RESUMO
BACKGROUND: The purpose of this study is to evaluate if and what social media use influences our patients' decisions to undergo breast augmentation. OBJECTIVES: A single-institution study was designed to evaluate women who underwent elective breast augmentation from 2017 to 2018. METHODS: Patients were contacted via validated, prompted telephone survey. Data regarding their demographic information and social media utilization pertaining to breast augmentation were collected after obtaining verbal consent. RESULTS: Inclusion criteria were met by 180 patients, of which 69% participated in the survey. Ninety-seven percent of the participants reported utilizing social media in general; the most common platforms were Facebook, Instagram, and the physician's website. Millennials (97%) and Generation X (92%) utilized social media the most and none of the baby boomers. Sixty-four percent of participants reported utilizing some form of social media to research breast augmentation, with the most common resource being Instagram. When analyzing the impact of the social media resources utilized by the participants, Instagram was reported as the most impactful at 54%. Only 18% of participants were utilizing a physician's social media account to research breast augmentation. Among the 50% of patients who utilized social media to compare their surgeon's work with another physician's, the majority (83%) were utilizing the physician's website. CONCLUSIONS: Social media influences patients' education and decisions to undergo breast augmentation, with Instagram being the most impactful. This study evaluated the patient population to stay up to date on their social media utilization and resources of education prior to breast augmentation.
Assuntos
Mamoplastia , Mídias Sociais , Feminino , Humanos , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Red breast syndrome (RBS) is a noninfectious erythema associated with acellular dermal matrix (ADM). The underlying cause remains unknown despite multiple suggested etiologies. No similar presentations to RBS have been reported in other anatomic regions. OBJECTIVES: The authors sought to describe and identify a common etiology for ADM-associated sterile inflammation in the breast and upper extremity. METHODS: A retrospective review of medical complaints reported to MTF Biologics (Edison, NJ) from July 1, 2017 to January 3, 2018 was performed. Inventory samples were tested for endotoxin content in endotoxin units (eu) via the Limulus Amebocyte Lysate method to determine a common etiology for sterile inflammation. RESULTS: Cases of RBS and upper extremity sterile inflammation, "red hand syndrome," are presented. Two patients developed RBS following implantation of ADM from the same donor; associated grafts in inventory had endotoxin levels of 167 eu and 320 eu per graft, respectively. Two patients developed red hand syndrome after joint arthroplasty with ADM from another donor; associated graft in inventory showed an endotoxin level of 1282 eu. Cultures were obtained and negative in 3 of the 4 cases. Since endotoxin screening of ADM donor lots began in January 2018 at MTF Biologics, no cases of sterile inflammation have been reported from screened units through December 31, 2018 (RBS rate, 39/15,529 [0.25%] vs 0/18,275 [0%], P < 0.0001). CONCLUSIONS: The sterile inflammatory response in RBS and newly reported red hand syndrome may be attributable to the presence of endotoxin in implanted ADM. Endotoxin screening has been adopted by MTF Biologics with a significant decrease in reported reactions.
Assuntos
Derme Acelular , Implante Mamário , Neoplasias da Mama , Implante Mamário/efeitos adversos , Endotoxinas/efeitos adversos , Eritema , Humanos , Inflamação , Estudos RetrospectivosRESUMO
BACKGROUND: Various theories exist to explain the etiology of iatrogenic symmastia. Subglandular over-dissection of the medial breast pocket over the sternum, disruption of midline sternal fascia, oversized implant base diameter, and over-dissection of the medial pectoralis muscle attachments to the sternum are popular explanations. OBJECTIVES: The authors hypothesized that the most common risk factor for iatrogenic symmastia is subpectoral breast augmentation. METHODS: A retrospective chart review was conducted including all symmastia patients who underwent surgery from January 2008 to April 2018 by a single surgeon (C.L.M.). ASAPS members were also surveyed regarding the etiology and incidence of symmastia in their practice. RESULTS: Twenty-three patients with symmastia were included in the retrospective chart review. All had previous subpectoral breast augmentation. In the ASAPS survey, 91 plastic surgeons reported seeing an average of 2.2 consults for acquired symmastia over the preceding year; 1.9 of the 2.2 (84.9%) acquired symmastia consults previously underwent subpectoral breast augmentation. Most surgeons attributed these patients' symmastia to over-dissection of the medial pectoralis muscle attachments to the sternum. CONCLUSIONS: Symmastia is most often caused by pectoralis major sternal dehiscence during subpectoral breast augmentation. In the senior author's experience, all patients with iatrogenic symmastia previously had a submuscular breast augmentation. The ASAPS survey supports multiple causes for symmastia with retromuscular breast augmentation occurring in the majority of patients. Repair of symmastia should include securing Scarpa's fascia to the sternum, reattaching the pectoralis major to the sternum, avoiding another subpectoral implant, and using postoperative modalities to protect the repair.
