Oncologic Safety of Immediate Oncoplastic Surgery Compared with Standard Breast-Conserving Surgery for Patients with Invasive Lobular Carcinoma.

BACKGROUND: Invasive lobular carcinoma (ILC) of the breast grows in a diffuse pattern, resulting in a high risk of positive margins at surgical resection. Oncoplastic approaches have been shown to reduce this risk, but concerns persist around the safety of immediate oncoplastic surgery for those with ILC. This study evaluated the short- and long-term oncologic outcomes of immediate oncoplastic surgery for patients with ILC. METHODS: This study retrospectively analyzed an institutional database of stages I to III ILC patients who underwent breast-conserving surgery (BCS) with or without immediate oncoplastic surgery (oncoplastic closure or oncoplastic reduction mammoplasty [ORM]). The study compared positive margin rates, rates of successful BCS, and recurrence-free survival (RFS) by type of surgery. RESULTS: For 494 patients the findings showed that the use of immediate ORM was associated with significantly lower odds of positive margins (odds ratio [OR], 0.34; 95 % confidence interval [CI], 0.17-0.66; p = 0.002). Both lumpectomy with oncoplastic closure and ORM were significantly associated with higher rates of successful BCS than standard lumpectomy (94.2 %, 87.8 %, and 73.9 %, respectively; p < 0.001). No difference in RFS was observed between those undergoing immediate oncoplastic surgery and those undergoing standard lumpectomy alone. CONCLUSIONS: The patients with stages I to III ILC who underwent immediate oncoplastic surgery had significant benefits including lower odds of positive margins and higher rates of successful BCS, with both types of immediate oncoplastic surgery showing similar RFS compared with lumpectomy alone. This supports the oncologic safety of immediate oncoplastic surgery for diffusely growing tumors such as ILC, providing it an ideal option for patients desiring BCS.

Comparison of two different electrosurgical devices in reduction mammoplasty: Monopolar electrocautery versus plasmakinetic cautery.

BACKGROUND: Many devices are used for dissection and hemostasis during reduction mammoplasty. While one of the most common methods is monopolar electrocautery, tissue damage due to thermal spread remains a controversial topic. New devices have been designed to minimize this effect. In this study, plasmakinetic cautery was hypothesized to reduce sensation loss, drainage, and wound-healing problems in reduction mammoplasty because it is less harmful to the surrounding tissues. METHODS: Sixty-eight patients were evaluated in a matched pair design, with random (blinded) assignment of 34 patients with conventional monopolar electrocautery (Group A) and 34 patients with plasmakinetic cautery (group B). Postoperative drainage volume, drain duration, nipple-areolar complex (NAC) sensation, and complications (dehiscence, seroma, ischemia, and nipple circulatory problems) were compared by the researcher, who was blinded to the device used for the patient. RESULTS: The groups were comparable in terms of age, body mass index (BMI), comorbidities, and medications (p > 0.05). The mean age of the patients were 38.50 ± 9.14 years in group A and 37.54 ± 8.17 in group B. The mean BMI was 25.19 ± 3.22 kg/m2 in group A and 25.65 ± 2.96 kg/m2 in group B. No differences were detected between the groups in terms of drain duration time, NAC sensation, or complications, but the drainage volume was statistically lower with plasmakinetic cautery (p < 0.05). CONCLUSION: The study findings indicate that the main advantage of plasmakinetic cautery in reduction mammoplasty was a decrease in drainage volume when compared with monopolar electrocautery.

The Infero-Central Mound Reduction Mammoplasty: A Single Surgeon, 20-year Experience.

