Composite Breast Remodeling After Implant Removal by Tissue Recruitment and Loops Fixation With Power-Assisted Liposuction and Lipofilling (PALLL)

2021 ◽  
Author(s):  
Marwan H Abboud ◽  
Ayush K Kapila ◽  
Svetlana Bogaert ◽  
Nicolas M Abboud
Keyword(s):  
Breast Implant ◽  
Capsular Contracture ◽  
Patient Characteristics ◽  
Fat Grafting ◽  
Implant Removal ◽  
Level Of Evidence ◽  
Patient Reported ◽  
Aesthetic Results ◽  
And Migration ◽  
The Aesthetic

Abstract Background An increasing number of women wish breast implant removal whilst maintaining an acceptable projection and form were possible. Objectives The authors propose a technique to remodel the breast after implant removal utilizing internal suture loops to project the breast, recruit abdominal and axillary tissue cranially and medially, and provide a matrix for lipofilling. Methods A prospective analysis was performed of consecutive patients undergoing implant extraction followed by power-assisted liposuction loops and lipofilling. Patient characteristics were measured. The aesthetic results were evaluated by 2 independent raters. Patient-reported satisfaction was measured by standardized questionnaires. Results Implants in 52 patients with an average age of 55 and body mass index of 23.7 were extracted followed by breast remodeling. A total of 73% of patients had implants for aesthetic reasons, 41% were smokers, and 43% of the reconstruction cases received radiotherapy. A total of 28% had implant extraction for rupture, 58% for capsular contracture, and 14% due to pain and migration. The average volume of the implants removed was 292 cc, followed by an average lipofilling of 223 cc, yielding a ratio of 0.76 to 1. The average tissue recruited by loops was 82.5 cc. Independent raters measured 79% of results as good, 13% as acceptable, and 8% as requiring improvement; 80% of patients were satisfied to very satisfied. Conclusions The authors propose implant extraction followed by power-assisted liposuction loops and lipofilling can provide footprint definition, sustained projection, and high patient satisfaction. Moreover, the recruitment of a vascularized adipo-cutaneous flap by loops allows a reduced ratio of fat grafting to implant volume. Level of Evidence: 4

scholarly journals Comprehensive Comparison Between Shaped Versus Round Implants for Breast Reconstruction: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 41 (1) ◽  
pp. 34-44 ◽  
Author(s):  
So-Eun Han ◽  
Kyeong-Tae Lee ◽  
Saik Bang
Keyword(s):  
Breast Reconstruction ◽  
Meta Analysis ◽  
Breast Implant ◽  
Capsular Contracture ◽  
Complication Rates ◽  
Level Of Evidence ◽  
Relative Risks ◽  
Patient Reported ◽  
Aesthetic Results ◽  
Retrospective Cohort Studies

Abstract Background Prosthetic breast reconstruction has been gaining popularity and a variety of implant options are currently available. Therefore, it is important to evaluate the safety and efficacy of newly developed shaped implants compared with those of conventional round implants. To date, few studies have investigated the outcomes of breast reconstruction with shaped versus round implants. Objectives The present study aimed to comprehensively compare, via meta-analytic methodology, shaped and round breast implant reconstruction in terms of complication profiles and aesthetic satisfaction. Methods PubMed/MEDLINE, Ovid, and Cochrane databases were searched to identify relevant studies presenting the complication rates for shaped and round implant groups. The relative risks of the following complications between the groups were calculated: infection, seroma, capsular contracture, rupture, rippling, reconstruction failure, and implant exchange or removal. Outcomes of aesthetic satisfaction included aesthetic results and patient-reported outcomes. Results Meta-analysis of 8 retrospective cohort studies, representing 2490 cases of implant-based breast reconstruction, was performed. There were no significant differences in the risks of infection, seroma, capsular contracture, and reconstruction failure between the 2 groups. The risks of implant rupture and rippling were significantly reduced with shaped implants. In a subgroup analysis of shaped/textured and round/smooth implants, the risk of infection was significantly enhanced in the former, whereas incidences of other complications, including capsular contracture and reconstruction failure, were similar. Aesthetic satisfaction analysis of the 2 groups demonstrated similar outcome scores with favorable overall results. Conclusions Our results suggest that both shaped and round implants might provide favorable breast reconstruction outcomes with similarly low complication rates and aesthetic results. Level of Evidence: 4

scholarly journals Abdominal Etching: Past and Present

2019 ◽  
Vol 39 (12) ◽  
pp. 1368-1377 ◽  
Author(s):  
Nneamaka Agochukwu-Nwubah ◽  
Henry A Mentz
Keyword(s):  
Paradigm Shift ◽  
Subcutaneous Fat ◽  
Senior Author ◽  
Fat Grafting ◽  
Level Of Evidence ◽  
The Past ◽  
Wide Range ◽  
Aesthetic Results ◽  
The Aesthetic ◽  
Fat Repositioning

