Superiorly Based Short-Scar Mastopexy Augmentation: A 10-Year Review of 1217 Consecutive Cases.

BACKGROUND: Mastopexy augmentation is a challenging procedure, and a technique to create desirable, consistent, predictable results with a low rate of problems has not been well standardized. The inherent difficulty lies in competing surgical maneuvers. This study sought to evaluate the authors' experience and describe the key concepts and steps that allow safe, efficient, predictable results with low complication and long-term reoperation rates. METHODS: A 10-year retrospective review of all aesthetic breast operations between 2005 and 2015 was performed. Two senior surgeons (S.H.W. and H.C.W.) performed 1217 one-stage, superiorly based, short-scar mastopexy augmentation procedures. The data were evaluated in the context of other published series in the literature. RESULTS: The overall revision rate was 4.8%. Patients who had undergone prior breast surgery were statistically more likely to require a revision compared with patients who had virgin breast tissue (10.4% versus 3.8%; P = 0.0005). Average follow-up was 39 months. Twenty-eight percent of revisions were performed more than 2 years after the original surgery; 16% were performed more than 6 years later. All revisions were included, regardless of procedure scope or timing. Of the 58 revision cases, 86% were purely implant or implant-pocket related; 7% were purely tissue related. There was one case of partial nipple necrosis. There were no cases of emergent reoperation, implant loss, implant exposure, or major wound dehiscence. CONCLUSIONS: The authors' approach has been refined to maximize aesthetics, longevity, consistency, and surgical efficiency, and to minimize complications. This study demonstrates that safe and predictable results can be attained in one stage with low complication and reoperation rates. . CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

An Observational Study of the Safety and Efficacy of Tissue Stabilized-Guided Subcision.

BACKGROUND: Cellulite is a common female cosmetic concern for which there are few treatment options with long-term effectiveness data. The aim of this multisite prospective registry study was to collect observational data on the real-life clinical use of a tissue stabilized-guided subcision (TS-GS) system for long-term improvement of cellulite appearance. METHODS: Fifty-three subjects were enrolled and received a single treatment using the TS-GS system. Physicians treated the subjects according to their standard of care. Global Aesthetic Improvement Scale (GAIS) was completed by the patient and clinician assessing overall aesthetic improvement after 180 days. Treatment parameters, pain scores, quality of life data, and expected treatment effects and adverse events were also recorded throughout the study. RESULTS: The patient and physician GAIS scores at Day 180 revealed an overall improvement in 91% and 96% of patients, respectively. Quality of life and self-confidence scores also improved through 180 days. No serious adverse events were reported. Expected treatment effects were similar to those reported in the pivotal trial supporting FDA clearance. CONCLUSION: This study demonstrated significant improvement in the appearance of cellulite after a single treatment session in patients with moderate-to-severe cellulite. These results are consistent with the previously published the pivotal study data.

Separation, Aspiration, and Fat Equalization: SAFE Liposuction Concepts for Comprehensive Body Contouring.

BACKGROUND: Separation, aspiration, and fatty equilibration (SAFE) liposuction uses a process approach to body contouring and minimizes injury to surrounding structures. The multistep process allows for (1) fat separation, (2) lipoaspiration, and (3) fat equalization. The purpose of this study was to review both outcomes and complications of primary SAFE liposuction. METHODS: Retrospective chart review was completed of patients undergoing SAFE liposuction from January of 2006 to January of 2011. Patient selection was limited to those undergoing liposuction alone with no adjuvant excisional procedures. Data were collected regarding demographics, body mass index, operative details, and outcomes. RESULTS: Seven hundred thirty-four patients were identified as having undergone SAFE liposuction. One hundred twenty-nine patients were found to have been treated with liposuction alone. Patient age ranged from 18 to 42 years and body mass index ranged from 18 to 42 kg/m (mean, 26.3 kg/m). Seven patients (5.4 percent) underwent treatment of the face and neck, six patients (4.7 percent) underwent treatment of upper extremities, 13 patients (10.1 percent) underwent treatment of the chest, 20 patients (15.5 percent) underwent treatment of lower extremities, 32 patients (24.8 percent) underwent treatment of the circumferential trunk, and 51 patients (39.5 percent) underwent treatment of circumferential trunk and additional area(s). No major complications occurred. Five of the 129 patients (3.87 percent) developed the minor complication of seroma formation. CONCLUSIONS: SAFE liposuction is a multistep process approach to body contouring consisting of (1) fat separation, (2) lipoaspiration, and (3) fat equalization. The results of this study show such technique to be safe and effective. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.