Aesthetic surgery journal. Open forum最新文献

{"title":"Addressing the Cosmetic Resident Education Gap – a Junior Cosmetic Fellowship Program","authors":"Kelsey Lipman, Joshua Korman, Dung Nguyen","doi":"10.1093/asjof/ojae007.051","DOIUrl":"https://doi.org/10.1093/asjof/ojae007.051","url":null,"abstract":"Abstract Goals/Purpose Incorporating adequate aesthetic surgery training into integrated plastic surgery programs in the United States has remained a challenge for several decades.[1-4] Specifically, residents report low confidence in performing facial cosmetic procedures compared to breast and body contouring.[1-2] This becomes increasingly relevant in the setting of heightened specialty creep and the rise in demand for cosmetic procedures overall according to the 2022 ASPS procedural statistics which show a 19% increase in cosmetic surgery procedures compared to the pre-pandemic 2019 report.[5] In a survey of 257 residents, 26.4% felt confident performing a lower blepharoplasty, 25% performing a facelift, 16.5% performing an endoscopic brow lift, and 14% performing a rhinoplasty.[2] This resident-reported difficulty with facial cosmetic procedures has shown little progress over time in reported survey data despite an increase in minimum cosmetic case numbers and length of training. A comprehensive aesthetic training also includes exposure to non-surgical interventions such as neuromodulators, injectables, non-surgical body contouring and facial rejuvenation technology. Though non-invasive fat reduction (ie. cryolypolysis) and non-surgical skin tightening (ie. radiofrequency micro-needling) have increased in demand since 2019 (77% and 22%, respectively), residents rarely have hands-on exposure to these treatment modalities.[5] Several integrated plastic surgery programs have a dedicated year of professional development or research, providing an opportunity for programs to fill this gap between cosmetic surgery training and real-world demand. Methods/Technique A junior cosmetic fellowship curriculum was created at a single institution focused on increasing confidence in performing aesthetic surgery, exposure to non-surgical cosmetic procedures, and increasing exposure to the business side of private practice. The fellowship was designed for a single resident during the professional development year of integrated plastic surgery training, completed between the third and fourth clinical years. The junior fellow spent the year within a single, multi-office private aesthetics practice in both the surgical and non-surgical setting. Over the course of the first four months (July 2023 - October 2023), the clinical experience of the Stanford junior cosmetic fellow was queried. Analysis of surgical case volume and non-surgical patient load was performed. This was then used to project surgical cases anticipated to be completed by year end. This was compared to case log minimums for graduating integrated plastic surgery residents in the United States, an essential metric of assessing resident experience and competence. Financial analysis of the non-surgical treatments by the junior fellow was performed. Using the initial four-month data, projections were also estimated to determine profitability for the practice over the course of the year-long fellowship. ","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"15 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140711895","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}

{"title":"A Comparison of Capsular Contracture Rates after Implant-Based Breast Reconstruction Using ADM Versus Synthetic Mesh","authors":"Jennifer Bai, Sarah Ferenz, Megan Fracol, John Y S Kim","doi":"10.1093/asjof/ojae007.018","DOIUrl":"https://doi.org/10.1093/asjof/ojae007.018","url":null,"abstract":"Abstract Goals/Purpose Capsular contracture is a local complication in which there is tightening of the capsule around the implant. This complication has been shown to occur in 15-30% of implant-based breast reconstruction patients and often requires revision surgery for correction. Prior investigations have suggested that the use of ADM can reduce the risk for development of capsular contracture, with more recent research suggesting that synthetic mesh may provide the same benefit. Several meta-analyses have attempted to compare ADM and mesh use for the prevention of capsular contracture, but they all emphasize the continued need for clinical investigation with direct comparisons. The goal of this study is to assess our own reconstruction patient population to compare capsular contracture rates between ADM and mesh cohorts, as well as to assess for other potential risks that may increase the rate of capsular contracture in these patients. Methods/Technique A 15-year retrospective review of all