Abstract Since its inception in the 1980s, liposuction has undergone a tremendous paradigm shift from the simple removal of excess subcutaneous fat to a procedure of extreme sophistication and elegance where we as surgeons are able to mold and shape a patient’s figure. Plastic surgeons have modified this procedure with the overall goal of improving the aesthetic results while focusing on maximizing safety and minimizing complications. These modifications include advanced liposuction technology and techniques, the increasing use of subdermal superficial liposuction, differential liposuction, the advent and introduction of a wide range of cannulas, and the use of fat grafting simultaneously with liposuction for targeted contour and fat repositioning. In this article, the authors discuss in detail the introduction and progression of abdominal etching, a procedure first introduced by the senior author (H.A.M.) in the early 1990s. The authors also present their experience over the past 4 years. In this procedure, the technique of differential liposuction is employed to enhance the detail of abdominal musculature. The literature on abdominal etching is fairly scarce. Thus, the authors hope that this review will not only give the provider a thorough review and understanding of liposuction and its evolution over the years but will also provide an overview of the indications, patient selection, technique, expectations, and complications of abdominal etching as well. Level of Evidence: 4

Transitioning From Conventional Textured to Nanotextured Breast Implants: Our Early Experience and Modifications for Optimal Breast Augmentation Outcomes

2020 ◽  
Author(s):  
Paolo Montemurro ◽  
Vincent K S Tay
Keyword(s):  
Breast Augmentation ◽  
Breast Implant ◽  
Capsular Contracture ◽  
Breast Implants ◽  
Patient Characteristics ◽  
Large Cell ◽  
Complication Rates ◽  
Level Of Evidence ◽  
Capsular Contractures

Abstract Background Nanotextured breast implants were hailed as an innovation that may address capsular contracture and breast implant-associated anaplastic large cell lymphoma and may provide the sweet spot between smooth and conventional textured implants. Objectives This study aimed to evaluate the introduction of nanotextured implants alongside conventional textured implants and to compare early complications. Methods Patients who underwent breast augmentation from the introduction of nanotextured implants in the author’s practice with at least 1 year of follow-up were included. They were divided into nanotextured and conventional textured implant groups and then into 3 chronological subgroups. Patient characteristics, implant specifications, operative factors, and complication rates were compared. Results A total 415 cases with a mean follow-up of 26.9 months were identified, of which 38.8% utilized nanotextured implants and 61.2% conventional textured implants. Utilization of nanotextured implants increased from 26.9% in period 1 to 54.5% in period 3. Complication rates for the conventional textured group were 0.8% at 1 year and 3.5% on overall follow-up, with mostly capsular contractures; for the nanotextured group, complication rates were 6.8% and 8.7%, respectively, and “bottoming out” was most common. When analyzed across chronological subgroups, complication rates decreased for nanotextured implants by period 3. Conclusions A learning curve and associated complications are expected for early adopters of new implants. In our series, nanotextured implants were associated with higher complication rates at 1 year and on overall follow-up. Modifications in patient selection, intraoperative techniques, and postoperative care reduced complications in the later period. Level of Evidence: 4

scholarly journals Simultaneous Mastopexy Explantation With a Vertical Bipedicle and Novel Open Pattern Marking Technique

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Elliot M Hirsch
Keyword(s):  
Plastic Surgery ◽  
Breast Implant ◽  
Implant Removal ◽  
Consecutive Series ◽  
Level Of Evidence ◽  
Areola Complex ◽  
Depth Analysis ◽  
Safe Technique ◽  
Marking Technique ◽  
Technical Considerations

