Incision Location Predicts 30-Day Major Adverse Events after Cosmetic Breast Augmentation: An Analysis of the Tracking Outcomes and Operations for Plastic Surgeons Database.

BACKGROUND: Enhanced understanding of early postoperative adverse events will improve patient counseling and preoperative risk modification to decrease complications in implant-based breast augmentation. This study seeks to evaluate the early major adverse events following cosmetic breast augmentation. METHODS: A retrospective cohort analysis of the Tracking Outcomes and Operations for Plastic Surgeons database was performed to identify any women undergoing augmentation mammaplasty with an implant between 2008 and 2016. RESULTS: A total of 84,296 patients were studied. Major adverse events were identified in 0.37 percent. Seroma requiring drainage was observed in 0.08 percent, hematoma requiring drainage was observed in 0.15 percent, deep wound disruption was observed in 0.09 percent, and implant loss was observed in 0.11 percent. The authors identified multiple independent predictors of major adverse events, including body mass index greater than 30 kg/m2 (relative risk, 2.05; p < 0.001), tobacco use (relative risk, 2.25; p < 0.001), and diabetes mellitus (relative risk, 1.8; p < 0.05). Use of a periareolar incision significantly increased the risk of developing an early postoperative complication (relative risk, 1.77; p < 0.001). CONCLUSIONS: The findings of this study indicate an early major adverse event rate following cosmetic breast augmentation with implants of 0.37 percent. The authors identified multiple independent predictors of major adverse events, including body mass index greater than 30 kg/m2, tobacco use, and diabetes mellitus. In addition, when controlling for other factors, periareolar incision significantly increased the risk for major adverse events, when compared to an inframammary incision. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Preoperative Use of Dexamethasone in Rhinoplasty: A Randomized, Double-blind, Placebo-Controlled Clinical Trial.

IMPORTANCE: Postoperative edema and ecchymosis following rhinoplasty are a cause of anxiety for both patients and physicians and can affect the cosmetic results. Corticosteroids have been used to reduce these events. OBJECTIVE: To determine whether preoperative use of dexamethasone sodium phosphate alters the occurrence of edema and ecchymosis following rhinoplasty. DESIGN, SETTING, AND PARTICIPANTS: Randomized, double-blind, placebo-controlled clinical trial at an institutional referral center among a sample of individuals with rhinomegaly. INTERVENTIONS: Patients were randomized into 2 groups. In group 1, dexamethasone was intravenously injected before surgery. In group 2, normal saline solution was intravenously injected before surgery. MAIN OUTCOMES AND MEASURES: When patients returned at 1 week after surgery, standardized photographs were obtained. The photographs were analyzed by 5 plastic surgeons who were blinded as to whether dexamethasone or normal saline solution had been injected. The plastic surgeons rated the degree of edema and ecchymosis. RESULTS: Forty-two patients participated in the study. Randomization by lottery resulted in 20 patients in group 1 and 22 patients in group 2. Group 1 showed lower rates of postoperative ecchymosis than group 2; the difference of 0.62 (P = .02) reflects less perceived ecchymosis when dexamethasone was administered. Group 1 also showed lower rates of postoperative edema than group 2; the difference of 0.68 (P = .01) reflects less perceived edema when dexamethasone was administered. CONCLUSIONS AND RELEVANCE: Preoperative use of dexamethasone reduced edema and ecchymosis at 7 days after rhinoplasty. Rigorous methods in this trial demonstrate the beneficial effect of preoperative corticosteroid administration in this surgical procedure. LEVEL OF EVIDENCE: 1.

Preemptive analgesia with bupivacaine in reduction mammaplasty: a prospective, randomized, double-blind, placebo-controlled trial.

BACKGROUND: Preincisional analgesia is an antinociceptive treatment that prevents altered central excitability from high-intensity noxious stimuli. To determine the analgesic efficacy of preoperative infiltration with bupivacaine for reduction mammaplasty, a randomized, double-blind, placebo-controlled trial was designed. METHODS: Women with mammary hypertrophy were allocated randomly to one of two study groups. Patients in group I received preincision infiltration with bupivacaine into each breast after general anesthesia. Group II patients received similar injections of saline injection alone after general anesthesia. RESULTS: Visual analogue pain score, verbal pain score, and short-form McGill Pain Questionnaire scores were higher in group II patients until 22 hours after surgery (p < 0.008). Patients in the saline group had higher intravenous meperidine consumption for 22 hours postoperatively and solicited opioids before the patients in the bupivacaine group (p < 0.001). The difference between groups was statistically significant. CONCLUSION: Preincisional infiltration with bupivacaine results in reduced pain and lower postoperative opioid requirements in the early postoperative phase of pain following breast reduction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.