Aesthetic Surgery Journal最新文献

Background: The dynamic interaction between breast implants and tissues influences long-term aesthetic outcomes after augmentation mammaplasty. Implant characteristics such as shape, gel cohesivity and surface texture may affect postoperative results.

Objectives: The aim of this study is to assess the stability of five implant types over a 12-month period using 3D image analysis.

Methods: A prospective single-surgeon study was conducted on 106 patients (212 breasts) undergoing primary breast augmentation. Five implant types were evaluated: smooth progressive gel ULTIMA (PgU) round, smooth high-strength cohesivity gel (HSC+) round, microtextured round, microtextured anatomical, and polyurethane (PU)-coated anatomical. 3D morphometric analysis (using Arbrea® software) measured nipple-to-inframammary fold distance (N-IMF) and lower pole ratio (LPR) at 6 and 12 months. Statistical associations between implant type, volume, and elongation were analyzed; complication and satisfaction rates were compared across groups.

Results: Smooth PgU round implants demonstrated the greatest elongation (Δ N-IMF: 0.98 ± 0.26 cm; Δ LPR: 6.84 ± 3.02 p.p.), whereas PU anatomical implants showed negligible change (Δ N-IMF: 0.04 ± 0.35 cm; Δ LPR: 0.46 ± 2.75 p.p.) (p < 0.001). Implant type and volume were significantly associated with elongation (p < 0.0001 and p < 0.05, respectively). The overall complication-per-implant rate was 2.4%, predominantly among smooth PgU implants (p = 0.011). Patient satisfaction was high and comparable across groups.

Conclusions: Implant gel cohesivity, surface texture and volume affect implant stability. PU-coated anatomical implants showed the least change, whereas smooth groups presented the highest elongation and complication rate.

Red Breast Syndrome (RBS) is an uncommon inflammatory complication that may occur following implant-based breast reconstruction and can clinically mimic cellulitis or surgical-site infection. This qualitative systematic review, based on comprehensive PubMed and Scopus searches conducted through October 31, 2025, summarizes the existing literature on RBS, focusing on its etiology, clinical presentation, diagnostic characteristics, and therapeutic approaches following breast reconstruction using acellular dermal matrices (ADMs). A management protocol is proposed based on available data, and a single-center case series is presented from the University Hospital of Udine (Italy), including patients who developed RBS after direct-to-implant (DTI) reconstruction with ADM between January 2022-December 2024. Twenty-nine studies met the inclusion criteria, comprising case reports, case series, and retrospective or prospective cohort studies. The reported incidence of RBS ranged from 0%-29.6%. Proposed etiologies include endotoxin contamination, residual cellular debris, delayed hypersensitivity reactions, and lymphatic or vascular impairment of mastectomy flaps. Most reports described localized erythema confined to the area of the ADM, with normal inflammatory markers and negative imaging findings, while antibiotic therapy frequently failed to achieve improvement. Corticosteroids represented the most consistently effective treatment, although some cases required ADM removal or replacement. In our institutional case series (n = 8), symptom onset occurred between 4 weeks and 7 months post-surgery. Inflammatory markers remained within normal limits, imaging rarely demonstrated fluid collections, and symptoms resolved within days to weeks with corticosteroid therapy or conservative management. Study limitations include overall low methodological quality, heterogeneity of ADM types and reporting standards, and small sample sizes. This review consolidates current evidence, proposes a diagnostic-therapeutic algorithm to differentiate RBS from infection, and highlights the need for prospective investigations and manufacturer-level endotoxin testing to elucidate pathogenesis and optimize clinical management.

Background: Because the breast is one of the target organs of estrogen and progesterone, it is confirmed to have periodic changes through the menstrual cycle. Several studies reported that surgeries on the breast could be influenced by the menstrual cycle, which remained controversial.

Objectives: The aim of the authors of this study is to determine whether the menstrual cycle affects breast reduction surgery.

Methods: Patients undergoing breast reduction from 2004 to 2021 were reviewed. They were grouped according to different menstrual phases in a standard 28-day cycle: proliferative (Days 3-7), follicular phase of differentiation (Days 8-14), luteal phase of differentiation (Days 15-20), secretory (Days 12-27), and menstrual (Days 28-2). Their length of surgery, drainage after operation, drainage duration, and incidence of hematoma were recorded and analyzed.

Results: The study on 722 patients demonstrated that there was no statistical difference in the length of operation and postoperative drainage when performing operations on different menstrual phases.