BACKGROUND: Reduction mammoplasty (RM) remains one of the most common plastic surgeries worldwide. Many different techniques have been described in the literature, each with its advantages and limitations. Nipple-areolar complex necrosis remains a daunting complication, regardless of the chosen surgical approach. OBJECTIVE: We describe the senior author's (HYK) unique reduction mammoplasty technique, employing the infero-central (IC) pedicle throughout the last two decades. PATIENTS AND METHODS: A retrospective chart review of 520 patients undergoing breast reduction was performed. After exclusion criteria, 360 were included in the study. These patients underwent RM with the IC technique, with stabilization of the breast mound and plication of the inferior pole dermis to prevent bottoming out. Demographics, operative data, and complications were recorded. Pre- and postoperative photographs were evaluated by a specialists' panel. The BREAST-Q questionnaire was utilized to assess satisfaction rates. RESULTS: BREAST-Q questionnaire-satisfaction with breast score was 84.19, and outcome score was 91.67. Aesthetic outcome evaluation, reviewed by four plastic surgeons, yielded a high score in all parameters (1.64-2; range 0-2). On a per-breast basis for all patients, the following complications were analyzed: dehiscence (3.61%), infection (2.22%), hematoma (1.66%), superficial wound healing problems (1.38%), seroma (0.83%), skin flap ischemia (1.52%), hypertrophic scar (1.38%), fat necrosis (0.97%), and partial nipple ischemia (0.27%). CONCLUSION: Infero-central mound technique can be applied to breast reductions of nearly all sizes, allowing for consistently satisfactory aesthetic outcomes for most patients. Due to robust vascularity of the pedicle, complication rates are kept at a minimum. IC mound technique is an essential tool in the plastic surgeon's armamentarium. 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 .

Does Prior Breast Irradiation Increase Complications of Subsequent Reduction Surgery in Breast Cancer Patients? A systematic Review and Meta-Analysis.

BACKGROUND: Reduction mammoplasty and mastopexy are potentially complicated by prior breast irradiation as part of breast conserving therapy. Associated tissue changes with therapeutic irradiation have led to surgeons deciding the risks may outweigh potential benefit for those patients. A systematic review of the existing literature was performed to explore surgical outcomes of patients undergoing delayed bilateral reduction mammoplasty or mastopexy following unilateral breast irradiation as part of breast conserving therapy. METHODS: Medline, PubMed and EMBASE were searched from 1990 to 2023 according to PRISMA guidelines. Studies were combined by the generic inverse variance method on the natural logarithms of rate ratios (RR) using a random effect model in Review manager 5.4.1. RESULTS: Fifteen studies reported outcomes in 188 patients who underwent breast reduction (BR) following unilateral breast conserving surgery and radiotherapy. The median age at BR was 51.5 years (range 39-60), and median time since radiotherapy was 48 months (range 11.7-86). We compared outcomes for irradiated breast (IB) versus non-irradiated breast (NIB). Pooled results showed higher rate of major complications in the IB (RR 2.52, 95%CI 0.96-6.63, p=0.06), but not statistically significant. However, rate of minor complications was significantly higher in the IB (RR 3.97 95%CI 1.86-8.50, p<0.0004). Incidence of fat necrosis as a discrete complication was 2× higher in IB (RR 2.14 95%CI 0.85-5.35, p-value 0.10) compared to the NIB, but not significant. CONCLUSION: We found breast reduction to be safe with acceptable risk of major complications. However, the overall complication rate remains higher in IB compared to NIB. LEVEL OF EVIDENCE III: 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 .

Reduction Mammoplasties: Risk Factors and Early Complications-About 1442 Cases.

BACKGROUND: Breast reduction surgery is a widely performed plastic surgery procedure. The incidence of such complications has been steadily decreasing in recent years but is still nonetheless 5.6%. The primary aim of this study was to analyze the incidence of the main postoperative complications of breast reduction surgery. In addition, we identified cause-and-effect links between complications and characteristics of the patients, such as smoking, age, weight resection, BMI, and wound drainage. MATERIALS AND METHODS: This retrospective study was performed on a population of 1442 women who underwent breast reduction surgery between January 2016 and October 2022 in the plastic surgery unit at Saint-Louis Hospital, Paris, France. At the follow-up examination, we evaluated the patients for complications. RESULTS: The average resection weight was 1297.7 g in a population for which the average BMI was 28.9. We found 19.9% rate of total complications, of which 3.5% were major complications. We found that only the resection weight was a risk factor for complications. DISCUSSION: The main strength of our study is the size of our sample. The large number of patients allowed us to conduct numerous analyses and obtain significant results despite the rarity of certain events. This large cohort was also responsible for the high statistical power of our results. CONCLUSION: The risk of developing a postoperative infection was 7.5% for resections of less than 2.4 kg, increasing to 13.9 % when greater than that. Thus, the administration of prophylactic antibiotic therapy to affected women to reduce the risk of infection is a distinct consideration. For the other factors, while none of them appeared to promote the occurrence of adverse events and, therefore, do not formally contraindicate breast reduction surgery, some preventive measures still strike us as being relevant, such as blade drainage, weight loss, diabetes control, and smoking cessation. LEVEL OF EVIDENCE III: 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 .

