfacing implant, both ligament and bone-stock sparing, is indicated for use in early-to-moderate stage trapeziometacarpal osteoarthritis. It was hypothesized that the postoperative outcome measures of the Pyrocardan implant would be comparable to those seen with ligament reconstruction and tendon interposition (LRTI) surgeries and those reported by the designer of the implant, Phillipe Bellemère, but that strength would be greater than for LRTI. Methods In this prospective case series, 40 Pyrocardan implants were performed in 37 patients. Average age was 58 years (range: 46–71). Patients were assessed preoperatively, 3 months, 6 months, 1 year, 2 years, and beyond (long term) wherever possible. Results There have been no major complications or revision surgeries for the series. Average follow-up was 29 months (range: 12 months–7 years). Twenty-eight joints were assessed at over 2 years post index surgery. Outcome measure scores improved from preoperative assessment to the most recent follow-up equal or greater than 2 years. Average grip strength at 2 years was 30 kg, as compared with 19.6 kg in an age-matched cohort who underwent trapeziectomy and 25 kg in Bellemère's original series of Pyrocardan implants. Conclusions Pyrocardan interposition arthroplasty appears to be a safe, effective treatment for trapeziometacarpal arthritis. Patient-reported clinical outcomes were at least equivalent to LRTI and are comparable to Bellemère's original series. Grip and pinch strength appear to be better than LRTI. Level of Evidence This is a Level III, prospective observational cohort study.

scholarly journals Multiple polyurethane implant punctures during fat grafting: case report and review of the literature

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Dmitry Batiukov ◽  
V. Podgaiski ◽  
D. Mikulich ◽  
S. Kalinin
Keyword(s):  
Case Report ◽  
Breast Reconstruction ◽  
Breast Augmentation ◽  
Surgical Procedure ◽  
Fat Grafting ◽  
Review Of The Literature ◽  
Level Of Evidence ◽  
Case Presentation ◽  
Tissue Ingrowth ◽  
First Case

Abstract Background Breast augmentation with implants continues to be the most popular aesthetic surgical procedure performed worldwide. Fat grafting may improve the results of breast augmentation and breast reconstruction with implants. However, fat grafting to the breast with implants carries the risk of implant puncture. To our best knowledge this is the first case in which polyurethane implant puncture during fat grafting is described. Case presentation We report multiple bilateral implant punctures with the cannula during fat grafting in a patient who previously underwent breast reconstruction with polyurethane implants. Conclusions Implants that promote tissue ingrowth may be more prone to puncture with the cannula during fat grafting. Specific planning and surgical maneuvers decrease the risk of implant puncture. Level of evidence Level V, case report.

Fat Grafting to Improve Results of Facelift: Systematic Review of Safety and Effectiveness of Current Treatment Paradigms

2020 ◽  
Vol 41 (1) ◽  
pp. 1-12 ◽  
Author(s):  
Felipe Molina-Burbano ◽  
J Michael Smith ◽  
Michael J Ingargiola ◽  
Saba Motakef ◽  
Paymon Sanati ◽  
...  
Keyword(s):  
Systematic Review ◽  
Fat Grafting ◽  
Treatment Modalities ◽  
Fat Graft ◽  
Cochrane Library ◽  
Complication Rates ◽  
Volume Loss ◽  
Level Of Evidence ◽  
Superficial Musculoaponeurotic System ◽  
Age Related

Abstract Background Autologous fat grafting is a helpful supplement to facelift surgery that helps to combat age-related volume loss of facial structures. Despite the widespread prevalence of combined facelift and fat-grafting, significant procedural variation exists between providers. Objectives The primary purpose of this systematic review was to study the efficacy and complication rates of facelift with lipofilling compared with facelift alone. Methods A systematic review of the Cochrane Library and MEDLINE databases as completed was undertaken to identify all clinical reports of fat grafting combined with facelift surgery based on the following key terms: (“fat grafting” OR “lipotransfer” OR “lipofilling” OR “fat transfer”) AND (“facelift” OR “rhytidectomy” OR “SMASectomy” OR “facial rejuvenation”). Data on techniques, outcomes, complications, and patient satisfaction were collected. Results The systematic review was performed in April 2017. In total, 248 articles were identified for review. After application of exclusion criteria, 15 primary studies were included in this review. Various facelift techniques were reported, including deep-plane or sub–superficial musculoaponeurotic system (SMAS) facelift, SMAS facelift, modified minimal access cranial suspension lift, component facelift, midface lift, SMAS plication, SMAS-stacking/SMASectomy, and SMASectomy. The most common locations of fat graft injection included the nasolabial folds, tear troughs, temporal regions, midface/cheek/malar eminence, marionette groove, lips, and ear lobes. The addition of fat grafting to facelift surgery resulted in significant improvements in facial volume and aesthetic assessments. Conclusions Combined facelift and fat grafting is a safe and efficacious means to simultaneously address age-related ptosis and volume loss. Further research is required to validate and improve existing treatment modalities. Level of Evidence: 3

scholarly journals Secondary Composite Breast Augmentation: Concept and Outcomes, Introduction to a Layered Approach

