Asunto(s)
Enfermedades de la Mama/terapia , Celulitis (Flemón)/terapia , Síndrome de Munchausen/etiología , Terapia de Presión Negativa para Heridas , Conducta Autodestructiva/etiología , Trasplante de Piel/métodos , Adulto , Enfermedades de la Mama/cirugía , Celulitis (Flemón)/cirugía , Femenino , HumanosRESUMEN
BACKGROUND: Breast implants can be characterized by their fill material, surface texture, or shape. Whereas long-term good quality studies have provided evidence for the fill material and texture, there is still little consensus for choosing the shape of an implant. Surveys indicate that many surgeons choose only one implant shape, for reasons that may not always agree with outcomes from long-term studies. OBJECTIVES: We reviewed the first author's experience over the last six years with both round and anatomical implants, compared the rate of complications with either implant shape, and discussed the importance of keeping an open mind about using both implant shapes for primary breast augmentation. METHODS: A review of all consecutive primary breast augmentation patients by the first author over a six-year time period who had a minimum follow up of 6 months after surgery. RESULTS: Six-hundred and forty-eight female patients had 1296 silicone breast implants inserted over the six-year period. Mean age at surgery was 30.5 years and mean BMI was 20.6 kg/m2. All implants were textured, 134 (in 67 patients, 10.3%) were round in shape with mean volume of 338 cc (range, 220-560 cc), while 1162 implants (in 581 patients, 89.7%) were anatomical shaped with a mean volume of 309 cc (range, 140-615 cc). Among these patients, 11.9% (n = 8) with round implants and 9.0% (n = 52) of those with anatomical implants developed complications postoperatively. CONCLUSIONS: A single, ideal implant that is suitable for every primary breast augmentation does not exist. The optimum choice of implant shape in any given situation should take into account the patient's physical characteristics, available implant types, patient's desires, and the surgeon's experience. Together with round implants, anatomical devices ought to be considered as one of the tools in the surgeon's toolbox. By choosing to ignore them a priori means that the surgeon will only have access to half of his armamentarium and will therefore be able to offer a limited set of options to his patients.
Asunto(s)
Implantación de Mama/métodos , Implantes de Mama/efectos adversos , Complicaciones Posoperatorias/epidemiología , Diseño de Prótesis , Adulto , Mama/anatomía & histología , Mama/cirugía , Implantación de Mama/efectos adversos , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Estudios Prospectivos , Geles de Silicona/efectos adversos , Resultado del Tratamiento , Adulto JovenRESUMEN
Background: Secondary aesthetic breast surgery is a complex and challenging scenario. It requires the surgeon to identify contributing factors, provide patient education, make a further management plan, and optimize the conditions for a favorable result. Various techniques have been described in literature but the rate of reoperation is still high. The first author has been using a supero-anterior capsular flap with a neopectoral subcapsular pocket and an implant change in these cases. Objectives: To review the patient characteristics, indications, and early results of using part of the existing implant capsule for secondary subpectoral breast augmentations. Methods: All patients who underwent secondary breast augmentation, over a period of 2 years by the first author (P.M.), using the supero-anterior capsular flap technique were included. The technique involves dissection of a new subpectoral pocket and uses the existing implant capsule as an internal brassiere. Results: A total of 36 patients were operated by this technique. Of these, 17 patients had developed a complication while 19 patients wanted a change in size only. At a mean follow up of 10.2 months, there was no bottoming out, double bubble, or capsular contracture. Conclusions: This reliable technique provides stable results as shown by low rate of complications with the existing follow up.
Asunto(s)
Implantación de Mama/métodos , Implantes de Mama/efectos adversos , Neoplasias de la Mama/cirugía , Colágeno/uso terapéutico , Reoperación/métodos , Colgajos Quirúrgicos/trasplante , Adulto , Anciano , Implantación de Mama/efectos adversos , Femenino , Humanos , Incidencia , Persona de Mediana Edad , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Andamios del Tejido , Resultado del TratamientoRESUMEN
BACKGROUND: The previously described Akademikliniken (AK) method is a comprehensive approach to breast augmentation with form stable implants that has been shown to afford favorable outcomes when applied by experienced surgeons. OBJECTIVES: To evaluate outcomes of a surgeon newly adopting this method at the beginning of his career. METHODS: A retrospective review of patients undergoing dual plane subpectoral augmentation with Style 410 implants between April 2009 and December 2014 was undertaken. The review was performed one year after the last operation. The first author (P.M.) performed all operations. Complications and reoperation rates were analyzed and correlated with patient and implant characteristics using the chi-square or Fisher's exact test, as appropriate. RESULTS: A total of 620 consecutive patients met the inclusion criteria with a mean follow up of 8 months (range, 1 week-60 months). Complications occurred in 14.8% of the patients: request for larger size (3.3%), rotation (3%), and Baker III/IV capsular contracture (2.2%) were the most common ones. Low implant projection was a statistically significant risk factor (P < 0.05) for the most common complication - request for a larger size. The overall reoperation rate was 8.7%. The most common indication for reoperation was request for larger size (2.2%) followed by rotation (2.2%) and capsular contracture (2%). CONCLUSIONS: Breast augmentation with form stable anatomical implants requires a considerably different process. By implementing a systematic approach such as the AK method, novices in this terrain can expect to achieve reasonable outcomes. LEVEL OF EVIDENCE: 4.