Assuntos
Doenças Mamárias/cirurgia , Implante Mamário/efeitos adversos , Complicações Pós-Operatórias/cirurgia , Reoperação/métodos , Adulto , Mama/cirurgia , Doenças Mamárias/epidemiologia , Doenças Mamárias/etiologia , Implante Mamário/métodos , Fasciotomia , Feminino , Humanos , Doença Iatrogênica , Pessoa de Meia-Idade , Músculos Peitorais/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Esterno/cirurgia , Adulto JovemRESUMO
BACKGROUND: Multimodal analgesic protocols are increasingly favored over traditional opioid regimens due to decreased adverse side effects and reduced opioid consumption. Concomitant use of selective cyclooxygenase (COX)-2 inhibitor celecoxib and anticonvulsant gabapentin have been proposed to adequately control acute postoperative pain. OBJECTIVES: To determine efficacy of postoperative pain control using nonopioid pain regimen vs traditional opioids for all aesthetic plastic surgery procedures. METHODS: A retrospective chart review was performed on 462 consecutive outpatient plastic surgery procedures by a single surgeon between November 2015 and July 2017. Procedures in the historical control group (n = 275) received traditional postoperative narcotic, hydrocodone-acetaminophen. Patients in the more recent nonopioid study group (n = 187) received a pre-, peri-, and postoperative regimen of celecoxib and gabapentin. RESULTS: Similar demographic characteristics between the control and study groups were observed: mean age, 39.7 vs 39.5 years; BMI, 24.6 vs 24.4 kg/m2; and ratio of female patients 92.7% vs 92.4%. A significant reduction in rescue analgesia (meperidine 44.6% vs 14.9%, P < 0.001) and antiemetic use (ondansetron 24.2% vs 16.3%, P < 0.05; promethazine 17.0% vs 4.7%, P < 0.001) in postanesthesia recovery unit (PACU) was noted in the nonopioid group compared to the control. The average stay in PACU also decreased in the study group (82 ± 39 min vs 70 ± 22 min, P < 0.001). Both groups reported low numbers of adverse events and need for additional pain prescriptions. These findings were reproducible in the breast subgroup. CONCLUSIONS: This nonopioid regimen is as effective as traditional opioid use for acute postoperative pain control and decreased recovery time for outpatient aesthetic plastic breast surgeries.
Assuntos
Analgésicos Opioides/administração & dosagem , Anticonvulsivantes/administração & dosagem , Inibidores de Ciclo-Oxigenase 2/administração & dosagem , Manejo da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico , Procedimentos de Cirurgia Plástica/efeitos adversos , Acetaminofen/administração & dosagem , Adulto , Idoso , Celecoxib/administração & dosagem , Combinação de Medicamentos , Quimioterapia Combinada/métodos , Feminino , Gabapentina/administração & dosagem , Humanos , Hidrocodona/administração & dosagem , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Assistência Perioperatória/métodos , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemAssuntos
Mamoplastia , Mídias Sociais , Cirurgiões , Humanos , Internet , Mamoplastia/efeitos adversosRESUMO
BACKGROUND: Implant malposition is becoming an increasingly recognized complication following subpectoral breast augmentation. Although several causes of medial malposition have been previously demonstrated, medial implant malposition secondary to unintended pectoralis muscle slips has not been previously described. OBJECTIVE: The goal of this study is to describe a form of medial implant malposition caused by pectoralis major and minor musculature vectors on the implant. METHODS: The primary investigator performed a retrospective review of all patients who underwent revisional breast surgery for the diagnosis of symmastia or medial implant malposition following subpectoral augmentation. Those patients with muscular-type etiology for medial implant malposition were identified. RESULTS: Five patients with pectoralis muscle slips causing medial implant malposition were identified. The pectoralis muscle slips were successfully diagnosed on preoperative exam and corrected with specific surgical procedures aimed at balancing surrounding forces and thus correcting malposition. CONCLUSIONS: Pectoralis muscle slips contributing to medial malposition can be found in some patients after subpectoral breast augmentation. The etiology of this deformity is unknown, but theorized to be caused by anatomic predisposition, with slips inadvertently formed during subpectoral pocket formation arising from the pectoralis minor and/or incompletely released or accessory pectoralis major muscles.
