Breast Implant Removal-Only: The Role of Targeted Compression.

BACKGROUND: The number of women seeking explantation of their breast implants has increased in recent years. Anxiety due to potential health problems has been one of the major catalysts. Mastopexy with or without autoaugmentation and fat grafting are the main techniques used in breast implant removal surgery. OBJECTIVES: To analyse the aesthetic and satisfactory outcomes after simple breast implant removal assisted by targeted compression. METHODS: Twenty-eight patients were included in the series. Targeted compression of the breast after implant removal was performed during the 1st month. A satisfaction survey using a Likert scale was used before and after the final visit. The patients were followed up for 1 year. RESULTS: The mean age of the patients was 41 years old, and the mean time between implantation and removal was 10 years. Subjective reasons for removal (46.4% of the patients) were more frequent in women with less time since implantation (5 years) versus 15 years for implant-related problems. A total of 57.14% of the women were satisfied with the aesthetic result, and 42.86% were very satisfied. Only 17.8% of the total would consider an aesthetic refinement. CONCLUSIONS: Simple breast implant removal yields good aesthetic outcomes, and patients are satisfied with the results. Good management of compression of the breast and close follow-up to treat any collection in the pocket provides good adhesion and allows for effective management of the process of deflation and setting of the breast mound. 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.

The Position of the Nipple-Areola Complex in Breast Augmentation.

BACKGROUND: There is some controversy regarding whether the nipple-areola complex (NAC) is elevated, remains stable, or is lowered in breast augmentation. There is a general belief that one can modulate its position depending on the implant chosen. In addition, many preoperative markings include elevating the arms to predict the final position of the NAC. OBJECTIVES: The aim of this study was to investigate changes in the position of the NAC and determine whether the postoperative position of the NAC can be predicted preoperatively by elevating the arms. METHODS: The study included 45 patients. A 3-dimensional scan was performed to take basal (preoperative) and 12-month measurements with the patient's arms in abduction and elevated over the head. The distances measured were the sternal notch-nipple (SN-Ni), nipple-nipple (Ni-Ni), and nipple-inframammary fold (Ni-IMF) distances. RESULTS: With arms abducted, the SN-Ni distance increased by 6% when measured linearly, 8.5% when measured on the skin surface, and 1% to 2% when measured on the sternal line. The Ni-Ni distance increased by 9% (linear) and 15% (over the surface). The Ni-IMF increased by 44%. With arms adducted, the SN-Ni distance increased by 9% (linear), 12% (on the skin surface), and 0.5% at the sternal midline projection. The Ni-Ni distance increased 11% (linear) and 19% (on the surface). The Ni-IMF distance increased by 53%. The postoperative position of the NAC with the arms abducted increased by 17% compared with the preoperative position in adduction. CONCLUSIONS: Implants do not elevate the NAC; its position remains nearly unaltered. The SN-Ni distance was increased in 90% of the patients. Lifting the arms for preoperative markings does not help to predict the postoperative position of the NAC.

Safety and Efficacy of Deoxycholic Acid Injection for Hypogastric Fat Reduction: A Pilot Study.

BACKGROUND: Although deoxycholic acid (DCA) has been proposed for use in other areas, it is used primarily for treating moderate-to-severe fat in the submental area. OBJECTIVE: To evaluate the safety and efficacy of DCA for fat reduction in the hypogastric region. MATERIALS AND METHODS: A prospective, longitudinal, nonrandomized, open-label, interventional pilot study was performed. Deoxycholic acid was transcutaneously injected in upper right, upper left, lower right, and lower left hypogastric zones. Fat thickness was assessed using calipers, ultrasound, and 3-dimensional scanning. The primary end point safety was evaluated by laboratory tests and the incidence of adverse events. RESULTS: Fourteen patients (54 treatment sessions) were included. The mean total volume administered was 26.6 mL. The main local adverse events were edema (94.4%), bruising (90.7%), and erythema (79.6%), all being self-limited (the mean duration 9.6, 7, and 2 days, respectively). A DCA dose was significantly associated with erythema duration (p = .0421) but not with edema duration (p = .1611) or bruising incidence (p = .1013). Measurement using calipers, ultrasound, and 3-dimensional scanning revealed significant fat thickness reduction. Patient-reported outcome measure scores revealed a significant improvement in patient satisfaction. CONCLUSION: Deoxycholic acid may be a safe and effective option for reducing fat thickness in the hypogastric region, although given the cost/benefit ratio probably should be reserved for small deposits.