Asunto(s)
Implantación de Mama/métodos , Implantes de Mama/efectos adversos , Mama/anatomía & histología , Contractura Capsular en Implantes/epidemiología , Geles de Silicona/efectos adversos , Adulto , Mama/cirugía , Implantación de Mama/efectos adversos , Femenino , Estudios de Seguimiento , Humanos , Contractura Capsular en Implantes/etiología , Persona de Mediana Edad , Tamaño de los Órganos , Diseño de Prótesis , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
Background: Extra full projection implants are used in a select group of aesthetic breast surgery patients. Their use is selective enough that they have not been included in long term manufacturer studies and the indications for their use have attracted much debate. Only a handful of studies have reported the outcomes from implantation of these devices. Objectives: We review our experience of using extra full projection anatomically shaped macrotextured silicone gel implants discussing our rationale, indications, and results. Methods: All patients undergoing primary aesthetic breast surgery with extra full projection anatomical implants by the first author (P.M.) over a seven-year period (January 2009 to December 2015) were included. Results: Three hundred and ten female patients had 620 macrotextured extra full projection anatomically shaped cohesive silicone gel breast implants of mean volume 338 cc (range, 195-615 cc) placed over the seven-year period. All of them had at least a 6-months follow up. There were 39 complications (12.6%) at an average follow up of 12.3 months, including implant malposition/rotation (5.4%), capsular contracture (2.6%), and bottoming out (1.6%). A total of 41 patients (13.2%) were reoperated, of which 30 (9.7%) were due to a complication and 11 (3.5%) because of patient choice. Most of the complications were in the initial part of the case series. Conclusions: The outcomes following the use of extra full projection implants in a carefully selected group of patients are comparable in the short term to those reported for other shaped implants and complications appear to decrease with experience. Level of Evidence: 4.
Asunto(s)
Implantes de Mama/efectos adversos , Mamoplastia/métodos , Complicaciones Posoperatorias/epidemiología , Geles de Silicona/efectos adversos , Adolescente , Adulto , Implantación de Mama/métodos , Femenino , Estudios de Seguimiento , Humanos , Mamoplastia/efectos adversos , Persona de Mediana Edad , Satisfacción del Paciente , Selección de Paciente , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
Growing evidence has shown the promise of mesenchymal stromal cells (MSCs) for the treatment of cutaneous wound healing. We have previously demonstrated that MSCs seeded on an artificial dermal matrix, Integra (Integra Lifesciences Corp., Plainsboro, NJ) enriched with platelet-rich plasma (Ematrix) have enhanced proliferative potential in vitro as compared with those cultured on the scaffold alone. In this study, we extended the experimentation by evaluating the efficacy of the MSCs seeded scaffolds in the healing of skin wounds in an animal model in vivo. It was found that the presence of MSCs within the scaffolds greatly ameliorated the quality of regenerated skin, reduced collagen deposition, enhanced reepithelization, increased neo-angiogenesis, and promoted a greater return of hair follicles and sebaceous glands. The mechanisms involved in these beneficial effects were likely related to the ability of MSCs to release paracrine factors modulating the wound healing response. MSC-seeded scaffolds, in fact, up-regulated matrix metalloproteinase 9 expression in the extracellular matrix and enhanced the recruitment of endogenous progenitors during tissue repair. In conclusion, the results of this study provide evidence that the treatment with MSC-seeded scaffolds of cutaneous wounds contributes to the recreation of a suitable microenvironment for promoting tissue repair/regeneration at the implantation sites.
