Successful breastfeeding after breast reduction surgery or mastopexy: A retrospective comparative study.

Breastfeeding has been widely encouraged by health care systems for many years. Breast reduction or mastopexy, are very frequent procedures often performed on young women. The main objective of this study is to evaluate the impact of breast surgery on breastfeeding by comparing the success rate of breastfeeding in operated women versus unoperated women. Secondary objectives are to evaluate the breastfeeding success rate according to the surgical technique or the weight resected. A retrospective comparative study was conducted. Women of childbearing age who underwent breast reduction surgery or mastopexy at Henri-Mondor Hospital were contacted to answer a questionnaire about their pregnancies. Two hundred nine patients answered and two groups of patients were constituted, a preoperative group of 104 women who had a pregnancy before surgery and a postoperative group formed by 61 women who had a pregnancy after surgery. Breastfeeding success rate was 82% in the preoperative group versus 41% in the postoperative group. A statistically significant difference was found on the success rate of breastfeeding, as well as the rate of exclusive breastfeeding, with significantly lower rates in the postoperative group. In contrast, there was no significant difference between the different pedicles used, neither according to the weight of the resected gland. The cause of failure in the postoperative group was in most cases insufficient milk. Breast reduction surgery or mastopexy seems to have negative impact on the ability of operated women to breastfeed. This impact is multifactorial so these results should be interpreted with caution and further studies are needed to improve the management of these patients.

Synergistic Effects of Autologous Platelet-Rich Plasma and Hyaluronic Acid Injections on Facial Skin Rejuvenation.

BACKGROUND: Many therapeutic options are currently available for facial skin rejuvenation, but little evidence exists about the efficacy of combining such procedures. OBJECTIVES: The aim of this study was to assess and investigate the synergistic effect of hyaluronic acid (HA) and autologous platelet-rich plasma (a-PRP) injections on facial skin rejuvenation. METHODS: For this randomized controlled prospective study, 93 eligible patients were enrolled and randomized into 3 intervention groups to undergo a series of 3 treatment sessions with either a-PRP, HA, or a mixture of a-PRP and HA (Cellular Matrix; Regen Lab) injected into facial cheeks. RESULTS: A total of 93 patients were included. Treatment with Cellular Matrix led to a very significant improvement in the overall facial appearance compared with treatment with a-PRP or HA alone (P < 0.0001). Participants treated with Cellular Matrix showed a 20%, 24%, and 17% increase in FACE-Q score at 1, 3, and 6 months posttreatment, respectively. For the HA group, the improvement in FACE-Q score was 12%, 11%, and 6% at 1, 3, and 6 months posttreatment, respectively, whereas for the a-PRP group the improvement was 9%, 11%, and 8% at 1, 3, and 6 months posttreatment, respectively. Biophysical measurements showed significantly improved skin elasticity for the Cellular Matrix group compared with the groups receiving a-PRP or HA alone. No serious adverse events were reported. CONCLUSIONS: Combining a-PRP and HA seems to be a promising treatment for facial rejuvenation with a highly significant improvement in facial appearance and skin elasticity compared with a-PRP or HA alone.

Postoperative Complications and Patient Satisfaction After Abdominal Etching: Prospective Case Series of 25 Patients.

INTRODUCTION: Conventional liposuction has provided good outcome for years. Abdominal etching (or abdominal high definition liposuction) allows the surgeon to shape and enhance the abdominal muscles by removing specific grooves of subcutaneous fat. The aim of this study is to describe the technique and the complications and to assess patients' satisfaction rate. MATERIALS AND METHODS: Between January 2015 and January 2017, 25 patients (21 men and 4 women) underwent abdominal etching procedures in our department. The authors describe the technique and the specific key points of the procedure. All patients were seen at day 5, 10, 30, and 180. At day 180, everyone answered a modified Likert scale survey relating to their satisfaction. RESULTS: No hematoma, infection, or seroma was reported. One patient experienced a superficial pressure wound caused by an improper positioning of the final dressing. Almost all patients (96%) were happy or very happy with the overall outcome of their abdominal etching. CONCLUSION: The number of requests for abdominal liposculpture should increase in the coming years, and plastic surgeons specialized in silhouette surgery should be able to master this technique in order to add it to their therapeutic arsenal. LEVEL OF EVIDENCE IV: 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.

