Does the Use of Intraoperative Breast Sizers Increase Complication Rates in Primary Breast Augmentation? A Retrospective Analysis of 416 Consecutive Cases in a Single Institution.

Background. Is the use of intraoperative breast sizers beneficial for plastic surgeons or do they result in higher complication rates? Methods. This is a retrospective study of 416 consecutive cases of primary breast augmentation with silicone implants at the Plastic Surgery Service of Professor Ivo Pitanguy at the 38th Infirmary Santa Casa Misericórdia Hospital, Rio De Janeiro, from January 2011 to March 2014. 212 cases (51%) were carried out with use of intraoperative breast sizers with 204 cases (49%) without the use of implant sizers. This study compares the outcome of cases that employed the use of intraoperative implant sizers versus those that did not in terms of infection, hematoma/seroma formation, and capsular contracture. Results. Of 416 primary breast augmentation cases, there were 5 cases of infection (1.2%), 4 cases of seroma (1%), 3 cases of hematoma (0.7%), and 7 cases of capsular contracture (Baker's Grade III/IV)(1.7%). Total complication rate limited to infection, seroma, hematoma, and capsular contracture was 1.15% (95% CI 0.96-1.93%). There was a significant difference in the scores for breast sizers (M = 4.3, SD = 1.4) and no breast sizers (M = 2.3, SD = 0.87) conditions, t(8) = 2.79, p = 0.018. The use of implant sizers was correlated with a higher complication rate. Conclusion. Good results could be obtained without the use of breast sizers in primary breast augmentation with use of a biodimensional tissue based planning system while eliminating risks of infection and reducing intraoperative time. Notwithstanding, in a residency program breast sizers can be an excellent training tool to shorten the learning curve in the novice surgeon.

On skin expansion.

This article discusses skin expansion without considering cellular growth of the skin. An in vivo analysis was carried out that involved expansion at three different sites on one patient, allowing for the observation of the relaxation process. Those measurements were used to characterize the human skin of the thorax during the surgical process of skin expansion. A comparison between the in vivo results and the numerical finite elements model of the expansion was used to identify the material elastic parameters of the skin of the thorax of that patient. Delfino's constitutive equation was chosen to model the in vivo results. The skin is considered to be an isotropic, homogeneous, hyperelastic, and incompressible membrane. When the skin is extended, such as with expanders, the collagen fibers are also extended and cause stiffening in the skin, which results in increasing resistance to expansion or further stretching. We observed this phenomenon as an increase in the parameters as subsequent expansions continued. The number and shape of the skin expanders used in expansions were also studied, both mathematically and experimentally. The choice of the site where the expansion should be performed is discussed to enlighten problems that can lead to frustrated skin expansions. These results are very encouraging and provide insight into our understanding of the behavior of stretched skin by expansion. To our knowledge, this study has provided results that considerably improve our understanding of the behavior of human skin under expansion.

Long-term ultrasonographic evaluation of midline aponeurotic plication during abdominoplasty.

BACKGROUND: The purpose of this study was to evaluate the efficiency of the plication of the anterior rectus sheath during abdominoplasty and the anatomical characteristics of patients with recurrence. METHODS: Thirty-eight patients were selected. Patients had undergone abdominoplasty between 1 and 5 years previously. Patients were divided into two groups: group A, 18 patients who had undergone surgery 5 years previously; and group B, 20 patients who had undergone surgery 1 year before. All patients were submitted to a complete physical examination by the plastic surgeon to evaluate the abdominal wall. In addition, an ultrasound examination was performed by the same radiologist in all patients to evaluate rectus diastasis recurrence at two levels: in the supraumbilical region and in the infraumbilical region. The insertion of the recti muscles in the costal margin was also assessed. Groups were compared using Fisher's exact test and the t test. Groups were similar regarding age, body mass index, number of smokers, physical activity, and number of pregnancies. RESULTS: There was no recurrence of diastasis in any cases of the group with a follow-up of more than 5 years, whereas in the 1-year follow-up group there were two cases of recurrence of the diastasis. Only one of the patients who had recurrence of rectus diastasis had a clinical complaint. CONCLUSIONS: Recurrence of rectus diastasis is not directly related to the length of the follow-up. It may occur within the first year after abdominoplasty. Recurrence of diastasis diagnosed by ultrasound is not related to a clinical complaint. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Mycobacteriosis in patients with breast implants: a case review from the Ivo Pitanguy Institute / Micobacteriose em implantes mamários: revisão da casuística do Instituto Ivo Pitanguy