Asunto(s)
Matriz Extracelular/patología , Trasplante de Células Madre Mesenquimatosas/métodos , Células Madre Mesenquimatosas/metabolismo , Piel/fisiopatología , Ingeniería de Tejidos , Cicatrización de Heridas , Heridas y Lesiones/fisiopatología , Animales , Diferenciación Celular , Células Cultivadas , Modelos Animales de Enfermedad , Masculino , Ratas , Regeneración , Piel/lesionesAsunto(s)
Tejido Adiposo/trasplante , Cicatriz/cirugía , Cejas/crecimiento & desarrollo , Glucocorticoides/efectos adversos , Triamcinolona Acetonida/efectos adversos , Adulto , Alopecia Areata/tratamiento farmacológico , Atrofia/inducido químicamente , Atrofia/cirugía , Cicatriz/inducido químicamente , Femenino , Glucocorticoides/uso terapéutico , Humanos , Triamcinolona Acetonida/uso terapéuticoAsunto(s)
Neoplasias de la Mama Masculina/epidemiología , Carcinoma Ductal de Mama/epidemiología , Carcinoma Lobular/epidemiología , Ginecomastia/patología , Sarcoma/epidemiología , Neoplasias de la Mama Masculina/genética , Neoplasias de la Mama Masculina/patología , Carcinoma Ductal de Mama/genética , Carcinoma Ductal de Mama/patología , Carcinoma Lobular/genética , Carcinoma Lobular/patología , Estrógenos/uso terapéutico , Ginecomastia/cirugía , Humanos , Masculino , Abuso de Marihuana/epidemiología , Mastectomía , Obesidad/epidemiología , Factores de Riesgo , Sarcoma/genética , Sarcoma/patología , Esteroides/uso terapéuticoAsunto(s)
Ligamentos/cirugía , Mamoplastia/métodos , Grasa Subcutánea/trasplante , Femenino , Humanos , Mamoplastia/instrumentación , AgujasRESUMEN
INTRODUCTION: The surgical management of dermatofibrosarcoma protuberans has historically been a challenge, particularly in the head and neck and other aesthetic areas. The current priority is to achieve local oncologic control and a good reconstructive outcome. Here, we present our experience using a novel combined approach with a dermal regenerative template, sub-atmospheric pressure and skin graft. MATERIALS AND METHODS: Five patients presenting at the Department of Plastic and Reconstructive Surgery of the University of Florence between January 2010 and October 2011 were included in the study following Institutional Review Board approval. All patients underwent a wide local excision of dermatofibrosarcoma protuberans affecting the head and neck. RESULTS: The combined approach using the negative-pressure device, a dermal regenerative template and skin grafting proved effective in the management of this type of sarcoma with a good aesthetic and functional outcome, particularly on the neck or the supraclavicular region. CONCLUSION: Although the present multi-step technique requires patient compliance, it results in good local oncologic control of the resection margins. It is possible to perform a wider excision in the event of positive margins without interfering with the last reconstructive outcome.
Asunto(s)
Dermatofibrosarcoma/cirugía , Neoplasias de Cabeza y Cuello/cirugía , Procedimientos de Cirugía Plástica/métodos , Terapia Combinada , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Terapia de Presión Negativa para Heridas , Regeneración/fisiología , Cuero Cabelludo/cirugía , Neoplasias Cutáneas/cirugía , Trasplante de Piel/métodos , Piel Artificial , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: In aesthetic medicine, the most promising techniques for noninvasive body sculpturing purposes are based on ultrasound-induced fat cavitation. Liporeductive ultrasound devices afford clinically relevant subcutaneous fat pad reduction without significant adverse reactions. This study aims at evaluating the histological and ultrastructural changes induced by ultrasound cavitation on the different cell components of human skin. METHODS: Control and ultrasound-treated ex vivo abdominal full-thickness skin samples and skin biopsies from patients pretreated with or without ultrasound cavitation were studied histologically, morphometrically, and ultrastructurally to evaluate possible changes in adipocyte size and morphology. Adipocyte apoptosis and triglyceride release were also assayed. Clinical evaluation of the effects of 4 weekly ultrasound vs sham treatments was performed by plicometry. RESULTS: Compared with the sham-treated control samples, ultrasound cavitation induced a statistically significant reduction in the size of the adipocytes (P < 0.001), the appearance of micropores and triglyceride leakage and release in the conditioned medium (P < 0.05 at 15 min), or adipose tissue interstitium, without appreciable changes in microvascular, stromal, and epidermal components and in the number of apoptotic adipocytes. Clinically, the ultrasound treatment caused a significant reduction of abdominal fat. CONCLUSIONS: This study further strengthens the current notion that noninvasive transcutaneous ultrasound cavitation is a promising and safe technology for localized reduction of fat and provides experimental evidence for its specific mechanism of action on the adipocytes.