Abstract There are limited studies in the plastic surgery literature that detail technical considerations in simultaneous breast implant removal and mastopexy procedures. These procedures are difficult, with significant potential for complications and poor cosmesis. The current plastic surgery literature describes a limited number of techniques that address these concerns, virtually all of which are variants of superior or superior medial pedicle vertical pattern mastopexy. This paper details a safe technique for simultaneous explantation and mastopexy with a novel open marking pattern and vertical bipedicle, which can restore breast cosmesis following implant removal. The study will briefly retrospectively review the results of a consecutive series of 86 patients who underwent this procedure from November 2018 to November 2019, with no incidence of partial or total nipple-areola complex necrosis. Thus, the technique is safe and allows the flexibility for intraoperative adjustments that are necessary for these procedures. A future study will conduct a more in-depth analysis of the results. Level of Evidence: 4

A Single Center's Clinical Experience With Ergonomix Breast Implants

2021 ◽  
Author(s):  
Giovanni Botti ◽  
Chiara Botti ◽  
Francesco Ciancio
Keyword(s):  
Capsular Contracture ◽  
Breast Implants ◽  
Early Experience ◽  
High Patient Satisfaction ◽  
Time Points ◽  
Important Improvement ◽  
Aesthetic Results ◽  
Capsular Contractures ◽  
The Aesthetic ◽  
Augmentation Mastopexy

Abstract Background This retrospective study reports on the early experience of a private surgical center with Motiva Ergonomix SilkSurface SikSurface breast implants. Objectives to examine the incidence of complications and satisfaction levels in women who received primary and revision breast augmentation or augmentation-mastopexy with this device. Methods 356 consecutive patients received Motiva Ergonomix breast implants from April 2014 to October 2018 by 3 different surgeons and were followed-up for a minimum of 12 months. Complications were assessed by measuring the rate of rupture, capsular contracture, malposition, late seroma, double capsule, reoperation, symmastia, ptosis, extrusion, and infection. Satisfaction with aesthetic results was assessed by both surgeon and patient, using the Likert scale. Results Only six major complications were observed in these 356 patients (712 implants). One unilateral implant ptosis (“bottoming out”) at 12 months (0.14 %) and 2 capsular contractures (0.28 %), one at 14 months and the other at 2 years. At all time-points, 98% of the patients were “extremely satisfied or very satisfied” with the aesthetic results and surgeons categorized the outcomes as “very important or important improvement” in 96% of the cases. Conclusions Motiva Ergonomix SilkSurface devices provided high patient satisfaction up to more than 5 years postoperatively with very few complications. These data are consistent with other reports in the literature. The observed favorable outcomes might be attributed, at least in part, to Motiva Ergonomix’s bio-engineered “cell-friendly” surface.

scholarly journals Pro-Fibrotic CD26-Positive Fibroblasts Are Present in Greater Abundance in Breast Capsule Tissue of Irradiated Breasts

2019 ◽  
Vol 40 (4) ◽  
pp. 369-379 ◽  
Author(s):  
Mimi R Borrelli ◽  
Dre Irizzary ◽  
Ronak A Patel ◽  
Dung Nguyen ◽  
Arash Momeni ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Cell Sorting ◽  
Therapeutic Option ◽  
Breast Implant ◽  
Capsular Contracture ◽  
Bilateral Mastectomy ◽  
Fluorescence Activated Cell Sorting ◽  
Level Of Evidence ◽  
Surface Marker Expression ◽  
Institutional Review

Abstract Background Breast capsular contracture is a major problem following implant-based breast reconstruction, particularly in the setting of radiation therapy. Recent work has identified a fibrogenic fibroblast subpopulation characterized by CD26 surface marker expression. Objectives This work aimed to investigate the role of CD26-positive fibroblasts in the formation of breast implant capsules following radiation therapy. Methods Breast capsule specimens were obtained from irradiated and nonirradiated breasts of 10 patients following bilateral mastectomy and unilateral irradiation at the time of expander-implant exchange, under institutional review board approval. Specimens were processed for hematoxylin and eosin staining as well as for immunohistochemistry and fluorescence activated cell sorting for CD26-positive fibroblasts. Expression of fibrotic genes and production of collagen were compared between CD26-positive, CD26-negative, and unsorted fibroblasts. Results Capsule specimens from irradiated breast tissue were thicker and had greater CD26-postive cells on immunofluorescence imaging and on fluorescence activated cell sorting analysis than did capsule specimens from the nonirradiated breast. Compared with CD26-negative fibroblasts, CD26-positive fibroblasts produced more collagen and had increased expression of the profibrotic genes IL8, TGF-β1, COL1A1, and TIMP4. Conclusions CD26-positive fibroblasts were found in a significantly greater abundance in capsules of irradiated compared with nonirradiated breasts and demonstrated greater fibrotic potential. This fibrogenic fibroblast subpopulation may play an important role in the development of capsular contracture following irradiation, and its targeted depletion or moderation may represent a potential therapeutic option. Level of Evidence: 2

