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

scholarly journals Failed Surgery for Patellar Tendinopathy in Athletes: Midterm Results of Further Surgical Management

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712199455
Author(s):  
Nicola Maffulli ◽  
Francesco Oliva ◽  
Gayle D. Maffulli ◽  
Filippo Migliorini
Keyword(s):  
Surgical Management ◽  
Revision Surgery ◽  
Case Series ◽  
Sports Participation ◽  
Patellar Tendinopathy ◽  
Symptom Duration ◽  
Level Of Evidence ◽  
Training Time ◽  
The Mean

Background: Tendon injuries are commonly seen in sports medicine practice. Many elite players involved in high-impact activities develop patellar tendinopathy (PT) symptoms. Of them, a small percentage will develop refractory PT and need to undergo surgery. In some of these patients, surgery does not resolve these symptoms. Purpose: To report the clinical results in a cohort of athletes who underwent further surgery after failure of primary surgery for PT. Study Design: Case series; Level of evidence, 4. Methods: A total of 22 athletes who had undergone revision surgery for failed surgical management of PT were enrolled in the present study. Symptom severity was assessed through the Victorian Institute of Sport Assessment Scale for Patellar Tendinopathy (VISA-P) upon admission and at the final follow-up. Time to return to training, time to return to competition, and complications were also recorded. Results: The mean age of the athletes was 25.4 years, and the mean symptom duration from the index intervention was 15.3 months. At a mean follow-up of 30.0 ± 4.9 months, the VISA-P score improved 27.8 points ( P < .0001). The patients returned to training within a mean of 9.2 months. Fifteen patients (68.2%) returned to competition within a mean of 11.6 months. Of these 15 patients, a further 2 had decreased their performance, and 2 more had abandoned sports participation by the final follow-up. The overall rate of complications was 18.2%. One patient (4.5%) had a further revision procedure. Conclusion: Revision surgery was feasible and effective in patients in whom PT symptoms persisted after previous surgery for PT, achieving a statistically significant and clinically relevant improvement of the VISA-P score as well as an acceptable rate of return to sport at a follow-up of 30 months.

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.

Single Staged Mastopexy With Autologous Fat Grafting: An Alternative to Augmentation Mastopexy With Implants

2019 ◽  
Author(s):  
Jules Walters ◽  
Lynn Bourn ◽  
Oren Tessler ◽  
Charles Patterson ◽  
Kamran Khoobehi
Keyword(s):  
Surgical Site Infections ◽  
Breast Implants ◽  
Fat Grafting ◽  
Level Of Evidence ◽  
Breast Ptosis ◽  
Autologous Fat ◽  
Ptotic Breast ◽  
The Mean ◽  
To Receive ◽  
Augmentation Mastopexy

Abstract Background Improving the ptotic breast with mastopexy and restoring upper pole fullness with augmentation continues to be a challenging issue for plastic surgeons. Autologous fat grating (AFG) for shaping and contouring of implant augmented breasts has shown positive outcomes with few complications. Objectives The objective of this study was to evaluate our experience with combined mastopexy and fat grafting for women with existing breast ptosis who prefer not to receive prosthetic breast implants but do desire volume enhancement. Methods A retrospective review of patients undergoing a single staged mastopexy with AFG, from 2006 to 2017, was performed. Inclusion criteria were women with breast ptosis or tuberous breasts desiring improved breast shape and volume. Patients were excluded if they were undergoing implant removal before the procedure. Clinical aesthetic outcomes were assessed by fellow plastic surgeons according to the Telemark Breast Scoring system. Results A total of 284 breasts, in 140 women, underwent a single staged mastopexy with AFG. The mean amount of fat grafted per breast was 299.4 mL (range, 50-710 mL). There were no surgical site infections, hematomas, or seromas. There were 3 major and 8 minor (0.06%) postoperative breast complications. A total of 13 plastic surgeons, of the 183 invited (7.1%), completed the breast outcomes survey. Regarding each category, there was significant improvement (P ≤ 0.0001) in upper pole fullness, ptosis, overall aesthetics, and symmetry postoperatively. Conclusion AFG combined with mastopexy is not associated with significant postoperative complications and results in excellent breast aesthetic outcomes. Level of Evidence: 4