The Influence of Scar Patterns After Reduction Mammoplasty on Eye Movement and Gaze Pattern: An Eye-Tracking Investigation.

BACKGROUND: Given that scars are acknowledged as the primary cause of postoperative dissatisfaction following reduction mammoplasty, it is imperative to comprehend the patient's visual perception of different scar patterns in order to enhance patient satisfaction. To achieve this, eye-tracking technology provides an unbiased method of evaluating how observers assess breast scars. METHODS: 58 participants (32 females and 26 males) between the ages of 19 and 82 years (mean age of 29.47 ± 10.98 years) were shown 18 color photographs, taken at 3 viewing angles (right 45° oblique, frontal and frontal view with arms raised), from 6 patients undergone reduction mammoplasty with the inverted T-scar technique (3 patients) or no-vertical-scar technique (3 patients). The images were presented to every participant for a fixed duration of 5 s each. Eye-tracking device was used to collect and analyze the gaze data of viewers. RESULTS: The nipple-areola complex (NAC) and the periareolar scar captured observers' gaze faster, had longer duration and more count of eye fixation than all other parts of breast scars, regardless of the viewing angle and scar pattern. Moreover, the scar region in the inverted T-scar pattern received greater and faster visual attraction of observer's gaze than the no-vertical-scar pattern. CONCLUSION: The NAC and the periareolar scar seem to be perceived as the most important regions for breast aesthetics. The findings can be helpful to assist plastic surgeons in determining the most appropriate technique for reduction mammoplasty, meanwhile underlining the importance of a fine periareolar scar and symmetric NAC for excellent aesthetic outcomes. This is to our best knowledge the first study using eye-tracking technology in evaluating reduction mammoplasty outcomes. This study explored the influence of different scar patterns after reduction mammoplasty on eye movements and gaze patterns among observers. The study have validated the significance of the NAC and the periareolar scar for breast aesthetics and revealed that the scar region in the inverted T-scar pattern may be judged less visually attractive than the no-vertical-scar pattern. LEVEL OF EVIDENCE V: 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 .

3D Analysis of Breast Morphological Changes after Vertical-Scar Reduction Mammoplasty: A Prospective Study.

BACKGROUND: In addition to symptom relief, the crucial objective of reduction mammoplasty is to achieve a stable and esthetically pleasing postoperative breast shape. However, the morphological changes in breasts following reduction mammoplasty have not been comprehensively understood. In this study, we applied three-dimensional (3D) scanning technology for long-term follow-up monitoring of breast morphological changes to discern their changing trends. Our goal was to provide a reliable basis for assessing postoperative effects and determining follow-up time points. METHODS: This prospective study included patients undergoing vertical-scar reduction mammoplasty. We utilized a combination of linear measurements and 3D scanning to measure various parameters, including breast volume, breast volume distribution, nipple position, and scar length at various time points: pre-surgery, immediately post-surgery, 3-month postoperative, 6-month postoperative, and 1-year postoperative. RESULTS: A total of 115 patients were enrolled in this study. Throughout the initial 3 months of postoperative follow-up, there was a gradual reduction in breast volume, which tended to stabilize from 3 to 12 months. The nipple position showed a gradual shift both laterally, inferiorly, and posteriorly. The volume of the lower and lateral part of the breast increased gradually. Notably, at 1 year after surgery, the scar length was approximately 6.3% shorter compared to the immediate postoperative measurement. CONCLUSIONS: Our 3D analysis unveiled comprehensive changes in breast morphology: The overall breast volume shifted laterally and inferiorly, the nipple position moved laterally, inferiorly, and posteriorly, and there was a significant reduction in scar length. Concurrently, breast volume exhibited a gradual decrease and stabilization after 3 months, establishing it as a suitable follow-up point for assessing postoperative results. Additionally, surgical plans can be formulated based on the overall trend of changes in breast volume and distribution, combined with methods such as three-dimensional scanning, to enhance surgical outcomes and patient satisfaction. 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 .

