Aesthetic Surgery Journal最新文献

Background: Breast reduction surgery provides both functional and aesthetic benefits and enables incidental detection of breast pathology. Although high-risk or malignant lesions are uncommon, their long-term clinical relevance remains unclear.

Objectives: The aim of this study was to evaluate the histopathological findings of breast reduction specimens and assess their relationship with long-term breast outcomes, including the development of new breast disease and the need for subsequent biopsy or mastectomy.

Methods: This retrospective cohort study included 1349 patients (2630 breasts) who underwent breast reduction with a minimum 5-year follow-up. Long-term clinical outcomes were assessed only in the subset of 377 patients (731 breasts) who completed a follow-up questionnaire. Histopathological findings were classified into 3 risk categories according to their association with malignancy. A follow-up questionnaire assessed breastfeeding ability, adherence to imaging, and the occurrence of new breast masses or interventions. Associations between baseline risk category, follow-up duration, and long-term outcomes were analyzed using Pearson χ2 tests.

Results: High-risk or malignant lesions were identified in 1.3% of specimens, predominantly among women over 40 years. Specimen weight and previous contralateral breast cancer history were not associated with pathological risk. Among 731 breasts evaluated by questionnaire, 80.1% retained breastfeeding ability, whereas 38% reported no imaging follow-up. Biopsy incidence increased significantly with follow-up time (2.6%, 6.2%, and 13.8% at 5-10, 10-15, and >15 years; P < .001). Mastectomy rates also rose with time (0%, 0.6%, and 8.3%; P < .001), showing a trend toward higher incidence in baseline high-risk specimens.

Conclusions: Breast reduction surgery facilitates incidental detection of high-risk lesions, particularly in women over 40 years. Higher baseline pathological risk and longer follow-up were associated with increased likelihood of mastectomy, underscoring the need for structured, risk-adapted surveillance to optimize long-term oncologic safety.

Level of evidence: 3 (therapeutic):

Background: Utilization of the subfascial plane in breast augmentation has many purported advantages. To further develop our understanding of the potential advantages of the subfascial augmentation technique a direct comparison to the ubiquitous subpectoral (dual-plane) technique is required.

Objectives: The goal of this study was to provide the first direct comparison of postoperative outcomes observed in subfascial and subpectoral breast augmentations utilizing an inframammary incision.

Methods: A retrospective chart review was performed identifying all patients who underwent either subfascial or subpectoral cosmetic breast augmentations by a single surgeon between 2011 and 2023. Acute and late complications were identified with particular attention to the double bubble deformity, lateral implant malposition, and capsular contracture.

Results: In total, 193 patients (386 breasts) were identified for the study. Of 193, 96 patients (192 breasts, 49.7%) underwent subpectoral augmentation, and 97 patients (194 breasts, 50.3%) underwent subfascial augmentation. A total acute complication rate of 1.0% was observed. The acute complication rate between the 2 groups was statistically insignificant (1/194 [0.5%] subfascial vs 3/192 [1.6%]) subpectoral, P = .61). Compared to the subpectoral cohort, the subfascial cohort demonstrated a statistically significant lower rate of capsular contracture (2/194 [1.1%] subfascial vs 10/192 [5.2%]) subpectoral, P = .04), lateral implant malposition (17/194 [8.8%]) subfascial vs 45/192 [23.4%]) subpectoral, P = <.001) and double bubble deformity (0/194 [0%] subfascial vs 7/192 [3.7%] subpectoral, P = .02).

Conclusions: Use of the subfascial plane in cosmetic breast augmentation offers several advantages over the traditional subpectoral (dual-plane) approach. These include reduced rates of lateral malposition, double bubble deformity development, and capsular contracture. These findings suggest that subfascial breast augmentation may be a superior option for many patients, particularly those who are physically active or concerned about long-term pectoralis muscle function.

Level of evidence: 3: (Therapeutic).

Background: Conventional breast augmentation using different approaches and implant pockets faces challenges such as societal stigma, long recovery time, invasion of the breast, and complication rates. Previous minimally invasive approaches have failed to provide long-term safety, effectiveness, and patient satisfaction. The authors of this study introduce a minimally invasive breast harmonization procedure, performed with an inflatable balloon and a biconvex-shaped silicone-filled implant, addressing these limitations with a safe and innovative solution.

Objectives: In this prospective controlled study, the authors evaluate the safety and effectiveness of this procedure, reducing surgical complications while providing a new treatment option for breast enhancement.

Methods: A 3-year, IRB-approved study enrolled 100 participants undergoing this procedure, utilizing an axillary incision with prepectoral implant placement. Safety was assessed by monitoring the cumulative incidence of postoperative complications in scheduled visits and with MRI evaluations in a randomized subcohort (33 participants). Patient satisfaction was measured pre- and postprocedure using Breast-Q questionnaires and scar evaluation with the Patient and Observer Scar Assessment Scale.