implant-based breast reconstructions performed by the senior author was performed. All operations occurred between 2008 and 2023 in a hospital setting. Patient demographics were assessed including age, BMI, implant size, radiation history, location of malposition, and use of either ADM or mesh. Post-operative complications including incidence of capsular contracture were recorded. Patients who had documented capsular contracture prior to scaffold insertion were excluded from the study. Wilcoxon signed rank test, 2-sided t-test, and Fischer’s Exact test were used to compare baseline demographics and capsular contracture rates between the two groups, along with a multivariate logistic regression analysis to control for potential confounders. Results/Complications Fifty-two breasts underwent capsulorraphy, of which 25 (48.1%) used ADM and 27 (51.9%) used mesh. Average age was 50.6 years, average BMI was 27.7, average implant size was 541.8 cc, and eight breasts (15.4%) had been irradiated. Average follow-up time was seven years (mean = 85.4 months, range 22 – 149 months, SD = 35.9). Fourteen (26.9%) capsulorraphies were for inferior malposition, 13 (25.0%) for lateral malposition, and 25 (48.1%) were for inferolateral malposition. Patients in the ADM group had significantly more lateral malposition prior to insertion as compared to the mesh group which had more inferior malposition (p=0.0246). There was no significant difference between the two groups for any other recorded baseline demographic; these demographics included age, BMI, hypertension, diabetes, history of tobacco use, radiation, chemotherapy, implant volume, and implant surface texture. Capsular contracture occurred in 2 ADM breasts (8.0%) and 4 mesh breasts (14.8%) with no significant difference between the two groups (p=0.6695). Five of these capsular contractures had documented Baker grades with three grade II, one grade III, and one grade IV. None of the recorded baseline demographics signific","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"8 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140712098","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}

{"title":"Marijuana Use in Aesthetic Surgery Patients: A Retrospective Review of 441 Cases","authors":"Veronique Doucet, Avinash Islur","doi":"10.1093/asjof/ojae007.025","DOIUrl":"https://doi.org/10.1093/asjof/ojae007.025","url":null,"abstract":"Abstract Goals/Purpose Marijuana use is increasing in Canada following its legalization in 2018. 27% of Canadians were reported to have consumed marijuana in 2022. Marijuana use in surgical patients is a topic that has had exponential growth in the literature recently. The drug has many therapeutic effects such as analgesia, muscle relaxation, sedation and mood improvement. However, it is also associated with deleterious cardiovascular, respiratory and coagulopathic effects that can significantly impact the care of surgical patients in the peri-operative period. Literature from other surgical specialities has shown similar recovery and ultimate surgical outcome between marijuana users and non-marijuana users despite increased pain and poorer quality of life associated with marijuana use. There is a paucity of information about the effects of marijuana on aesthetic plastic surgery outcomes. The prevalence of marijuana use in aesthetic plastic surgery patients is currently unknown and there is a need for more evidence to develop clinical practice guidelines regarding the use of marijuana in the perioperative period. The purpose of this study is to describe the effects of marijuana consumption on aesthetic plastic surgery outcomes. Methods/Technique A single-center retrospective review was completed including all patients who underwent abdominoplasty, mastopexy and/or other body contouring surgery (such as brachioplasty, thigh lift or lower body lift) between January 2021 and August 2023. Other procedures such as liposuction, fat grafting, implant insertion or removal were also reviewed if they took place during the same general anesthetic. Marijuana use was defined as use within 4 weeks pre- and/or post-operatively. Data collection included patient demographics, body mass index (BMI), marijuana use, smoking status, comorbidities, surgical procedure(s) performed, operative time, resection weight and/or liposuction volume (if applicable), complications and follow up. Results/Complications A total of 1000 procedures in 441 patients were reviewed during the 32-month study period. Average patient age was 43 years old and average patient BMI was 27.3 kg/m2. 20.4% of patients were marijuana users. The average number of procedures completed per patient was 2.3 and average operative time was 167 minutes (2 hours and 47 minutes). 