Defining Minimal Clinically Important Difference and Patient Acceptable Symptom State After Isolated Endoscopic Gluteus Medius Repair

2019 ◽  
Vol 47 (13) ◽  
pp. 3141-3147 ◽  
Author(s):  
Kelechi R. Okoroha ◽  
Edward C. Beck ◽  
Benedict U. Nwachukwu ◽  
Kyle N. Kunze ◽  
Shane J. Nho
Keyword(s):  
Clinical Outcomes ◽  
Minimal Clinically Important Difference ◽  
Case Series ◽  
Gluteus Medius ◽  
Patient Characteristics ◽  
Harris Hip Score ◽  
Level Of Evidence ◽  
Common Procedure ◽  
Clinically Important Difference ◽  
Patient Reported

Background: Endoscopic surgical repair has become a common procedure for treating patients with gluteus medius tears. However, meaningful clinical outcomes after the procedure have not been defined. Purpose: To (1) define the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) in patients undergoing endoscopic gluteus medius repair and (2) determine correlations between preoperative patient characteristics and achievement of MCID/PASS. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review was performed of prospectively collected data from all patients undergoing primary endoscopic repair of gluteus medius tears between January 2012 and February 2017 with a minimum 2-year follow-up. Patient data collected included patient characteristics, radiographic parameters, preoperative clinical function scores, and postoperative patient-reported outcomes (PROs). Paired t tests were used to compare the differences in 2-year PROs. The MCID and PASS for each PRO were calculated and Spearman coefficient analysis was used to identify correlations between MCID, PASS, and preoperative variables. Results: A total of 60 patients were included in the study. A majority of patients were female (91.7%), with an average age and body mass index of 57.9 ± 9.91 years and 27.6 ± 6.1, respectively. The MCIDs of the Activities of Daily Living (ADL) and Sport-Specific (SS) subscales of the Hip Outcome Score (HOS) and the modified Harris Hip Score (mHHS) were calculated to be 15.02, 14.53, and 14.13, respectively. The PASS scores of HOS-ADL, HOS-SS, and mHHS were calculated to be 81.32, 67.71, and 77.5, respectively. In addition, 76.7% of patients achieved either MCID or PASS postoperatively, with 77.8% and 69.0% reaching at least 1 threshold score for achieving MCID and PASS, respectively, and 48.3% achieving both MCID and PASS. Smoking had a negative and weak association with achieving PASS ( r = −0.271; P = .039). No other patient characteristic variables were found to correlate with achieving MCID or PASS. Conclusion: In patients undergoing endoscopic gluteus medius repair, our study defined MCID and PASS for HOS-ADL, HOS-SS, and mHHS outcome scores. A large percentage of patients (76.7%) achieved meaningful clinical outcomes at 2 years after surgery.

Breast Reconstruction with Implants and Tissue Expanders

2019 ◽  
pp. 669-676
Author(s):  
Ruth J. Barta ◽  
Omotinuwe Adepoju ◽  
Bruce Cunningham
Keyword(s):  
Breast Reconstruction ◽  
Acellular Dermal Matrix ◽  
Fat Grafting ◽  
Implant Design ◽  
Patient Specific ◽  
Dermal Matrix ◽  
Tissue Expanders ◽  
Aesthetic Results ◽  
The Aesthetic ◽  
Acellular Dermal

This chapter details breast reconstruction following breast surgery. Over the past decade the number of women choosing reconstruction with tissue expanders and implants has steadily increased, while the percentage of women having autologous reconstruction has plateaued or fallen off. The authors explain the use of tissue expanders and implants and detail the advancements made in the ability to evaluate tissue in real-time intervals. Additional advances in technique, implant design, acellular dermal matrix, and fat grafting have improved the aesthetic results of breast reconstruction even further, and these techniques are discussed in detail. The authors address patient-specific indications and contraindications, the use of acellular dermal matrix, the assessment of the defect and perfusion, patient markings, room setup, and operative technique.

