Aesthetic Plastic Surgery最新文献

Background: Necrosis of the nipple-areolar complex (NAC) is a rare but devastating complication after reduction mammaplasty or mastopexy. Various approaches for improving compromised perfusion of the NAC have been described. However, detailed data on this topic in the literature is still scarce. The authors aim to share the experience, treatments and outcomes of their patient collective.

Methods: All patients treated at a single institution due to compromised NAC perfusion after reduction mammaplasty or mastopexy were included. A retrospective evaluation of the patient data using electronic medical records was performed. Intraoperative and postoperative treatments, as well as interventions, were examined.

Results: A total of 31 patients (35 NACs) were included. Mean age was 48 years, mean BMI 30.8 kg/m² and mean resection weight 910.4 grams. A venous perfusion problem occurred in most cases (26, 74.3%). Statistical analysis showed a significantly better outcome for NACs treated either intraoperatively (p = 0.031) or postoperatively (p = 0.023), compared to those left untreated. Overall, 80% of all NACs healed without visible consequences (15) or with a pigment disorder (13). Five cases (14.3%) resulted in a complete loss and two cases (5.7%) in a partial loss.

Conclusions: This study represents the largest complication series in the literature. Preventing nipple necrosis due to breast reduction or mastopexy is crucial. If compromised perfusion of the NAC occurs, surgeons have various intraoperative or postoperative options available to improve circulation. Early recognition and prompt treatment are essential for the best possible outcome. Nipple necrosis can thus often be avoided.

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 .

Purpose: Breast reduction (BR) involves a large surface area of manipulated tissue, increasing the risk of postoperative hematoma. Pulse irrigation (PI) uses a device to deliver intermittent pressurized irrigant intraoperatively. This study aims to evaluate whether the use of PI is associated with reduced incidence of postoperative hematoma after BR.

Methods: An IRB-approved, retrospective cohort study was performed on all female patients >18 years old who underwent BR at a single academic medical center from 2019 to 2023. Patients operated on by surgeons who performed BR exclusively with or exclusively without PI were excluded. Demographics, surgical details, and postoperative complications were compared using T-tests for independent samples and Pearson chi-square tests of significance (statistical significance set at p<0.05).

Results: A total of 418 patients met inclusion and exclusion criteria: 196 PI patients (46.9%) and 222 (53.1%) non-PI patients. PI patients had differences in race, type of insurance and higher usage of liposuction (all p<0.001). There was a statistically significantly lower hematoma rate in PI patients compared to non-PI patients (0.0% vs. 2.7%, p=0.020). Although not statistically significant, PI patients had lower rates of seroma (1.0% vs. 3.6%, p=0.085) and superficial incisional SSI (1.5% vs. 2.7%, p=0.410) than non-PI patients.

Conclusion: Intraoperative use of PI reduces the rate of postoperative hematoma in patients undergoing BR. This finding is hypothesized to be due to provocative disruption of unstable clots which thereby helps to identify sites of tenuous hemostasis so that they can be better cauterized prior to completion of the procedure.

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 .

Background: Pseudogynecomastia in MWL patients is characterized by excess skin in chest, lateral chest, axilla and upper abdomen without enlargement of the breast glandular component. The aim of this work was to study long-term aesthetic outcomes of correction of severe pseudogynecomastia post-weight loss with inferior pedicle technique with some refinements.

Methodology: This prospective study included 15 patients underwent chest contouring after massive weight loss within period of 2 years between January 2022 and January 2024. All patients were subjected to local examination (position of nipple-areola complex and degree of ptosis and chest anthropometry) and photographic assessment, and pre- and postoperative results were compared. Patient satisfaction survey was done.

Results: The ages ranged from 20 to 45 years (mean 32.67 years), the previous weight ranged with mean 158.8, the mean current weight was 87.53, and the mean BMI was 28.49. The time of weight loss ranged from 8 to 48 months (mean 20.07 months), and the duration of weight stability ranged from 6 to 24 months with mean 10.0 months. Regarding the complications, no major complications required readmission, four patients had minor complications (26.7%), one (6.7%) case had asymmetry of the NAC, one (6.7%) case had minor hematoma, one (6.7%) case had seroma, and one (6.7%) case had partial wound dehiscence. The overall satisfaction rate was high.

Conclusion: Patient satisfaction with male chest contouring for pseudogynecomastia following significant weight loss is excellent. In this study, we provide a reliable technique for management of pseudogynecomastia in post-MWL with good outcomes.

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 .

Introduction: Rib resection and remodeling have gained attention as cosmetic procedures to enhance body contours, particularly waist-to-hip ratio. Historically, rib resection has been used for medical reasons; however, plastic surgeons have recently adopted it for aesthetic purposes. However, concerns remain regarding the safety and effectiveness of the procedure, particularly due to the potential for complications, such as pneumothorax, chronic pain, and impaired respiratory function. This systematic review aimed to assess the existing evidence on rib resection or remodeling for body contouring.