79% of cases involved more than one surgical procedure. 63% of the 441 cases involved an abdominoplasty, 49% involved a mastopexy, 5% involved a brachioplasty and 4% involved a thigh lift procedure. 33% of cases included breast implants and 47% liposuction. Average follow up time was 5.2 months. Overall surgical complications consisted of a 5% superficial infection rate, 1% deep infection rate, 9% seroma rate, 1% hematoma and lymphocele rates, 3% rate of wound dehiscence requiring surgical intervention and 11% rate of superficial delayed wound healing. There were no cases of nipple necrosis or full thickness skin necrosis. A compari","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"21 22","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140710214","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}

{"title":"To Stage or Not to Stage? Direct-to-Implant Versus Staged Reconstruction for Implant-Based Breast Reconstruction","authors":"C. Siotos, Kelly A. Harmon, Nikki Rezania, Deana S Shenaq","doi":"10.1093/asjof/ojae007.080","DOIUrl":"https://doi.org/10.1093/asjof/ojae007.080","url":null,"abstract":"Abstract Goals/Purpose Implant-based breast reconstruction remains the common method of reconstruction after mastectomy in the US. An increasing number of centers are now offering direct-to-implant (DTI) breast reconstruction, avoiding staged reconstructions with tissue expander placement first. However, little is known regarding the need for revisions following DTI. In this study we sought to investigate short- and long-term complications and revisions following DTI versus staged reconstruction. Methods/Technique We retrospectively reviewed all patients who underwent bilateral nipple-sparing-mastectomies seeking implant-based breast reconstruction between September 2016 to September 2021. We extracted demographic and clinical information for the selected patients. Patients were divided in two cohorts: the DTI cohort, and the staged cohort. Baseline differences among the two groups were assessed by performing non-parametric statistical tests. Number of complications and revisions were assessed by employing chi-square. Logistic regression was then employed to adjust for possible confounders. Results/Complications During the study period, we identified 143 patients, 69 in the DTI cohort and 74 in the staged cohort. Patients in the staged cohort were more likely to have higher BMI (mean 26 kg/m2 versus 24.3 kg/m2 in the DTI cohort) and have undergone prior radiotherapy than those in the DTI cohort. No differences based on age, race/ethnicity or comorbidities were present. According to our analysis and within the follow up period time of average 21 months, the two cohorts had similar rates of minor and major short- and long-term surgical complications. After adjusting for potential confounding factors, the DTI group had a significantly higher rate of overall revisions (OR 2.73, 95% CI 1.23-6.07, p-value 0.01) and specifically revisions with implant exchange (0R 3.06, 95% CI 1.06-8.85, p-value 0.03). Most common reason for reason was asymmetry or contour deformity. However, the DTI cohort had significantly lower charges associated with their care during the follow up period (d=-100,178.14 US dollars, p-value=0.001). Complications rates were similar among the two groups. Conclusion An increasing number of patients are now interested in DTI breast reconstruction. According to the results of our study, DTI patients may have increased number of revisions but share similar rates of complications. DTI breast reconstruction is also associated with lower charges, even after accounting for the additional necessary revision procedures. Careful selection of patients for DTI and appropriate education on the need for revisions in the future is paramount.","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"1 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140710466","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}

{"title":"A 16-Year Analysis of Aesthetic Surgery Volume and Its Association with U.S. Economic Performance","authors":"Caroline C. Bay, Peter J. Wirth, E. Shaffrey, Sarah M. Thornton, Venkat K. Rao","doi":"10.1093/asjof/ojae007.084","DOIUrl":"https://doi.org/10.1093/asjof/ojae007.084","url":null,"abstract":"Abstract Goals/Purpose Historically, demand for plastic surgery has been associated with the performance of the United States (US) economy. Over the past two decades, the US has weathered a recession, several presidential election cycles, and has seen a rise in the use and influence of social media. Each of these events has led to varying effects on the economy, which undoubtedly have had an impact on plastic surgery demand and expenditures. Thus, this study aims to evaluate the relationship between indicators