2020 ◽  
Vol 40 (9) ◽  
pp. 981-986 ◽  
Author(s):  
Eric Auclair ◽  
Alexandre Marchac ◽  
Nathalie Kerfant
Keyword(s):  
Soft Tissue ◽  
Revision Surgery ◽  
Breast Augmentation ◽  
Revisional Surgery ◽  
Treatment Plan ◽  
Fat Grafting ◽  
Level Of Evidence ◽  
Soft Tissue Envelope ◽  
The Mean ◽  
Over Time

Abstract Background Secondary procedures following breast augmentation are often more difficult than primary cases because the soft-tissue envelope changes over time. Objectives This study was conducted to confirm the utility of a composite technique in breast revisional surgery. Methods This was a 9-year retrospective chart and photographic data study of one surgeon’s experience with the combined use of fat and implants in revisional cases. The 148 patients had a follow-up at least 1 year after surgery. Our approach consists of a detailed analysis of the different layers covering the implant and yields a treatment plan addressing all issues involving the secondary breast. Results On average, revisional surgery was performed 8.66 years after the first augmentation. The mean age of the patients at revision surgery was 42 years (range, 22.2-70.7 years). The mean fat harvest was 600 mL (range, 100-3000 mL) and the mean volume of fat reinjected was 153 mL (range, 60-400 mL). The mean volume before and after revision was the same (288 mL vs 289 mL). At the original surgery, the breast implants were located in a subpectoral pocket in 78.7% of the patients and, at the revision surgery, in a subglandular pocket in 74.8% of the patients. Within the first 2 years, 13 patients (8.7%) underwent reoperation for additional fat grafting. Among 45 preoperative breast capsular contractures, there were 8 recurrences in the first 3 years resulting in 4 reoperations. Conclusions Secondary breast augmentation cannot rely solely on implant exchange. Because the soft-tissue envelope also ages over time, fat grafting is mandatory in the vast majority of secondary cases. A rigorous preoperative analysis enables breast defects to be treated appropriately. Level of Evidence: 4

Comparison of Fat Repositioning Versus Onlay Segmental Fat Grafting in Lower Blepharoplasty

2021 ◽  
Author(s):  
Per Hedén ◽  
Sebastian Fischer
Keyword(s):  
Online Survey ◽  
Study Groups ◽  
Fat Grafting ◽  
Fat Graft ◽  
The Novel ◽  
Level Of Evidence ◽  
Lower Blepharoplasty ◽  
Novel Technique ◽  
Tear Trough ◽  
Tear Trough Deformity

Abstract Background Lower blepharoplasty is one of the most challenging procedures in aesthetic surgery. In particular, blending the lid-cheek junction and correction of the tear trough are prone to failure and unsatisfactory outcomes. Objectives The aim of this study was to combine lower eyelid blepharoplasty with a novel technique of autologous fat grafting, commonly called segmental fat grafting, and to analyze the safety and efficacy of this approach. Methods A retrospective analysis of 339 lower blepharoplasties was performed to compare the novel technique of segmental fat grafting to traditional fat transposition during lower blepharoplasty. Outcomes were assessed objectively by several measurements as well as via online survey of 148 invited experts in plastic surgery. Statistical analysis included t test for unpaired and paired samples as well as 1-way analysis of variance for matched data. Results There were no differences in baseline characteristics and comorbidities between study groups. After a mean follow-up of 12.9 months (range, 5-120 months), the group that underwent segmental fat grafting had a significant reduction in tear trough width compared compared with the group receiving lower blepharoplasty with fat transposition. Based on an expert (blinded) online survey, segmental fat grafting was superior or equal in 47% and 35% of cases, respectively. Complications (4%) and revision surgeries (9%) did not differ significantly between study groups. Conclusions The novel technique of transplantation of a segmental fat graft during lower blepharoplasty is a safe and effective way to overcome tear trough deformity and blend the lid-cheek junction. Level of Evidence: 4

Central Tunnel Technique and Fat Grafting for Surgical Correction of Inverted Nipples and Introduction of a Treatment Algorithm

2019 ◽  
Vol 40 (5) ◽  
pp. NP238-NP250
Author(s):  
Amin Kalaaji ◽  
Stine Dreyer ◽  
Vanja Jönsson ◽  
Jakob Schnegg ◽  
Ileana Orejuela ◽  
...  
Keyword(s):  
Treatment Algorithm ◽  
Fat Grafting ◽  
Recurrence Rates ◽  
Level Of Evidence ◽  
Therapeutic Goals ◽  
Aesthetic Appearance ◽  
Breast Feed ◽  
Tunnel Technique ◽  
Inverted Nipples

