Annales De Chirurgie Plastique Esthetique最新文献

Introduction: Asian women, including Vietnamese, generally have smaller breast volumes than Europeans. Breast-conserving surgery or unilateral reconstruction often results in contour deformities and poor symmetry in patients with small breasts. Therefore, they may require not only breast reconstruction but also contralateral augmentation to achieve optimal symmetry. Previously, surgery was typically performed in two stages, increasing both cost and treatment time for patients. In this study, we report the outcomes of direct-to-implant (DTI) breast reconstruction with simultaneous contralateral augmentation.

Methodology: This is a prospective observational study on 60 breast cancer patients undergoing skin-sparing or nipple-sparing mastectomy (SSM/NSM) with DTI reconstruction and simultaneous contralateral augmentation from January 2019 to January 2024. Data on patient characteristics, disease stage, surgical techniques, complications, aesthetic and oncologic outcomes were collected.

Results: The mean age was 40.4±7.5 years. Most patients had a BMI <25 (86.7%) and small breast volume. Over a median follow-up of 25.7 months (range, 14-59 months), complications occurred in 11 patients (18.3%), including 10 related with the reconstructive implant and 1 with the contralateral augmentation. 1 patient (1.7%) developed local recurrence, and another (1.7%) presented with liver metastasis. No deaths were reported. Aesthetic outcomes were rated as "good" to "excellent" in 75% of cases at 12 months.

Conclusion: Direct-to-implant reconstruction with simultaneous contralateral augmentation can be safely performed in breast cancer patients with small breast volume, showing low complication rates and favorable aesthetic outcomes.

Introduction and importance: Pyoderma gangrenosum (PG) is a rare condition caused by dermal inflammation with neutrophilic infiltration, often associated with an underlying systemic disease. The breast is an uncommon site for this condition. It is an exclusion diagnosis, challenging to establish, which may initially lead to an alternative one and the initiation of inappropriate treatment.

Presentation of case: A 41-year-old woman with a medical history of morbid obesity, breast reduction 14 years ago, common variable immunodeficiency (CVID), and autoimmune thrombocytopenia presented with a spontaneous inflammatory ulcer of the left breast. The clinical course rapidly deteriorated, progressing to septic shock despite antibiotics. This presentation led to the consideration of necrotizing soft tissue infection (NSTI) as the primary diagnosis. The patient underwent multiple surgical debridements combined with broad- spectrum antibiotic therapy, which resulted in only a slow improvement in her condition. Histopathological examination of the surgical specimens revealed a cutaneous ulcer with dermal inflammation predominantly composed of neutrophils. Her condition eventually stabilized, allowing for reconstruction of the left breast with a split-thickness skin graft. In the immediate postoperative period, the patient developed a fever of unknown origin and inflammatory lesions with a violaceous border at the graft donor site. PG was suspected. One month later, the patient presented with a spontaneously occurring violaceous inflammatory lesion on the controlateral breast.

Clinical discussion: This case of spontaneous PG, is a condition only very rarely described in the literature. A combination of concordant findings support this diagnosis.

Conclusion: PG is a rare condition with a challenging diagnosis, as it is one of exclusion. The breast is an uncommon site of involvement, typically described in postoperative cases and very rarely presenting spontaneously. When a patient presents with breast dermo-hypodermitis that shows limited improvement despite appropriate treatment, PG should be considered as a differential diagnosis.

The non-surgical rhinoplasty is presented as safe by majority of authors, with very rare risk of vision loss and skin necrosis. Publications explain that by injecting with cannulas against the bone and cartilage, complications are really reduced, compared with the use of needles. The description of a deep fat plane below the nasal subcutaneous muscular aponeurotic system (smas) could explain the safety of it's injections. Thanks to a good knowledge of the surgical anatomy of the nose and that if you know how to manage the complications, it's a reliable and safe procedure. On the other hand, an update on blindness from filler published in Aesthetic Surg J in 2024 report 48 cases in 3 years from 2015 and 365 new cases in the following 3 years from 2019. This dramatic increase in the number of cases of vision loss prove our current safety procedures are flawed. A publication by the Department of Plastic and Reconstructive Surgery Shanghai Ninth People's Hospital shows that 90% of cases of extensive necrosis and loss of vision following hyaluronic acid injections occur when cannulas are used. This can be explained by the fact that the nasal smas in which the vessels are located is attached to bone and cartilage. Consequently the universal advice to inject against bone and cartilage may be not the best way to avoid too frequent acute vascular obstruction. We propose another technique, the dermal medical rhinoplasty (D.M. R.). The skin must be pinched and disjoined from the smas. The injection must be very superficial, in the upper dermis or lower dermis to be sure of not creating a vascular obstruction. Upper dermis injections used the interpores technique to help create for instance lines of light thanks to sharp elevation of the tip of a 34 G needle, beveled angle turned upward and visible through the skin. The effect of the volume injected is instantly visible. Lower dermis injections used the vacuum technique to help creating volume on a precise spot above the smas, in the dead space created by a sharp elevation of the tip of a 27 G needle, beveled angle turned downward and then injecting the required volume The effect is instantly visible and under control. One advantage of the superficial nature of these injections is the precise modelling of the shape of the nose, with less volume of filler than after a deep injection. With 206 cases in 2 years of D. M. R. using these 2 techniques, there have been no complications of vascular obstruction or skin necrosis. This nonsurgical rhinoplasty is a really safe and effective alternative or complement to traditional augmentation rhinoplasty.