of economic performance and the popularity and profitability of aesthetic surgery from 2006 to 2022. Methods/Technique Data from the Aesthetic Society’s (AS) Aesthetic Plastic Surgery National Databank and the American Society of Plastic Surgeons’ (ASPS) Plastic Surgery Statistics Report was collected from 2006 to 2022. Surgical procedures analyzed included the most commonly performed cosmetic surgeries: breast augmentation, breast reduction, mastopexy, abdominoplasty, liposuction, blepharoplasty, facelift, and rhinoplasty. The non-surgical botox injections and dermal fillers were also included. A total of 24 variables were examined, including the 10 procedures and two composite variables—total surgical procedures and total injectables; case change percent difference and patient expenditures percent difference were recorded for each of these. Within the corresponding period, economic indices were collected, including personal disposable income per capita (PDI), consumer price index (CPI), medical care services CPI, average gross domestic product per capita (GDP), and annual average closing prices of the NASDAQ, S&P 500, and the Dow Jones (DOW). Pearson correlation tests were used to analyze the strength of association between each financial indicator and case volumes and expenditures for each procedure included in the ASPS and AS reports. Results/Complications From 2006 to 2020 ASPS data demonstrated GDP year-over-year (YOY) change that was positively correlated with case volume and expenditures across 13 out of the 24 different procedure metrics (54.2%). From 2006 to 2016, AS data was positively correlated with the performance of NASDAQ, S&P500, and DOW in 12 of the 24 procedure metrics (50%). GDP YOY change closely followed suit with positive correlations to 11 variables (45.8%). YOY change of PDI, CPI, and medical care services CPI were less frequently associated amongst both data sets. For ASPS data, YOY medical services CPI change was negatively associated with five variables, indicating that as medical services CPI increased, volume of procedures and expenditures decreased. PDI YOY change was not significantly associated with any variables. In the AS dataset between 2006 and 2016, CPI YOY change was not found to be significantly associated with any variables. Across 2019–2022, CPI YOY and disposable YOY change were found to be significantly associated with three variables each. Conclusion Our study suggests that aesthetic plastic surg","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"75 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140709477","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}

{"title":"Abdominal Etching with Renuvion Helium Plasma","authors":"Dieter Brummund, Tarik Husain","doi":"10.1093/asjof/ojae007.074","DOIUrl":"https://doi.org/10.1093/asjof/ojae007.074","url":null,"abstract":"Abstract Goals/Purpose Differential liposuction with abdominal etching is a powerful technique in high definition liposculpture to achieve an athletic aesthetic. Etching is performed in a superficial plane to create indentures mirroring the dermal-fascial inscriptions of the underlying desired musculature. Renuvion radiofrequency-helium plasma energy (Apyx Medical, Clearwater, FL) is an emerging technology that is used for subdermal coagulation and contraction of the subcutaneous tissue. This case series describes combination of differential liposuction with abdominal etching and Renuvion helium plasma subdermal coagulation in 68 patients and evaluates the outcomes. Methods/Technique A retrospective chart review of 68 patients undergoing differential liposuction with abdominal etching and Renuvion helium plasma subdermal coagulation between 2021 to 2023 by the senior author. The preoperative evaluation, markings, surgical technique and postoperative care are discussed. Clinical parameters assessed include age, gender, body mass index, combination of procedures, volume of lipoaspirate, degree of etching (light, moderate, deep), postoperative changes in weight, and complications such as contour irregularity, wound dehiscence, seroma, surgical site infection, patient dissatisfaction and operative revision. Results/Complications 68 consecutive patients who underwent abdominal etching with Renuvion by the senior author between July 2021 and August 2023 were included in this case series. There were 29 males (43%) and 39 females (57%). The average age of the patients was 39.11 (range, 22 to 64 years), with a non obese, average body mass index of 27.65 kg/m2 (range, 20.8 to 33.9 kg/m2). The average estimated intraoperative blood loss of patients was 104.68 ml (range, 75 to 150 ml); with an average tumescence of 4600 ml (range, 1400 to 8000 ml). The average lipoaspirate was 3920 ml (range, 500 to 