A three-dimensional human adipocyte model of fatty acid-induced obesity.

Obesity prevalence has reached pandemic proportions, leaving individuals at high risk for the development of diseases such as cancer and type 2 diabetes. In obesity, to accommodate excess lipid storage, adipocytes become hypertrophic, which is associated with an increased pro-inflammatory cytokine secretion and dysfunction of metabolic processes such as insulin signaling and lipolysis. Targeting adipocyte dysfunction is an important strategy to prevent the development of obesity-associated disease. However, it is unclear how accurately animal models reflect human biology, and the long-term culture of human hypertrophic adipocytes in anin vitro2D monolayer is challenging due to the buoyant nature of adipocytes. Here we describe the development of a human 3Din vitrodisease model that recapitulates hallmarks of obese adipocyte dysfunction. First, primary human adipose-derived mesenchymal stromal cells are embedded in hydrogel, and infiltrated into a thin cellulose scaffold. The thin microtissue profile allows for efficient assembly and image-based analysis. After adipocyte differentiation, the scaffold is stimulated with oleic or palmitic acid to mimic caloric overload. Using functional assays, we demonstrated that this treatment induced important obese adipocyte characteristics such as a larger lipid droplet size, increased basal lipolysis, insulin resistance and a change in macrophage gene expression through adipocyte-conditioned media. This 3D disease model mimics physiologically relevant hallmarks of obese adipocytes, to enable investigations into the mechanisms by which dysfunctional adipocytes contribute to disease.

Antibiotic Prophylaxis in Alloplastic Breast Reconstruction: Regimens and Outcomes.

PURPOSE: Surgical site infections (SSI) in prosthesis-based breast reconstruction can have a significant impact on patient outcome. Despite current CDC (Centers for Disease Control and Prevention) guidelines recommending 24 hours of postoperative antibiotics, various perioperative antimicrobial regimens are reported in the literature. Consensus on the optimal duration of antibiotics remains unclear. In this study, the aim is to compare the incidence of surgical site infections following different antibiotic durations in alloplastic breast reconstruction. METHODS: In this retrospective cohort study, all consecutive patients who underwent expander/implant-based breast reconstruction between January 2009 and December 2014 at a tertiary centre were included. Data on patient demographics, risk factors, operative time, choice and timing of antibiotic used before surgery, and the duration of postoperative antibiotic use were collected. The primary outcome, SSI, is defined according to CDC criteria. RESULTS: A total of 507 consecutive expander/implant-based cases were included. Minimum follow-up time was 1 year. The overall infection incidence was 14% (95% CI: 11%-17%), and the rate of subsequent explantation was 8%. Of the infected cases, 80% (45/56) received 1 week of postoperative antibiotic, while 20% (11/56) had a prolonged course of antibiotics (2-3 weeks; P = .003, odds ratio [OR] = 2.9; 95% CI: 1.4-5.8). Most infections were superficial (65%). Prior history of radiation treatment was identified as a risk factor for developing surgical site infection (P = .02). CONCLUSION: Overall infection rate and risk factors for infections are in keeping with current literature. Prescribing one week of postoperative antibiotic was found to be associated with a higher incidence of SSI compared to a more prolonged antibiotic regimen.

OBJECTIF: Les infections au site opératoire (ISO) des reconstructions mammaires avec prothèse peuvent avoir des conséquences importantes sur le pronostic de la patiente. Malgré les directives à jour des Centers for Disease Control and Prevention (CDC) recommandant la prise d'antibiotiques pendant 24 heures après l'opération, les publications font état de diverses posologies antimicrobiennes périopératoires. La durée consensuelle optimale de la prise d'antibiotiques n'est pas bien établie. Dans la présente étude, les chercheurs comparent l'incidence d'ISO après une reconstruction mammaire alloplastique en fonction de diverses durées d'antibiothérapie. MÉTHODOLOGIE: Toutes les patientes consécutives qui ont subi une reconstruction mammaire par expanseurs ou par implants entre janvier 2009 et décembre 2014 dans un centre de soins tertiaires ont participé à la présente étude rétrospective de cohorte. Les chercheurs ont colligé les données sur la démographie, les facteurs de risque, la durée de l'opération, le choix et le moment de l'antibiothérapie préopératoire ainsi que la durée de l'antibiothérapie postopératoire. Le résultat clinique primaire, les ISO, est défini d'après les critères des CDC. RÉSULTATS: Au total, 507 cas consécutifs d'expanseurs ou d'implants ont été inclus dans l'étude. Le suivi était d'une durée minimale d'un an. L'incidence globale d'infection s'élevait à 14 % (IC à 95 %, 11 % à 17 %) et le taux d'explantations subséquent, à 8 %. De plus, 80 % des cas d'infection (45 sur 56) avaient reçu une antibiothérapie postopératoire d'une semaine, et 20 % (11 sur 56), une antibiothérapie prolongée (de 2 à 3 semaines; p=0,003, rapport de cote=2,9; IC à 95 %, 1,4 à 5,8). La plupart des infections étaient superficielles (65 %). Une radiothérapie antérieure était considérée comme un facteur de risque d'ISO (p=0,02). CONCLUSION: Le taux et les facteurs de risque globaux d'infection sont conformes aux publications à ce jour. La prescription d'antibiotiques pendant une semaine après l'opération était associée à une plus forte incidence d'ISO qu'une antibiothérapie plus longue.

