Aesthetic surgery journal. Open forum最新文献

{"title":"Augmentation-Mastopexy With 4-Layer Autologous Fat Grafting and Evaluation of Viability With MRI.","authors":"Hüseyin Kandulu","doi":"10.1093/asjof/ojae046","DOIUrl":"https://doi.org/10.1093/asjof/ojae046","url":null,"abstract":"<p><strong>Background: </strong>Autologous fat (AF) grafting is widely used in plastic surgery and is generally considered a safe and effective procedure. A combined approach utilizing vibration amplification of sound energy at resonance (VASER) to prepare AF grafts with a 4-layer fat grafting technique was explored in this study.</p><p><strong>Objectives: </strong>To offer a customized solution that accommodates individual anatomical differences.</p><p><strong>Methods: </strong>This retrospective, cross-sectional case series involved 40 breasts from 20 female patients who underwent primary augmentation-mastopexy. After removing excess breast tissue and exposing the pedicle, lateral pillars, and pectoral muscle, the 4-layer fat grafting was performed as follows: 150 mL of AF under the pectoral muscle directed toward the medial and central zones; 100 mL into the pectoral muscle toward these zones; 50 mL under the pectoral fascia, moving retrograde from cephalic to caudal portions at a 30° to 45° cannula angle. After closing the epithelial and subepithelial incisions, an additional 100 to 150 mL of AF was injected under the subcutaneous layer around the breast, depending on each patient's contour and breast shape. Patients were monitored for 2 years with MRI scans to assess breast volume, anatomy, and fat graft survival.</p><p><strong>Results: </strong>The average follow-up was 26 ± 2.81 months. MRI evaluations indicated an efficient survival rate of the fat grafts. None of the patients experienced minor or major complications.</p><p><strong>Conclusions: </strong>The 4-layer AF grafting technique appears to be a safe and effective procedure for customized breast sculpting in augmentation-mastopexy surgery, with a high rate of fat graft sustainability and survival.</p><p><strong>Level of evidence 4: </strong></p>","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"6 ","pages":"ojae046"},"PeriodicalIF":0.0,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11483719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Labial Length and Patient Symptomatology: Is There a Correlation?","authors":"Deepa Bhat, Ruth Tevlin, Kelsey Lipman, Francisco Canales, Heather Furnas","doi":"10.1093/asjof/ojae039","DOIUrl":"10.1093/asjof/ojae039","url":null,"abstract":"<p><strong>Background: </strong>Labia minora length is used in classification systems and to determine labiaplasty candidacy, with shorter labia leading to nonsurgical recommendations.</p><p><strong>Objectives: </strong>The aim of the study was to investigate the correlation between labia length and symptomatology.</p><p><strong>Methods: </strong>Patients undergoing labiaplasty from January 2017 to May 2023 underwent chart review. Data collected included age, exposed, and total labia length. Patients completed a preoperative survey with possible scores from 0 to 13 to gauge complaints and symptoms.</p><p><strong>Results: </strong>Out of 50 charts with complete data, the average age was 34. Exposed labia lengths were 10.1 mm (right) and 11.4 mm (left); total lengths from sulcus to edge measured 32.0 mm (right) and 33.4 mm (left). Survey scores averaged 6.5 (range, 2-11) median of 7. The correlation between exposed labia length and symptoms yielded Pearson correlation coefficient values (<i>R</i>) of 0.25 for both right and left sides, with coefficient of determination (<i>r</i> ²) values at 0.06. For total labia length, <i>R</i> values were 0.08 (right) and 0.06 (left), and <i>r</i> ² values were 0.007 (right) and 0.003 (left).</p><p><strong>Conclusions: </strong>The correlation between a patient's exposed and total labia length and reported symptomatology is weak. Patients with longer labia can experience few symptoms, just as those with shorter labia can have a high degree of symptomatology. Rather than use labia length as a primary factor determining labiaplasty candidacy, the focus should be on patient-reported symptoms.</p><p><strong>Level of evidence 2: </strong></p>","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"6 ","pages":"ojae039"},"PeriodicalIF":0.0,"publicationDate":"2024-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11164564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141307453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Publication Trends in Aesthetic Breast Surgery: A Bibliometric Analysis.","authors":"Roshan Singh Rupra, Kian Daneshi, Dinithi Liyanage, Alessandra Ceccaroni, Antonioenrico Gentile, Ankur Khajuria","doi":"10.1093/asjof/ojae045","DOIUrl":"10.1093/asjof/ojae045","url":null,"abstract":"<p><strong>Background: </strong>Aesthetic breast surgery (ABS) encompasses breast augmentation, breast reduction, mastopexy, and mastopexy augmentation. This topic has seldom been assessed as a bibliometric study. This analysis aims to address this gap and identify trends in ABS literature to guide future research areas. Bibliometrics, the quantitative analysis of publications, particularly scholarly literature, offers valuable insights into research trends and impact.