Methods: A systematic review was conducted following PRISMA guidelines. Databases including PubMed, EMBASE, Cochrane, and others were searched for studies involving rib resection or remodeling for aesthetic purposes. Studies were selected based on predefined inclusion criteria, including adult patients and outcomes related to waist circumference reduction, adverse events, and patient satisfaction. Risk of bias was assessed using the ROBINS-I tool.

Results: This review included 12 studies that revealed variability in techniques, patient selection, and outcomes. Rib resection was associated with significant risks such as pneumothorax and chronic pain; however, newer rib remodeling techniques, such as green-stick fractures and rib shaving, showed fewer complications. Despite promising results in some cases, the lack of long-term studies and randomized clinical trials limits the ability to draw definitive conclusions regarding the efficacy and safety of these procedures.

Conclusion: Rib remodeling appears to offer a less invasive alternative to full-rib resection, with a reduced risk of complications. However, the current literature is insufficient to provide conclusive evidence regarding the long-term safety and efficacy of these procedures. Further high-quality studies, including randomized trials, are needed to inform surgical practices and patient decision-making regarding rib-based body contouring.

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 .

Background: Endoscopic mastectomy has gradually become an important surgical modality for the treatment of breast diseases, and is the preferred procedure for gynecomastia. However, endoscopic mastectomy presents challenges such as a steep learning curve, prolonged surgical duration, increased hospitalization costs, and high technical difficulty. This study aimed to evaluate the clinical efficacy and patient satisfaction of endoscopic mastectomy using a single axillary incision versus a triple lateral chest wall incision for gynecomastia.

Methods: Patients were stratified into a single-port group and a three-port group based on the surgical approach. Propensity score matching was used for the nearest neighbor matching, adjusting baseline data differences at a 1:1 ratio, with a caliper value set at 0.2 to ensure comparability between the two groups. Clinical efficacy and patient satisfaction were compared after propensity score matching.

Results: A total of 36 pairs of patients were successfully matched after propensity score matching, with no differences in baseline characteristics (P > 0.05). Notably, the three-port group experienced longer surgical durations compared to the single-port group, alongside higher hospitalization costs (P < 0.05). There were no differences in surgical bleeding volume, postoperative drainage volume, extubation time, postoperative hospitalization time , surgical complications, visual analog scale pain scores, and recurrence rate (P > 0.05). After a 6-month follow-up, the vancouver scar scale assessment showed no differences in scar color, thickness, vascularity, softness, and total score (P > 0.05). Based on the BODY-Q questionnaire chest module scores, the single-port group showed better overall satisfaction in appearance (P = 0.038), especially in the smoothness of the chest wall, with significantly higher scores than the three-port group (P = 0.001). No differences were found in nipple symmetry, nipple sensation, and skin redundancy (P > 0.05).

Conclusion: The single axillary incision endoscopic mastectomy demonstrated advantages in shorter surgical duration and lower hospitalization costs, while providing a smoother chest wall appearance, thereby enhancing overall patient satisfaction. Consequently, this surgical approach may arise as one of the preferred procedures for gynecomastia.

Level of evidence ii: 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 .

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 .

Background: Mandibular angle osteotomy (MAO) is a popular procedure to improve facial aesthetics, however, over-resection of the mandibular angle can lead to both functional and aesthetic challenges. Precision is essential in restoring these over-resected mandibles to achieve balanced outcomes. Polyetheretherketone (PEEK) implants offer biocompatibility, durability, and customization potential, making them valuable for achieving precise and predictable results. This study examines the efficacy of PEEK patient-specific implants (PSIs) in endoscopic-assisted mandibular angle revision (MAR) surgery, assessing improvements in surgical accuracy and aesthetic outcomes.

Methods: We retrospectively analyzed 24 patients (39 mandibles) who underwent MAR from January 2019 to December 2023. Surgical accuracy was measured by comparing planned and achieved PSI positions using root mean square error (RMSE) and maximum deviation (MaxD). Patient satisfaction was assessed using the FACE-Q questionnaire, administered preoperatively and at least six months postoperatively, with correlations drawn between implant fit accuracy and FACE-Q scores changes.

Results: The average RMSE ranged from 0.1166 to 0.3149 mm, with 96% of PSIs showing deviations under 0.3 mm. FACE-Q scores for lower facial appearance and psychological well-being improved significantly, form 42.50 ± 5.28 to 56.08 ± 4.58 and 61.50±4.31 to 70.58 ± 6.46, respectively. A strong negative correlation was observed between implant fit accuracy (RMSE, MaxD) and FACE-Q score improvements related to appearance.

Conclusions: Endoscopic-assisted MAR with PEEK PSIs offers precise correction and significant aesthetic improvements for patients with over-resected mandibles. This technique demonstrated high surgical accuracy and favorable patient-reported outcomes. Future studies on a larger scale are recommended to validate these findings.

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.