9000 ml). In addition to the abdominal region, other areas liposuctioned at the time of etching included flanks (68, 100%), back (66, 97.05%), thighs (14, 20.58%), arms (9, 13.23%), neck (9, 13.23%), chest (8, 11.76%), axilla (3, 4.41%), calves (1, 1.47%). Use of ultrasound was used in 6 cases (8.82%), which were revisionary liposuction. Of our 68 abdominal etching with Renuvion cases the most common combined procedure was autologous fat transfer (20, 29.41%), platysmaplasty (4, 5.88%), mastopexy (5, 8%), breast augmentation (4, 5.88%), buccal fat pad excision (3, 4.41%), umbilical hernia repair (1, 1.47%) and rhytidectomy (1, 1.47%). There were 5 cases of seroma (7.35%) and 4 cases of contour irregularity (5.88%). There were 3 cases of surgical site infection (4.41%), but all in the area of fat grafting and not in the area of liposculpture. No cases of hyperpigmentation were identified. No major complications occurred including skin burns, skin necrosis, visceral injury, deep vein thrombosis, or pulmonary embolism. Overall 66 patients (97.05%) were satisfied fol","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"16 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140711134","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}

{"title":"Marijuana Use Increases Risk of Hematoma Formation in Patients Undergoing Abdominal Body Contouring Surgery","authors":"Hayeem L. Rudy, Yi-hsueh Lu, Daniel Chernovolenko, Julia Grande, Michelle Park, Joseph A Ricci","doi":"10.1093/asjof/ojae007.004","DOIUrl":"https://doi.org/10.1093/asjof/ojae007.004","url":null,"abstract":"Abstract Goals/Purpose The physiological effect of marijuana is thought to include platelet inhibition and poor wound healing, however, there is mixed clinical evidence in the plastic surgery literature regarding this topic. As marijuana usage continues to increase, this study sought to identify the effect of marijuana on postoperative complication rates in patients undergoing abdominal body contouring surgery (ABCS) while controlling for tobacco consumption and other comorbidities. Methods/Technique A retrospective cohort study was conducted in patients who underwent panniculectomy or abdominoplasty at our institution between 2016 and 2021. Patients were separated into groups of active (at time of surgery), former, and no marijuana use. Demographic characteristics, smoking history, laboratory results, comorbidities, operative details, and postoperative complications including hematoma, deep vein thrombosis (DVT) and pulmonary embolism (PE), and wound healing complications were analyzed. Parametric, nonparametric, and multivariable regression modeling was used for analysis. Results/Complications 815 patients who underwent panniculectomy or abdominoplasty were included in the study. 61 patients (7.5%) reported active marijuana use at time of their surgery, and 31 patients (3.8%) reported former marijuana use (defined as last use >2 months prior). Patients who reported any marijuana use were significantly younger (40.5 years vs 45.9 years; p<0.0001) and more likely to identify as Black (OR=2.34; p=0.005). Any marijuana use was significantly associated with reported tobacco use (OR=4.80; p<0.001; 95% CI 1.69-12.69) After adjusting for age, BMI, tobacco use, platelet count, and comorbidity index, active marijuana use was associated with significantly higher risk of hematoma formation (OR=2.55; P= 0.03; 95% CI 1.12-6.55) as well as any complication combined (OR=1.73; p=0.02, 95% CI 1.15-3.56). Other complications, including venous thromboembolism, infection, seroma, umbilical necrosis, wound dehiscence, or anesthetic-related complications were not significantly associated with reported marijuana use. Conclusion When controlling for multiple confounders, marijuana use appears to be independently associated with increased risk of hematoma development in patients undergoing abdominal body contouring surgery with either abdominoplasty or panniculectomy. Further research is warranted to investigate the exact relationships and mechanisms of action behind this finding.","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"7 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140710786","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}