Conclusions: For patients having breast reduction surgery, their menstrual cycle had no influence on the length of surgery and postoperative drainage, whereas further studies were needed.

Level of evidence: 3 (therapeutic):

Background: The Baker classification is used to grade capsular contracture after breast-implant surgery; yet, its correlation with patient-reported outcomes is poor.

Objectives: To determine whether histopathological verification of capsular contracture status strengthens the association between Baker grade and BREAST-Q scores.

Methods: Women scheduled for implant exchange or removal completed the BREAST-Q "Physical Well-Being-Chest" module. Raw BREAST-Q sum scores were transformed to a 0-100 scale, where higher scores indicate increased comfort. The attending surgeon classified breasts using the Baker scale (I-IV). Capsule biopsies were scored with a validated histopathological scoring system. Baker grades were deemed "confirmed" when histology and Baker grade were aligned and otherwise deemed "misclassified". Linear regressions compared the relationship between BREAST-Q scores and Baker grade in confirmed vs misclassified cases.

Results: A total of 103 patients (58 augmentation, 45 reconstruction) were included. The Baker classification was confirmed histologically in 53/58 augmentation patients (91%), and 36/45 reconstruction patients (80%). In confirmed augmentation cases, each one-grade increase in Baker significantly worsened chest well-being by -8.80 BREAST-Q points (95% CI [-14.42, -3.18]; P = .003). No correlation was found in the misclassified augmentation cases (-3.21 points; P = .57), confirmed reconstruction cases (-5.00 points; P = .19), or in the misclassified reconstruction cases (-5.72 points; P = .54).

Conclusions: Histologically confirmed Baker classification correlates significantly with chest well-being assessed with BREAST-Q for the patients with breast augmentation, whereas no such correlation was observed in cases where the histology and Baker classification showed a mismatch. This suggests that histopathological scoring can increase diagnostic accuracy when assessing capsular contracture status.

Level of evidence: 3 (therapeutic):

Background: Breast reduction surgery effectively alleviates symptoms of macromastia, but the impact of diabetes on surgical outcomes remains insufficiently studied.

Objectives: The authors of this study aim to evaluate the effect of diabetes, stratified by treatment modality, on postoperative outcomes following breast reduction surgery.

Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried (2017-2023) to identify female patients undergoing breast reduction. Patients were classified as nondiabetic or diabetic, with the latter further stratified into diabetes mellitus treated with oral agents (DM-ORAL) or with insulin (DM-INS). Preoperative characteristics and 30-day postoperative outcomes were compared, and multivariable confounder-adjusted regression analyses were performed.

Results: The cohort included 29,346 female patients, of whom 4.3% (n = 1261) had diabetes. Among diabetic patients, 83% (n = 1046) had DM-ORAL and 17% (n = 215) DM-INS. Compared with nondiabetic patients, those with diabetes were significantly older (49.8 ± 13.0 vs 39.0 ± 14.5 years; P < .0001), had a higher body mass index (31.5 ± 11.2 vs 28.4 ± 10.0 kg/m2; P < .0001), and exhibited a greater overall burden of comorbidities. Multivariable analysis revealed that DM-INS was associated with a significantly increased risk of overall adverse events (odds ratio [OR] 1.9; P = .001), surgical complications (OR 1.6; P = .04), medical complications (OR 3.1; P = .02), and unplanned readmission (OR 4.9; P < .0001). In contrast, DM-ORAL did not correlate with an increased risk of postoperative complications (OR 1.1; P = .6).

Conclusions: DM-INS is associated with an increased perioperative risk following breast reduction surgery. These findings underscore the need for tailored perioperative strategies and support risk-specific guidelines in this population.

Level of evidence: 3 (therapeutic):

Background: Poly-4-hydroxybutyrate (P4HB), a naturally occurring component of human connective tissue, serves as a biomedically produced thermoplastic polyester scaffold that has been used in many surgical subspecialties. The utilization of P4HB in cosmetic and reconstructive breast surgery has been popularized internationally for the past 12 years.

Objectives: The purpose of this study was to assess and report long-term international outcomes of P4HB use in aesthetic breast surgery.

Methods: A standardized retrospective outcome review was completed from the records of 5 international surgeons, each with significant expertise in using P4HB.