American Society of Plastic Surgeons Evidence-Based Clinical Practice Guideline Revision: Reduction Mammaplasty.

SUMMARY: A multidisciplinary work group involving stakeholders from various backgrounds and societies convened to revise the guideline for reduction mammaplasty. The goal was to develop evidence-based patient care recommendations using the new American Society of Plastic Surgeons guideline methodology. The work group prioritized reviewing the evidence around the need for surgery as first-line treatment, regardless of resection weight or volume. Other factors evaluated included the need for drains, the need for postoperative oral antibiotics, risk factors that increase complications, a comparison in outcomes between the two most popular techniques (inferior and superomedial), the impact of local anesthetic on narcotic use and other nonnarcotic pain management strategies, the use of epinephrine, and the need for specimen pathology. A systematic literature review was performed, and an established appraisal process was used to rate the quality of relevant scientific research (Grading of Recommendations Assessment, Development and Evaluation methodology). Evidence-based recommendations were made and strength was determined based on the level of evidence and the assessment of benefits and harms.

Cost-effectiveness Analysis of Abdominal-based Autogenous Tissue and Tissue-expander Implant following Mastectomy.

BACKGROUND: Patients who had undergone both autologous abdominal tissue (AAT) and tissue expander and implant (TE/I) breast reconstruction reported satisfaction with their reconstruction. While aesthetics and quality of life are important, the cost associated with these procedures must also be considered when choosing one method over the other. The objective of this study was to determine whether AAT-based breast reconstruction is cost-effective compared with 2-stage TE/I reconstruction at a 12-month follow-up. METHODS: Thirty-five patients consented and complied to participate in the study with a follow-up of 12 months. The effectiveness of both AAT and TE/I was measured using the Health Utilities Index Mark 3 (HUI-3). From the HUI-3 results, quality-adjusted life years were calculated for each reconstructive approach. Direct healthcare and productivity costs were captured from surgeon billing codes, patient files, and patient diaries. The perspectives of both the Ministry of Health and of society were considered. RESULTS: From the perspectives of both the Ministry of Health and of society, AAT was less effective and more costly when compared with TE/I. CONCLUSIONS: In this economic evaluation, TE/I dominated AAT, in that TE/I was more effective and less costly as compared with AAT from the perspectives of both the Ministry of Health and of society at 12 months of follow-up. This conclusion should be interpreted with caution due to a small sample size, the short timespan of the study, and the nonrandomized study design.

Comparing the Clinical and Cost-Effectiveness of Abdominal-based Autogenous Tissue and Tissue-Expander Implant: A Feasibility Study.

BACKGROUND: To determine the superiority of autologous abdominal tissue (AAT) or tissue-expander implant (TE/I) reconstruction, a robust comparative cohort study is required. This study sought to determine the feasibility of a future large pragmatic cohort study comparing clinical and cost-effectiveness of AAT and TE/I at 12 months postoperative. METHODS: Potential participants were screened during consultation with their surgeon. Three health-related quality-of-life scales, the Health Utility Index Mark 3, the 12-Item Short Form Health Survey, and the BREAST-Q were used preoperatively, 1, 6, and 12 months postoperatively. Direct medical costs and postoperative patient/caregiver productivity loss were collected using patient diaries. Feasibility was assessed through patient recruitment rates and compliance of patients and study staff to complete required study documentation. RESULTS: Sixty-three patients consented to participate, 44 completed baseline questionnaires; the feasibility objective of recruiting 80% of eligible patients was not met. A 90% completion rate for patient questionnaires was seen at 1-month follow-up and decreased up to 12 months. Quality-adjusted life years were calculated at 0.77 and 0.89 for the AAT and TE/I group, respectively. Case report form completion by study staff and patient diary completion was moderate and low, respectively. Collaborating with hospital case-costing specialists to identify direct medical costs was reliable and efficient. CONCLUSIONS: A future large-scale study is feasible. However, due to a diminishing rate of questionnaire completion, almost twice as many patients need to be recruited than expected to have adequate power. Cost data collection from hospital sources was reliable. Case report forms need to be tailored more toward a busy hospital setting.