Preferencias de uso de implantes mamarios entre los miembros de la Asociación Española de Cirugía Estética Plástica: encuesta 2019 / Breast implants preferences among members of the Spanish Association of Aesthetic Plastic Surgery: 2019 survey

INTRODUCCIÓN Y OBJETIVO: Últimamente ha surgido gran controversia sobre diversos aspectos de los implantes mamarios. De hecho, la posible relación entre la texturación del implante y el linfoma anaplásico de células grandes llevó a la retirada voluntaria del mercado de los implantes con cubierta Biocell(R) de Allergan en julio de 2019. El propósito principal de este estudio fue evaluar las preferencias y prácticas habituales de los miembros de la Asociación Española de Cirugía Plástica Estética (AECEP) con respecto a la cirugía con implantes mamarios. Además, analizamos los cambios en la práctica clínica experimentados desde la encuesta publicada en 2016. MATERIAL Y MÉTODO: Llevamos a cabo una encuesta con 15 preguntas relativas a la selección y diferentes aspectos clínicos relacionados con el aumento mamario, en diciembre del año 2019 entre los miembros de la AECEP. Por otro lado, hacemos un estudio comparativo entre los datos actuales y los obtenidos en la encuesta publicada en el año 2017. RESULTADOS: Los 146 miembros de la AECEP recibieron una invitación a participar en la encuesta, de los cuales respondieron 74 (50.7%). De las respuestas obtenidas, 50 (67.6%) correspondieron a hombres. El 89.2% (n=66) tenían una experiencia profesional superior a 10 años y un 70.2% (n=52) tenían una edad comprendida entre los 46 y los 65 años. Respecto al tipo de implante, un 52.7% (n=39) mostró preferencia por los implantes microtexturizados redondos y un 47.3% (n=35) prefirió los microtexturizados anatómicos. En comparación con la encuesta del 2017, una proporción significativamente mayor de participantes prefirió los implantes microtexturizados redondos y microtexturizados anatómicos (p = 0.0025 y p = 0.0015 respectivamente). Por el contrario, una proporción significativamente menor prefirió el uso de implantes macrotexturizados redondos (p = 0.0018) y macrotexturizados anatómicos (p < 0.0001). El plano submuscular fue de elección para el 44.6% de los participantes (n=33). La contractura capsular grado III/IV fue la principal indicación de capsulectomia total para el 94.5% (n=70). La mayor parte fueron partidarios de una actitud vigilante en pacientes con implantes con cubierta Biocell(R) (n=68, 93.1%). El 85.1% (n=63) recomendó vigilancia con técnicas de imagen y sólo 19 participantes (25.7%) fueron partidarios de prohibir el uso de implantes macrotexturizados. CONCLUSIONES: Los resultados de esta encuesta muestran un cambio significativo en la práctica clínica habitual de los encuestados. Respecto a 2017 se ha producido un incremento significativo en el uso de implantes mamarios lisos/nanotexturizados y microtexturizados, mientras que se ha reducido, de forma significativa, el uso de implantes mamarios macrotexturizados