High-Intensity Focused Ultrasound: A Satisfactory Noninvasive Procedure for Neck Rejuvenation.

BACKGROUND: High-intensity focused ultrasound (HIFU) is an advanced technology that has been developed in response to the growing demand for noninvasive face rejuvenation. OBJECTIVES: The aim of this study was to evaluate the rejuvenation effects, patient satisfaction, and safety of HIFU treatment of the neck in a European population. METHODS: This was a prospective study of 20 patients. The patients were treated with HIFU, and the outcomes were investigated. The modified FACE-Objective Assessment Scale, developed by our team, and the subjective Investigator Global Improvement Assessment Scale (IGIAS; -1 to 3) were used to judge the results of HIFU. Five blinded evaluators scored the procedure outcomes based on photographs taken before and 6 months after the procedure. Side effects were reported and pain was evaluated on a visual analog scale of 0 to 10. RESULTS: Clinical results, such as better definition of the cervicomental angle, were observed in the treated areas. The pretreatment and posttreatment evaluation scores for double chin and skin laxity were evaluated by 4 of 5 evaluators as significantly improved. The IGIAS score was between 1 and 5 in 2 patients, between 6 and 10 in 7 patients, and between 11 and 15 in 11 patients. No patients had a score between -5 and 0. No major complications were reported. The mean pain scores for the D4, M7, and S7 transducer treatments were 5.6 (range, 4.5-6.7), 4.2 (range, 2.5-5.9), and 2.05 (range, 1.05-3.05), respectively. CONCLUSIONS: HIFU may be considered a satisfactory, simple, reproducible, rapid, and safe procedure for neck rejuvenation.Level of Evidence: 4.

Surgical treatment of clitoral phimosis.

The clitoris has a crucial role in the feminine pleasure. Chronic inflammatory dermatosis along with post-menopausal atrophy of the vulva and obstetrical traumas can cause clitoral phimosis, thereby compromising its function. Medical treatments exist depending on the etiology, but when irreversible scarring occur, a surgical treatment can be necessary to regain its function. We present here our surgical technique that achieves excellent functional results with low morbidity and the outcome of our patients in order to improve this sexual dysfunction.

Treatment of hidradenitis suppurativa: Surgery and yeast (Saccharomyces cerevisiae)-exclusion diet. Results after 6 years.

BACKGROUND: Hidradenitis suppurativa is a complex disorder, the pathogenesis of which is still unsolved. The known association between hidradenitis suppurativa and Crohn's disease, an autoimmune disease diagnosed with the presence of Anti-Saccharomyces cerevisiae antibodies of the IgG family, suggests that a much more complex mechanism than a simple infectious disorder is involved. The goal of this study is to report patients' characteristics and the outcome of 6 years of a yeast (Saccharomyces cerevisiae)-exclusion diet and surgery in the treatment of hidradenitis suppurativa. METHOD: We analyzed 185 patients with hidradenitis suppurativa with a self-evaluative questionnaire. Thirty-seven patients were treated in our center following our protocol. The other 148 were members of a support group for patients with hidradenitis suppurativa treated by other centers. RESULTS: In 80% of patients who had the onset of hidradenitis suppurativa before the age of 30, the female to male ratio was 3.34:1, 74% were active smokers, and 5% also had Crohn's disease. In the diet group, 70% had an improvement of hidradenitis suppurativa symptomatology, 81% of whom in less than 6 months. Also, 87% of patients demonstrated an immediate recurrence of skin lesions less than a week after consuming a food containing the yeast. Immunologic testing showed intolerance to yeast, wheat, and cow's milk in 20%, 29%, and 23% of patients, respectively. CONCLUSION: The analysis confirmed the stabilization and regression of hidradenitis suppurativa with our diet, presumably by decreasing the local and systemic inflammation, leading to a less invasive operative treatment. These new findings seem to link hidradenitis suppurativa to food intolerance and gut dysbiosis.