INTRODUCTION: Reports of infections caused by rapidly growing mycobacteria during plastic surgery have increased in recent years despite improvements in techniques of asepsis/antisepsis and antibiotic prophylaxis. Infections occurring after the insertion of breast implants are a cause of patient morbidity and a significant problem for the surgeon. METHODS: Breast implant surgery cases complicated by mycobacterial infections at the Infirmary ward 38th of the Santa Casa da Misericórdia, Rio de Janeiro were retrospectively reviewed. A description of the current guidelines for the prevention and treatment of mycobacteriosis is included. Laboratory confirmed and clinically suspected cases were included in this study. RESULTS: Of 483 augmentation mammaplasty cases, 3 patients developed mycobacterial infections in the last 3 years. In 2 patients, there was a suspicion of infection that was not confirmed by laboratory data. CONCLUSIONS: Prophylaxis is fundamental for reducing the incidence of mycobacteriosis during plastic surgery procedures. However, the identification, diagnosis, and treatment of mycobacterial diseases are important to minimize the morbidity of this type of infection.

INTRODUÇÃO: Nos últimos anos, foram crescentes os registros de infecções por micobactéria de crescimento rápido em cirurgia plástica, mesmo com a melhoria dos métodos de assepsia/ antissepsia e da antibioticoprofilaxia. A infecção após inclusão de implantes mamários causa grande morbidade às pacientes e transtorno ao cirurgião. MÉTODO: Estudo retrospectivo dos casos de infecção por micobactéria de crescimento rápido da 38ª Enfermaria da Santa Casa da Misericórdia do Rio de Janeiro, após inclusão de implantes mamários, em que são apresentadas propostas de prevenção e tratamento da micobacteriose. Foram incluídos os casos confirmados laboratorialmente e os clinicamente suspeitos. RESULTADOS: Até o presente momento foram confirmados 3 casos de infecção por micobactéria, num total de 483 mamaplastia de aumento no decorrer de 3 anos. Em 2 pacientes, houve suspeita de infecção, porém sem confirmação laboratorial. CONCLUSÕES: A profilaxia é o pilar fundamental para a redução do impacto da micobacteriose em procedimentos de cirurgia plástica. Entretanto, saber identificar, diagnosticar e tratar corretamente a micobacteriose é de suma importância para minimizar a morbidade da paciente.

Ethical issues in plastic and reconstructive surgery.

Plastic, reconstructive, and cosmetic surgery refers to a variety of operations performed in order to repair or restore body parts to look normal or to enhance a certain structure or anatomy that is already normal. Several ethical considerations such as a patient's right for autonomy, informed consent, beneficence, and nonmalfeasance need to be given careful consideration. The principal objective of the medical profession is to render services to humanity with full respect for human dignity. Plastic surgeons should merit the confidence of patients entrusted to their care, rendering to each a full measure of service and devotion. They require an extensive amount of education and training. The increases in demand for aesthetic plastic surgery and the advocacy of practice in the media have raised concerns about the circumstances under which cosmetic surgery is ethical and permissible. Innovative research, and new technologies derived from such research, almost always raises ethical and policy concerns. Medical ethics regulate what is, and what is not, correct in promoting plastic surgery to the public. It is essential to create an educated and informed public about the ethical issues in the plastic and reconstructive surgery field. Plastic surgeons need to carefully evaluate the degree of deformity, physical and emotional maturity, and desired outcome of patients who request plastic surgery procedures. Science is a powerful force for change in modern society and plastic surgeons have a responsibility to shepherd that change with thoughtful advocacy and careful ethical scrutiny of their own behavior.

Silicone gel em cicatrizes de cirurgia plástica: estudo clínico prospectivo / Silicone gel in plastic surgery scars: a prospective study

Introdução: O uso de gel de silicone em cicatrizes data do começo da década de 1980. Desde então, um grande número de trabalhos científicos, e dezenas de diferentes fórmulas do produto, vêm sendo publicados e experimentados, atestando os benefícios do gel de silicone na prevenção de cicatrizes hipertróficas e quelóides. Apesar do mecanismo exato de ação do silicone ainda ser desconhecido, a hipótese mais aceita é que o curativo oclusivo estimula os queratinócitos à maior secreção de fatores de crescimento localmente, influenciando consequentemente a regulação dos fibroblastos. Método: Com o objetivo de comprovar os benefícios do silicone gel na melhora clínica das cicatrizes de etiologia cirúrgica eletiva,foi realizado um estudo prospectivo, numa população miscigenada, no Serviço de Cirurgia Plástica na 38ª Enfermaria da Santa Casa da Misericórdia do Rio de Janeiro. Resultados: O gel de silicone demonstrou ação favorável em cicatrizes pós-cirurgia plástica. Conclusão: O uso de silicone gel mostrou-se útil na melhora de cicatrizes recentes, melhorando parâmetros subjetivos e objetivos, como eritema, prurido e endurecimento.