BACKGROUND AND OBJECTIVE: Over the last several years there has been great controversy about different aspects related to breast implants. In fact, the potential relationship between implant texture and anaplastic large cell lymphoma led to the voluntary recall of Biocell(R) coated implants (Allergan(R)) in July 2019. The main purpose of this study was to evaluate the preferences and daily practice of members of Spanish Association of Aesthetic Plastic Surgery (AECEP) regarding to breast implant surgery. Additionally, we assessed possible changes experienced in clinical practice since our survey published in 2017. METHODS: A 15 questions survey, regarding to the selection and different clinical aspects related to breast augmentation, was carried out between January and March 2019 among AECEP members. In addition, a comparative study between current data and those reported in 2017 survey was conducted. RESULTS: The 146 members of the AECEP received an invitation to participate in the survey, of whom 74 (50.7%) responded to it. Of the responses obtained, 67.6% (n=50) corresponded to men, 89.2% (n=66) had more than 10 years of professional experience and 70.2% (n=52) had an age between 46 and 65 years. Regarding the type of implant, 52.7% (n=39) showed a preference for round microtextured implants and 47.3% (n=35) preferred anatomical microtextured implants. Compared to the 2017 survey, a significantly greater proportion of participants preferred round microtextured and anatomical microtextured implants (p = 0.0025 and p = 0.0015, respectively). In contrast, a significantly lower proportion preferred the use of round macrotextured implants (p = 0.0018) and anatomical macrotextured ones (p <0.0001). The submuscular plane was of choice for 44.6% (n=33). Grade III / IV capsular contracture was the main indication for total capsulectomy for 94.5% (n=70). Most of participants ( 93.1%, n=68) were in favor of a vigilant attitude in patients with Biocell(R)-coated implants. 85.1% (n=63) recommended surveillance with imaging techniques and only 25.7% (n=19) thought that the use of macro-textured implants must be prohibited. CONCLUSIONS: The results of this survey showed a significant change in the current clinical practices among the participants. Comparing with 2017 survey, there has been a significant increase in the use of smooth / nano-textured and microtextured breast implants, while the use of macro-textured breast implants has been significantly reduced

Breast Augmentation Surgery: How Do We Do It? Results of a Joint Survey from European Association of Societies of Aesthetic Plastic Surgery.

INTRODUCTION: The purpose of this study was to evaluate the current perceptions, preferences, and practice of plastic surgeons in Europe regarding breast implant surgery after the controversy on macrotextured implants and BIA-ALCL and the voluntary recall of all biocell implants. METHODS: A survey comprising 15 questions about implant selection and postoperative routines associated with breast augmentation was sent to all society members of the EASAPS. RESULTS: Out of 1473 correspondents, 416 completed the survey with response rate being 28.2%. Countries with less than ten respondents were not included in the analysis. A total of 359 respondents (24.4%) were included in the analysis. Twenty-one respondents (5.8%) had a clinical experience < 5 years, 43 (12%) had 5-10 years' experience, and 295 (82.2%) had > 10 years' experience. Regarding the type of implant, only 6.1% would use a macrotextured implant. Fourteen per cent of surgeons would recommend to change a biocell implant in any case, even without symptoms or problems (rupture, seroma, and capsular contracture), 99.7% would send the capsule for histopathological study (99.7%), 98.9% would perform bilateral implant replacement in case of a unilateral problem of rupture, contracture, or seroma, and 80.8% of respondents considered capsulectomy as a technique for managing capsular contracture degree III/IV. CONCLUSIONS: The main conclusion is the heterogenicity of answers and practice, due to the lack of guidelines and scientific evidence on breast implants. Although 22 (6.1%) respondents would use a macrotextured implant (either round or anatomic), 71.6% of respondents considered that there is not enough information for removing macrotextured implants from the market and that they should be allowed to be used unrestrictedly or under close surveillance of the regulatory agencies. LEVEL OF EVIDENCE III: 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 .

Effects of Silicone Implants on the Mammary Gland: Ultrasonographic and 3D Study.