Results: Effectiveness endpoint at 3 years reported a 75.3% bra increase of 1 to 3 cup sizes. The overall Kaplan-Meier complication rate at 3 years was 3.2%, with low reoperation rates and 93% follow-up compliance. There were no patient reports of nipple or breast sensitivity loss, nor surgeon-reported incision-related complications, implant rupture, capsular contracture (Baker Grade III/IV), infection, seroma, rippling, hematoma, or breast implant-associated anaplastic large cell lymphoma.

Conclusions: This study demonstrates very low complication rates, faster recovery, and enhanced patient satisfaction with this procedure compared with conventional breast augmentation. Its minimally invasive tissue-preservation approach introduces new surgical concepts, advancing surgical techniques and technologies beyond conventional methods.

Level of evidence: : 4 (Therapeutic).

Background: Previous studies suggest higher revision rates after primary breast augmentation after massive weight loss (MWL); yet, specific risk factors remain unclear. Robust predictive models are lacking.

Objectives: The study aimed to create a nomogram to predict 5-year revision risk after primary breast augmentation in women with massive weight loss, providing a clinical tool to guide surgical decision-making.

Methods: A nationwide, population-based study was conducted within the Breast Reconstruction After Bariatric Surgery project (ClinicalTrials.gov NCT07059104). Data from the Scandinavian Obesity Surgery Registry and the Swedish Breast Implant Registry (2008-2022) were linked with national healthcare and prescription databases. Univariable logistic regression and group LASSO with 1000 bootstrap iterations were applied to identify predictors of revision within 5 years. A final multivariable model informed the development of a clinical nomogram.

Results: Among 810 women undergoing 1604 primary breast augmentations after massive weight loss, 84 (10%) required revision during a median follow-up of 5.5 years. Revisions were associated with smaller implant volumes (P = .032) and shorter intervals between bariatric surgery and augmentation (P = .042). In bootstrap analyses, implant volume (92% selection), surgical timing, and medications impairing wound healing were consistently retained. The final model included these three predictors, forming the basis of the nomogram.

Conclusions: Implant volume, timing of augmentation, and relevant medications were independent predictors for revision. The nomogram provides a tool to support surgical planning and patient counselling in this high-risk population.

Level of evidence: 3 (risk):

Background: Nipple hypertrophy is a common aesthetic concern that can cause psychological discomfort and disrupt breast harmony. Although many techniques exist for nipple reduction, they often have limitations in reducing all dimensions simultaneously and carry risks of deformity or impaired lactational function.

Objectives: The authors of this study aim to introduce and evaluate the effectiveness and safety of the "folded flap" technique, a simple, anatomically guided approach designed to achieve simultaneous reduction in nipple height, diameter, and base width while preserving a natural contour and function.

Methods: A retrospective analysis was performed on 61 patients (122 nipples) treated between January 2018 and December 2024 using the folded flap technique. The procedure involves clear, anatomically based preoperative marking, excision of a precise tissue block, placement of a 3-point key suture, and layered closure to achieve a natural cylindrical nipple shape. Postoperative follow-up was conducted at 1, 3, 6, and 12 months to evaluate aesthetic outcomes, complications, sensitivity, and lactational function.

Results: No intraoperative or major postoperative complications occurred. The average procedure time was 10 to 15 min. The mean reduction in nipple height and diameter was 40% to 70% of baseline, with additional narrowing of the base. Aesthetic outcomes were rated as stable and predictable. No cases of necrosis, deformity, significant scarring, or sensitivity loss were observed. Among 7 patients who became pregnant postoperatively, no breastfeeding difficulties were reported.

Conclusions: The folded flap technique is a safe, effective, and reproducible method for nipple reduction, offering precise simultaneous reduction of all key dimensions while maintaining a natural, balanced contour and minimizing risk of complications.

Level of evidence: 4 (therapeutic):

Background: The FDA requires implant manufacturers to continue collecting safety and efficacy data annually through Year 10. Investigators are encouraged to follow their enrolled patients in person to obtain the most accurate and complete data.

Objectives: The authors reviewed the 5-year data on the safety and effectiveness of Motiva SmoothSilk silicone gel-filled breast implants submitted to the FDA. The reported data include both the primary and revisional breast augmentation cohorts.

Methods: The 5-year clinical data from the breast augmentation cohorts of the Motiva IDE 10-year pivotal study were submitted to the FDA in 2024. Data were collected on adverse events, reoperation, patient and physician satisfaction, connective tissue and rheumatologic diseases, and quality-of-life instruments. MRIs were obtained at Years 1, 2, 3, and 5 for patients enrolled in the MRI substudy.

Results: There were 451 primary augmentation patients and 109 revisional augmentation patients enrolled in the pivotal study. Follow-up rates were 87% of expected patients at both Years 4 and 5. Of the 218 patients enrolled in the MRI cohort, 152 underwent MRI screening at Year 5, an overall compliance of 79.2% of expected screenings. The reported reoperation rates for any reason were 8.8% in the primary augmentation cohort and 36.0% in the revisional augmentation cohort.