Designing a Mission statement Mobile app for palliative care: an innovation project utilizing design-thinking methodology.

BACKGROUND: Eliciting individual values and preferences of patients is essential to delivering high quality palliative care and ensuring patient-centered advance care planning. Despite advance care planning conserving healthcare costs by up to 36%, reducing psychological distress of patients and caregivers, and ensuring palliative care delivery in line with patient wishes, less than 33% of adults engage in it. We aimed to develop a mobile application intervention to address the challenges related to advance care planning and improve the delivery of palliative care. METHODS: Design-thinking methodology was used to develop a mobile application, in response to issues prominently identified in current palliative care literature. RESULTS: Issues surrounding communication of patient values from both the patient and provider side is identified as a main issue in palliative care. We designed a mobile application intervention prototype to address this. CONCLUSIONS: Our "Mission Statement" mobile application will allow patients to create a mission statement identifying what they want their care team to know about them, as well as space to identify important values and preferences. Patients will be able to evolve their mission statement and values and preferences over the course of their palliative care journey through the application. Design-thinking methodology is an effective tool to drive healthcare innovation and bridge the gap between research findings and implementation.

One stage placement of permanent implant compared to two stage tissue expander reconstruction.

With the advent of the skin sparing mastectomy, immediate breast reconstruction with placement of the definitive prosthesis at the time of mastectomy is possible. The question remains: does single-stage prosthetic reconstruction result in greater numbers of complications or rates of re-operation, compared to two-stage tissue expander reconstruction? A retrospective cohort study of a single centre?s experience with these techniques was carried out. From 2004 to 2012, 54 cases of immediate breast reconstruction with implant were identified, and 108 cases of immediate breast reconstruction using a tissue expander were identified. Gathered preoperative data included tumour, prior exposure to radiation, preoperative chemotherapy, smoking, and comorbidities. Complication rates, as well as the rate of secondary operations, were examined. There were no significant increased risks in the rate of post-operative complications (p = .910, odds ratio = 0.9) nor in the rate of re-operation (p = 0.421, odds ratio = 1.4) associated with the insertion of a definitive prosthesis at the time of skin sparing mastectomy. However, previously radiated breasts experienced a 100% rate of wound complications in our subset of 9 breasts that underwent one stage breast reconstruction with immediate final prosthesis placement. Our study suggests that patients with early stage disease can undergo single stage breast reconstruction without increased risk of complications nor need for secondary operations. While the mean time to completion of the reconstructive process is shortened by 5 months with the single stage technique, implant based breast reconstruction requires careful counseling and patient selection in radiated patients.

Cellular Reprogramming Allows Generation of Autologous Hematopoietic Progenitors From AML Patients That Are Devoid of Patient-Specific Genomic Aberrations.

Current treatments that use hematopoietic progenitor cell (HPC) transplantation in acute myeloid leukemia (AML) patients substantially reduce the risk of relapse, but are limited by the availability of immune compatible healthy HPCs. Although cellular reprogramming has the potential to provide a novel autologous source of HPCs for transplantation, the applicability of this technology toward the derivation of healthy autologous hematopoietic cells devoid of patient-specific leukemic aberrations from AML patients must first be evaluated. Here, we report the generation of human AML patient-specific hematopoietic progenitors that are capable of normal in vitro differentiation to myeloid lineages and are devoid of leukemia-associated aberration found in matched patient bone marrow. Skin fibroblasts were obtained from AML patients whose leukemic cells possessed a distinct, leukemia-associated aberration, and used to create AML patient-specific induced pluripotent stem cells (iPSCs). Through hematopoietic differentiation of AML patient iPSCs, coupled with cytogenetic interrogation, we reveal that AML patient-specific HPCs possess normal progenitor capacity and are devoid of leukemia-associated mutations. Importantly, in rare patient skin samples that give rise to mosaic fibroblast cultures that continue to carry leukemia-associated mutations; healthy hematopoietic progenitors can also be generated via reprogramming selection. Our findings provide the proof of principle that cellular reprogramming can be applied on a personalized basis to generate healthy HPCs from AML patients, and should further motivate advances toward creating transplantable hematopoietic stem cells for autologous AML therapy.