Soft Tissue Thickness Variations of the Nose: A Radiological Study

2020 ◽  
Vol 40 (7) ◽  
pp. 711-718
Author(s):  
Melekber Çavuş Özkan ◽  
Fatma Yeşil ◽  
İnci Bayramiçli ◽  
Mehmet Bayramiçli
Keyword(s):  
Soft Tissue ◽  
Soft Tissues ◽  
Soft Tissue Coverage ◽  
Limited Information ◽  
Tissue Thickness ◽  
Level Of Evidence ◽  
Age And Gender ◽  
Soft Tissue Envelope ◽  
Soft Tissue Thickness ◽  
And Gender

Abstract Background Soft tissue thickness (STT) is a major factor affecting the outcome in rhinoplasty. However, limited information is found in the literature on the age- and gender-related variations of the nasal STT. Objectives The purpose of this study was to measure STT at various landmarks over the nasal framework and compare the age- and gender-related differences. Methods STT measurements were made at 11 landmarks in 325 patients by employing magnetic resonance imaging. Patients were divided into subgroups to compare the STT differences between female and male and between the age groups as young, middle age, and elderly. Results Soft tissue was thickest at the nasion and thinnest at the rhinion. The soft tissue coverage was significantly thicker in the male population at the supratip, tip, nasal bones, upper lateral cartilages, and alar lobules, whereas it is thicker in females at the rhinion. Average thickness of the soft tissues over the entire nasal framework increases with age except the rhinion. Conclusions The STT is variable over different parts of the osteocartilaginous framework. Gender and age influence the STT. The soft tissue is thicker at the distal half of the nose in male patients, and these areas become gradually thicker with age, whereas the soft tissue over the midvault becomes thinner. Increasing age presents a particular challenge to achieve predictable results in rhinoplasty, and an understanding of the soft tissue envelope allows for improved aesthetic outcome. Level of Evidence 2

scholarly journals Decision Making in Preservation Rhinoplasty: A 100 Case Series With One-Year Follow-Up

2019 ◽  
Vol 40 (1) ◽  
pp. 34-48 ◽  
Author(s):  
Aaron M Kosins ◽  
Rollin K Daniel
Keyword(s):  
Soft Tissue ◽  
Case Series ◽  
Open Rhinoplasty ◽  
Level Of Evidence ◽  
Soft Tissue Envelope ◽  
Primary Rhinoplasty ◽  
Proper Patient Selection ◽  
Total Preservation ◽  
One Year

Abstract Background Preservation rhinoplasty (PR) is a new chapter in rhinoplasty history. The term was coined by Daniel in 2018 and represents a fundamental change in philosophy. Objectives The aim of this study is to discuss a single-surgeon case series utilizing PR techniques. Methods One hundred fifty-three primary rhinoplasty cases were studied retrospectively between December 2016 and August 2017. One hundred cases had at least 1 year of follow-up. Technical details were recorded, including dissection plane, ligament preservation, tip support, lateral crural maneuvers, alar contour grafts, and preservation of the dorsum vs traditional reduction. These 100 cases can be categorized as either complete preservation rhinoplasty (PR-C) or partial preservation rhinoplasty (PR-P). Results All patients had open rhinoplasty and the average follow-up time was 13 months. All patients had preservation of the dorsal soft tissue envelope, and in 36 the entire soft tissue envelope and ligaments were preserved. Fifty-four had preservation of the alar cartilages. Thirty-one had dorsal preservation. The combinations include: PR-C (skin, dorsum, and alars): 24; PR-P (skin and dorsum): 2; PR-P (alars and dorsum): 2; and PR-P (skin and alars): 7. Conclusions In most patients, the dorsal soft tissue envelope and nasal ligaments can be preserved. When possible, the lateral crura should be preserved and tensioning chosen over excision. Dorsal preservation is a versatile technique when proper patient selection is undertaken, and long-term issues with the middle vault and keystone area can be avoided. Some patients will benefit from total preservation where nothing is removed/disrupted and underlying structures are reshaped. Level of Evidence: 4

A Novel Extended Deep Plane Facelift Technique for Jawline Rejuvenation and Volumization