Assuntos
Implante Mamário/métodos , Implantes de Mama/efeitos adversos , Músculos Peitorais/anatomia & histologia , Músculos Peitorais/cirurgia , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Reoperação , Estudos RetrospectivosRESUMO
BACKGROUND: Although the anatomy of the individual pectoralis major and minor muscles has been described previously, never before has the anatomic relationship between these muscles been investigated. OBJECTIVE: The authors identify the anatomic relationship of the costal origins of the pectoralis major and minor muscles. METHODS: Bilateral thoracic wall dissection was completed in 102 cadavers. In each dissection, the chest wall soft tissue was removed, and the distance between costal origins of the pectoralis major and the pectoralis minor muscles was measured. RESULTS: In 49 female and 53 male cadavers, 202 pectoralis major muscles were lifted to expose the costal origins of the pectoralis major and minor muscles. Distances between pectoralis major and pectoralis minor muscles were separated into 3 categories: less than 1 cm, between 1 and 3 cm, and greater than 3 cm. Forty-nine (24%) pectoralis muscle dissections displayed a distance of less than 1 cm between costal muscle origins. Eighty-three dissections (41%) showed an intermediate distance of between 1 and 3 cm, while the remaining 70 (35%) were over 3 cm. No significant difference was observed in these percentages with regard to sex. Ten cadavers displayed asymmetry in pectoralis muscle origin distance. Eight specimens displayed shared fibers between pectoralis major and minor muscles. CONCLUSIONS: The anatomic relationship between the costal origin of the pectoralis major and minor muscles is highly variable. Understanding this spatial relationship has important implications for cosmetic and reconstructive breast surgery.
Assuntos
Músculos Peitorais/anatomia & histologia , Adulto , Cadáver , Dissecação , Feminino , Humanos , Masculino , Músculos Peitorais/cirurgia , Costelas/anatomia & histologiaRESUMO
BACKGROUND: The pectoralis major typically is manipulated for implant coverage and pocket design in subpectoral breast augmentation. An understanding of its anatomy can guide successful creation of the implant pocket. OBJECTIVES: The authors evaluated the anatomy of the sternal origin of the pectoralis major to inform surgical planning, help establish a technique for subpectoral augmentation mammaplasty, and identify the most common locations of perforators. METHODS: The sternal origins of 24 pectoralis major muscles were dissected and examined in 15 female cadavers to determine the structure and width of the pectoralis major sternal origin and its relationship to the locations of internal mammary perforators. RESULTS: The average width of the sternal origin of the pectoralis major was 7.1 mm (range, 3 mm-1.8 cm). This width decreased slightly from the second rib to the second intercostal space and then increased progressively in the caudal direction toward the fifth rib. The sternal origin terminated an average of 5.4 mm (range, 1-16 mm) from the midline, with the greatest distance at the fifth rib and large variability throughout. A row of perforators from the internal mammary artery traversed the subpectoral space an average of 2.7 cm from the midline (range, 1-3.7 cm). CONCLUSIONS: The sternal origin of the pectoralis major was thin and highly variable, suggesting that its partial release for implant medialization during subpectoral augmentation is unsafe.
Assuntos
Implante Mamário , Mamoplastia , Músculos Peitorais/anatomia & histologia , Esterno/anatomia & histologia , Idoso , Idoso de 80 Anos ou mais , Pesos e Medidas Corporais/métodos , Cadáver , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Breast augmentation is the most popular cosmetic surgery procedure in the United States. Postoperative striae is a known but incompletely understood complication of breast augmentation. OBJECTIVES: The authors investigated their own patient population to discern risk factors for new-onset striae after cosmetic breast augmentation. METHODS: A retrospective chart review was performed for patients who underwent primary breast augmentation from 2005 to 2012 in a single-surgeon practice. Initial chart review revealed that only patients aged ≤25 years exhibited new striae; therefore, only patients from this age group were included. Potential risk factors examined included age, body mass index (BMI), oral contraceptive use, time of last menstrual period (LMP), parity, smoking and alcohol status, diabetes mellitus, and personal history of striae. Implant and surgical factors examined included implant material (silicone vs saline), volume, and location (submuscular vs subglandular placement) and the site of incision. RESULTS: Of the 549 patients included in the study, 17 (3.10%) had new-onset striae, observed at a mean of 58 days postoperatively. The risk of striae was statistically significantly higher (P<.05) among patients who were younger (3.3 times), were nulliparous (14.38 times), began their LMP>14 days before surgery (9.24 times), and had a history of striae (6.11 times). There was a strong correlation between new-onset breast striae and implant size, as well as BMI (P=.07). CONCLUSIONS: There is a strong correlation between new-onset striae and hormone levels, genetic factors, and tissue stretch components in patients who undergo cosmetic breast augmentation. This information can be utilized to better educate patients about this potential complication. LEVEL OF EVIDENCE: 4.
