Are Surgical Approaches Correlated With BREAST-Q Score Improvements After Reduction Mammoplasty? A Systematic Review.

BACKGROUND: Despite the commonly recognized benefits and drawbacks of each surgical technique for reduction mammoplasty, data on the influence of each surgical approach on patient quality of life and satisfaction remains limited. Our study aims to evaluate the association between surgical factors and BREAST-Q scores for reduction mammoplasty patients. METHODS: A literature review through August 6, 2021, was conducted using the PubMed database to select publications that used the BREAST-Q questionnaire to evaluate outcomes after reduction mammoplasty. Studies examining breast reconstruction, breast augmentation, oncoplastic reduction, or breast cancer patients were excluded. The BREAST-Q data were stratified by incision pattern and pedicle type. RESULTS: We identified 14 articles that met selection criteria. Among 1816 patients, the mean age ranged from 15.8 to 55 years, mean body mass index ranged from 22.5 to 32.4 kg/m 2 , and bilateral mean resected weight ranged from 323 to 1845.96 g. Overall complication rate was 19.9%. On average, satisfaction with breasts improved by 52.1 ± 0.9 points ( P < 0.0001), psychosocial well-being improved by 43.0 ± 1.0 points ( P < 0.0001), sexual well-being improved by 38.2 ± 1.2 points ( P < 0.0001), and physical well-being improved by 27.9 ± 0.8 points ( P < 0.0001). No significant correlations were observed when mean difference was modeled against complication rates or prevalence of superomedial pedicle use, inferior pedicle use, Wise pattern incision, or vertical pattern incision. Complication rates were not correlated with preoperative, postoperative, or mean change in BREAST-Q scores. A negative correlation was noted between the prevalence of superomedial pedicle use and postoperative physical well-being (Spearman rank correlation coefficient [SRCC], -0.66742; P < 0.05). The prevalence of Wise pattern incision was negatively correlated with postoperative sexual well-being (SRCC, -0.66233; P < 0.05) and physical well-being (SRCC, -0.69521; P < 0.05). CONCLUSIONS: Although either preoperative or postoperative BREAST-Q scores may be individually influenced by pedicle or incision type, there was no statistically significant effect of surgical approach or complication rates on the average change of these scores, and overall satisfaction and well-being scores improved. This review suggests that any of the main surgical approaches to reduction mammoplasty provide equally substantial improvements in patient-reported satisfaction and quality of life, but more robust comparative studies would strengthen this area of research.

A Systematic Review of the Impact of Patient Factors on BREAST-Q Outcomes After Reduction Mammoplasty.

BACKGROUND: As reduction mammoplasty rises in popularity, it will become increasingly important to understand the patient-reported outcome measurements associated with a successful operation. There has been a growing body of literature on BREAST-Q outcomes for patients undergoing reduction mammoplasty, but meta-analyses of patient factors and BREAST-Q Reduction Module scores are lacking. This study sought to ascertain which patient factors were associated with improvements in BREAST-Q scores compared with preoperative levels. METHODS: A literature review through August 6, 2021, was conducted using the PubMed database to select publications using the BREAST-Q questionnaire to evaluate outcomes after reduction mammoplasty. Studies examining breast reconstruction, breast augmentation, oncoplastic reduction, or breast cancer patients were excluded. BREAST-Q data were stratified by comorbidities, age, body mass index (BMI), complication rate, and resection weight. RESULTS: Among 14 articles and 1816 patients, the mean age ranged from 15.8 to 55 years, mean BMI ranged from 22.5 to 32.4 kg/m2, and bilateral mean resected weight ranged from 323 to 1845.96 g. Overall complication rate was 19.9%. On average, satisfaction with breasts improved by 52.1 ± 0.9 points (P < 0.0001), psychosocial well-being improved by 43.0 ± 1.0 points (P < 0.0001), sexual well-being improved by 38.2 ± 1.2 points (P < 0.0001), and physical well-being improved by 27.9 ± 0.8 points (P < 0.0001). The mean age was positively correlated with preoperative sexual well-being (Spearman rank correlation coefficient [SRCC]: 0.61, P < 0.05). Body mass index was negatively correlated with preoperative physical well-being (SRCC: -0.78, P < 0.01) and positively correlated with postoperative satisfaction with breasts (SRCC: 0.53, P < 0.05). The mean bilateral resected weight was significantly positively correlated with postoperative satisfaction with breasts (SRCC: 0.61, P < 0.05). No significant correlations were observed between complication rate and preoperative, postoperative, or mean change in BREAST-Q scores. CONCLUSIONS: Reduction mammoplasty improves patient satisfaction and quality of life as reflected by the BREAST-Q. Although preoperative or postoperative BREAST-Q scores may be individually influenced by age and BMI, these variables demonstrated no statistically significant effect on the average change between these scores. This literature review suggests that reduction mammoplasty delivers high satisfaction across a diverse range of patient populations, and additional prospective cohort or comparative studies gathering robust data on other patient factors would benefit this area of research.