2018 ◽  
Vol 39 (12) ◽  
pp. 1265-1281 ◽  
Author(s):  
Andrew A Jacono ◽  
Lucas M Bryant ◽  
Nigar N Ahmedli
Keyword(s):  
Fat Grafting ◽  
Visual Perspective ◽  
Volume Depletion ◽  
Level Of Evidence ◽  
Gonial Angle ◽  
Change In The Mean ◽  
Rotational Flap ◽  
Mandibular Region ◽  
The Mean

Abstract Background Jawline aging is a complex process. We believe loss of posterior jawline definition and volume depletion is an underappreciated factor in the aging face. Objectives The aim of this study was to describe a novel composite, rotational flap modification of an extended deep-plane rhytidectomy. We evaluated long-term efficacy on improving jawline contour and volumization of the posterior mandibular region overlying the gonial angle. Methods We performed a prospective study on patients who underwent our modification of extended deep-plane rhytidectomy. We define and introduce the mandibular defining line, a new anatomic metric in evaluating the mandibular contour. We define the area of the posterior lower face overlying the gonion and mandibular angle as the gonial area. Using 3-dimensional photography, we quantify contour changes along the mandibular border and volume change along the gonial area. Results Eighty-nine patients (178 hemifaces) were analyzed. The mean gonial area volume gained was 3.5 cc. Average follow-up was 19 months. There was a statistically significant change in the mean mandibular defining line from 7.1 cm preoperatively to 9.8 cm postoperatively. This represents a lengthening of the visual perspective of the mandibular contour of 2.7 cm. Conclusions Composite, rotational flap modification of extended deep-plane rhytidectomy provides significant long-term augmentation of volume to the posterior mandibular region and lengthens the visual perspective of the inferior mandibular contour, creating a more youthful jawline. In selected cases, this may obviate the need for other volumization procedures used to improve jawline contour, such as autologous fat grafting. Level of Evidence: 4

Using Nasal Self-Esteem to Predict Revision in Cosmetic Rhinoplasty

2020 ◽  
Author(s):  
Tyler S Okland ◽  
Priyesh Patel ◽  
George S Liu ◽  
Sam P Most
Keyword(s):  
Revision Surgery ◽  
Revision Rate ◽  
Retrospective Chart Review ◽  
Self Esteem ◽  
Level Of Evidence ◽  
Survey Question ◽  
Outcomes Measures ◽  
Cosmetic Rhinoplasty ◽  
The Mean ◽  
Single Question

Abstract Background It would be useful if existing tools or outcomes measures could predict which patients are at greater risk of revision surgery following rhinoplasty. Objectives The authors sought to determine if a single question assessing nasal self-esteem could be utilized to predict which patients are at greatest risk of revision surgery following rhinoplasty. Methods The authors conducted a retrospective chart review of 148 patients who underwent cosmetic rhinoplasty. Results of pre- and postoperative Standardized Cosmesis and Health Nasal Outcomes Survey questionnaires and rates of revision or patient-initiated revision discussions (RD) were collected. Patients were stratified based on answers to Standardized Cosmesis and Health Nasal Outcomes Survey question 5 (SQ5), “Decreased mood and self-esteem due to my nose.” Results Of the 148 patients included in the analysis, 72.9% were women, and the mean age was 30.9 (15-59, standard deviation = 10.3) years. Those patients who selected 4 or 5 on SQ5 had an overall revision rate of 16.7% and 18.8%, respectively, and a RD rate of 27.8% and 31.25%, respectively. Those patients who selected 0 through 3 on SQ5 had an overall revision rate of 0% and an overall RD rate of 10.4%. Only SQ5 was predictive of revision and RD on logistic regression analysis (P = 0.0484 and P = 0.0257) after Bonferroni correction. Conclusions SQ5 appears to offer a useful adjunct to guide surgical management of the cosmetic rhinoplasty patient. Those patients who reported worse nasal self-esteem and associated mood preoperatively were more likely to request and undergo revision. Level of Evidence: 4  

scholarly journals Hybrid Implant and Grafted Fat Breast Augmentation: Designing the Pathway to a Future With Breasts Free of Silicone Breast Implants