</p><p><strong>Objectives: </strong>This analysis aims to address this gap and identify trends in ABS literature to guide future research areas.</p><p><strong>Methods: </strong>The 100 most-cited publications in ABS were identified on Web of Science (Clarivate Analytics, Philadelphia, PA), across all available journal years (from 1953 to 2024). Study details, including the citation count, main content focus, and outcome measures, were extracted and tabulated from each publication. The Oxford Centre for Evidence Based Medicine and levels of evidence (LOE) of each study were assessed.</p><p><strong>Results: </strong>The 100 most-cited publications in ABS were cited by a total of 11,522 publications. Citations per publication ranged from 46 to 1211 (mean 115.2 ± 135.7), with the highest-cited study being the Pusic BREAST-Q paper (<i>n</i> = 1211). A majority of publications were LOE 4 (<i>n</i> = 30), representative of the large number of case series. The number of publications for LOE 5, 3, 2, and 1 was 12, 28, 21, and 9, respectively. The main content focus was \"outcomes\" in 52 publications, followed by \"nonoperative management\" (<i>n</i> = 12) and \"surgical technique\" (<i>n</i> = 12). Patient-reported outcome measures (PROMs) were used in 29 publications, and 53 publications reported aesthetic outcome measures.</p><p><strong>Conclusions: </strong>This analysis highlights that research methodologies in ABS studies should be improved. This necessary improvement would be facilitated by vigorous, high-quality research, and the implementation of validated ABS-specific PROMs enhancing patient satisfaction, particularly in aesthetic procedures, such as BREAST-Q.</p><p><strong>Level of evidence 4: </strong></p>","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"6 ","pages":"ojae045"},"PeriodicalIF":0.0,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11249954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141629365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stackable Medical-Grade Skincare for the Cosmetic Medicine Patient: A Long-Term Pilot Assessment.","authors":"Sydney Pryor, Alec Semersky, Tiffany Sabev, Julius Few","doi":"10.1093/asjof/ojae037","DOIUrl":"10.1093/asjof/ojae037","url":null,"abstract":"<p><strong>Background: </strong>Multiple intrinsic and extrinsic factors influence aging and lead to visible changes in the skin, including dryness, fine lines and wrinkles, loss of elasticity, surface roughness, uneven pigmentation, and loss of luminosity. Although it is well established that a single combination of topicals can address multiple signs of skin aging, it is common for patients' at-home skin treatment routines to include multiple different topicals with different active ingredients. The layering of active ingredients can cause skin irritation, and lead to noncompliance with a consistent routine. Further, multiple active ingredients may exacerbate irritation from in-office aesthetic treatments.</p><p><strong>Objectives: </strong>To assess the long-term efficacy, safety, tolerability, and patient adherence to a Stackable Treatment topical routine consisting of 4 complementary topical formulations.</p><p><strong>Methods: </strong>This study examined a daily topical routine (Stackable Treatment routine) consisting of 4 topical formulas with different active ingredients, and evaluated the routine's safety, tolerability, and efficacy in a composite of in-office treatment patients who applied the routine for a minimum of 1 year.</p><p><strong>Results: </strong>Of the 14 patients, 0 experienced adverse reactions. Improvements to multiple skin parameters were observed, including improvements to skin hydration, surface texture, pigmentation, vasculature, and the appearance of scars. The majority of patients continue to use the Stackable Treatment routine after the study's conclusion.</p><p><strong>Conclusions: </strong>The combination of low incidence of irritation, high patient satisfaction, and overall efficacy of the routine indicates the Stackable Treatment routine may be well suited as a foundational skin care regimen that can complement in-office aesthetic treatments.</p><p><strong>Level of evidence 4: </strong></p>","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"6 ","pages":"ojae037"},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11150041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141263306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiofrequency and Electrical Muscle Stimulation: A Synergistic Treatment That Achieves Lipolysis and Circumferential Waist Reduction in Noninvasive Body Contouring.","authors":"Neil M Vranis, Ashkan Ghavami, Rodney J Rohrich, Spero Theodorou","doi":"10.1093/asjof/ojae042","DOIUrl":"10.1093/asjof/ojae042","url":null,"abstract":"<p><strong>Background: </strong>Surgeons and providers in aesthetic medicine seek noninvasive devices that can be utilized for safe, efficient, and effective body contouring. Patient demand has propelled the development of novel devices that can simultaneously improve skin laxity, adipolysis along with stimulation of muscle hypertrophy.