Masculinizing Mammoplasty for Female-to-Male Transgenders: 10 Years' Experience.

BACKGROUND: Masculinizing mammoplasty is a surgical procedure frequently performed in transmale individuals. Despite providing a positive impact for the patient, this surgery has high rates of complications and revisions. In cases requiring a double incision, there are advantages in using an inferior pedicle when possible. METHODS: This was an observational study. Outcomes and complications were analyzed in 104 patients operated on by the author using three techniques: concentric periareolar surgery, double incision with an areola graft, and double incision with an inferior areolar pedicle. The Breast-Q questionnaire adapted for transgender males was applied. RESULTS: The responses of the adapted Breast-Q questionnaires demonstrated high scores regarding quality of life and satisfaction. The rates of complications and surgical revisions were 24.3 and 25.6%, respectively, with no significant difference between the techniques. The most common complication was hematoma (13.6%), which was positively associated with the use of testosterone. Ischemia of the nipple-areola complex was present in 8.7% of the operated breasts. When using the inferior pedicle, areola ischemia occurred more often when the nipple-fold distance was greater than 8 cm. CONCLUSIONS: Quality of life, satisfaction, complications, and revisions were comparable to those observed in the literature. Hematoma was the most frequent complication, and an association with the use of testosterone was observed. When a double incision is indicated, the inferior pedicle is more advantageous than the areola graft; however, it should be used when the distance between the nipple and the inframammary fold is 8 cm or less. 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 .

Technical Refinements for Reducing Reoperations in Single-Stage Augmentation Mastopexy: A Retrospective Matched Cohort Study.

BACKGROUND: The goals of mastopexy differ significantly from those of augmentation mammoplasty. Mastopexy is designed to lift and reshape the breasts, while augmentation mammoplasty is designed to increase the volume of the breasts. This conflict causes that one-stage augmentation mastopexies showed a revision rate from 8.7 to 23.2%. The aim of our study is to present some technical refinements for reducing the risk of implant exposure and reoperation. METHODS: We designed a retrospective matched cohort study, including 216 consecutive patients, undergone augmentation mastopexy between January 2013 and December 2022. We divided them in two groups: Group A undergone an inverted-T superomedial pedicled augmentation mastopexy and Group B undergone our inverted-T modified augmentation mastopexy. The groups were matched for clinical and surgical variables, with the surgical technique the only difference between the two. RESULTS: Complications were registered in ten patients (9.3%) in Group A (two wound breakdowns at T with implant exposure and eight wound dehiscences), six of which required surgical revision. In contrast, only three patients (2.8%) in Group B reported a complication, which was wound dehiscence without implant exposure in all cases. None of the dehiscence required surgical revision. The difference between complication and revision rates was statistically significant. CONCLUSIONS: Separating the implant and the mastopexy dissection planes reduces the implant exposure and the reoperation rate in one-stage augmentation mastopexy. LEVEL OF EVIDENCE III: 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 https://link.springer.com/journal/00266 .

Retrospective Study on Optimizing Breast Augmentation Outcomes in Transgender Patients: A Comprehensive Analysis of Tumescent Local Anesthesia Technique.