{"title":"Endoscopic Transaxillary Breast Augmentation – a Case Series of 1300 Patients","authors":"Y. Sardiwalla, S. Ching","doi":"10.1093/asjof/ojae007.035","DOIUrl":"https://doi.org/10.1093/asjof/ojae007.035","url":null,"abstract":"Abstract   Level of Evidence: V – case series  Goals/Purpose Breast augmentation is currently one of the most common aesthetic surgical procedures performed in the United States. Transaxillary breast augmentation offers an advantageous hidden scar compared with other options for implant placement. While first described as a blunt and blind approach, endoscopic technique further refined this procedure to offer surgeons complete control and visualization of dissection for precise implant placement. Despite this, breast augmentation is done far more commonly as was initially described over 60 years ago with incisions on the breast that can result in visible scarring. The purpose of this study was to report surgical outcomes on the largest published series to date in a patient cohort of 1389 endoscopic transaxillary breast augmentations. We describe the refinement of this technique and statistical analysis of patient outcomes. Methods/Technique This study included all patients with breast hypoplasia who chose endoscopic transaxillary breast augmentation from 2006 to 2022 by a single surgeon (S.C.). All patients were followed for a minimum of 3 months post procedure. All implants used were smooth, round, silicone gel implants with volumes ranging from 180 to 800cc. Implants were placed in the subfascial or submuscular plane. An incision was marked in the most prominent axillary crease. If there were no creases, an incision was marked at the highest point of the armpit along Langer’s lines. A 30 degree endoscope (Karl Storz, USA) was placed in an endoscopic breast retractor (Karl Storz, USA) and dissection proceeded either in the submuscular plane between the pectoralis major and minor, or in the subfascial plane with an angled suction cautery (Black and Black Surgical, Texas). In the case of subfascial implant placement, the pocket was dissected according to the preoperative markings. With submuscular placement, pocket dissection also followed markings, but the pectoralis muscle was divided with cautery from the level of the areola along the sternal origins of the muscle to completely divide the muscle inferiorly and laterally. The inframammary fold was lowered as necessary by cautery dissection above the level of the pectoralis fascia inferiorly. Glandular scoring was performed with cautery when needed as well. After dissection was completed, saline breast implant sizers were inserted and filled with air to estimate implant size and confirm pocket dissection in the upright position. Adjustments were made to the implant pocket with endoscopic cautery dissection as was necessary. Results/Complications A total of 1389 patients were included in our data analysis for surgeries performed between March 2006 and December 2021. Overall complication rate in our cohort was 6.69%. Malposition of implants was the most common complication at 3.64%. Contracture rate was 1.74%. There was a significant increase noted in hematoma rate in subfascial placement (3.51% in","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"27 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140711539","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}

{"title":"Breast Implant Illness (BII) As a Clinical Entity: A Systematic Review of the Literature","authors":"Kshipra Hemal, Raeesa Kabir, Eloise Stanton, Thomas J Sorenson, C. Boyd, N. Karp, Mihye Choi","doi":"10.1093/asjof/ojae007.073","DOIUrl":"https://doi.org/10.1093/asjof/ojae007.073","url":null,"abstract":"Abstract Goals/Purpose Breast implant illness (BII) has become a contentious subject in recent years, raising concerns among both patients and healthcare professionals. While some studies have reported associations between breast implants and autoimmune diseases, others have failed to establish a definitive link. Therefore, the objective of this systematic review is to provide a comprehensive evaluation of the existing literature with a specific emphasis on identifying any symptom or patient patterns to critically evaluate the existence of BII as a distinct entity. Methods/Technique A comprehensive search of relevant published studies up until 2023 was conducted across multiple databases, including PubMed and MEDLINE. A total of 31 studies met inclusion criteria in our analysis. To qualify for inclusion, studies had to focus on breast implant illness and associated systemic symptoms. Two reviewers independently assessed the abstracts, manuscripts, and extracted data from the selected papers. From the included studies, cohort size, reason for implantation, mean age, implant type, implant texture, plane of implant placement, mean follow-up time, implant explantation status, time to implant explantation, symptom resolution after explantation, infections, and complications were extracted. Descriptive statistics was used where appropriate. Results/Complications The mean age of patients was 44.2 ± 9.30 years for all studies included. For studies that included length of time between implant exposure and onset of clinical symptoms (9/31; 29.0%), the mean time from implant