2021 ◽  
Author(s):  
Marcos Sforza ◽  
Scott Spear
Keyword(s):  
Breast Augmentation ◽  
Surgical Planning ◽  
Breast Implants ◽  
Fat Grafting ◽  
Physician Satisfaction ◽  
Planning System ◽  
Early Age ◽  
Silicone Breast Implants ◽  
Satisfaction Rate ◽  
The Mean

Abstract Background Fat grafting in breast augmentation surgery is becoming increasingly popular, allowing surgeons to fill the gaps that implant augmentation alone cannot. However, one of the current issues surrounding fat grafting is the lack of standardization. In this prospective study, we present our experience of fat grafting in 56 patients who had fat transfer together with silicone breast implants. Objectives The objective of this study was to validate and summarize an expert-based advice to help plastic surgeons to better understand the benefits of using fat grating to reduce implants sizes in their surgical planning. Methods A 3D planning system was used to plan the procedure and also to analyse the fat retention and resorption rates. Pictures served as a basis for a questionnaire in which both patients and physicians were asked to rate their satisfaction. Results Patients reported a satisfaction rate of "excellent" in 83.3% of cases and "good" in 16.7%. Physician satisfaction rated as "excellent" in 84.5% of cases and "good" in 13.3% and fair in 4.2% of cases. The mean of volume grafted per breast was 113.63ml. The mean of absorption rate of 4.53%. Conclusions The procedure presented consistent and reproducible results. Hybrid breast augmentation can help designing a pathway for a future with breasts free of silicone. This information is particularly relevant for women that have their first breast augmentation at an early age and will probably have 2 to 5 additional surgeries in their lifetime due to the nature of the current silicone breast technology.

scholarly journals Tibiotalocalcaneal Intramedullary Nailing for Unstable Geriatric Ankle Fractures

2021 ◽  
Vol 12 ◽  
pp. 215145932110207
Author(s):  
Elif Kulakli-Inceleme ◽  
David B. Tas ◽  
Diederik P.J. Smeeing ◽  
Roderick M. Houwert ◽  
Nicole M. van Veelen ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Postoperative Complications ◽  
Intramedullary Nailing ◽  
Weight Bearing ◽  
Primary Treatment ◽  
Ankle Fractures ◽  
Fixation Method ◽  
Soft Tissue Envelope ◽  
Patient Reported ◽  
The Mean

Background: Tibiotalocalcaneal (TTC) intramedullary nailing has been suggested as an alternative to open reduction and internal fixation (ORIF) for the primary treatment of unstable fragility ankle fractures with a poor soft tissue envelope. This study aims to investigate the clinical efficacy of TTC intramedullary nail fixation for the primary treatment of unstable ankle fractures in frail elderly patients with poor soft tissue condition, by assessing the number of postoperative complications and the patient-reported functional outcomes. Methods: A retrospective cohort study was performed including patients with an unstable ankle fracture treated between 2015 and 2019 with TTC stabilization using a retrograde intramedullary hindfoot nail that was inserted without joint preparation and allowing immediate weight-bearing postoperatively. The primary outcome was the total number of postoperative complications. Results: A total of 10 patients were included out of 365 operatively treated ankle fractures. The mean age was 85.2 years (range 66-92) with a mean follow-up of 11.2 months (range 6-16). Fracture types included AO/OTA 44-B2 (n = 1), 44-B3 (n = 6), 44-C1 (n = 2) and 44-C3 (n = 1). Postoperative complications were observed in 4 patients (40%), including 3 nonunions, 2 implant related complications and 1 wound infection. No wound healing disorder or below-the-knee amputation was observed. Four patients (40%) deceased between post-operative 6 to 16 months due to medical conditions unrelated to surgery. The mean Foot and Ankle Outcome Score was 52.6 (range 44.2-73.8). Conclusion: Hindfoot nailingis a viable treatment option in selected high-risk patients with an advanced age, unstable ankle fractures with significant bone loss, poor soft tissue condition and/or severely impaired pre-injury mobility. In a frail geriatric population, hindfoot nailing may be a safe alternative fixation method with a low risk of wound complication or major amputation. However, unprepared joint may lead to symptomatic nonunion after TTC intramedullary nailing.

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 &lt; 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

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