Brachioplasty: A Personal Approach.

Brachioplasty has become one of the most rapidly growing operations in plastic surgery. There are a variety of arm presentations, due to either weight loss or other reasons, and the extent of the defect can carry into the lateral chest wall and the back. In this featured operative technique article, the author describes indications, patient selection, and criteria for classifying brachioplasty, and illustrates the surgical techniques of this procedure. Markings, scar positioning, and the various operative steps are described along with the intricacies of postoperative care, including scar control. A personal experience, along with the limitations of brachioplasty, are discussed.

Does Implant Insertion with a Funnel Decrease Capsular Contracture? A Preliminary Report.

BACKGROUND: Capsular contracture remains a common and dreaded complication of breast augmentation. The etiology of capsular contracture is believed to be multi-factorial, and its causes may include biofilm formation due to implant/pocket contamination with skin flora. It has been shown that insertion funnel use reduces skin contact and potential contamination by 27-fold in a cadaver model. After incorporating the funnel into our surgical protocols, we anecdotally believed we were experiencing fewer capsular contractures in our augmentation practices. OBJECTIVES: The purpose of this study was to test the hypothesis that capsular contracture related reoperation rates decreased after insertion funnel adoption using data from multiple practices. METHODS: At seven participating centers, we retrospectively reviewed the surgical records from March 2006 to December 2012 for female patients who had undergone primary breast augmentation with silicone gel implants. Group 1 consisted of consecutive augmentations done without the insertion funnel, and Group 2 consisted of consecutive augmentations done with the insertion funnel. The primary outcome variable was development of grade III or IV capsular contracture that led to reoperation within 12 months. RESULTS: A total of 1177 breast augmentations met inclusion criteria for Group 1 and 1620 breast augmentations for Group 2. The rate of reoperation due to capsular contracture was higher without use of the insertion funnel (1.49%), compared to Group 2 with funnel use (0.68%), a 54% reduction (P = 0.004). CONCLUSIONS: The insertion funnel group experienced a statistically significant reduction in the incidence of reoperations performed due to capsular contracture within 12 months of primary breast augmentation.

Outpatient-based massive weight loss body contouring: a review of 260 consecutive cases.

BACKGROUND: Massive weight loss (MWL), whether from bariatric surgery or self-directed efforts, has become an increasingly-frequent reason for which patients present for body-contouring procedures. As the incidence of post-MWL surgery has increased, there has also been an increase in the frequency of outpatient ambulatory techniques for complex procedures. OBJECTIVES: The author describes his experience with MWL body contouring in an outpatient setting. METHODS: A retrospective review was performed of 260 consecutive patients who presented to the author's clinic for post-MWL body contouring in the author's accredited outpatient clinic. Many patients (n=150) underwent concurrent operations, for a total of 544 procedures. All patients received general anesthesia delivered by a board-certified anesthesiologist, received rigorous perioperative education, and were discharged on the day of operation. RESULTS: Of the 260 patients, 241 were women and 19 were men. The average patient age was 42 years (range, 19-70 years). Among the 544 procedures, the most common complication was minor wound separation. There were no wound infections and only one pulmonary embolism. There were no hospital readmissions and no deaths. CONCLUSIONS: With judicious patient selection, standardized perioperative teaching, and appropriate anesthesia, practitioners' advanced knowledge about complex MWL operations can allow them to perform these procedures safely and effectively in an accredited outpatient setting. LEVEL OF EVIDENCE: 4.