Bilateral reduction mammoplasty following breast cancer: A case-control study.

PURPOSE: Many women undergo a bilateral reduction mammoplasty after lumpectomy and radiation for breast cancer due to breast hypertrophy. The outcomes of these patients, focusing on complications and the need for additional surgery, are reviewed. METHODS: A matched case-control study with patients serving as their own control (treated breast cancer breasts were 'cases', healthy breasts were 'controls') was performed. Patients were identified through hospital records between 1980 and 2007. Patients treated by lumpectomy and radiation with subsequent bilateral reduction surgery were included. Data regarding demographics, medical history, and peri- and postoperative complications were collected. Measured outcomes included hematoma or seroma, delayed wound healing, infection, nipple-areolar complex problems, scarring, asymmetry and the need for further surgery. Continuous variables are reported as mean ± SD, and categorical variables are reported as proportions. RESULTS: Of the nine patients included in the study, delayed wound healing occurred in 22% of cases. Wound infections occurred in 66.7% of cases, with 22.2% experiencing a second wound infection. One patient experienced partial nipple-areolar complex loss on the radiated breast. There was abnormal scarring in 33.3% of radiated breasts. Postoperative asymmetry occurred in 77.8% of patients. Additional surgery was performed on three patients (33.3%). CONCLUSIONS: Results of the present study suggest that women with a history of breast cancer treated by lumpectomy and radiation experience higher occurrence of postoperative complications on the radiated breast following bilateral breast reduction. Patients must be informed of these potential risks and require careful postoperative follow-up. An appropriately powered, prospective, multicentred study is required to draw definitive conclusions.

OBJECTIF: De nombreuses femmes subissent une réduction mammaire bilatérale après une lumpectomie et des radiations pour traiter un cancer du sein causé par une hypertrophie mammaire. L'issue de ces patientes, axée sur les complications et la nécessité de procéder à des opérations supplémentaires, est analysée. MÉTHODOLOGIE: Les chercheurs ont mené une étude cas-témoins appariée auprès de patientes étant elles-mêmes leur propre sujet témoin (le sein traité contre le cancer était le « cas ¼ et le sein non atteint, le « témoin ¼). Ils ont repéré les patientes au moyen des dossiers hospitaliers de 1980 à 2007. Ils ont inclus les patientes traitées par lumpectomie et radiation qui ont subi une réduction mammaire bilatérale par la suite. Ils ont assemblé les données relatives à la démographie, aux antécédents médicaux et aux complications périopératoires et postopératoires. Les issues mesurées étaient les hématomes ou les séromes, le retard de guérison de la plaie, l'infection, les problèmes du complexe mamelon-aréole, la cicatrisation, l'asymétrie et la nécessité de procéder à d'autres opérations. Les variables continues sont déclarées sous forme de moyenne ± ÉT, et les variables catégoriques, sous forme de proportions. RÉSULTATS: Chez les neuf patientes incluses dans l'étude, les chercheurs ont remarqué un retard de guérison de la plaie dans 22 % des cas et des infections de la plaie dans 66,7 % des cas, dont 22,2 % de deuxième infection. Une patiente a présenté une perte partielle du complexe mamelon-aréole sur le sein ayant subi des radiations. On observait des cicatrices anormales sur 33,3 % des seins traités, et une asymétrie postopératoire chez 77,8 % des patientes. Trois patientes ont subi des opérations supplémentaires (33,3%). CONCLUSIONS: D'après les résultats de la présente étude, les femmes ayant des antécédents de cancer du sein traitées par lumpectomie et radiation présentent une plus forte occurrence de complications postopératoires après une réduction mammaire bilatérale. Les patientes doivent être informées de ces risques potentiels et ont besoin d'un suivi postopératoire attentif. Une étude prospective multicentrique comportant un nombre suffisant de sujets s'impose pour tirer des conclusions définitives.

WITHDRAWN: Syringoma: the clear cell variant made clearer.

This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.

A systematic review of heparin to treat burn injury.