BACKGROUND: Breast implants may be responsible for secondary deformities produced by parenchymal atrophy. However, few studies in the literature have reported changes in breast tissue after augmentation surgery. In this study, the breast thickness of patients undergoing breast augmentation was monitored by ultrasound, and correlations with surface, volume and projection measurements were examined. METHODS: We studied the parenchymal thickness at the lower pole of the breast with ultrasound in 36 women (72 breasts). In another group of 33 patients (66 breasts), we studied the thickness at the upper and lower poles along the meridian of each breast by ultrasound and measured the anthropometric metrics, volume and projection of the breast with a 3D camera. RESULTS: Midline measurements close to the areola showed reduced thickness at the lower pole, with 31.8% at the midpoint of the lower pole and 42% at the infra-areolar level (p < 0.0001). At the upper pole, there was a decrease of 14.6% (p < 0.001), but the thickness was increased by 6% and 38% at more cranial levels. No correlations with volume were found. Anatomical implants produced more atrophy at the lower pole, and round implants at the upper pole. More atrophy was found with subfascial than submuscular augmentation. Compared with the expected values, the final volume was very similar, but the projection was 29% less. Surface measurements changed significantly up to 4 months postoperatively and remained stable thereafter. CONCLUSIONS: Implants affect significatively the thickness of the glandular tissue. All changes occur very soon postoperatively but stabilize after 4 months. 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 .

Implantes mamarios en España: resultados de encuesta a cirujanos plásticos / Breast implants in Spain: results of a survey to plastic surgeons

Introducción y Objetivo. La cirugía de implantes mamarios tiene un impacto social, científico y económico de primer orden. Recientemente se han producido algunas controversias en cuanto a la texturizacíón de los implantes y su relación con ciertas complicaciones, así como en cuanto a sus garantías. Llevamos a cabo una encuesta entre cirujanos plásticos españoles para conocer su opinión sobre ciertos aspectos relacionados con los implantes mamarios: tipos, complicaciones, garantías. Material y Método. Los cuestionarios se repartieron vía internet en un periodo de 15 días en la primera mitad del mes de noviembre del 2016 a 760 cirujanos plásticos, miembros numerarios de la Sociedad Española de Cirugía Plástica, Reparadora y Estética (SECPRE). Resultados. Contestaron 216. No encontramos diferencias significativas en cuanto al tipo de implante usado, siendo el implante anatómico ligeramente más frecuente. Las marcas norteamericanas Allergan(R) y Mentor(R) dominan la cuota de mercado en este segmento, tanto para prótesis anatómicas (60%) como redondas (50%). Un 30% de encuestados habían cambiado de marca recientemente. En cuanto a la garantía ofrecida por los fabricantes, la mayor parte de los cirujanos (68%) están conformes con ella, aunque también la mayoría (56.9%) piensa que debería ser vitalicia y que las pacientes están mal informadas al respecto. Los resultados también muestran una gran desconfianza del profesional frente a la objetividad de la casa fabricante cuando esta ha de evaluar el implante para determinar si la garantía es aplicable. Conclusiones. Existe un predominio de uso de prótesis anatómicas respecto a redondas entre los cirujanos plásticos españoles que contestaron la encuesta. Sin embargo, parece que algunos han cambiado su preferencia ante el miedo a problemas como doble cápsula, seromas e incluso linfoma anaplásico de células gigantes (LACG). Respecto a la garantía, se percibe como un beneficio para la paciente aunque debería durar toda su vida. La información que se tiene acerca de dichos programas se considera pobre. En general hay una gran desconfianza entre los encuestados en relación a los análisis que los propios fabricantes hacen de las prótesis rotas (AU)

