Hybrid Prepectoral Direct-to-Implant and Autologous Fat Graft Simultaneously in Immediate Breast Reconstruction: A Single Surgeon's Experience with 25 Breasts in 15 Consecutive Cases.

BACKGROUND: The direct-to-implant method depends on the quality of the mastectomy flaps and can be used only when the flaps are adequately perfused. Even though the method was designed to be a definitive reconstruction procedure, it has been associated with an increased likelihood that additional operative revision will be required in order to achieve the expected final cosmetic outcome. The authors describe a hybrid prepectoral direct-to-implant method that combines autologous fat grafting in the superior medial pole with immediate reconstruction. METHODS: In this prospective study, 15 patients (25 reconstructed breasts) underwent simultaneous hybrid prepectoral direct-to-implant reconstruction together with autologous fat grafting performed by a single senior plastic surgeon (Y.G). RESULTS: The mean quantity of autologous fat grafted in the superior medial aspect of the breast was 59.4 ± 12.8 cc. The mean total volume of the hybrid reconstructed breast, including implant and autologous fat graft, was 497.2 ± 89.1 cc. Satisfying final outcomes were achieved in all cases. There were no major complications, although minor complications were observed. CONCLUSIONS: The authors' hybrid approach allows the surgeon to achieve a more satisfying outcome with regard to the cleavage area. It results in a better natural appearance, an improved contour, and reduced upper pole rippling and deflation, with a lower likelihood that an additional operative revision will be required to achieve the desired final aesthetic outcome. The authors believe that their hybrid approach should be implemented as an integral part of the direct-to-implant prepectoral reconstruction procedure. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

[BREAST RECONSTRUCTION WITH THE BRAVA DEVICE AND AUTOLOGOUS FAT].

AIMS: To report our experience and results in BRAVA breast pretreatment for full breast reconstruction by autologous fat grafting. BACKGROUND: BRAVA (bra like vacuum-based external tissue expander) is a method developed to expand the skin envelope, thus creating more space for the fat graft for breast reconstruction. METHODS: Since 2015 we began to perform a full breast reconstruction by BRAVA and autologous fat grafting. This is a multiprocedure breast reconstruction that includes pretreatment by using the BRAVA device for 180 hours before each surgery. We will focus on the number of procedures and time duration that was needed to complete the breast reconstruction the aesthetic results and the complication rates. RESULTS: Between the years 2015-2019 we preformed 13 late full breast reconstructions using the BRAVA. Six women were post-radiotherapy and they completed their breast reconstruction after 5.7±1.3 rounds during 20.3± 5.3 months. Non-irradiated patients completed their breast reconstruction after 2.7±0.5 rounds during 9.4±2.6 months. We grafted an average volume of 218±16.7 ml of fat per surgery. This was in comparison to an average of 100ml fat volume grafted in surgery without pre-expansion according to the literature. We had no complications and the aesthetic results were satisficing. CONCLUSIONS: The addition of BRAVA expansion procedure before autologous fat grafting leads to a larger volume of fat that can be injected in every operation and reduction of procedures. The procedure is safe and with good aesthetic results.

[Reconstruction in plastic surgery using osmotic tissue expanders].

BACKGROUND: Tissue expander is a major reconstructive modality. Its main disadvantages include: long and inconvenient period of inflation with temporary deformity of the surrounding tissue. Osmotic expander was developed in order to eliminate some of these limitations. It is a self-filling device which absorbs fluids in order to achieve tissue expansion faster. PURPOSE: We present our experience with 28 consecutive cases of tissue reconstruction using osmotic expanders. We wish to emphasize the main advantages and limitations of this device. METHODS: The present study was launched in May 2008, until April 2014, for twenty eight patients, median age 26 years with reconstructions using an osmotic expander (total of 35 expanders). The reasons for using tissue expander included large congenital nevi (75%) and scars. RESULTS: In all of the cases, the operative and post-operative management was uneventful. During the expansion period, there were 2 outpatient clinical visits. The average expansion time was 9 weeks. In 11% (three patients) there was partial extrusion of the expander. In all other cases there were no complications and the final aesthetic results were satisfying. DISCUSSION: Osmotic expander is an advanced modality for tissue reconstruction. The final shape and size are precisely predictable. Its initial small size allows for a small surgical incision and short overall operating time. The expansion period is shorter and more convenient for the patient. Its main disadvantage includes the inability to control the filling rate and the need to remove the expander in case of damage to the overlying tissue. CONCLUSION: Osmotic expander is a reliable tool for tissue expansion. It allows for a satisfying aesthetic result in a shorter period of time and with less inconvenience to the patient.

Self-inflicted burns in soldiers.

BACKGROUND: Self-inflicted burns are a multidisciplinary medical challenge. In contrast to the more common motive of attempted suicide in self-infliction of a burn, usually of a serious degree, a second motive is malingering. Motivation of this nature has been exhibited among Israeli soldiers who inflict on themselves low- to moderate-degree burns to obtain dismissal from mandatory military service. The purpose of our study is to investigate and define this phenomenon. METHODS: A retrospective analysis was performed on a population of 75 soldiers admitted to our Medical Center during the year 2010 with the diagnosis of any sort of burn. We set up a database including all relevant information about the burns including date and time of occurrence, cause, body location, depth of burn injury, area and shape of burn, etiology, and prescribed treatment. RESULTS: The summer was found to be the season with the highest incidence of burns. As far as the day of the week was influential, we found that the greater percentage of burns occurred at the beginning of the week. Most of the burns involved a minor surface area on the dorsal aspect of the foot. Scalding with hot water was the most common cause of burn. Eighty-one percent of the burns were atypical, being well demarcated.Most of the burn cases happened at home with no witnesses to the event. Sixty-one percent of the patients were not admitted to the hospital and were conservatively treated. CONCLUSIONS: Israeli soldiers tend to inflict burns on themselves for ulterior motives. Such burns are almost always minor with a small trauma area and sharp demarcations, and hence can be differentiated from other self-inflicted burns described in the literature. We found that most of the burns occur when the soldiers are on vacation at home. This is probably because the privacy allows them to carry out their act undisturbed. It is important to raise the awareness of attending physicians to the characteristics of these burns. Such patients should be evaluated by medical teams including mental health professionals to help them psychologically and to eliminate this unfortunate problem.