This systematic review was conducted to assess the evidence for using heparin to treat burn injury. The following databases were searched for relevant studies: MEDLINE, EMBASE, CINAHL, The Cochrane Central Database of Controlled Trials, Web of Science, and BIOSIS. Additional searches involved the reference lists of included studies, the "grey " literature (eg, government reports), and consultations with experts to obtain unpublished manuscripts. Included studies were summarized descriptively and in tabular form, and assessed for methodological quality. A metaanalysis was conducted to obtain a summary estimate for the association between heparin use and postburn mortality. Nine studies were abstracted and included in the review. Five studies contained adult and pediatric patients, one contained adults only, and three contained pediatric patients only. Burn etiologies included flame, scald, thermal, or smoke inhalation. Heparin administration was done topically, subcutaneously, intravenously, or via aerosol. Heparin was reported to have a beneficial impact on mortality, graft and wound healing, and pain control. For mortality, the overall estimate (relative risk) of heparin's effect was 0.32 (95% confidence interval = 0.18-0.57). Heparin's reported benefits may be severely biased because the abstracted studies were beset by poor methodological quality (eg, inadequate definitions of treatment and outcome, no control of confounding). Given poor study quality, there is no strong evidence to indicate that heparin can improve clinical outcomes in the treatment of burn injury. Further research is needed to assess the clinical utility of using heparin in the treatment of burn injury.

The uses of heparin to treat burn injury.

OBJECTIVES: To assess the evidence for using heparin in the treatment of burn injury or the complications of burn injury in adults and children. DATA SOURCES: The following databases were searched: MEDLINE (1966-current), EMBASE (1980-current), Cumulative Index to Nursing & Allied Health (CINAHL) (1982-current), The Cochrane Central Database of Controlled Trials (1995-current), Web of Science (1976-current), and BIOSIS (1976-current). Additional data sources included the U.S. and European Patent Offices, technical experts, the partner organization, and reference lists. REVIEW METHODS: Studies identified from the data sources went through two levels of title and abstract screening. Passing studies advanced to full text screening. Studies that met the full text screening criteria were abstracted. Criteria for abstraction included publication in any language, human patients of any age, and burns of any type, grade, or total body surface area. All formulations of heparin, and all application methods (e.g., topical, subcutaneous), were eligible for inclusion in the report. Abstracted studies required a comparison group. Outcomes of interest included mortality, pain, length of stay in hospital, thrombosis and emboli, psychiatric adjustment, and adverse effects (e.g., bleeding). RESULTS: Nineteen articles from 18 unique studies were abstracted and included in this report. In these articles, there were multiple uses of heparin to treat burns (e.g., wound healing, inhalation injury, sepsis, pain). However, the overall quality of the articles was weak. Examples of weakness included unclear or inappropriate treatment allocation, no blinding, no control of confounding, poorly defined burn characteristics (e.g., thickness), unclear duration of treatment, incomplete description of heparin treatment, and use of inadequately described or invalid outcome measures. Overall, the evidence from these weak articles was insufficient to determine whether the effectiveness of heparin to treat burn injury was different from the effectiveness of other treatments, or whether treatment effectiveness varied according to (a) the method of applying heparin to (b) burn etiology. Four studies mentioned contraindications to using heparin to treat burns. These contraindications were bleeding diathesis, bleeding history, active bleeding or associated trauma with potential bleeding, active intestinal ulcer, thrombocytopenia, liver disease, renal disorders, or allergy to heparin. CONCLUSIONS: There is no strong evidence in the 19 abstracted articles to suggest that heparin should be used in the treatment of burn injury on account of its non-anticoagulant properties.

A comparison of complication rates in large and small inferior pedicle reduction mammaplasty.

The main objective of this retrospective study was to determine whether the rates of complications are higher in large reductions (> or =1000 g per breast) as compared with smaller reductions (< or =999 g per breast) using the inferior pedicle technique. A retrospective chart review of 133 consecutive patients operated on between October of 2000 and March of 2002 was undertaken. Complication data were recorded and analyzed on a per-breast basis. Two hundred sixteen breasts had reductions of 999 g or less, whereas 50 breasts had reductions of 1000 g or more. The overall mean follow-up period was 152 days (range, 20 to 522 days). There were no statistically significant differences in the rates of nipple necrosis, hematoma formation, seroma, delayed healing, culture-positive wound infection, fat necrosis, cyst formation, nipple sensation, or hypertrophic scarring between the large and small reductions. However, the rate of wound dehiscence was significantly lower in the smaller reduction group. The rates of wound dehiscence and hypertrophic scarring were also significantly lower in patients who had received at least 5 days of postoperative antibiotics. A statistically significant difference was also reported for clinical wound infection (p < 0.0005). Body mass index had no statistically significant effect on the rate of nipple necrosis, hematoma formation, fat necrosis, cyst formation, nipple sensation, or hypertrophic scarring. However, body mass index had a statistically significant effect on delayed healing, wound dehiscence, and culture-positive wound infection. A higher mean body mass index predicted a delayed healing, wound dehiscence, and infection. The inferior pedicle technique is a safe method of breast reduction regardless of degree of parenchymal resection. However, the use of postoperative antibiotics for at least 5 days is recommended to reduce rates of wound dehiscence and improve postoperative scarring.