or biomaterial exposure to onset of clinical symptoms of BII was 13.4 ± 2.92 years. Fourteen (14/31; 45.2%) studies reported implant explantation status with 60% of the total patient population choosing to remove their implants. Among these, 9 studies reported symptom improvement in 657 patients (83.5%) from a total of 788 patients undergoing implant explantation. Eight studies (8/31; 25.8%) reported whether patients experiencing BII related symptoms were in the cosmetic or reconstructive group. Patients in the cosmetic cohort (899/1005; 89.5%) experienced significantly more BII-related symptoms compared to patients in the reconstructive cohort (213/352; 60.5%) (p < 0.001). Conclusion This systematic review provides a comprehensive overview of the current state of knowledge regarding BII. While the literature offers valuable insights into the potential associations and outcomes related to BII, there are several limitations stemming from heterogeneity in study designs, patient populations, and reporting practices. Our study highlights a relationships between BII and indication for implants (cosmetic vs. reconstructive), infection, and explantation, among other variables, offering valuable directions for future research.","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"23 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140710038","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}

{"title":"The Impact of Metabolic Syndrome on Post-Operative Outcomes in Abdominal Body Contouring: A Propensity Score-Matched Nationwide Analysis","authors":"M. J. Escobar-Domingo, A. H. Alvarez, J. Foppiani, Iulianna C. Taritsa, Kirsten Schuster, James E. Fanning, Daniela Lee, Samuel J. Lin, Bernard T. Lee","doi":"10.1093/asjof/ojae007.078","DOIUrl":"https://doi.org/10.1093/asjof/ojae007.078","url":null,"abstract":"Abstract Goals/Purpose Metabolic syndrome (MetS) represents cardiometabolic dysregulation, defined by hypertension, obesity, diabetes, and dyslipidemia. Its prevalence is on the rise, affecting approximately 47.3% of U.S. adults. In recent years, MetS has been associated with an elevated risk of postoperative complications. However, there remains a significant gap in our understanding of how patients with MetS fare after abdominal body contouring procedures. The objective of this study is to assess the influence of MetS on postoperative outcomes of abdominal body contouring by concurrent abdominoplasty and panniculectomy. Methods/Technique The ACS-NSQIP database was utilized to identify patients who underwent concurrent abdominoplasty and panniculectomy procedures from 2015 to 2021. Through propensity score matching, distinct cohorts were established based on the presence of MetS, characterized by patients receiving medical interventions for diabetes mellitus and hypertension, with a body mass index exceeding 30kg/m2. Disparities among groups were assessed via unpaired T-tests and Fisher's Exact tests. Logistic regression models were constructed to evaluate the occurrence of mild and severe systemic complications, reoperation rates, and wound complications between these groups. Results/Complications A total of 13,346 patients underwent abdominal body contouring. Following propensity score matching, 586 patients were included in the analysis, with 293 in each group (MetS vs. non-MetS). Bivariate analysis revealed a longer hospital length of stay (2.4 vs. 1.7 days; p=0.002) and higher readmission rates (11.9 vs. 6.5; p=0.031) in the MetS group in comparison to the non-MetS cohort. While surgical-related reasons for readmission were predominant across both groups, statistically significant differences were observed only for medical-related reasons (p=0.028). Logistic regression models demonstrated a statistically significant elevated likelihood of 30-day readmission in the MetS group (OR 1.96; 95% CI 1.091-3.507; p=0.024). No noteworthy disparities were observed in the rates of 30-day wound complications, mild systemic, and severe systemic complications between the groups. Conclusion Our findings revealed no increase in postoperative wound and systemic complications among patients with MetS who underwent concurrent abdominoplasty and panniculectomy. This suggests that abdominal body contouring remains a secure option for patients with MetS. Nonetheless, the higher readmission rates and longer hospital length stays observed in patients with MetS may potentially translate to increased overall costs. Continued research is warranted to comprehensively assess the economic implications of MetS in the context of abdominal body contouring.","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"91 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140710959","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}