Dual-Plane Gluteal Myocutaneous Flap for Reconstruction of Ischial Tuberosity Pressure Wounds.

PURPOSE: Ischial tuberosity pressure wounds are the most common type of pressure wound and contribute to a large percentage of the total cost of surgical and nonsurgical management of pressure wounds. Gluteal myocutaneous and fascocutaneous flaps are well-documented methods of coverage for ischial pressure wounds. This study aimed to describe results using a novel dual-plane gluteal myocutaneous flap technique for reconstruction of ischial tuberosity pressure wounds. METHODS: A retrospective chart review was performed of all patients who underwent dual-plane gluteus maximus myocutaneous flap reconstruction for ischial tuberosity pressure wounds performed by a single surgeon from 2012 to 2018. Patient demographic, clinical, and operative characteristics were reviewed. Outcomes were assessed by analyzing complication rates including recurrence, need for revision surgery, dehiscence, necrosis, wound infection, seroma, and hematoma. RESULTS: Eight dual-plane gluteus maximus myocutaneous flaps were performed for reconstruction of ischial tuberosity pressure wounds in 7 male patients with a mean age of 49.1 ± 14.9 years (mean ± SD) and mean body mass index of 26.7 ± 6.4 kg/m. All patients were nonambulatory secondary to spinal cord injury or congenital neurological disease. Two patients (28.6%) were diabetic, and 1 patient (14.3%) was an active smoker. The mean defect size after debridement of ischial pressure wounds was 60.7 ± 29.4 cm. After a mean follow-up of 16.4 months, partial wound dehiscence occurred in 1 patient (14.3%) and was managed with local wound care only. Infection and recurrence occurred in another patient (14.3%) and required revision surgery. CONCLUSIONS: The dual-plane gluteal myocutaneous flap is an effective method for reconstruction of ischial tuberosity pressure wounds. Partially elevating the cutaneous layer off the gluteus maximus muscle allows for greater mobility and rotation of the muscle flap into the ischial pressure wound defect and closure of the flap and donor site with the cutaneous layer.

Assessing Patient-Reported Outcomes After Female Cosmetic Genital Surgery.

PURPOSE: Patient-reported outcomes after female cosmetic genital surgery (FCGS) have been well documented; however, methods vary widely between studies and are often very detailed, time-consuming, and difficult to reproduce. The purpose of this study was to assess patient-reported outcomes after FCGS using a novel method and survey as well as to present the results of a pilot study aimed at validating this survey. METHODS: A retrospective chart review identified patients who underwent FCGS. Demographic, clinical, operative, and outcome characteristics were recorded. A novel survey, including 14 items administered by telephone interview, was developed and extrapolated from the BREAST-Q for augmentation mammaplasty, to assess patient-reported outcomes after FCGS with regard to satisfaction with outcome and physical, psychosocial, and sexual well-being. RESULTS: The survey response rate was 50.6% (39 patients). Over a mean time after surgery of 56 months, 14 complications occurred in 11 patients (28.2%), and 10 complications required revision surgery. Postoperative asymmetry and dehiscence were the most common complications. Despite the higher complication and revision surgery rates, 97.4% agreed that the surgery was a good experience and were satisfied with the results after surgery. In addition, patient-reported outcomes after FCGS showed significant improvement in physical well-being, psychosocial well-being, and sexual well-being (P < 0.001). CONCLUSIONS: This novel survey can be used to assess patient-reported outcomes after FCGS in an efficient approach. Despite the potential complications and need for revision surgery, the vast majority of patients who undergo FCGS feel that it is a good experience, are satisfied with the results after surgery, and show significant improvement in physical, psychosocial, and sexual well-being after surgery.

Outcomes, Techniques, and Risk Factors for Dehiscence in Central Wedge Labiaplasty.