Results: A total of 621 patients were included in the review. Average follow-up was 1.33 years (range, 1-9.3 years). Most patients had P4HB placed during primary breast surgery (n = 460; 74%); primary procedures included augmentation-mastopexy (n = 253), mastopexy (n = 125), and breast reduction (n = 71). A subset (n = 161; 26%) of patients had P4HB placed during breast revisions, including revision augmentation-mastopexy (n = 81), revision augmentation (n = 73), and mastopexy with implant removal (n = 7). The main indications for revision included recurrent ptosis (n = 166), implant malposition (n = 64), and capsular contracture (n = 61). An overall complication rate of 3.7% (n = 23) was observed, the most common being delayed wound healing (n = 7) and hypertrophic scarring (n = 5). Of the overall complications, device-related complications associated with P4HB were observed only in 5 patients (0.8%), while non-device-related complications were seen in 18 patients (2.9%).

Conclusions: This study suggests there is a defined role for the use of P4HB in both primary and revision aesthetic breast surgery; its use does not appear to increase the inherent complication risk of cosmetic breast surgery.

Level of evidence: 4 (therapeutic):

Background: The efficacy of 1-stage augmentation-mastopexy has been well established throughout the literature. Limited evidence exists examining outcomes in the secondary augmentation-mastopexy patient.

Objectives: To evaluate the long-term safety and efficacy of secondary augmentation-mastopexy through an analysis of clinical outcomes.

Methods: A retrospective review of 847 patients who underwent 1664 consecutive secondary augmentation-mastopexy procedures from January 2009 to January 2021 was performed. Demographics, operative characteristics, and postoperative outcomes, including complication and reoperation rates were collected and analyzed.

Results: Over a mean follow-up period of 47 months (3 to 131 months), the complication rate was 11% (n = 94) with a reoperation rate of 8.7% (n = 74). Tissue-related complications occurred in 7.3% (n = 62) and implant-related complications in 3.8% (n = 32). Indications for reoperation were primarily due to tissue-related complications in 5.4% (n = 46), most commonly recurrent ptosis in 3.4% (n = 29). Implant-related indications for reoperation (3.3%, n = 28) were most commonly capsular contracture (Baker III or IV; n = 21, 2.5%) and implant malposition in (n = 11, 1.3%). Comparing the incidence of reoperation with the number of previous breast procedures identified a significant increase in reoperation rate for patients with 3 or more previous breast implant procedures (P = .041), as well as a significantly higher reoperation rate in patients with a history of tobacco use (P = .013).

Conclusions: Secondary augmentation-mastopexy can be performed safely with low complication and reoperation rates. Success with this procedure is directly proportional to control of the soft tissue envelope, implant, pocket, and the nipple to inframammary fold distance. An individualized approach coupled with a thorough preoperative evaluation of these components should be employed for optimal results.

Level of evidence: 4:  (Therapeutic).

Background: Achieving breast symmetry represents a critical endpoint in reduction mammoplasty. Historically, surgeons have been predominantly depended on anthropometric parameters, such as linear measurements and tactile evaluation, to guide intraoperative decision-making. Nonetheless, there remains a substantial unmet need for objective, intraoperative volumetric assessment techniques. While 3-dimensional volumetric analyses have become well-established tools for preoperative planning and postoperative evaluation, the literature on intraoperative volumetric assessment is still quite limited and relies on scanning devices lacking rigorous validation.

Objectives: In this study, following extensive preliminary investigations, we present the first evaluation of the validated Vectra H2 3D photogrammetric imaging system applied intraoperatively during reduction mammoplasty. The primary aim was to investigate if integrating this objective intraoperative volumetric data could facilitate improved postoperative breast volume symmetry.

Methods: We analyzed 100 patients undergoing reduction mammoplasty with supero-medial pedicle and wise pattern skin resection. We compared volumetric differences of the last 50 reduction mammoplasty procedures before using intraoperative volumetric measurements (group A; control) to the first 50 reduction mammoplasties after implementation of intraoperative volumetric analysis using Vectra H2 3D photogrammetry (group B; intraoperative 3D). The follow-up period was 12 months.

Results: Fifty patients were included in group A and 50 patients in group B. Patient demographics, mean resection weight, and complications did not differ statistically significantly. The 3-month postoperative volumetric differences between the breasts of the same patient averaged 5.8% ± 3.0% (mean ± SD, 0.1%-12.2%) in Group A (control) and 2.9% ± 1.5% (mean ± SD, 0.8%-6.9%) in Group B (intraoperative 3D). These differences were statistically significant (P < .05).

Conclusions: In our study, intraoperative 3D photogrammetry for volumetric analysis significantly improved volumetric symmetry following reduction mammoplasty. Although the volumetric differences in both groups were relatively small, the technique facilitated the intraoperative identification of outliers and resulted in superior volumetric symmetry.

Level of evidence: 3 (therapeutic):