</p><p><strong>Objectives: </strong>To determine the efficacy of body contouring after 3 treatments using the noninvasive Transform (InMode, Lake Forest, CA) device.</p><p><strong>Methods: </strong>A prospective, multicenter study was performed. Outcomes evaluated include: standardized caliper and ultrasound measurements of abdominal skin/soft-tissue thickness, waist circumference, histologic evaluation, patient comfort, and satisfaction assessments.</p><p><strong>Results: </strong>Forty-four patients were successfully enrolled in the study and completed the series of 3 treatments which involved combined electrical muscle stimulation (EMS) and noninvasive bipolar radiofrequency (RF). Abdominal ultrasound measurements reveal a decrease in soft-tissue thickness (average 3.1 mm; <i>P</i> = .001), there was a significant decrease in caliper measurements of periumbilical skin thickness (<i>P</i> < .003), and the average reduction of abdominal circumference was 1.9 cm (<i>P</i> < .0001) 3 months after the treatment series. Histology confirmed subcutaneous adipolysis without damaging the dermal layer. Patients reported a high degree of satisfaction with the overall result (<i>P</i> = .003) and that each of the 3 treatments were progressively more comfortable (<i>P</i> < .005).</p><p><strong>Conclusions: </strong>This study demonstrates that a series of simultaneous noninvasive RF with EMS treatments to the abdomen decreases subcutaneous soft-tissue thickness of the treated area. These comfortable treatments ultimately result in a high degree of patient satisfaction at 3 months.</p><p><strong>Level of evidence 4: </strong></p>","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"6 ","pages":"ojae042"},"PeriodicalIF":0.0,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11333964/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142010026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally Invasive Beaded Electrosurgical Dissectors, Basic Science, and Pilot Studies.","authors":"Taiyo C Weber, Mark Jewell, Carl I Schulman, Jefferson Morgan, Alison M Lee, Alicia K Olivier, Elizabeth A Swanson","doi":"10.1093/asjof/ojae034","DOIUrl":"https://doi.org/10.1093/asjof/ojae034","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive beaded electrosurgical dissectors (\"BEED devices\") provide simultaneous sharp dissection, blunt dissection, and electrosurgical coagulation while performing 100 cm² porcine tissue plane dissections in 0.8 to 3 min with minimal bleeding and no perforations.</p><p><strong>Objectives: </strong>The aim of the study was to report the basic science and potential clinical applications and to video document the speed and quality of planar dissections in in vivo and ex vivo porcine models with thermal damage quantified by thermal and histopathologic measurements. Additionally, in vivo porcine specimens were followed for 90 days to show whether adverse events occurred on a gross or macroscopic basis, as evidenced by photography, videography, physical examination, and dual ultrasonography.</p><p><strong>Methods: </strong>Ex vivo porcine models were subjected to 20, 30, and 50 W in single-stroke passages with BEED dissectors (granted FDA 510(k) clearance (K233002)) with multichannel thermocouple, 3 s delay recordation combined with matching hematoxylin and eosin (H&E) histopathology. In vivo porcine models were subjected to eight 10 × 10 cm dissections in each of 2 subjects at 20, 30, and 50 W and evaluated periodically until 90 days, wherein histopathology for H&E, collagen, and elastin was taken plus standard and Doppler ultrasounds prior to euthanasia.</p><p><strong>Results: </strong>Five to 8 mm width dissectors were passed at 1 to 2 cm/s in ex vivo models (1-10 cm/s in vivo models) with an average temperature rise of 5°C at 50 W. Clinically evidenced seromas occurred in the undressed, unprotected wounds, and resolved well prior to 90 days, as documented by ultrasounds and histopathology.</p><p><strong>Conclusions: </strong>In vivo and ex vivo models demonstrated thermal values that were below levels known to damage subcutaneous adipose tissue or skin. Tissue histopathology confirmed healing parameters while Doppler ultrasound demonstrated normal blood flow in posttreatment tissues.</p><p><strong>Level of evidence 4: </strong></p>","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"6 ","pages":"ojae034"},"PeriodicalIF":0.0,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11210070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141473177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic Primary Breast Augmentation With Loco-Regional Anesthesia: Preliminary Experience of 200 Consecutive Patients.","authors":"Araco Antonino","doi":"10.1093/asjof/ojae033","DOIUrl":"https://doi.org/10.1093/asjof/ojae033","url":null,"abstract":"<p><strong>Background: </strong>Breast augmentation with implants recorded over 1.6 billion procedures globally in 2022. To reduce surgical trauma and complications and facilitate a fast recovery, we employ an ultrasound-guided local-regional anesthesia technique, the creation of a partial submuscular implant pocket by direct endoscopic visualization and minimal skin access on the mammary fold.