Background and Objective. Breast implants surgery has a major social, scientific and economic impact. Recently there have been some controversies regarding the texture of the implants and their relation with certain complications as well as with the guarantees of the implants. A survey was carried out among Spanish plastic surgeons to know their opinion on certain aspects related to breast implants: types, complications, guarantees. Methods. The questionnaires were sent online during the first half of November 2016 to 760 surgeons, all of them members of the Spanish Society of Plastic, Reconstructive and Aesthetic Surgery (SECPRE). Results. There were 216 answers. There was no significant difference in the type of implants used, with the anatomic slightly more frequent in use. American brands Allergan(R) and Mentor(R) dominate the market share in this segment, both for anatomical prostheses (60%) and round (50%). Thirty per cent of respondents had recently changed brands. As for the warranty offered by the manufacturers, most surgeons are satisfied with it (68%), although most think it should be lifelong (56.9%) and that the patient is misinformed about it. The results also show a great distrust of the professional against the objectivity of the manufacturer when they have to evaluate the implant to determine if the guarantee is applicable. Conclusions. There is a predominance of use of anatomical prostheses compared to round among surgeons who have answered the survey. However, it seems that a group has changed their preference for fear of problems like double capsule, seroma and even anaplasic large cell lymphoma (ALCL). Regarding the guarantee, it is perceived as a benefit for the patient although it should last throughout her life. Information about these programs is considered poor. In general there is a great distrust among the respondents in relation to the analysis that the own manufacturers do on the prostheses broken (AU)

Nipple Shields in Transaxillary Breast Augmentation.

BACKGROUND: Infection after breast augmentation occurs in 1.1% to 2.5% of patients. Bacterial contamination of the implants could explain some complications of breast implant surgery, including infection, capsular contracture and even anaplastic large cell lymphoma. Because of the evidence of bacterial spread from the nipple, nipple shields have been proposed as a routine maneuver to avoid contamination of the implants. OBJECTIVE: To determine if nipple shields are useful in transaxillary breast augmentation. METHODS: A culture was obtained from the dressing (nipple shield) in 26 patients with transaxillary incision, and follow-up lasted for 18 months. A retrospective study of patients undergoing breast augmentation between 2008 and 2012 was conducted as well to know our rate of infections. A total of 753 patients between the ages of 18 and 62 years, with a mean age of 34 years, were identified. Of these 753 patients, most underwent surgery using a transaxillary incision (72.5%). The most common placement plane was subfascial (59.2%), and in most cases, an anatomical prosthesis (78%) was used. RESULTS: No cases of infection or capsular contracture were observed in the study group. However, 13.5% of the breasts had positive cultures of swabs taken under the nipple shields. Staphylococcus epidermidis and Enterococcus faecalis were isolated from the nipple culture. Within the retrospective study, we detected 2 cases of acute infection (0.26%) and 5 cases of late infection (0.66%). The acute infections were caused by Staphylococcus aureus. In the late infections, Pseudomonas aeruginosa was isolated in 3 cases, and S. aureus was isolated in 1 case. CONCLUSIONS: Nipple shields did not make any difference for outcomes when using the transaxillary method. Acute infections seem to occur more frequently via the areola route. Late infections seem to have a hematogenous component because an infectious background was present in all cases.

Five-Year Outcomes of Breast Augmentation with Form-Stable Implants: Periareolar vs Transaxillary.

BACKGROUND: Form-stable 410 implants have the potential advantage of maintaining their anatomic form thanks to the cohesiveness of the gel. Furthermore, Biocell texturing appears to maximize adhesion and to allow for implant immobility. OBJECTIVES: To compare the rate of reoperations for transaxillary and periareolar approaches for breast augmentation. METHODS: This retrospective study consisted of 373 patients with a 5-year follow up. Patient demographics, self-perception and esteem, surgical technique, and implant characteristics were documented. The reasons for reoperation for both approaches were reviewed. RESULTS: Transaxillary breast augmentation was used in 302 patients (81%) and periareolar breast augmentation in 71 patients (19%). In the axillary group, 210 had subfascial placement (69.5%), and 92 patients had submuscular placement (30.5%). In the nipple-areolar complex group, 50 were subfascial (70.4%), and 21 were submuscular (29.6%). The reoperation rate for the patients operated on during this time and followed for 5 years was 11% (8 patients) for the nipple-areolar complex approach and 8.3% (25 patients) in the axillary group. Capsular contracture grade III or IV were the main causes for reoperation for any technique (4.2% nipple-areolar complex vs 3.3% axillary). Other reasons were implant rupture, seroma, infection, implant malrotation, implant malposition, and rippling. CONCLUSIONS: The rate of reoperations was similar to those described in the literature for this type of implant. There were no statistically significant differences between the various techniques, although the reoperation rate was significantly higher when a periareolar subfascial technique was used. LEVEL OF EVIDENCE: 3 Therapeutic.