BACKGROUND: Tumescent local anesthesia (TLA) involves the infusion of a saline solution containing lidocaine and epinephrine into tissues to achieve localized anesthesia and vasoconstriction. While the use of TLA in sub-glandular augmentation mammoplasty has been documented, we present a modified TLA approach for primary sub-muscular breast augmentation in transgender patients based on our experience over the past years. METHODS: Between the years 2014 and 2021, we performed primary sub-muscular breast augmentation on 20 transgender patients under TLA and conscious sedation. The tumescent solution consisted of 25 mL of 2% lidocaine, 8 mEq of sodium bicarbonate, and 1 mL of epinephrine (1 mg/1 mL) in 1000 mL of 0.9% saline solution. Initially, the solution was infiltrated between the pectoral fascia and the mammary gland, and subsequently, during the surgery, under the pectoralis major muscle. RESULTS: The average volume of tumescent solution infiltrated during TLA was 740 mL per breast. There were no reports of adrenaline or lidocaine toxicity, and no cases required a conversion to general anesthesia. Patients experienced no pain or discomfort during the preoperative infiltration or surgical procedure. Reoperations due to short-term complications never occurred. We observed a major complication rate of 5%, represented by 1 hematoma. Long-term complications comprised one case of implant dislocation and one occurrence of dystrophic scar formation. No cases of capsular contracture needing reoperation, asymmetry, and implant rupture occurred. In total, one individual (5%) requested larger implants. Follow-up time ranged from 30 days to 1 years. CONCLUSIONS: Overall, augmentation mammaplasty is a valuable choice for transgender women aiming to enhance their feminine characteristics and alleviate gender dysphoria. It is imperative for patients to conduct thorough research, grasp the potential pros and cons, and consult experienced healthcare professionals in transgender care. Additionally, tumescent local anesthesia (TLA) has proven to be a safe and efficient method for sub-muscular breast augmentation, providing effective pain control with minimal postoperative complications, resulting in high patient satisfaction. 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 .

Reviewing Outcomes and Complications with the Use of Mesh in Breast Reduction Surgery.

INTRODUCTION: Reduction mammoplasty is a common reconstructive and esthetic procedure with variable long-term outcomes regarding breast shape, projection, and nipple-areolar complex. One common complaint is recurrent breast ptosis, which may be mitigated by sufficient support of the inferior pole. This review will look at the effects of mesh in mitigating postoperative ptosis following reduction mammoplasty. METHODS: A comprehensive review of the literature was performed using the PubMed database. Manuscripts that provided data with respect to the effects of mesh on cosmetic outcomes, patient-reported outcomes, complications, and surveillance were utilized. RESULTS: Six studies with a total of 634 patients were included in this review. There is limited evidence to support a cosmetic benefit with the use of mesh in reduction mammoplasty patients. While subjective satisfaction was demonstrated in one paper, few others had objective measurements of the impact of mesh. Complications included infection, skin necrosis, and loss of nipple sensation. Mammography was found to not be affected by mesh placement. DISCUSSION: The use of mesh during reduction mammoplasty is a relatively modern innovation that does not appear to have a significantly different risk profile than that of traditional reduction procedures. There is limited cosmetic value based on currently available data. More objective future analysis is necessary in order to justify the use of mesh in reduction mammoplasty for its claimed cosmetic benefits. LEVEL OF EVIDENCE III: 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 Table of Contents or online Instructions to Authors www.springer.com/00266.

Feasibility and Safety of Superomedial Pedicle for Breast Reduction in Geriatric Patients.

INTRODUCTION:  Historically, inferior breast reduction is more commonly performed overall and this applies to the elder population. No study to this date has compared whether there is any difference in complications and overall safety between when using superomedial pedicle and inferior pedicle in geriatric patients and furthermore whether the safety profile of superomedial pedicle differs when compared to general population. METHODS: Patient files of women who had undergone breast reduction by a single surgeon over a 9 year period (2015-2023) was reviewed retrospectively. Patients over 65 years old at the time of surgery were selected as the main study group. Results were compared to a control group aged 65 years and younger consisting of 136 patients, who also had a breast reduction by the same surgeon. RESULTS: Fifty-four women met the inclusion criteria for the study group and they were further broken down into two subgroups; inferior and superomedial pedicle groups with 25 and 29 patients into each group, respectively. The mean age at the time of the operation was 67.8 years. Geriatric group had more significant comorbidities (37% vs. 9%, p<0.05). Looking solely on patients undergone superomedial pedicle breast reduction, OR times were similar between two age groups and hospital stay was slightly longer in the geriatric population albeit statistically insignificant. The average weight of specimens resected from each breast was 592.4 gr in geriatric population and slightly higher in the younger population with an average weight of 624 grams (p=0.27). Two women in the geriatric group and  six women in the  non-geriatric group developed major complications where superomedial pedicle was utilized, no meaningful difference was seen when major complications were compared (p=0.24). On the other hand, minor complications were significantly higher in the geriatric population compared to the younger cohort regarding superomedial pedicle reductions (p=0.02). 'Satisfaction with breasts' scores of BreastQ from the superomedial breast reduction subgroup was slightly higher than inferior pedicle breast reduction subgroup in geriatric population and it was statistically significant (0.032). CONCLUSION: Safety margins and satisfaction scores of superomedial pedicled breast reduction in geriatric patients seem similar to their younger counterparts. Furthermore, with similar complication rates and with its slightly higher 'Satisfaction with breasts'  scores  when compared to inferior pedicle, superomedial pedicled breast reduction technique can be utilized without reservation in geriatric candidates for breast reduction. 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 .

