Body contouring in the male weight loss population: assessing gender as a factor in outcomes.

BACKGROUND: Growing numbers of men are presenting for consultation and potential postbariatric body contouring surgery. Due to concerns about whether men might have increased rates of complications or dissatisfaction with aesthetic surgery, the authors assessed their clinical experience with male patients. METHODS: The authors examined male patients in their prospective database who had undergone body-contouring surgery. Chi-square analysis, regression analysis, and a binary logistic regression model were used to study categorical variables, surgical outcomes, continuous variables, and significant factors. Odds ratios were calculated. RESULTS: Of 481 patients, 48 (10 percent) were male. There were no significant differences in baseline comorbidities between the genders, except that women had a higher incidence of anxiety/depression. Men had a greater weight loss before body-contouring surgery, but this did not correlate with greater operative time or estimated blood loss. Male gender, however, was associated with a 14.6 percent incidence of postoperative hematoma and a 25 percent incidence of seroma, in contrast to female gender, with 3.5 and 13 percent, respectively. Logistic regression showed that male gender was associated with an increased incidence of hematoma, seroma, and postoperative complications. It was an independent risk factor for hematoma and seroma formation, with odds ratios of 3.76 and 2.65, respectively. Gender was not an independent predictor of wound dehiscence, flap loss, transfusion, or surgical-site infection. CONCLUSIONS: Men who are considering body-contouring surgery should be advised that they are at an increased risk of postoperative hematoma and seroma formation. The causal relationship between gender and postoperative complications is an area for further study. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

Carotid rupture following electrical injury: a report of two cases.

Electrical injuries often result in extensive tissue damage where vascular damage may occur and result in thrombosis and spontaneous rupture of blood vessels. Rupture of the brachial, radial, ulnar, internal mammary, and obturator arteries has been reported in the literature. The authors present two cases of carotid artery rupture following high-voltage electrical injuries. The first case is a 21-year-old man who was climbing a fence near a high-voltage power line when a gold chain he was wearing around his neck caught on the power line, resulting in a 10% circumferential electrical injury to his neck. He presented with visible arterial bleeding from the large neck wound and was taken to the operating room, where a 1-cm laceration to the carotid artery was repaired with a vein patch. On the second postoperative day, the patch dislodged, and a spontaneous rupture of the common carotid artery occurred. The damaged artery was subsequently ligated. The patient recovered with no neurological sequelae. The second case is a 43-year-old man who suffered a high-voltage injury while working on an electrical panel, resulting in a 50% TBSA full-thickness burn to the face, scalp, trunk, and extremities. Four weeks after admission, a latissimus dorsi myocutaneous free flap was used for coverage of exposed outer table of the skull. Intraoperatively, the carotid artery spontaneously ruptured proximal to where the dissection was being carried out. The patient recovered with no neurological sequelae. High-voltage electrical injury results in significant damage to blood vessels via a number of mechanisms. Rupture of a major vessel is a rare, life-threatening sequelae of electrical injury.

Mammographic changes after fat transfer to the breast compared with changes after breast reduction: a blinded study.

BACKGROUND: : One issue in the adoption of autologous fat transfer to the breast is concern over mammographic changes that may obscure cancer detection. The authors compared mammographic changes following fat grafting to the breast with changes seen after breast reduction. METHODS: : Twenty-seven women who had normal preoperative mammograms were treated with fat grafting to the breast, including admixing of autologous adipose stem cells with the fat graft, for cosmetic augmentation. Repeated mammograms were performed 12 months after surgery. As a control group, postsurgical mammograms from 23 reduction mammaplasty patients were compared. Eight academic breast imaging radiologists reviewed each mammogram in a blinded fashion. Outcomes analysis accounting for individual radiologist's tendencies was performed using generalized estimating equations. RESULTS: : The average volume of fat injected per patient was 526.5 cc. Fifty mammograms (27 lipotransfer, 23 breast reduction) were assessed. Differences in interpretation among individual radiologists were consistently observed (p < 0.10). Differences in abnormality rates were nonsignificant for oil cysts, benign calcifications, and calcifications warranting biopsy. Scarring (p < 0.001) and masses requiring biopsy (p < 0.001) were more common in the reduction cohort. Breast Imaging Reporting and Data System scores were higher after breast reduction (p < 0.001). Significant differences in the recommended follow-up time were also seen (p < 0.01). CONCLUSIONS: : Compared with reduction mammaplasty, a widely accepted procedure, fat grafting to the breast produces fewer radiographic abnormalities with a more favorable Breast Imaging Reporting and Data System score and less aggressive follow-up recommendations by breast radiologists. CLINICAL QUESTION/LEVEL OF EVIDENCE: : Therapeutic, III.