Abstract Background Inverted nipples are prevalent in 3% to 10% of women and can often cause functional, psychological, and aesthetic problems. Objectives The authors sought to treat inverted nipples and restore the aesthetic appearance of the nipple while minimizing ductal disruption, preserving the ability to breast-feed, and reducing recurrence rates. Methods A retrospective review was performed on a total of 161 inverted nipples in 86 consecutive patients who underwent correction of inverted nipples at Oslo Plastic Surgery Clinic. Mean age at operation was 28.7 years and mean follow-up period was 14 months. A novel technique with central tunnelization of the retracted fibers/ducts was employed in 39 patients (45%); partial incision of the center of the inversion through a tunnel in 31 patients (36%); and total cut of the lactiferous ducts in 16 patients (19%). Fat grafting was utilized as support in 14 patients (26 nipples). Postoperatively, nipples were suspended for 4 weeks with a manually constructed device. Results Most patients had moderate (grade 2, 40 patients) or severe (grade 3, 52 patients) nipple inversion. Infection occurred in 4 patients and 2 patients had local irritation. Recurrence was seen in 32 patients (55 nipples) after the first operation, in 6 patients (6 nipples) after the second operation, and in 1 patient (1 nipple) after the third operation. Conclusions The authors propose a treatment algorithm that addresses important therapeutic goals when treating inverted nipples. Clinical examination is crucial to determine the method to be employed. The new central tunnel method and fat grafting to support the nipple are promising, although additional follow-up is necessary. Level of Evidence: 4

scholarly journals Management of Severe Equinovalgus in Patients With Cerebral Palsy by Naviculectomy in Combination With Midfoot Arthrodesis

2017 ◽  
Vol 38 (9) ◽  
pp. 1011-1019 ◽  
Author(s):  
Chakravarthy U. Dussa ◽  
Leonhard Döderlein ◽  
Raimund Forst ◽  
H. Böhm ◽  
Albert Fujak
Keyword(s):  
Cerebral Palsy ◽  
Case Series ◽  
Success Rates ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Revision Operation ◽  
3 Dimensional ◽  
Joint Deformity ◽  
The Mean

Background: Equinovalgus deformity is the second most common deformity in cerebral palsy and may be flexible or rigid. Several operative methods from joint sparing to arthrodesis have been described with varying success rates. The aim of this study was to investigate the effectiveness of naviculectomy in combination with midfoot arthrodesis (talo-cuneiform and calcaneocuboid arthrodesis) in the correction of a rigid equinovalgus foot deformity in cerebral palsy. Methods: Forty-eight rigid equinovalgus feet were operated upon in 30 patients from 2008 to 2013. Of these, 44 feet in 26 patients with cerebral palsy (Gross Motor Function Classification System III, IV, or V) with follow-up of more than 2 years were included in the study. The mean age at surgery was 18.1 years. The outcomes were measured objectively using radiographic angles and subjectively using 5 questions to be answered by the caregiver. The feet were then graded into excellent, good, fair, and poor. The mean follow-up was 5.0 ± 1.7 years. Results: Excellent to good results were obtained in 81% of the feet. Both objective and subjective outcomes improved significantly postoperatively ( P < .001). Three feet in 2 patients were graded as poor and underwent a revision operation for pain and recurrence. Conclusions: Naviculectomy in combination with midfoot arthrodesis enabled a good 3-dimensional correction of the forefoot. However, the procedure did not necessarily correct the fixed subtalar joint deformity. Several additional bony and soft-tissue procedures were necessary to achieve a complete correction in these difficult feet. Level of Evidence: Level IV, retrospective case series.

Review of Quantitative Imaging for Objective Assessment of Fat Grafting Outcomes in Breast Surgery

2021 ◽  
Vol 41 (Supplement_1) ◽  
pp. S39-S49
Author(s):  
Urmila Sampathkumar ◽  
Zhale Nowroozilarki ◽  
Mary Catherine Bordes ◽  
Gregory P Reece ◽  
Summer E Hanson ◽  
...  
Keyword(s):  
Quantitative Imaging ◽  
Objective Assessment ◽  
Fat Grafting ◽  
Fat Necrosis ◽  
Level Of Evidence ◽  
3 Dimensional ◽  
Quantitative Measurements ◽  
Implementation Guidelines ◽  
Objective Outcome ◽  
Surface Images

Abstract This article presents a comprehensive review of the use of quantitative measurements based on breast images to assess fat retention, breast aesthetics, and fat necrosis after autologous fat grafting. Breast volume measured from MRI and 3-dimensional surface images is widely used as a measure of fat retention. Breast aesthetics are assessed from a combination of anthropometric (distance and contour) measurements on breast surface images. Examination of radiologic images (ultrasonography, mammography, and MRI) is utilized to assess fat necrosis. The article discusses implementation guidelines for objective outcome assessment to support robust quantification and enable investigations of fat grafting efficacy. Level of Evidence: 4

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