Local Anesthetic Infiltration for Pain Control in Aesthetic Breast Reduction Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

BACKGROUND: Aesthetic breast surgeries, including breast reduction, are commonly performed surgical procedures associated with postoperative pain. Pain control is essential to patient comfort, satisfaction, and early recovery. This systematic review is the first to conduct both qualitative and quantitative analysis to evaluate the efficacy and safety of local anesthetic infiltration in reducing pain after breast reduction surgeries. METHODS: This systematic review is registered in PROSPERO, assessed for bias using the RoB2 tool, and follows the PRISMA guidelines. A full electronic search was performed in different databases for all clinical papers on adult female patients undergoing cosmetic breast reduction surgery who were given local anesthetic infiltration for postoperative pain relief. RESULTS: A systematic review of five randomized clinical trials with a total of 191 patients found that local anesthetic infiltration significantly reduces postoperative pain in breast reduction surgery, reduces opioid consumption, and improves patient outcomes. A meta-analysis of two trials reported the mean VAS score for postoperative pain in the local anesthetic and placebo groups. CONCLUSION: A systematic review and a meta-analysis show a significant reduction in postoperative pain following local anesthetic infiltration, but further research is needed to understand its effectiveness and potential adverse effects. LEVEL OF EVIDENCE I: 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 .

Long-Term Biodegradation of Polyacrylamide Gel Residues in Mammary Glands: Physico-Chemical Analysis, Chromatographic Detection, and Implications for Chronic Inflammation.

In the past, polyacrylamide hydrogel was a popular choice for breast augmentation filler, and many women underwent mammoplasty with this gel. However, due to frequent complications, the use of polyacrylamide hydrogel in mammoplasty has been banned. Despite this ban, patients experiencing complications still seek medical treatment. The aim of this study was to investigate the fate of the polymer over a defined implantation period. Biopsies of breast implants were obtained from patients with 23 and 27 years of post-mammoplasty. These biopsies were meticulously purified from biological impurities and subjected to analysis using IR spectrometry, liquid chromatography-mass spectrometry, gas chromatography, and differential scanning calorimetry. The findings revealed the presence of polyacrylamide hydrogel residues, along with degradation products, within the infected material. Notably, the low-molecular-weight degradation products revealed via gas chromatography are aggressive and toxic substances capable of inducing chronic inflammation. This study sheds light on the long-term consequences of polyacrylamide hydrogel implantation, highlighting the persistence of harmful degradation products and their role in exacerbating patient complications.

[Breast restoration by the lipomodeling technique after breast sequelae following complications of reduction mammoplasty]. / Rattrapage des séquelles esthétiques de réduction mammaire par la technique du lipomodelage.

BACKGROUND: Complications of reduction mammoplasty can lead to aesthetic sequelae, which are known to be difficult and delicate to treat, and only a few articles deal with this subject. PURPOSE: The objective of this article is to present and analyze our experience of lipomodeling for the secondary management of aesthetic sequelae occurring after a complication of reduction mammoplasty. MATERIAL AND METHODS: An uniform and consecutive series of 22 female patients, operated with the lipomodeling technique from December 2003 to March 2019 by the last author, to correct aesthetic sequelae after secondary complications of reduction mammoplasty was studied analyzing the efficiency and the tolerance of this technique. RESULTS: The results showed 86.4% of very good results and 13.6% of good results. Seventeen patients (77.3%) were highly satisfied with the postoperative outcome, and 5 patients were satisfied (22.7%). The number of procedures varied from 1 to 3: 15 patients (68.2%) underwent only one session of lipomodeling, 5 patients (22.7%) underwent two sessions, and 2 patients (9.1%) underwent three sessions. The mean time between two interventions was 4 months (3-12). No patient of this series initiates any medico-legal proceeding towards the first surgeon. CONCLUSION: After this study, lipomodeling, in association with ancillary procedures, seems to be an effective and safe solution to correct aesthetic sequelae following secondary complications of reduction mammoplasty. It should have a key role for the correction of these sequelae. An effective and appropriate care of these patients leads to good results and patients' final satisfaction, and manages to avoid any medico-legal proceeding, always badly lived as much for the patient as for the first surgeon.