Female Cosmetic Genital Surgery: Patient Characteristics, Motivation, and Satisfaction

2018 ◽  
Vol 39 (12) ◽  
pp. 1455-1466 ◽  
Author(s):  
Amin Kalaaji ◽  
Stine Dreyer ◽  
Ivana Maric ◽  
Jakob Schnegg ◽  
Vanja Jönsson
Keyword(s):  
Breast Implant ◽  
Patient Characteristics ◽  
Negative Effects ◽  
Multicenter Studies ◽  
Level Of Evidence ◽  
Genital Surgery ◽  
Surgery Patient ◽  
Safety Warning ◽  
Negative Comments ◽  
Mail System

Abstract Background Female cosmetic genital surgery is rapidly growing. However, controversy reports raised around these procedures question their indications, motives, and safety. Warning against performing this surgery might unjustly restrict surgical alleviation of symptoms. Objectives Through anonymous research, the authors explored patient characteristics and motivation, when women started to think about surgery, and effects of surgery on psychosocial and cosmetic aspects. Methods Of 125 patients who underwent female cosmetic genital surgery at Oslo Plastic Surgery Clinic between 2010 and 2016, 69 patients were reachable by email. A questionnaire with 40 questions was completed anonymously. Answers were processed by a third, independent party via QuestBack return mail system. Results The response rate was 77%. Mean follow-up time was 31.4 months. Mean patient age was 30.8 years. Motivations for surgery were cosmetic (69.8%), physical/practical (62.3%), emotional (54.7%), and intimate (49.1%). When emotional reasons were involved, media (39.7%), pornography (31.5%), and negative comments (28.8%) influenced the decision to undergo surgery. Genital concerns had negative effects on self-esteem (63.2%) and sexual attractiveness (57.9%) among others; 90.5% thought about surgery for more than 1 year. The overall cosmetic result was satisfactory for 69.8%, and the operation as a whole was satisfactory for 75.5%. Conclusions Age, level of education, and gross income of patients who underwent this surgery seem high compared with those of breast implant patients. Genital dissatisfaction arose early in life and affected various psychosexual aspects. Most patients are satisfied with the outcome of surgery and would recommend this surgery to others. Additional anonymous multicenter studies are recommended. Level of Evidence: 4

Total Ankle Arthroplasty Survival and Risk Factors for Failure

2019 ◽  
Vol 40 (9) ◽  
pp. 997-1006 ◽  
Author(s):  
Mario I. Escudero ◽  
Vu Le ◽  
Maximiliano Barahona ◽  
Michael Symes ◽  
Kevin Wing ◽  
...  
Keyword(s):  
Risk Factors ◽  
Predictive Model ◽  
Patient Characteristics ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthritis ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Radiographic Parameters ◽  
Patient Reported ◽  
Component Revision

Background: Total ankle arthroplasty (TAA) is an increasingly selected treatment for end-stage ankle arthritis; however, failure and revision of the tibial and talar components remains an issue. Although multiple risk factors have been shown to contribute to early component revision, no study has looked at combining such risk factors into a predictive model that could potentially decrease revision rates and improve implant survival. This study aimed to develop a predictive model for TAA failure based on patient characteristics, patient-reported outcomes (PROs), and immediate postoperative radiographs. Methods: A retrospective review of a single-site ankle arthritis database was conducted. All patients with current-generation ankle replacements including the Hintegra and Infinity prostheses implanted between 2004 and 2015 and with complete postoperative radiographs taken between 6 and 12 weeks postoperatively were included. Eight coronal and sagittal radiographic parameters were assessed and performed twice by 2 independent orthopedic surgeons on included TAAs. These radiographic parameters were then analyzed in association with patient demographics and PRO. Advanced statistical methods including survival analysis were used to construct a predictive model for TAA survival. A total of 107 patients were included and analyzed with a median clinical follow-up of 49 months (minimum 24 months). Results: A predictive model was created, with 4 parameters identified as being statistically associated with TAA metal-component revision: diabetes mellitus, poor baseline Ankle Osteoarthritis Scale (AOS) score, excessively dorsiflexed talar component, and an anteriorly/posteriorly translated talus relative to the tibial axis. The presence of 3 parameters predicted TAA survival of 0.60 whereas presence of all 4 parameters predicted survival of only 0.13 in the period studied. Conclusion: Our predictive model is based on a combination of patient factors, PROs, and radiographic TAA alignment. We believe it can be used by surgeons to predict failure in their TAA patients, thereby optimizing postoperative outcomes by improving patient selection and modifiable outcome-specific parameters. Level of Evidence: Level III, retrospective cohort study using prospectively collected data.

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