Background: The use of silicone gel on surgical wounds began in the 1980’s. Since then, a large number of scientific papers and dozens of different formulas have been published and experimented, attesting the benefits of this product in the prevention of hypertrophic scars and keloids. Although the exact mechanism of action of silicone gel has not yet been elucidated, the most widely accepted theory explains that the occlusive film stimulates the keratinocytes to increase the local secretion of growth factors, subsequently influencing the regulation of fibroblasts. Methods: A prospective study was undertaken at the 38th Ward of the Santa Casa General Hospital, Rio de Janeiro, to evaluate the positive effects of silicone gel on surgical wounds, in a mixed race population. Results: Silicone gel demonstrated apositive effect on surgical wounds following plastic surgery. Conclusion: Silicone gel is useful to enhance the quality of recent scars, in both subjective and objective parameters, such as erythema, pruritus and firmness.

Junior plastic surgeon's confidence in aesthetic surgery practice: a comparison of two didactic systems.

The importance of residents' training in aesthetic surgery and the need for acquiring confidence in performing cosmetic procedures is an established knowledge. A survey was done in two different training systems to evaluate the experience of junior plastic surgeons in performing four common aesthetic surgery procedures at the end of their residency. The first system guarantees a theoretical background and a certain number of aesthetic procedures to be performed by the trainee, in contrast to the second system where mainly theoretical knowledge in cosmetic surgery is warranted to residents. The residents' comfort in performing specific operations was quite varied between the two systems. The comparison showed that junior plastic surgeons reached a higher degree of self-confidence in aesthetic practice in system A when compared to system B. The similarities and differences between the two systems are analysed and discussed. The possibility of reforming residency programmes by following the structure and the philosophy of system A is proposed.

Estudo prospectivo da avaliação da qualidade de vida e aspectos psicossociais em cirurgia plástica estética / Prospective study of quality of life and psychosocial aspects in aesthetics plastic surgery

Introdução: O aumento do número de cirurgias estéticas ocorrido nas últimas décadas nos faz supor que está havendo uma melhora na auto-imagem de uma maneira geral, porém esta suposição é subjetiva. Para aferir de maneira objetiva a importância da Cirurgia Plástica estética tentou-se neste trabalho analisar a qualidade de vida e os aspectos psicossociais dos pacientes submetidos a tais procedimentos. No sentido amplo da palavra: Saúde não significa somente a ausência de doença, e sim o bem estar físico e social, tornando a cirurgia plástica estética o elo para esse bem estar. Objetivo: O presente estudo tem o objetivo de comparar a qualidade de vida pré e pós-operatória relacionada aos aspectos psicossociais destes pacientes. Método: Foram avaliados 90 pacientes submetidos a cirurgia plástica estética no Instituto Ivo Pitanguy, no período de 30 de abril a 15 de junho de 2007. Os pacientes foram submetidos a questionário de qualidade de vida SF-36 e questionamentos sobre aspectos psicossociais no pré e pós-operatório de 5 meses. Resultados: Noventa e seis por cento dos pacientes eram do sexo feminino e o maior grupo etário foi de 21 a 35 anos; mamoplastia e abdominoplastia perfizeram 32% e 27%, respectivamente. A motivação maior para operar foi insatisfação com a auto-imagem (72%). A qualidade de vida analisada demonstrou melhora estatística significativa em relação à saúde geral. Cinquenta e cinco por cento dos pacientes relataram manter o mesmo nível de conflito familiar prévio à cirurgia, porém 94% sentiam-se mais seguros com a auto-imagem. Discussão: A cirurgia plástica tem por finalidade melhorar a qualidadede vida e aspectos psicossociais dos pacientes. Neste estudo houve uma melhora com significância estatística(p<0,005) no aspecto da saúde geral, aumento de auto-estima, assim como uma influência positiva no relacionamento interpessoal dos pacientes analisados. Conclusão: Conclui-se que é alto o grau de satisfação dos pacientes operados...

