Patient information before aesthetic lipomodeling (lipoaugmentation): a French plastic surgeon's perspective.

Fat grafting to the breasts has long been controversial among aesthetic surgeons. We have developed a new, safe, effective, and reliable lipomodeling method to be used in breast augmentation. This method grew out of our clinical and radiologic experience acquired since 1998 with fat injections to the breast. The aim of the present report is to provide facts and data concerning lipomodeling and to document our procedures for ensuring that clear, consistent, up-to-date information is given to the patients who are undergoing aesthetic lipomodeling. The key element in our preparation is our commitment to avoid missing the diagnosis or altering the presentation of a preexisting or newly arising breast cancer. We must also ensure that the patient understands the need to comply with follow-up recommendations, such as a specific radiologic examination before and one year after the procedure, as well as a biopsy evaluation of any lesion that is considered suspicious during the physical examination. The patient must sign a confirmation that she has received the appropriate information and that she understands the notice provided by the surgeon at her first visit. This notice must deliver clear, complete, objective, evidence-based information, must be written clearly and understandably, and must not contain any unrelated or confusing information.

Perforation of viscera, a dramatic complication of liposuction: a review of 19 cases evaluated by experts in France between 2000 and 2012.

BACKGROUND: Perforation of one or several intraperitoneal organs during a liposuction procedure is an exceptional but underestimated complication. Knowledge of this complication is essential because of frequent delay in diagnosis and possible dramatic consequences. METHODS: Nineteen cases were evaluated by experts and are presented in a retrospective analysis. Sixteen women and three men, aged 24 to 72 years, were operated on in France between July of 2001 and January of 2012. Abdominal liposuction (200 to 2400 ml) was performed in combination or not with an abdominoplasty. RESULTS: Uncommon pain and an intestinal obstruction were present in all of the patients. The peritonitis was never frank, replaced frequently by infraclinic peritonitis with septic and/or hypovolemic shock. Diagnosis, performed by abdominal scan between days 1 and 7, revealed intraperitoneal gas or liquid. Perforation, unique or multiple, because of the intraperitoneal passage of the cannula, often in the umbilical region and promoted by the presence of a hernia, involved the following organs: ileum (14 cases), jejunum (two cases), spleen (two cases), transverse colon (one case), cecum (one case), and sigmoid (one case). Death occurred in three cases, between days 2 and 11. Eleven patients had temporary ileostomy or colostomy. Associated complications were abdominal wall cellulitis, necrotizing fasciitis, thrombophlebitis, lung collection, and late subobstructive syndrome. CONCLUSIONS: Visceral perforation during liposuction, a severe and sometimes fatal complication with late and difficult diagnosis, is not often reported. Careful technique, particularly if an umbilical approach is used, should avoid this dramatic complication. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.