Impact of Hematoma on Capsular Contracture: A Comparative Study of Smooth and Textured Implants in a Miniature Pig Model.

BACKGROUND: Capsular contracture is a significant complication following mammaplasty, with varying incidence rates and symptoms. The etiology of capsular contracture is multifactorial, with postoperative hematoma being recognized as a potential contributing factor. OBJECTIVES: The study aimed to investigate the impact of postoperative hematoma on capsular contracture following mammaplasty, utilizing pig models and modified biomechanical testing. It sought to compare the severity of capsular contracture between smooth and textured implants in the presence of hematoma, assess the biomechanical properties of the capsules, and explore the histological and molecular changes associated with the condition. METHODS: The study involved five female miniature pigs, implanted with both smooth and textured implants. Hematoma models were established, and various methods were employed to evaluate the impact of the prosthesis surface and hematoma on capsular contracture, including ultrasound assessment, biomechanical tests, scanning electron microscopy, histological analysis, and transcriptome sequencing. RESULTS: Capsules in hematoma groups were classified as Baker III/IV, with significantly unfavorable thickness, elastic modulus, and relaxation/creep amounts compared to non-hematoma groups. Smooth implants under hematoma conditions exhibited increased muscle content and biomechanical strength of the capsule. Transcriptomic analysis highlighted differential gene expression related to muscle development and contraction in smooth implants with hematomas. CONCLUSIONS: Hematomas increase the risk of capsular contracture, with smooth implants exacerbating this effect by enhancing pathways related to muscle development and contraction. This underscores the importance of hematoma prevention and treatment strategies, particularly when using smooth implants, to minimize the occurrence of capsular contracture. The study provides insights into the mechanisms underlying capsular contracture and offers evidence to guide surgical and postoperative management strategies.

Pectoral Nerve Blocks Under Direct Vision During Endoscopic-Assisted Transaxillary Breast Augmentation: A Novel, Effective Regional Blocking Approach.

BACKGROUND: Endoscopic-assisted transaxillary breast augmentation allows performing Pecs block under direct visualization. This study aimed to describe this new technique and demonstrat its short-term efficacy and safety with a preliminary clinical study. METHODS: Patients enrolled for transaxillary endoscopic-assisted prosthetic breast augmentation between February 2022 and March 2023 in two medical centers were included in the pectoral nerve block group. Postoperative VAS scores at 1, 4, 12, 24, 48, and 72 h, surgery duration, and the occurrence of nausea and vomiting were compared with a historical cohort of patients collected between February 2021 and January 2022 with the same inclusion criteria. RESULTS: 229 patients were included in the Pecs group and 116 patients were identified in the control group. No statistical difference was observed in patient characteristics. VAS score at postoperative 1 h and 72 h was similar between the two groups, whereas VAS score at postoperative 4 h, 12 h, 24 h and 48 h in Pecs group was significantly lower than control group. The occurrence of PONV in the Pecs group is significantly lower than in the control group. The duration of surgery is similar between the two groups. No block-related complication was observed in the Pecs group. CONCLUSION: A novel approach by combining pectoral nerve blocks with transaxillary endoscopic-assisted breast augmentation to perform blocks under direct vision was proposed and its short-term efficacy and safety was determined by this study. 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 .

Analysis of Factors Affecting the Choice of Implant-based or Autologous Fat Grafting Breast Augmentation: A Retrospective Study.

BACKGROUND: Breast augmentation mainly includes implant-based and autologous fat grafting augmentation. Choosing the right surgical method for the patient is particularly important. However, an analysis of the factors that may affect the choice of surgical methods among patients has not yet been performed. In this study, the authors sought to identify the factors that influence the choice of surgical methods for women who receive implant or autologous fat grafting breast augmentation. METHODS: A total of 192 female patients with micromastia who were hospitalized for breast augmentation from June 2018 to June 2021 were included in the study. The enrolled patients were divided into the implant group (n=92) and the fat group (n=100). Univariate and multivariate analyses were then performed on the data. RESULTS: In the univariate analysis, there were statistical differences between the implant and fat group in weight, BMI, marital status, occupation, bilateral midsternal line-nipple distance difference, bilateral nipple-inframammary fold distance difference in the natural state, and others ( P <0.05). In the final logistic binary regression analysis, the statistically different factors included the acceptable number of operations, chest circumference through the armpit, and chest circumference through the inframammary fold ( P <0.05). CONCLUSION: There were several factors, such as acceptable numbers of operations, chest circumference through the armpit, and chest circumference through the inframammary fold, may affect the choice of breast augmentation surgery method for Chinese female patients. LEVEL OF EVIDENCE: Level-III, retrospective cohort study.

3D Analysis of Breast Morphological Changes after Vertical-Scar Reduction Mammoplasty: A Prospective Study.