PURPOSE: Outcomes after female cosmetic genital surgery (FCGS) performed by plastic surgeons working in a group practice setting have not been well documented. This article aimed to assess outcomes and to describe FCGS techniques used in a large group private plastic surgery practice. METHODS: A retrospective chart review identified patients who underwent FCGS from 2009 to 2018. Demographic, clinical, and operative information was reviewed and recorded. Outcomes were assessed by evaluating postoperative complications and the need for revision surgery. RESULTS: Seventy-seven women between the ages of 14 and 53 years underwent FCGS performed by 1 of 6 surgeons. Forty-five patients underwent central wedge excision for labia minora hypertrophy, whereas 32 patients underwent extended central wedge excision for labia minora and clitoral hood hypertrophy. Four patients underwent liposuction of the mons pubis as an additional procedure. Over a mean follow-up of 37.4 months, postoperative asymmetry/redundancy occurred in 12 patients, requiring revision in 10. Wound dehiscence occurred in 12 patients, requiring revision in 9. There was one hematoma postoperatively requiring evacuation, one case of dyspareunia, and one case of decreased sensation. A single-layer wound closure (P = 0.050) and mons liposuction (P = 0.011) were risk factors for wound dehiscence. CONCLUSIONS: Central wedge excision and extended central wedge excision labiaplasty were the techniques used in a large group plastic surgery practice. Postoperative asymmetry and dehiscence were the most common complications, and the revision surgery rate was high. A single-layer wound closure and additional mons liposuction were risk factors for dehiscence after central wedge labiaplasty.

Incidence of Cellulitis in Lower Extremity Burns: 6-Year Analysis.

INTRODUCTION: Patients with burn wounds of the lower extremities are at increased risk of developing cellulitis. The probability of developing burn-associated cellulitis is presumed to be correlated with a medical history of diabetes, the etiology of the burn, delay in hospitalization of the patient during their initial presentation, and depth of the burn itself. This study aims to identify factors that place patients at increased risk for developing lower extremity burn wound cellulitis. MATERIALS AND METHODS: A retrospective chart review was performed of all Nassau University Medical Center Burn Center admissions from January 2010 to January 2016. All patients admitted with burns of any etiology isolated to the lower extremity were included in this study. Patients who were evaluated and followed as an outpatient were not included in this study. Pediatric patients less than or equal to 12 years of age were excluded from this study. RESULTS: Of the 218 admissions for lower extremity burns during the 6-year study period, 34% of patients developed cellulitis. Risk factors for developing lower extremity burn wound cellulitis included being male, greater depth of burn, and burn-to-admission delay. This was true in both univariate and multivariate analysis. total body surface area was a risk factor on univariate analysis but was not found to be an independent risk factor on multivariate analysis. No difference was observed in the development of cellulitis in patients discharged on oral antibiotics compared with those not given antibiotics. CONCLUSIONS: Burn wound cellulitis is the second most common complication observed in burns. Identification of patients at risk for developing cellulitis is important. Admitting these patients at increased risk and excising and grafting the burned area is a reasonable solution in preventing this costly complication.

Pain after breast surgery: Etiology, diagnosis, and definitive management.

BACKGROUND: Breast procedures are among the most common surgeries performed by Plastic Surgeons. The prevalence of persistent pain remains unknown. Our experience has been that persistent breast pain is often related to intercostal nerve trauma. The purpose of this article was to increase awareness of this problem while describing the diagnostic and management strategies for patients with post-operative breast pain. METHODS: A retrospective review of 10 patients with breast pain was stratified according to the index surgical procedures: implant-based reconstruction (7), breast reduction (1), breast augmentation (1), and mastopexy (1). Outcomes were assessed with a numerical analog score. Physical examination demonstrated painful trigger points along the pathway of one or more intercostal nerves. Prior to surgery, each patient improved ≥5 points after a diagnostic Xylocaine/Marcaine local anesthesia block of the suspected intercostal nerves. At surgery, one or more intercostal nerves were resected and implanted into adjacent muscles. RESULTS: At a mean of 16.5 months, there were six excellent, one good, and three poor self-reported results. Intercostal nerves resected included the intercostal-brachial (5 patients), 3rd (7 patients), 4th (8 patients), 5th (9 patients), 6th (7 patients), and 7th (1 patient). Multiple intercostal nerves were resected as follows: 3 nerves (4 patients), 4 nerves (1 patient), 5 nerves (3 patients), 6 nerves (1 patient), and 8 nerves (1 patient). CONCLUSIONS: Intercostal neuromas can be the source of breast pain following breast surgery. The same clinical and diagnostic approach used for upper and lower extremity neuroma pain can be used in patients with breast pain. © 2016 Wiley Periodicals, Inc. Microsurgery 36:535-538, 2016.

Quality of life after breast reduction surgery: a 10-year retrospective analysis using the Breast Q questionnaire: does breast size matter?