Assuntos
Implante Mamário/efeitos adversos , Estrias de Distensão/etiologia , Adolescente , Adulto , Fatores Etários , Implante Mamário/instrumentação , Implantes de Mama , Feminino , Humanos , Desenho de Prótese , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Estrias de Distensão/diagnóstico , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Nipple hypertrophy is associated with physical and psychological sequelae, leading patients to seek corrective treatment. OBJECTIVES: The authors present a simple surgical technique to reduce nipple height with minimal tissue manipulation. METHODS: Between November 2000 and October 2010, the senior author (CM) employed a nipple amputation technique to correct nipple hypertrophy in 30 consecutive patients. A horizontal incision was made through the distal portion of the nipple in the nonerect state to remove the predetermined nipple height. After nipple amputation, epinephrine-soaked gauze was applied to the surgical site for 5 minutes, followed by a postoperative dressing of nonstick gauze with antibacterial ointment. In 29 of the 30 patients, simultaneous breast procedures were also performed, primarily breast augmentation. RESULTS: A total of 60 nipple reductions were performed on 29 women and 1 man (mean age, 37.8 ± 7.14 years). The mean follow-up was 35.9 weeks. All patients reported being satisfied with the procedure. Three patients noted decreased sensation, 1 noted a size discrepancy requiring further surgical intervention, and 1 noted persistent oozing from the surgical site on postoperative day 1. One patient who became pregnant postoperatively was identified; this patient was able to lactate in the postpartum period but was not able to produce enough milk bilaterally to perform breastfeeding. CONCLUSIONS: This simplified surgical technique for correction of nipple hypertrophy was easy to perform, both alone and in combination with additional surgical procedures, and provided reproducible, satisfactory aesthetic results in this case series. LEVEL OF EVIDENCE: 4.
Assuntos
Mamoplastia/métodos , Mamilos/cirurgia , Adulto , Feminino , Humanos , Hipertrofia , Masculino , Pessoa de Meia-Idade , Mamilos/patologiaRESUMO
BACKGROUND: As demand for outpatient procedures has increased, abdominoplasties are now judiciously being performed in accredited outpatient facilities. Previous reports on outpatient abdominoplasties are limited by small cohorts and have not distinguished among different types of body contouring procedures. Furthermore, these reports included patients who remained in the hospital overnight, rather than patients who were discharged within hours postoperatively. OBJECTIVES: The authors review a case series of patients who underwent full abdominoplasty procedures performed in an outpatient facility with same-day discharge. METHODS: Charts were retrospectively reviewed for 319 consecutive patients who underwent full abdominoplasty with the senior author (CLM) between 1992 and 2010. The charts of 206 patients for whom complete electronic medical record data were available were analyzed as a separate cohort. Demographic, operative, and postoperative data were collected. Systemic and local complications were assessed, as were revision rates. RESULTS: No patients in this series developed any systemic complications, including deep venous thrombosis or pulmonary embolism, blood transfusion, intra-abdominal perforation, or death. The most common local complication was seroma, at a rate of 19.4%. CONCLUSIONS: This report serves to add to the literature a large cohort of patients who underwent full abdominoplasty and were discharged within hours of surgery. The study shows that full abdominoplasty procedures can be safely performed without systemic complications in an outpatient setting. Based on these data, the ever-present sentiment that abdominoplasty is the plastic surgery procedure associated with the highest rate of venous thromboembolism should be carefully evaluated. LEVEL OF EVIDENCE: 4.
