Retropectoral Fat Graft Survival in Mammoplasty: Evaluation by Magnetic Resonance Imaging.

BACKGROUND: Fat grafting is used in combination with mammoplasty to improve filling of the upper pole of the breasts. Its effectiveness remains in question due to unpredictable results. Difficulty in isolating the grafted fat and differentiating it from host tissues may hinder assessment of graft integration. The plane between the pectoral muscles is free of fat and has already been described with respect to placement of breast implants and fat grafting in breast surgeries. This study sought to evaluate via magnetic resonance imaging (MRI) the integration and retention of retropectoral fat grafts in mammoplasty. METHODS: Thirty patients with breast flaccidity who desired to undergo mammoplasty were selected. Fat collected from the abdomen was separated by sedimentation and transferred to the retropectoral region after undermining of the breast and resection of excess tissue. The patients underwent MRI preoperatively and at three and six months after surgery. Fat volumes were calculated by multiplying the values for the major vertical, horizontal, and anteroposterior axes by the constant 0.523. RESULTS: Twenty-five patients completed the study. The mean volume grafted was 116.4 ± 22.5 ml per breast. Six months after surgery, the mean fat graft volume in the retropectoral plane was 48.1 ± 25.71 ml, and the integration rate was 40.82% (range, 32.2-49.4%). The rate of complications related to fat grafting was 8%. CONCLUSIONS: In mammoplasty, retropectoral fat grafting showed good integration rates and is a safe and predictable approach that can contribute to improving the outcomes of aesthetic and reconstructive breast surgeries. LEVEL OF EVIDENCE IV, COHORT ANALYTIC STUDY: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Evaluation of Retropectoral Fat Grafting in Breast Reduction by Magnetic Resonance Imaging: A Pilot Study.

BACKGROUND: One of the challenges in breast reduction is to maintain breast projection with 45% of its volume in the upper pole and 55% in the lower pole. Although widely used in breast surgeries, the behavior of fat grafts is still not completely understood. OBJECTIVES: To evaluate by magnetic resonance imaging (MRI) the survival of fat transferred to the retropectoral plane in patients undergoing breast reduction, in the search for an oncologically safe procedure with high predictability and reproducibility. METHODS: This pilot study was conducted with 7 patients who underwent breast reduction combined with fat grafting in the submuscular plane. Aspirated fat was processed by sedimentation. MRI of the breasts was performed preoperatively and at 1 and 6 months postoperatively. Fat survival was calculated as the difference between the volumes of fat measured preoperatively and postoperatively by MRI divided by the volume of grafted fat. RESULTS: Fourteen breasts were operated on and received on average 119.6 mL of autologous fat in the submuscular plane. Fat survival rate was 43.9% at 1 month after surgery, decreasing to 23.4% in the late postoperative period. The mean anteroposterior projection of the grafted tissue was 1.51 cm at 1 month postoperatively, decreasing to 1.07 cm in the late postoperative period. CONCLUSIONS: Retropectoral fat grafting may contribute to maintaining the fullness of the upper pole of the breasts. This is an innovative experimental model for future studies on fat harvesting, preparation, and grafting techniques, allowing the evaluation of fat graft survival.

