Standardized Practice Reduces Complications in Breast Augmentation: Results with the First 290 Consecutive Cases Versus Non-standardized Comparators.

BACKGROUND: Several systematic methods for breast augmentation have been published, providing key principles and technical steps for minimizing complications and optimizing patient satisfaction. The aim of this study was to compare complication rates in patients receiving a breast augmentation performed using a structured, standardized approach versus comparator patients operated on without a standardized approach. METHODS: This was a single-center, retrospective review of 290 consecutive breast augmentations performed between October 2016 and September 2017 based on a standardized technique (Randquist's "five P's" combined with Adams' 14-point plan), and 235 comparators who underwent breast augmentations prior to standardization between April 2014 and September 2016. All study subjects were females aged ≥ 18 years, undergoing bilateral breast augmentation, either alone or in the context of augmentation mastopexy or implant replacement. Various implant ranges were used before standardization; most (94.8%) of the standardized procedures used Natrelle® devices. Follow-up lasted for ≥ 12 months. RESULTS: Significantly fewer patients in the standardized surgery group experienced complications (14.5%, n = 42) compared with the non-standardized group [29.4%, n = 69; Chi square = 6.57; degrees of freedom (df) = 1; p = 0.01041]. Complication rates were also significantly lower in the standardized surgery group for each of the three types of breast augmentation surgery assessed separately. Reoperation rates with standardized and non-standardized surgery were 4.1% (n = 12) and 11.9% (n = 28), respectively (Chi square = 6.4; df = 1; p = 0.01145). Patient satisfaction was increased post-surgery in both groups. CONCLUSIONS: The use of a structured, standardized approach to breast augmentation reduced the risk of postoperative complications. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Effects of a new centrifugation method on adipose cell viability for autologous fat grafting.

The use of adipose tissue transfer in plastic and reconstructive surgery is not new and has been studied extensively. Due to different results with regard to adipose cell damage and the level of survival of the transferred tissue in clinical practice, the authors aimed to investigate the effects of centrifugation on fat aspirates to optimize the centrifugal force for fat transplantation and to obtain an increased number of intact adipose progenitor cells. The following different centrifugation forces were evaluated in vitro in terms of fat decantation: 3,000 rpm (1,500×g), 1,300 rpm (250×g), and 500 rpm (50×g). Moreover, the density level, morphology of fat cells, cell viability, and progenitor cell number also were evaluated. Centrifugation leads to a good fat tissue density, with a significant number of progenitor cells, and efficiently removes the liquid portion. High centrifugal forces (at 3,000 rpm) caused significant damage to fat cells with low cell viability, whereas very low centrifugal forces (at 500 rpm) showed little effect on adipose tissue density, resembling fat decantation. Fat aspirates, withdrawn from 30 healthy donors in vivo, were centrifuged at different rotations per minute (rpm), as follows. For the 10 patients in group A, Coleman's technique was used with a centrifugation of the aspirated fat at 3,000 rpm (1,500×g) for 3 min. For the 10 patients in group B, the authors' technique was used, with centrifugation of the aspirated fat at 1,300 rpm (250×g) for 5 min. For the 10 patients in group C, simple decantation of fat was used. In conclusion, a centrifugal force of 1,300 rpm resulted in better density of adipose tissue, with good cell viability and increased ability to preserve a significant number of progenitor cells.

Histologic effects of external ultrasound-assisted lipectomy on adipose tissue.

This study aimed to observe the effects of ultrasound waves at different frequencies on abdominal fat tissue. External ultrasound-assisted lipectomy (XUAL) via both histologic and immunohistochemic examinations was used to assess adipose tissue alterations, including cells and collagenic fibers. The results, at the immunofluorescence level, show that ultrasound used at 1 MHz with a potency of 3 W resulted in no alterations or only limited cell destruction with collagen fibers intact. In contrast, when the ultrasound was 2 and especially 3 MHz, adipocyte alterations usually were evident. Massive adipose tissue destruction, confirmed using Oil red-O staining, was observed. In addition, at the immunofluorescence level, diffuse collagen fiber retraction was detected. This was particularly evident in comparisons with biopsies of intact control samples, which showed normal adipose tissue and intact collagen fibers. The results obtained using morphologic techniques, which do not allow fixation artifacts and include collagen observations, demonstrate that with the XUAL technique, ultrasound at 1 MHz does not induce cellular alterations. In contrast, both 2- and 3-MHz frequencies are capable of causing complete fat tissue disruption, including destruction of adipose cells and collagenic fibers.

Late onset of von Recklinghausen's disease.

Neurofibromatosis is an autosomal dominant genetic disorder, although it may occur as a spontaneous mutation; clinically it is characterized by typical peripheral nerve tumours (Neurofibromas) and cafe au lait spots; they are more frequent over the trunk and legs. In this particular case study a patient with neurofibromatosis is described, who, besides the characteristic cafe au tait spots at birth, has developed, late and rapidly, lesions of neurofibromatous origin in the submammary region, right hip and bilaterally in the areolar region.