Can reduction mammoplasty patients be promised a particular size postoperatively?

This retrospective study used self-reported bra sizes, heights and weights pre- and postoperatively in patients who underwent reduction mammoplasty by one surgeon between 2001 and 2003. Preoperative data were collected on 91 patients. Postoperative data were collected from 69 respondents by telephone survey. Bra sizes were standardized according to cup size. In bra-making, the cup is the same size for decreasing cup letter size as the band size increases. The most common standardized cup size was seven, representing bra sizes 34 F, 36 E, 38 D, 40 C, etc. The range of preoperative cup sizes was five (34 D) to 17 (42 L). The mass of tissue removed from each breast was averaged for each patient and ranged from 147 g to 2453 g (mean 522 g). The average body mass index was 29.6 kg/m(2) preoperatively and 29.3 kg/m(2) postoperatively, with six patients reporting weight gain, 13 reporting weight loss and 50 reporting no change at all. Postoperative standardized cup sizes ranged from five (34 D) to 14 (44 H). The difference between pre- and postoperative cup size ranged from zero to eight as follows: for no cup size change (n=17), mean tissue removed per breast was 577.1 g; decrease by one cup size (n=23), 489.2 g; decrease by two cup sizes (n=25), 425.8 g. These data indicate that when self-reported data from patients are used, a plastic surgeon may find that as many as 25% report no change in bra size after reduction mammoplasty, even when more than 500 g of tissue is removed from each breast, which may adversely affect patients' satisfaction with the surgical results. Future studies will determine the cause of the apparent discrepancy between operative and self-reported results.

La présente étude rétrospective a fait appel au tour de poitrine, à la taille et au poids transmis par les patientes avant et après une opération de réduction mammaire effectuée par un chirurgien entre 2001 et 2003. Les données préopératoires ont été recueillies auprès de 91 patientes; les données postopératoires, auprès de 69 répondantes, par sondage téléphonique. La taille du soutien-gorge a été normalisée d'après la taille du bonnet. Dans la fabrication des soutiens-gorge, le bonnet est de la même taille pour des lettres décroissantes à mesure que le tour de thorax augmente. La taille de bonnet normalisée la plus courante était de sept, représentant les tailles de soutien-gorge 34 F, 36 E, 38 D, 40 C, etc. La plage de tailles de bonnet préopératoires oscillait entre cinq (34 D) et 17 (42 L). La masse de tissus retirée de chaque sein a été moyennée pour chaque patiente et variait entre 147 g et 2 453 g (moyenne de 522 g). L'indice de masse corporelle moyen était de 29,6 kg/m2 avant l'opération et de 29,3 kg/m2 après l'opération, six patientes ayant déclaré un gain de poids, 13, une perte de poids et 50, aucun changement. Les tailles de bonnet normalisées après l'opération variaient entre cinq (34 D) et 14 (44 H). La différence entre la taille de bonnet préopératoire et postopératoire variait entre zéro et huit. Ainsi, lorsque le bonnet demeurait le même (n=17), la quantité moyenne de tissus retirée était de 577,1 g; lorsque le bonnet diminuait de un (n=23), l'exérèse moyenne était de 489,2 g, et lorsqu'il diminuait de deux (n=25), de 425,8 g.Ces données indiquent que s'il se fonde sur les données transmises par les patientes, le plasticien peut découvrir que jusqu'à 25 % d'entre elles ne déclarent aucune modification de la taille de leur soutien-gorge après une réduction mammaire, même si plus de 500 g de tissus sont retirés de chaque sein, ce qui peut entacher leur satisfaction face aux résultats de l'opération. De futures études permettront de déterminer la cause de l'écart apparent entre les résultats opératoires et les résultats signalés par les patientes.