BACKGROUND: Patient reported outcome studies are extremely valuable. We hypothesize that breast reduction surgery has a high satisfaction rate, and that body mass index (BMI), and the amount of breast tissue removed would not alter this outcome. The purpose of this study was to determine if there is an improvement in the quality of life in patients undergoing breast reduction surgery, and whether breast volume or patient size influences this outcome. METHODS: A retrospective chart review was performed on 600 consecutive patients at a single institution from 2000 to 2010. Patients were mailed The Breast Q questionnaire to complete. Demographic, surgical, and clinical data were collected and entered into a database. Descriptive statistical analyses were conducted using SAS Software version 9.1.3 with statistical significance determined at P<0.05. RESULTS: A total of 178 surveys were returned and included in our study (a response rate of 29.6%). Patient data included a mean BMI of 28.3 (4.6) kg/m, and mean total amount of breast tissue removed of 1220.9 (665.4) g. The primary indications for patients having breast surgery were for symptomatic macromastia (85%), asymmetry (5.6%), and for cosmesis (2.5%). The Breast Q questionnaire demonstrated patients overwhelmingly agreed that they were satisfied with their breast surgery. The mean response was 2.8 with a standard deviation (SD) of 0.47 (where 1, disagree; 2, somewhat agree; and 3, definitely agree). Patient BMI and total amount of breast tissue removed had a statistically significant positive correlation (0.479; P<0.0001). There was no statistically significant difference between the amount of total breast tissue removed and patient response (P=0.57). CONCLUSIONS: The study supports a positive outcome after breast reduction surgery. Over 95% of the patients surveyed were satisfied and would do it again. It demonstrates the improvement of the patient's quality of life regardless of the amount of breast tissue removed. Furthermore, it suggests that the size and weight of the patient has no impact on this outcome. As we face new government and insurance restrictions for surgeries that have both cosmetic and reconstructive value, patient reported outcome studies may have an influence on future third-party payer.

Limberg flap reconstruction for sacrococcygeal pilonidal sinus disease with and without acute abscess: Our experience and a review of the literature.

BACKGROUND: The efficacy of Limberg flap reconstruction for pilonidal sinus with acute abscess remains unclear. This study aimed to compare outcomes after Limberg flap reconstruction for pilonidal sinus disease with and without acute abscess. A secondary objective was to perform a review of the literature on the topic. METHODS: A retrospective chart review was conducted of all patients who underwent excision and Limberg flap reconstruction for pilonidal sinus from 2009 to 2018. Patient demographics, wound characteristics, and complication rates were reviewed and analyzed. RESULTS: Group 1 comprised 19 patients who underwent Limberg flap reconstruction for pilonidal sinus disease without acute abscess and group 2 comprised four patients who underwent reconstruction for pilonidal sinus disease with acute abscess. The average defect size after excision was larger in group 2 than group 1 (107.7±60.3 cm2 vs. 61.4±33.8 cm2, respectively). There were no recurrences, seromas or cases of flap necrosis postoperatively. There was only one revision surgery needed for evacuation of a postoperative hematoma in group 1. There were comparable rates of partial wound dehiscence treated by local wound care, hematoma, need for revision surgery and minor infection between group 1 and group 2. CONCLUSIONS: Limberg flap reconstruction for pilonidal sinus in the setting of acute abscess is a viable option with outcomes comparable to that for disease without acute abscess. This practice will avoid the pain and cost associated with a prolonged local wound care regimen involved in drainage of the abscess prior to flap reconstruction.

Abdominoplasty in the Obese Patient: Risk versus Reward.

BACKGROUND: The incidence of obesity is on the rise worldwide. Many surgeons elect not to perform abdominoplasty on patients with a high body mass index, fearing an increased risk of perioperative complications. In this study, the authors compare the outcomes of obese and nonobese patients who underwent abdominoplasty. METHODS: A retrospective chart analysis was performed on all patients who underwent abdominoplasty by a single surgeon from 2009 to 2016. Complication rates were compared in obese and nonobese patients. Patients were excluded if they did not undergo a full abdominoplasty, underwent a combined surgical procedure, or underwent liposuction in an area outside of the abdomen or flanks at the time of the abdominoplasty. RESULTS: A total of 83 patients were included: 62 nonobese and 21 obese patients. The obese group had a higher average body mass index (34. 9 kg/m versus 25.1 kg/m; p < 0.001). Follow-up time was similar (310 days versus 265 days; p = 0.468). No significant differences were seen with regard to perioperative seroma formation (14.2 percent versus 22.5 percent; p = 0.419)), wound dehiscence (9.5 percent versus 11.29 percent; p = 0.822), hematoma formation (4.7 percent versus 1.6 percent; p = 0.438), or surgical-site infection (9.5 percent versus 8.0 percent; p = 0.835). No instances of venous thromboembolism were observed. CONCLUSIONS: Abdominoplasty, with or without concurrent liposuction, in obese patients, is a safe and effective procedure with similar perioperative complication rates as the nonobese patient population. No significant differences were observed in perioperative complications. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