BACKGROUND: In addition to symptom relief, the crucial objective of reduction mammoplasty is to achieve a stable and esthetically pleasing postoperative breast shape. However, the morphological changes in breasts following reduction mammoplasty have not been comprehensively understood. In this study, we applied three-dimensional (3D) scanning technology for long-term follow-up monitoring of breast morphological changes to discern their changing trends. Our goal was to provide a reliable basis for assessing postoperative effects and determining follow-up time points. METHODS: This prospective study included patients undergoing vertical-scar reduction mammoplasty. We utilized a combination of linear measurements and 3D scanning to measure various parameters, including breast volume, breast volume distribution, nipple position, and scar length at various time points: pre-surgery, immediately post-surgery, 3-month postoperative, 6-month postoperative, and 1-year postoperative. RESULTS: A total of 115 patients were enrolled in this study. Throughout the initial 3 months of postoperative follow-up, there was a gradual reduction in breast volume, which tended to stabilize from 3 to 12 months. The nipple position showed a gradual shift both laterally, inferiorly, and posteriorly. The volume of the lower and lateral part of the breast increased gradually. Notably, at 1 year after surgery, the scar length was approximately 6.3% shorter compared to the immediate postoperative measurement. CONCLUSIONS: Our 3D analysis unveiled comprehensive changes in breast morphology: The overall breast volume shifted laterally and inferiorly, the nipple position moved laterally, inferiorly, and posteriorly, and there was a significant reduction in scar length. Concurrently, breast volume exhibited a gradual decrease and stabilization after 3 months, establishing it as a suitable follow-up point for assessing postoperative results. Additionally, surgical plans can be formulated based on the overall trend of changes in breast volume and distribution, combined with methods such as three-dimensional scanning, to enhance surgical outcomes and patient satisfaction. 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 .

In Vitro Study of Thymosin Beta 4 Promoting Transplanted Fat Survival by Regulating Adipose-Derived Stem Cells.

BACKGROUND: Autologous fat grafting (AFG) has emerged as a highly sought-after plastic surgery procedure, although its success has been hampered by the uncertain fat survival rate. Current evidence suggests that adipose-derived stem cells (ADSCs) may contribute to fat retention in AFG. In previous studies, it was confirmed that thymosin beta 4 (Tß4) could enhance fat survival in vivo, although the precise mechanism remains unclear. METHODS: ADSCs were isolated from patients undergoing liposuction and their proliferation, apoptosis, anti-apoptosis, and migration were analyzed under Tß4 stimulation using cell counting kit-8, flow cytometry, wound healing assay, and real-time quantitative PCR. The mRNA levels of genes relating to angiogenesis and Hippo signaling were also determined. RESULTS: Tß4 at 100 ng/mL (p-value = 0.0171) and 1000 ng/mL (p-value = 0.0054) significantly increased ADSC proliferation from day 1 compared to the control group (0 ng/mL). In addition, the mRNA levels of proliferation-associated genes were elevated in the Tß4 group. Furthermore, Tß4 enhanced the anti-apoptotic ability of ADSCs when stimulated with Tß4 and an apoptotic induction reagent (0 ng/mL vs. 1000 ng/mL, p-value = 0.011). Crucially, the mRNA expression levels of angiogenesis-related genes and critical genes in the Hippo pathway were affected by Tß4 in ADSCs. CONCLUSIONS: Tß4 enhances adipose viability in AFG via facilitating ADSC proliferation and reducing apoptosis, and acts as a crucial positive regulator of ADSC-associated angiogenesis. Additionally, Tß4 could be accountable for the phenotypic adjustment of ADSCs by regulating the Hippo pathway. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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 .

Pedicle Selection and Design in Reduction Mammaplasty: The Role of Preoperative Fluorescence Imaging.

BACKGROUND: Breast reduction has a wide selection of pedicles but often relies on the surgeon's preference and experience. Necrosis of the nipple-areola complex (NAC) is a catastrophic complication of breast reduction surgery. OBJECTIVES: To solve the above problem objectively, we applied fluorescence imaging technology to the pedicle selection and design of breast reduction surgery for the first time, so that the dominant vessels of the NAC were included in the designed pedicle. METHODS: We retrospectively enrolled 120 patients with breast reduction (a total of 239 breasts). We compared 60 patients who underwent breast reduction without fluorescence imaging for pedicle selection (Group A) with 60 patients who underwent pedicle selection with fluorescence imaging (Group B). The NAC blood supply was monitored after the operation. RESULTS: In this study, 60 Group A cases (119 breasts) and 60 Group B cases (120 breasts) were analyzed. There were no statistically significant differences in patient demographic data or intraoperative resection weights. There were 7 cases of NAC necrosis in Group A (1 case of complete necrosis and 6 cases of partial necrosis), while no NAC necrosis occurred in Group B. There was a significant difference in the rate of NAC necrosis between the 2 groups. CONCLUSIONS: Preoperative fluorescence imaging can guide the selection and design of breast reduction, significantly reducing postoperative NAC blood supply obstacles and necrosis.