Sexualidade após mamoplastia de aumento / Sexuality after breast augmentation

Introdução: A mama é símbolo de feminilidade, maternidade e sexualidade. Mamoplastia de aumento é a segunda cirurgia estética mais realizada no Brasil, e está relacionada à melhora da imagem corporal, autoestima e qualidade de vida. Sexualidade é importante componente da qualidade de vida. O quociente sexual feminino (QS-F) é questionário desenvolvido e validado que avalia sexualidade, aplicado para avaliar o impacto do tratamento na saúde sexual. Consiste em 10 questões, que avaliam quatro domínios: desejo, excitação, conforto e satisfação sexual. O objetivo é avaliar a sexualidade após mamoplastia de aumento. Métodos: 47 candidatas a aumento das mamas foram selecionadas, tratadas cirurgicamente, e responderam ao questionário QS-F no pré e no pós-operatório de 2, 4 e 18 meses. A técnica adotada foi semelhante para todas pacientes: incisão no sulco mamário, loja subglandular, implante redondo entre 260 e 325 mL. Foram formados os grupos: com ou sem relacionamento estável; e com ou sem estrias. Resultados: 45 pacientes concluíram o estudo, com idade média de 26 anos. As complicações observadas foram: simastia (1), galactorreia (1), e estrias (10). Houve melhora significante entre o escore total do QS-F no pré e no pós-operatório de 4 (p = 0,001) e 18 meses (p = 0,001), relacionado ao significante aumento da pontuação dos domínios excitação (p < 0,001) e satisfação sexual (p = 0,001). Nas pacientes que apresentaram estrias não houve melhora significante da sexualidade (p = 0,627), ao contrário das que não apresentaram (p < 0,001). Não houve diferença significante na sexualidade entre o grupo com ou sem relacionamento estável. Conclusão: A sexualidade aumentou significantemente após mamoplastia de aumento.

Introduction: The breasts are symbol of femininity, motherhood and sexuality. Breast augmentation is the second most performed cosmetic surgery in Brazil, and it is related to improvement of body image, self-esteem and quality of life. Sexuality is a significant component of quality of life. The female sexual quotient questionnaire (FS-Q) was validated as an evaluation tool for sexuality, and it is used to evaluate the impact of many treatments for sexual health. The questionnaire entails 10 questions, which assess four domains of sexuality: sexual desire, sexual arousal, comfort and sexual satisfaction. To evaluate sexuality after breast augmentation. Methods: We selected 47 patients with interest in breast enlargement. During treatment patients completed the FSQ questionnaire before and after 2, 4 and 18 months of the surgery. The surgical technique used was the same for all patients: inframammary incision, subglandular pocket, round implant, volume 260 to 325 mL. There were four groups: with or without stable relationship, and with or without striae. Results: A total of 45 patients were considered for the study. Patients' mean age was 26 years. Complications observed were: symmastia (1), galactorrhea (1), and striae distensae(10). Significant improvement was observed between the total FSQ score at preoperative, 4 months (p = 0.001), and postoperative, 18 months (p = 0.001), and also related with the significant increase in arousal scores (p < 0.001), and sexual satisfaction (p = 0.001). Patients with striae did not show significant improvement in sexuality (p=0.627), differently of patients without striae (p < 0.001). No significant difference in sexuality was seen between the group with or without stable relationship. Conclusion: Sexuality increases significantly after breast augmentation.

Striae distensae after breast augmentation: treatment using the nonablative fractionated 1550-nm erbium glass laser.

BACKGROUND: Stretch marks, or striae distensae, are dermal scars and result in considerable aesthetic concern. The responsible factors for their development are poorly understood. Development of striae distensae is a rare complication after breast augmentation. Successfully treating striae distensae has always been challenging. Lasers and light devices have recently become a good therapeutic option. The fractional laser has shown encouraging results with less risk of pigmentation in the treatment of recent stretch marks. METHODS: Forty-seven patients underwent breast augmentation over a period of 2 months; of these, 10 patients developed new striae distensae. They were submitted to nonablative fractionated 1550-nm erbium glass laser treatment. Response was assessed from photographs obtained before and 4 weeks after the end of treatment. Two plastic surgeons analyzed improvements clinically and photographically, and a patient satisfaction score was recorded as well. RESULTS: There was a significant relationship between age and development of striae, (p = 0.003), but there was no significant relationship between striae distensae and nulliparity (p = 0.147), volume of the silicone implant (p = 0.892), or use of oral contraceptive (p = 1.00). The scores achieved by both the evaluators and the patients were high, with 50 percent of them between 9 and 10 (maximum scores), and with a high index of satisfaction with the treatment. CONCLUSIONS: Age is statistically significant in the development of striae distensae after breast augmentation. This report demonstrates excellent patient and plastic surgeon satisfaction after treatment. The use of fractional photothermolysis is a good treatment modality for striae rubrae.