Ultrasound guided lateral femoral cutaneous nerve (LFCN) block: safe and simple anesthesia for harvesting skin grafts.

Many burn patients experience more intense pain from the split thickness skin donor site than in the grafted burn wound in their postoperative period. Often, split thickness autografts are harvested from the lateral thigh area, which is innervated by the lateral femoral cutaneous nerve (LFCN). Sonographic nerve localization has been an increasingly popular technique to provide regional nerve blocks and we explore its role in improving pain control during skin harvesting. The LFCN was identified and blocked using ultrasound in 16 patients with a variety of wounds. The donor site was tested and marked after the injection. General anesthesia or sedation was administered after markings were completed. A postoperative survey was performed to assess the return of sensation at the donor site. All blocks were successful with adequate visualization of LFCN using ultrasound. Full anesthesia at the donor site, defined as absence of pain in response to a sharp object prick, was tested at 15 min and confirmed at 20 min after the block. The size of the anesthetized field ranged from 119 to 630 cm(2), with a mean surface area of 268.5 cm(2). Donor site sensation returned within 5-16 h with a mean time of 9.1h. Ultrasound guided LFCN block provides a simple and safe choice of anesthesia for harvesting skin from the lateral thigh.

Comparison of seroma formation following abdominoplasty with or without liposuction.

BACKGROUND: In light of the scarce literature published regarding seroma formation following abdominoplasty when performed with or without liposuction, the objective of this study was to determine whether abdominoplasty performed in conjunction with flank liposuction confers an increased risk for seroma formation compared with abdominoplasty alone. METHODS: This was a retrospective cohort study of 200 patients who underwent abdominoplasty with or without liposuction from 2004 to 2007. Medical records were reviewed to collect data regarding patient demographics, length of drain use, operative technique, seroma formation, and other complications. Seroma formation was determined by physical examination 1 week after closed-suction drain removal. Logistic regression analysis was used to determine independent predictors of seroma formation. Results were considered significant for values of p < 0.05. RESULTS: One hundred twenty-five patients underwent abdominoplasty with flank liposuction and 75 patients underwent abdominoplasty alone. The incidence of seroma formation was 16.0 percent in the abdominoplasty-alone group and 31.2 percent in the abdominoplasty with liposuction group (p < 0.05). The mean age was 43.1 ± 10.2 years and the mean body mass index was 27.3 ± 5.4 kg/m2. Increasing body mass index (odds ratio, 1.1; 95 percent confidence interval, 1.02 to 1.17) and liposuction of the flanks (odds ratio, 3.3; 95 percent confidence interval, 1.37 to 7.97) were independent and significant predictors of seroma formation in abdominoplasty patients. CONCLUSIONS: Patients should be counseled regarding an increased risk of seroma formation following abdominoplasty when combined with liposuction of the flanks. In addition, patients who are overweight are at increased risk for developing a postoperative seroma compared with patients with normal body mass indices.

Scar endometriosis - a rare cause for a painful scar: A case report and review of the literature.

Endometriosis is described as the presence of functioning endometrial tissue outside the uterine cavity. Scar endometriosis is a rare disease, and is difficult to diagnose. The symptoms are nonspecific, typically involving abdominal wall pain at the incision site at the time of menstruation. It commonly follows obstetrical and gynecological surgeries. The diagnosis is frequently made only after excision of the diseased tissue. A case report of a patient with a troublesome scar after a caesarian section is presented. Surgical excision led to the diagnosis of scar endometriosis. The pathogenesis, diagnosis and treatment of this somewhat rare condition are discussed.

Facial neurothekeoma in a 10-year-old child.

Neurothekeoma is a rare and benign tumour that occurs most frequently on the head and neck. It is classified as a nerve sheath tumour and epidemiologically occurs in young adults. It is rare to find these tumours occurring in children. The following report describes a case of neurothekeoma in a young girl, its treatment and a review of the literature. Specific histological analysis may reveal atypical and aggressive features, which, in turn, affect resection and reconstructive options.