Reduction mammoplasty in adolescents and elderly: A ten year case series analyzing age related outcome with focus on safety and complications.

INTRODUCTION: Reduction mammoplasty alleviates symptoms of macromastia in various ways. Current study results mainly identify perioperative risk factors for middle aged patients. We investigated a large series of consecutive breast reductions procedures to study whether patients' age at the time of operation is related to the postoperative outcome. METHODS: We retrospectively reviewed all non-oncologic breast reduction procedures at a single institution over a ten year time period, analyzing patients (age, BMI, comorbidities, medication) and operation specific characteristics' (pedicle, nipple-to-sternal notch, resection weight, complications) to identify risk factors related to patients' age at the time of operation. Patients were therefore divided into three groups, according to their age (group I ≤ 20 years, group II ≥60 years, group III 21 to 59 years). RESULTS: 539 patients were included in the study, in total 1065 reduction mammoplasties were performed over a ten year period. The overall complication rate was 33% (n = 175). Excluding minor complications, the total complication rate was 9.5% (n = 51). High body mass index (≥30 kg/m2) (p = 0.02) could be identified as a statistically significant risk factor for major and minor complications. Smoking (p = 0.09) and age ≥ 60 years (p = 0.08) showed a tendency toward higher risk for major and minor complications. CONCLUSION: This study shows an increased risk for complications when performing reduction mammoplasty in older patients, presumably due to the higher prevalence of comorbidities in this patient group as compared to young patients.

Phalloplasty in Female-to-Male Transsexuals by Gottlieb and Levine's Free Radial Forearm Flap Technique-A Long-Term Single-Center Experience Over More than Two Decades.

BACKGROUND: The free radial forearm flap phalloplasty is the most utilized method for penile reconstruction. Among the techniques described in the literature, evidence for the flap design after Gottlieb and Levine is poor. METHODS: From January 1993 until December 2015, 402 phalloplasties were performed in our clinic. Among the 247 free radial forearm flap phalloplasties, 232 free radial forearm flap phalloplasties were performed after Gottlieb and Levine in 229 patients. Operation and patient-specific characteristics were evaluated. RESULTS: This study presents the highest number of free radial forearm flap phalloplasties after Gottlieb and Levine. The rate of total flap failure was 3%; 46% of the patients were heavy smokers. Urinary fistulae and strictures are common. The revision rate for urinary fistulae and/or strictures was 1.3 per patient. The number of postoperative complications, such as bleeding (14.2%), thrombosis of the flap requiring revision (11.2%), or delayed wound healing (16.8%) was considering the high rate of nicotine abuse (45.9%) reasonable. CONCLUSION: The free radial forearm phalloplasty in the design by Gottlieb and Levine is well established at our institution and has proven safe and reliable since 1993. The operative results are satisfactory for both patients and surgeons even in the presence of relevant comorbidities and heavy smoking. We acknowledge the long ordeal and psychological pressure that our patients suffer from, before presenting in our outpatient clinic.