Introduction: The number of cosmetic surgeries occurred in recent decades confirms the improvement inself-image. One way to measure is the importance of aesthetic plastic surgery is to examine the quality of life and psychosocial aspects of patients undergoing such procedures. Objective: This study aims to compare the quality of life and pre and post operative psychosocial aspects related to these patients. Methods: Ninety patients undergone aesthetic plastic procedures in the Ivo Pitanguy Institute, from April 30 to June 15 in 2007, were analysed. Patients were submitted to quality of life questionnaire SF-36 and questions on psychosocial aspects in the pre and 5 months post operative. Results: 96% were female and the largest age group was between 21 and 35 years. Mammaplasty and abdominoplasty represents 32% and 27%, respectively. The main motivation was dissatisfaction with self-image (72%). The quality of life analysis showed the significant statistical improvement on general health. 55% of patients reported maintaining the same level of family conflict prior to surgery, but 94% feel more secure with self-image. Discussion: Plastic surgery aims to improve the quality of life and psychosocial aspects of patients. In this study there was a statistically significant improvement (p<0.005) in the aspect of general health, increased self-esteem and a positive influence on inter-personal relation ships of the patients analyzed. Conclusion: It is demonstraded a high level of satisfaction from the patients operated for aesthetic purposes in the Ivo Pitanguy Institute.

Algoritmo para as alopécias cicatriciais e suas opções de tratamento / Algorithm for approaching scar alopecia and treatment options

A cirurgia plástica dispõe de um variado arsenal de técnicas para o tratamento das alopéciascicatriciais. A correção cirúrgica dos defeitos do couro cabeludo deve começar por uma sistematizaçãoda classificação das lesões. A proposta de um algoritmo tem por objetivo organizarde maneira racional as opções para cada caso, sem, no entanto, substituir o julgamento e acriatividade do cirurgião. Este trabalho apresenta um raciocínio clínico que poderá facilitara escolha da melhor opção cirúrgica para corrigir cicatrizes do couro cabeludo.

Plastic surgery has a varied arsenal of techniques for the treatment of scar alopecia. Thesurgical correction of scalp defects should begin with a systematic classification of thetype of injury. An algorithm has been developed that rationalizes and organizes the surgicaloptions in each case, without attempting to replace the surgeon’s judgment and creativity.This paper presents a clinical analysis that could assist the selection of the best surgicalalternative for different cases of scar alopecia.

Primary essential cutis verticis gyrata--a case report.

Cutis verticis gyrata (CVG) is a skin deformity characterised by excessive growth of the skin of the scalp, resulting in furrows and folds which are similar to gyri of the brain cortex. CVG can be classified into two forms: 'primary' (essential and non-essential) and 'secondary'. The primary non-essential type is associated with the neurological and ophthalmological changes, while the primary essential form does not present any other disorder except for the cutaneous alterations. Secondary forms of CVG are much more frequent and accompany other pathologies. The treatment consists of local hygiene and surgical resection of skin excess. This study reports a case of CVG of the primary essential type in a male patient, who was referred to us for a surgical treatment.

Relative implant volume and sensibility alterations after breast augmentation.

BACKGROUND: Recent studies have provided diverging results regarding the factors that may affect sensibility after primary breast augmentation. Implant volume is believed to be an important factor, but the relation of implant size to breast volume has not been adequately addressed. In addition, the literature shows that a conflict exists when the periareolar and inframammary approaches are compared. This study aimed to refine the volumetric analysis comparing the implant and final breast size as well as the intrinsic association of these two factors with postoperative sensory alteration of the breast. METHODS: A prospective study investigated patients who underwent aesthetic breast augmentation between June 2004 and October 2005 (i.e., a 16-month period) at the Ivo Pitanguy Institute. The sensibility in nine regions of the breast was tested before and after surgery using Semmes-Weinstein monofilaments. Breast sizers were used to compare the pre- and postoperative breast volumes. Statistical analysis of the data took into consideration the relative volume of the implant, the surgical approach, the presence of minor complications, the breast-feeding history, and the subjective evaluation of sensory changes in the patients. RESULTS: A total of 37 patients who underwent breast augmentation were examined preoperatively. The relative volume of the implant was found to be associated with sensibility alterations. No difference was found between the periareolar and inframammary incision approaches. Other factors such as previous breast-feeding, minor complications, and subjective alterations were not associated with sensory alterations. CONCLUSIONS: The study findings suggest that larger implants and smaller breasts show an increased association with postoperative sensory alterations of the breast. Plastic surgeons and their patients should be aware of this possibility. Implant volume should be considered together with breast size to avoid sensory complications, and this is summarized in the concept of relative volume.