[Breast pillars reconstruction during mammoplasty]. / Technique de reconstitution des piliers du sein au cours des mammoplasties.

The reconstruction of the 2 contiguous breast pillars during a mammoplasty for reduction or treatment of ptosis represents an essential time to define a satisfactory breast curve, to avoid sub-mammary disunions postoperatively, and to contribute to the projection of the nipple areola thus stabilized. The pillars of the breast are the two glandular and fatty columns of segment III of the breast; these pillars have a variable thickness according to the habits of the surgeon but also according to the density of the gland and the residual fat that the practitioner chooses to keep to reformat the breast. Their repair or creation is essential to obtain a nice breast curve and long-term stability.

Optimizing Tissue Oxygenation in Reduction Mammoplasty: The Role of Continuous Diffusion of Oxygen: A Feasibility Pilot Randomized Controlled Trial.

INTRODUCTION: Bilateral reduction mammoplasty (BRM) aims to alleviate macromastia-related symptoms in women. This procedure involves a T-Junction suture at the medial inframammary fold that encompasses 12%-39% of wound breakdowns mainly due to reduced perfusion. Continuous diffusion of oxygen (CDO) may enhance breast tissue oxygenation to prevent such complication. We explored the feasibility of this therapy. METHODS: A 4-wk feasibility-pilot randomized controlled trial of women undergoing BRM was conducted. By internal randomization (left/right side), participants received standard of care (SOC) in one breast using topical skin adhesive, while their other breast received SOC + CDO at the T-junction covered by a silicon sheet (sCDO), or CDO directly to the T-Junction skin (dCDO). Feasibility outcomes included protocol delivery, outcome measurement, device-related adverse events, and device acceptability. Exploratory outcomes were T-Junction SatO2 and deoxyhemoglobin assessed with near-infrared spectroscopy and wound dehiscence. RESULTS: Sixteen participants (age = 33 ± 8 y; body mass index = 34.34 ± 5.85 kg/m2) were recruited, conforming n = 32 breasts (SOC, n = 16; dCDO, n = 10, sCDO, n = 6). At 4 wk, protocol delivery was 93.7%, outcome measuring 100%, and device-related adverse events 0%. Device acceptability showed an 85.4% strong agreement for attitude toward use, 78.2% perceived ease of use, and 77.7% perceived usefulness. Breasts undergoing sCDO showed higher SatO2 (P < 0.001), whereas lower deoxyhemoglobin (P < 0.001) compared to all other breast groups. However, wound dehiscence was not different between groups (P = 0.66). CONCLUSIONS: Self-applied CDO to the T-Junction is feasible, safe, and acceptable, in patients undergoing BRM. In a proper wound environment, CDO may enhance breast tissue oxygenation. However, it is unclear whether CDO leads to decreased wound dehiscence. This study showed reproducibility for larger randomized trials.

Assessment of Three Breast Volume Measurement Techniques: Single Marking, MRI and Crisalix 3D Software®.