Conclusions: The 5-year data from the primary and revisional breast augmentation cohorts reveal low rates of device rupture. Size change and malposition were the most common causes of reoperation in the primary augmentation cohort, and capsular contracture and size change were the leading drivers of reoperation in the revisional augmentation cohort.

Level of evidence: : 2 (Therapeutic).

Background: Gynecomastia, a common condition involving benign breast tissue enlargement in men, poses challenges for plastic surgeons, especially in severe cases. Current surgical methods for severe gynecomastia often require complex, invasive procedures with skin resection, resulting in significant scarring. Conversely, techniques avoiding skin resection frequently leave skin redundancy and an unsatisfied chest contour.

Objectives: The authors of this study introduce a skin redistribution and fixation approach, which help to improve aesthetic outcomes and eliminate the need for skin excision.

Methods: The surgical procedure comprised 4 stages: an initial liposuction, a mastectomy, a subsequent liposuction session, and an approach for the redistribution and fixation of skin. Liposuction was extended across the breasts, chest wall, and lateral chest wall. Subcutaneous mastectomy was performed through small infraareolar incisions. The redistribution and fixation approach involved 2 steps: surgeons manually distributed the loose and accumulated skin evenly across the chest, followed by the application of a sterile, self-adhesive foam dressing to secure the skin on each side of the chest.

Results: Between July 2018 and January 2024, 77 patients with severe gynecomastia received treatment with skin redistribution and fixation, whereas 73 underwent traditional liposuction and mastectomy. Follow-up periods ranged from 13 months to 5 years. Patients received skin redistribution and fixation approach reported improved satisfaction regarding the final shape, contour, and symmetry.

Conclusions: The skin redistribution and fixation approach could help to enhance aesthetic outcomes and achieve better chest contour in surgical treatment for severe gynecomastia.

Level of evidence: 4 (therapeutic):

Background: Serotonergic antidepressants have been associated with an increased risk of weight gain. Because being overweight is strongly linked to macromastia development, which is a primary indication for breast reduction, it is very important to assess whether these medications pose the risk of postoperative complications.

Objectives: The aim of this study was to evaluate the association between preoperative serotonergic antidepressant use and the incidence of postoperative complications following breast reduction.

Methods: A retrospective cohort analysis was conducted using the TriNetX Global Collaborative Network. Female patients >18 years old who underwent breast reduction were divided into 2 groups: those with documented serotonergic antidepressant use prior to surgery and those with no history of serotonergic antidepressant use. Propensity score matching was applied to balance demographic and clinical variables. Primary outcomes included postoperative complications at 3 time intervals: 30 days, 60 days, and 90 days. Secondary outcomes included long-term complications after 1 and 2 years.

Results: After 1:1 propensity score matching, each cohort consisted of 8625 patients. Within 30 days following breast reduction, patients in the serotonergic cohort had a significantly increased risk of surgical site infection (risk ratio [RR], 1.42; P = .003), wound dehiscence (RR, 1.524; P < .0001), inpatient hospitalization (RR, 1.375; P = .004), opioid use (1.474, P < .0001), and any surgical site complication (1.28, P < .0001) compared with the control cohort. These elevated risks persisted at 60 and 90 days postsurgery. For long-term outcomes, similar rates were noted after 1 and 2 years.

Conclusions: Serotonergic antidepressant use is associated with an increased risk of short-term postoperative complications following breast reduction surgery.

Level of evidence: 2 (therapeutic):

Background: As the demand for body contouring surgery has increased following the widespread adoption of Glucagon-like Peptide-1 receptor agonists (GLP-1 RA), the impact of different weight-loss methods on patient selection, operative techniques, and postoperative outcomes remains unclear.

Objectives: This study compared complications rates across weight loss modalities and identified predictors of adverse outcomes in body contouring patients.

Methods: A single center, retrospective, cohort study of patients who underwent post-weight loss body contouring surgery between January 2019 through December 2024 was performed. Eligible patients were adults who achieved weight loss and subsequently underwent panniculectomy, brachioplasty, thighplasty, or breast surgery. Patients were classified into four groups based on weight loss modality: surgical, injectable GLP-1 pharmacotherapy, combination, or lifestyle. The primary outcome was the incidence of postoperative complications within 90 days for each procedure.

Results: Among 1,002 post-weight loss patients undergoing body contouring, weight-loss methods included surgery (67.9%), lifestyle (14.3%), GLP-1 pharmacotherapy (7.8%), and combination therapy (10.1%). Baseline characteristics differed significantly across groups. Across all procedures, complication rates did not differ by weight-loss modality. Panniculectomy, brachioplasty, thighplasty, and breast procedures demonstrated expected procedure specific complication patterns, with higher BMI at the time of surgery and diabetes independently predicting increased risk.

Conclusions: Weight loss modality does not appear to impact the incidence of postoperative complications following body contouring surgery. BMI at the time of surgery and diabetes are independent predictors of adverse outcomes.