Assuntos
Abdome/cirurgia , Procedimentos Cirúrgicos Ambulatórios , Procedimentos de Cirurgia Plástica , Adulto , Idoso , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Distribuição de Qui-Quadrado , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Procedimentos de Cirurgia Plástica/efeitos adversos , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Authorship in a peer-reviewed journal is highly regarded in both the academic and private sectors of plastic surgery. Recently, several articles have cited an increased contribution from women in the plastic surgery literature; however, none to date has analyzed the demographic trends of these female authors. The purpose of this study was to conduct an analysis of female authors in three well-known plastic surgery journals. METHODS: Articles published in Plastic and Reconstructive Surgery, Annals of Plastic Surgery, and Aesthetic Surgery Journal between January of 2015 and December of 2015 were reviewed. Supplemental journal, review, and CME articles were excluded. First, second, and last authors from the United States were reviewed and stratified by a number of categories, including sex, geographic location, and title. RESULTS: Two-thousand fifty authors were reviewed. Of these, 20 percent of first authors, 24 percent of second authors, and 15 percent of last authors were women. Female representation was fairly equal among the journals, and 39 percent of women authors were international. Overall, 16 percent of fully trained plastic surgeon authors and 25 percent of resident authors were women, as compared to 15 percent female fully trained plastic surgeons and 36.2 percent female residents represented in the overall community. CONCLUSIONS: Faculty are on par with national percentages of women plastic surgeons; however, women residents have lower representation in the literature than in the community as a whole. Residents and faculty must promote productivity of the younger generation of women plastic surgeons to continue increasing contributions of women to the specialty.
Assuntos
Autoria , Publicações Periódicas como Assunto , Médicas/estatística & dados numéricos , Cirurgia Plástica , Eficiência , Feminino , Humanos , MasculinoRESUMO
BACKGROUND: Plastic surgery to improve chest appearance is becoming increasingly popular. The BODY-Q is a patient-reported outcome instrument designed for weight loss and/or body contouring. In this article, the authors describe the development of a new module for masculinizing chest contouring surgery. METHODS: Qualitative methods were used to develop the BODY-Q Chest Module, which was subsequently field-tested in Canada, the United States, The Netherlands, and Denmark between June of 2016 and June of 2017. Participants were aged 16 years or older and seen for gynecomastia, weight loss, or transman chest surgery. Data were collected using either a Web-based application or paper questionnaire. Rasch measurement theory analysis was performed. RESULTS: The sample included 739 participants (i.e., 174 gynecomastia, 224 weight loss, and 341 gender-affirming). Rasch measurement theory analysis refined a 10-item chest scale and a five-item nipple scale. All items had ordered thresholds and good item fit, and scales evidenced reliability [i.e., person separation index and Cronbach alpha values were 0.95 and 0.98 (chest scale) and 0.87 and 0.94 (nipple scale), respectively]. Scores for both scales correlated more strongly with similar (satisfaction with the body) versus dissimilar (psychological and social function) BODY-Q scales. The mean scores for the chest and nipple scales were significantly higher (p < 0.001 on independent samples t tests) in participants who were postoperative compared with preoperative. CONCLUSION: This new BODY-Q Chest Module is a clinically meaningful and scientifically sound patient-reported outcome instrument that can be used to measure outcomes for masculinizing chest contouring surgery.
Assuntos
Contorno Corporal/métodos , Procedimentos Cirúrgicos Torácicos/métodos , Adolescente , Adulto , Idoso , Antropometria , Feminino , Ginecomastia/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Procedimentos de Readequação Sexual/métodos , Tórax , Redução de Peso , Adulto JovemRESUMO
BACKGROUND: Young female subjects are known to have the highest baseline menstrual hormone levels of any female age group. Studies have found an association between hormone levels and wound healing. This has been researched in the orthopedic, gynecologic, and dermatologic literature, and more recently, in young patients undergoing augmentation mammaplasty. The purpose of this study was to determine whether the timing of surgery relative to the menstrual cycle plays a role in surgical complications following bilateral reduction mammaplasty. METHODS: All female patients aged 25 years or younger with a documented last menstrual cycle undergoing a bilateral reduction mammaplasty from 2005 to 2013 were reviewed. Surgical timing and postoperative complications relative to the last menstrual cycle were recorded. The preovulatory phase referred to days 1 to 14 after the patient's last menstrual cycle, whereas the postovulatory phase referred to days 15 to 28. RESULTS: Forty-nine patients met inclusion criteria. Undergoing bilateral reduction mammaplasty during the postovulatory phase was associated with development of wound dehiscence and hypertrophic scarring (p < 0.005), which were the most common postoperative complications. Surgery in the preovulatory or postovulatory phase did not affect hematoma, seroma, wound infection, or nipple-areolar complex necrosis rates (p > 0.05). Age, race/ethnicity, body mass index, large resection mass, and medical comorbidities did not affect wound dehiscence or scar hypertrophy rates (p > 0.05). CONCLUSIONS: Young patients undergoing bilateral reduction mammaplasty during the postovulatory phase of the menstrual cycle have an increased risk of wound healing issues and poor scarring. This may be attributable to hormonal fluxes occurring during this phase and the already high hormone levels in this population.