Follicular transplantation for the correction of various stigmas after rhytidoplasty.

BACKGROUND: Rhytidoplasty may cause permanent and unwanted stigmas, such as dislocation of the temporal and cervical hairline. Widened scars inside the hairline may cause considerable social embarrassment. Furthermore, pretrichial incisions, even if well placed, may widen or become hypochromic, thus revealing that an aesthetic procedure has been performed. Various procedures for the correction of these undesirable telltale signs of a face-lift have been published. This report aims to present the results of correction for postrhytidoplasty stigmas using follicular transplantation. Patient assessment is discussed, and relevant technical aspects are detailed and illustrated. METHODS: A prospective study at the Ivo Pitanguy Clinic investigated patients who underwent hair transplantation to correct unaesthetic signs secondary to rhytidoplasty from January 2001 to December 2004. The aesthetic results and complications were evaluated, as well as the patients' satisfaction rate. The patients presented in this series either were referred from another service or had their rhytidoplasty originally performed in the authors' service. RESULTS: A total of 33 female patients were included in this study. Two patients were lost to follow-up evaluation and not included. The complications were minor. In the late follow-up assessment, 24 patients classified the result as excellent, 4 as satisfactory, and 3 as unsatisfactory. Only the patients who classified the results as unsatisfactory requested a second procedure (i.e., another follicular transplantation). CONCLUSIONS: When performed by an experienced surgical team, the follicular unit transplantation technique is a simple, safe, and efficient way to correct stigmas secondary to a rhytidoplasty, such as a visible scar or a displaced hairline, with satisfactory results and a very low complication rate.

Transplante capilar como alternativa para a correção da elevação da linha de implantação pilosa temporal após ritidoplastias / Hair transplantation as an alternative for correction of sideburn defects after rhytidoplasty

Introdução: A elevação da linha de implantação pilosa temporal - a costeleta - é um dos principais estigmas de pacientes submetidos a ritidoplastias. Este deslocamento pode ser inerente ao procedimento, devido à tração súpero-lateral do retalho, ou pode resultar de dano permanente dos folículos pilosos, por um descolamento superficial do retalho facial. O objetivo deste estudo é analisar a correção da elevação da costeleta pós-ritidoplastias através da técnica de transplante folicular. Método: Os autores acompanharam prospecti-vamente os pacientes submetidos a transplante folicular, para a correção do apagamento da costeleta pós-ritidoplastias, realizados no Serviço de Cirurgia Plástica do Professor Ivo Pitanguy, no período de janeiro de 2003 a outubro de 2004. Foram avaliados os resultados estéticos, as complicações, assim como o grau de satisfação dos pacientes. Resultados: Vinte e cinco pacientes do sexo feminino foram analisadas. No acompa-nhamento tardio, realizado seis e doze meses após a cirurgia, todas as pacientes obtiveram melhora estética importante. Como complicações, identificamos 4 per cent de alargamento da cicatriz da área doadora e 28 per cent eflúvio telógeno. Apenas 8 per cent das pacientes foram submetidas a um novo procedimento para aumentar a densidade capilar. Conclusões: Os autores acreditam que o transplante folicular é uma alternativa válida, segura e que apresenta resultados satisfatórios na correção da elevação da costeleta pós¬ritidoplastias.

Repeated expansion in burn sequela.

This paper presents a retrospective study of the use of 346 expanders in 132 patients operated at the Ivo Pitanguy Clinic, between the period of 1985 and 2000. The expanders were used in the treatment of burn sequela. In the majority of cases, more than one expander was used at the same time. In 42 patients, repeated tissue expansion was done. The re-expanded flaps demonstrated good distension and viability. With the increase in area at each new expansion, larger volume expanders were employed, achieving an adequate advancement of the flaps to remove the injured tissue. The great advantage of using tissue re-expansion in the burned patient is the reconstruction of extensive areas with the same color and texture of neighboring tissues, without the addition of new scars.