INTRODUCTION: Measuring breast volume is important to obtain satisfactory breast surgery results, and many techniques are used for this purpose. Thus, the aim of the present study was to compare 3 breast volume techniques: Pessoa's single marking technique, magnetic resonance imaging (MRI) and Crisalix 3D software®. METHODS: Fourteen patients indicated for mammoplasty were selected. Three breast volume measurement techniques were compared: Pessoa's single marking technique, MRI and Crisalix 3D software®. The volumes were tabulated and analyzed using R software. RESULTS: Average age was 30.93 ± 10.25 years. The breast volume was 1554.54 ± 512.54 cm3, as measured by the MRI technique (considered the gold standard), 1199.64 ± 403.13 cm3 using Crisalix 3D software® and 1518.04 ± 468.72 cm3 by Pessoa's single marking technique. Comparison between the Crisalix 3D software® and MRI techniques using the pairwise t test demonstrated a statistically significant difference (t = 4.3957, df = 27, p value = 0001543), but no significant difference between the single marking and MRI techniques (t = 1.3841, df = 27, p value = 0.1777). CONCLUSION: When compared to MRI, breast volume measurement using Pessoa's single marking technique showed no statistically significant difference between them. However, the Crisalix 3D® technique exhibited a difference in relation to MRI. Anthropometric measurements are useful in measuring breast volume because they are easy to obtain, practical and inexpensive, and should be part of a plastic surgeon's arsenal. 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 .

Effect of Reduction Mammoplasty on Insulin and Lipid Metabolism in the Postoperative Third month: Compensatory Hip Enlargement.

BACKGROUNDS: The positive effects of reduction mammoplasty on metabolic profile have been shown in a limited number of studies. This study objective to reveal the effects of reduction mammoplasty on metabolic profile and anthropometric measurements. SUBJECTS AND METHOD: The study was prospectively conducted on 42 patients who were operated between April 2019 and March 2020. Fasting plasma glucose, fasting plasma insulin, total cholesterol, triglyceride, high-density lipoprotein and low-density lipoprotein cholesterol, HgA1c, homeostasis model assessment scores, adiponectin, leptin, and resistin levels were evaluated. In addition, age, height, weight, body mass index; breast, chest, waist, hip circumference; waist-hip ratio, and bilateral breast resection tissue weights were recorded. Data and blood samples were collected one hour before the operation, 6 and 12 weeks after the operation. RESULT: The patients' mean age was 43.14±10.24, and their average height was 159.42±4.96 cm. The excised bilateral dermo fatty tissue weight was 1435.85±721.16 g. At the postoperative 40th day a decrease in leptin (p = 0.001), resistin (p =0.008), glucose (p = 0.021) and insulin resistance values (p=0.013) stated. There was an increase in adiponectin (p < 0.001) and HDL (p = 0.013) levels at the postoperative 40th day. In the postoperative third month, these data returned to the previous levels that were measured before operations. However, an increase in hip circumference (p = 0.034) and a decrease in waist-hip ratio (p < 0.001) was detected in third month. Also, there was no difference in body mass index and weight compared to pre-operation. CONCLUSION: After reduction mammoplasty, compensatory fat growth in the hip area, an increase in the hip circumference, and a decrease in the waist-hip ratio were observed in the postoperative third month. LEVEL OF EVIDENCE: 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 .

Impact of Incisional Access Site in Primary Breast Augmentation: Evaluation of Patient Satisfaction with SCAR-Q.

BACKGROUND: Scarring at the incision site represents one of the most impactful outcomes in breast augmentation surgery for both the patient and the surgeon. Few studies exist with the aim of assessing patient perception of scarring outcomes in primary breast augmentation. The aim of this study was to evaluate the impact on quality of life of scars by submitting the SCAR-Q in patients who underwent primary augmentation mammoplasty. METHODS: The SCAR-Q was administered at one and at 6 months after surgery to 54 consecutive patients underwent primary breast augmentation with inferior hemi-periareolar or inframammary incision. A total of 50 patients were divided into two groups of 21 patients with inferior hemi-periareolar incision and 29 patients with inframammary fold incision, respectively. Statistical analysis was performed with Prism 9. RESULTS: All mean values of the three SCAR-Q scales tend to decrease at the second administration meaning that the perception of the scar is better at time 6 from the patient perspective. In the "Psychosocial scale," lower values at both 1 month and 6 months for group 2 compared to group 1 were shown. Unpaired T tests with Welch's correction showed significance for delta values variations between the two groups with P values <0.0001. CONCLUSION: Data show that patients undergoing primary breast augmentation have a scar that has no significant impact. Patients with inframammary fold scar have less psychosocial impact than those with inferior hemi-periareolar scar. There were no statistically significant differences in scar-related symptoms and scar appearance between scar along the inframammary groove and inferior hemi-periareolar scar. LEVEL OF EVIDENCE IV: Case series study. 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 .