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Ultrasonography: a useful tool for plastic surgeons.

UNLABELLED: Ultrasonography is a diagnostic technique used in many clinical specialties that should also be used by plastic surgeons. The authors have used ultrasonography since 2011 as part of the routine follow-up evaluation for all their patients who have undergone breast augmentation (the main indication), body implants, gynecomastia, fat transfer, or abdominoplasty. The main goal of this study was to correlate normal and pathologic conditions clinically with their respective imaging findings. The secondary aim was to establish the utility of this tool in a plastic surgery setting. With increasing experience, the use of ultrasound evaluation was expanded to include evaluation of seromas and hematomas, determination of the diastasis recti width, and confirmation of the presence of hernias, especially in patients with high adiposity, who are difficult to scan. This report describes several clinical cases of complications associated with breast augmentation and discusses the most significant common problems encountered during the first 2 years of ultrasonography scanner use in a plastic surgeon's office. LEVEL OF EVIDENCE V: 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.

Columella reconstruction using a free flap from the first web space of the foot.

Nasal columella defects can result in significant cosmetic and functional deformities. If a local flap transfer cannot be performed, columella reconstruction becomes a significant challenge for the surgeon. The columella of a healthy 30-year-old woman whose nose was scarred and contracted because of cocaine abuse, was successfully reconstructed by transferring a microvascular free flap from the first web space of the foot. The reconstructed columella had a satisfactory contour and a good texture, although there was slight, albeit unproblematic, color mismatching.

Efectos de la cirugía estética y los tratamientos estéticos sobre la imagen corporal, la autoestima y las relaciones de pareja: implicaciones para la psicoterapia / Effects of the cosmetic surgery and the aesthetic treatments on the corporal image, the autoesteem and the relations of pair: implications for the psychotherapy

Este trabajo presenta dos estudios. El primero de ellos contrasta los efectos de la cirugía estética sobre la imagen corporal mediante un deiseño de pre-post en el que la variable "imagen corporal" se evaluó utilizando la versión española del cuestionario MBSRQ. En él se demuestra que, tras operarse, (a) se produce un incremneto en la valoración subjetiva positiva de la imagen corporal; (b) los pacientes son más conscientes de los aspectos relevantes concernientes a su aspecto físico; (c) Llos pacientes se centran más en el mantenimiento de su forma física, (d) los pacientes se sienten más atractivos físicamente y (e) el factor Cuidado del Aspecto Físico no se ve afectado por la intervención. En referencia a los resultados del estudio 2, las intervenciones y tratamientos realizados a la muestra de participantes en este estudio contribuyeron a mejorar su autoestima en la dimensión de imagen corporal(AU)

This paper presents two studies. The first one of them confirms the effects of the cosmetic surgery on the corporal image by means of a deiseño of pre-post in that the variable " corporal image " was evaluated using the Spanish version of the questionnaire MBSRQ. In him there is demonstrated that, after occurring, (a) an incremneto takes place in the subjective positive valuation of the corporal image; (b) the patients are more conscious of the relevant aspects relating to his physical aspect; (c) patient Llos centres more on the maintenance of his physical form, (d) the patients feel more attractive physically and (e) the factor Taken care of the Physical Aspect does not meet affected by the intervention. With reference to the results of the study 2, the interventions and treatments realized to the participants' sample in this study helped to improve his autoesteem in the dimension of corporal image (AU)