</p><p><strong>Objectives: </strong>The aim in this study is to evaluate whether breast augmentation performed in endoscopy under local-regional anesthesia reduces postoperative recovery time, reduces complications, and increases patient satisfaction.</p><p><strong>Methods: </strong>Patients provided their consent through a signed form. We set strict inclusion and exclusion criteria. We prospectively evaluated postoperative pain and recovery times, the rate of complications, and patient satisfaction at 12 months postsurgery.</p><p><strong>Results: </strong>Between January 2021 and September 2022, 200 patients met the inclusion criteria. The average operation time was 54.2 min. Patients were discharged from the hospital within 2 to 3 h. Eighty-nine percent of patients expressed great satisfaction with the result. None of the patients experienced postsurgical complications.</p><p><strong>Conclusions: </strong>In our initial study, we showed that endoscopic breast augmentation conducted under localized anesthesia is safe. It allows for quick recovery postsurgery and swift resumption of everyday activities. The overall complication risk is less than what has been reported in scientific studies for the classic dual-plane technique. Moreover, this approach yields excellent patient satisfaction. Additional prospective and randomized studies will be required to enhance the scientific validity of this technique. Moreover, a larger patient cohort will be essential to stratify the risks associated with varying prosthetic volumes.</p><p><strong>Level of evidence 4: </strong></p>","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"6 ","pages":"ojae033"},"PeriodicalIF":0.0,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11210060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141473176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cellulite and the Aesthetic Management of the Buttocks and Thighs: 6 Cases Illustrating Targeted Verifiable Subcision as Part of a Multimodal Approach to Lower Body Rejuvenation.","authors":"Laurie A Casas, M Bradley Calobrace, Johnny Franco, Jennifer Harrington, Kristi Hustak, Sachin M Shridharani","doi":"10.1093/asjof/ojae031","DOIUrl":"https://doi.org/10.1093/asjof/ojae031","url":null,"abstract":"<p><strong>Background: </strong>In the buttocks and thighs, skin quality, focal adiposity, volume deficiency, skin laxity, and/or textural issues each contribute to overall appearance. For patients undergoing rejuvenation/beautification procedures, global improvement is desired, making multimodal treatment the standard of care to address these mechanistically distinct concerns. Resolution of cellulite depressions is central to patient satisfaction and aesthetic outcomes: without management, the overall aesthetic suffers, and patients are left partially unsatisfied with treatment results. With minimally invasive Targeted Verifiable Subcision (TVS; Avéli [Revelle Aesthetics, Inc., Mountain View, CA]), septa with a confirmed role in dimple formation can be released through mechanically verified subcision, permitting consistent outcomes.</p><p><strong>Objectives: </strong>Discuss the application of TVS as part of a multimodal approach to buttock and thigh rejuvenation and share best practices for obtaining optimal improvement.</p><p><strong>Methods: </strong>A group of 6 experts in aesthetic plastic surgery and dermatology convened for a 2 h roundtable discussion of select case studies, best practices, and their approaches for obtaining optimal outcomes in clinical practice.</p><p><strong>Results: </strong>Clinical cases from 6 patients who presented for buttock and/or thigh rejuvenation/beautification are presented where TVS was applied as part of a multimodal approach. Before and after images, details of patient cases, and a discussion of best practices for patient education and evaluation, treatment planning, technique, safety, postprocedure care, and open research questions are included.</p><p><strong>Conclusions: </strong>TVS is emerging as a valuable tool for the treatment of cellulite in the buttocks and thighs that may potentially be used alongside surgical and nonsurgical approaches, often on the same day.</p><p><strong>Level of evidence 4: </strong></p>","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"6 ","pages":"ojae031"},"PeriodicalIF":0.0,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11210067/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141473175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feminizing Gender Affirming Breast Surgery: Procedural Outcomes at a Single Academic Institution.","authors":"Nicole Sanchez Figueroa, Doga Kuruoglu, Vahe Fahradyan, Nho Tran, Basel Sharaf, Jorys Martínez-Jorge","doi":"10.1093/asjof/ojae032","DOIUrl":"10.1093/asjof/ojae032","url":null,"abstract":"<p><strong>Background: </strong>Implant-based breast augmentation is a gold standard procedure for transfeminine patients to create a more feminine-appearing chest. In many cases, ancillary procedures are performed simultaneously to achieve an optimal aesthetic result.</p><p><strong>Objectives: </strong>To determine the clinical outcomes of patients undergoing feminizing gender-affirming breast surgery in a single academic institution.