Síndrome de Moebius / Möbius syndrome

A síndrome de Moebius (ou de Möbius, como também é escrito) é uma patologia que afeta principalmente o segmento cefálico dos indivíduos acometidos, e por isso está incluída nas síndromes cranio-faciais, mais particularmente no grupo de doenças denominadas miopatias mistas. A síndrome de Moebius caracteriza-se pela paralisia congênita dos pares cranianos VI e VII. A fisiopatologia inicia-se na fase embrionária e continua suas manifestações até a etapa final do crescimento do indivíduo. Por acometer tanto os tecidos molose quanto o tecido ósseo, esta doença interessa a diversos profissionais. Dentre as especialidades implicadas no tratamento devem-se citar o cirurgião plástico e maxilo-facial, odontólogos especializados em ortopedia funcional dos maxilares e ortodontia (móvel e fixa), pediatras, ortopedistas, fonoaudiólogos, psicólogos e geneticistas.

Iatrogenia e cirurgia plástica / Iatrogenesis and plastic surgery

O vocábulo iatrogenia origina-se de duas palavras gregas: iatros (médico) e genesis (origem), e significa o resultado de qualquer ação médica. Deve-se entender ação médica em seu significado mais amplo, como sendo uma atitude médica ou de uma equipe de saúde, ou resultando de qualquer de seus componentes ou mesmo dos efeitos dos ambientes médicos. Ao abordarmos o tema Iatrogenia, enfatizando a relação médico-paciente, torna-se fundamental tecer algumas considerações sobre conceitos de beleza, de imagem corporal, do papel que representa o grupo social, pois estes são elementos determinantes na motivação do paciente que procura o cirurgião plático.

Reconstruçäo total e parcial da orelha nas patologias congênitas e adquiridas / Treatment of congenital and acquired ear deformities

Análise das modalidades de tratamento para reconstruçäo auricular nos casos de deformidades congênitas e adquiridas, adotando a conduta cirúrgica em dois tempos, e discutindo suas implicaçöes e resultados. Realizou-se uma revisäo de 85 casos operados na 38º enfermaria da Santa Casa de Misericórdia do RJ e Clínica Ivo Pitanguy, de 1983 a 1995, onde säo avaliados os resultados da técnica preconizada pelo autor sênior

Lesöes nasal e palatina provocadas por cocaína / Nasal and palatine lesions resulting from cocaine abuse

Os autores descrevem um caso de perfuraçäo do septo e do pálato provocadas por cocaína. A paciente relatou uso de cocaína por mais de cinco anos. Sua queixa principal era a alteraçäo na sua fonaçäo, com hipernasalidade. Näo havia outros sintomas. A perda de sustentaçäo causada pela lesäo septal resultou em nariz em sela. Ao exame havia uma soluçäo de continuidade no palato mole de aproximadamente 2,0 por 1,5 cm. Optou-se por realizar correçäo da fístula palatina com técnica semelhante a palatoplastia de Von Langenbeck. A deformidade nasal foi tratada com enxertos cartilaginosos auriculares em dorso e columela. A evoluçäo ocorreu sem complicaçöes. A paciente refere melhora da fonaçäo, apresentando boa cicatrizaçäo do palato. Säo discutidas as formas de tratamento e as dificuldades inerentes a estas lesöes. Apesar dos tecidos locais serem friáveis, pode-se tratar com uma técnica simples e segur. Salientam também particularidades do paciente dependente da cocaína. Uma cirurgia eficaz pode ajudar na recuperaçäo do indivíduo, porque os resultados podem facilitar sua reintegraçäo social e auxiliá-lo na recuperaçäo da auto-estima. O paciente deve estar livre do uso da droga para sucesso da cirurgia

Abdominoplastia: classificaçäo e técnicas cirúrgicas / Abdominoplasty: classification and surgical techniques

O abdomen participa intimamente na definiçäo do contorno corporal. A partir da classificaçäo proposta pelo autor sênior, baseada no exame físico de cada paciente, o tipo de procedimento cirúrgico torna-se dirigido, proporcionando um tratamento mais adequado e com melhor resultado estético e funcional. A lipoaspiraçäo dos flancos associada à abdominoplastia trouxe uma contribuiçäo importante à cirurgia do contorno corporal, assegurando uma maior definiçäo à regiäo dos flancos e cintura. Abdominoplastia pela técnica de Pitanguy foi o procedimento mais utilizado no Serviço por ter baixos índices de complicaçäo, ser de fácil aprendizagem e apresentar resultados satisfatórios