</p><p><strong>Methods: </strong>A retrospective electronic chart review of feminizing gender-affirming breast surgery patients at Mayo Clinic, Rochester, from 2017 to 2022 was conducted. Patients' demographics and surgical outcomes were gathered. A survival analysis was performed to obtain the time-to-event complication rate.</p><p><strong>Results: </strong>Over 5 years, 46 patients (92 breasts) were included. The mean age was 39 years (standard deviation [SD] ±15), and most had an above-normal body mass index (BMI) (58.7%). Thirty (65%) had previous gender-affirming surgeries. The mean implant volume was 289 mL (SD ±95; 140-520). Most implants were placed in a subglandular plane (81%) with an inframammary fold incision (91.3%). All implants used were smooth, round cohesive silicone gel implants. Ancillary procedures were performed in 32 patients (69.57%). Eight patients presented complications (4 major vs 4 minor) in a median postoperative follow-up of 372 vs 392 days; at 1-month follow-up, the probability of a complication having occurred is 2.17% (95% CI: 0%-6.3%) vs 5% (95% CI: 0%-11.5%), and at 1 year, the probability is 10.21% (95% CI: 0%-20.9%) vs 12.5% (95% CI: 0%-23.4%), which remains the same up to 4 years.</p><p><strong>Conclusions: </strong>Breast augmentation with implants is a safe procedure to achieve feminization of the breast with a low rate of complications.</p><p><strong>Level of evidence 4: </strong></p>","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"6 ","pages":"ojae032"},"PeriodicalIF":0.0,"publicationDate":"2024-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11134292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141176955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Use of Next Generation Sequencing to Detect Early Implant Infections: The Future of Microbiology and Targeted Antibiotic Treatment","authors":"Jaime L Bernstein, Anna M. Vaeth, Karina Condez, Kristen Castellano, Grant Black, D. Otterburn","doi":"10.1093/asjof/ojae007.077","DOIUrl":"https://doi.org/10.1093/asjof/ojae007.077","url":null,"abstract":"Abstract Goals/Purpose The presence of fluid around foreign bodies, particularly breast implants, is a well-established phenomenon; However scant data exists regarding the composition of this fluid. The difficulty in studying this fluid arises from the lack of safe access to aspirate fluid post-breast augmentation, and by the loss of sterility once fluid exits the body via a drain bulb as traditionally placed during breast reconstruction. Our innovative breast reconstruction approach utilizes a drainless technique with a dual chamber tissue expander (TE) in the pre-pectoral plane, offering a unique avenue to sterilely aspirate peri-implant fluid through a percutaneous drainage port. In this study, we employ Next Generation Sequencing (NGS), utilizing polymerase chain reaction technology, to discern the composition of microbial DNA within peri-prosthetic breast implant fluid. NGS, known for its precision and cost-effectiveness, circumvents the biases inherent in traditional culture methods. By integrating this cutting-edge technology with our breast reconstruction methodology, we sought to study peri-prosthetic breast implant fluid to better understand when implant infections arise and if peri-prosthetic fluid could detect infections before clinical symptoms arise. Methods/Technique This is a single surgeon, prospective study of patients undergoing mastectomy, followed by pre-pectoral, drainless, TE reconstruction. Peri-prosthetic fluid was collected through the TE drainage port in the OR immediately after closure, at 1 week post op, and 3 weeks post op. This fluid was sent for traditional culture and NGS. Patients were observed for signs of infection, antibiotics, return to OR, or implant loss. Results/Complications 33 breasts from 20 patients were included. Patients had a mean age of 50 years. The average length of drainage was 21 days post-operative, with a mean of 131 cc of fluid drained per breast per week. Eight breasts had concern for skin necrosis. In 25 breasts (76%), complete sterility was achieved at the end of the case with no NGS detection of microorganisms in the initial peri-implant fluid sample. However, NGS detected microorganisms in the initial sample in 8 breasts (24%). In 5 of these 8 breasts, microorganisms were cleared by the 1-week sample and another 2 cleared by 3 weeks. The remaining 1 breast continued to have positive NGS and developed clinical signs of infections by week 2, which were not picked up by traditional culture until week 3. One breast with skin necrosis developed a positive NGS at week 3 and clinical signs of infection at week 4. No other clinical infections were seen throughout the study. Conclusion We are one of the first groups to demonstrate the ability to achieve peri-implant sterility at the time of implant insertion in the operating room. This could have significant implications for understanding the necessity of peri-operative antibiotics following breast implant placement. Our investigation into the m","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"42 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140709916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}