Aesthetic Results In Patients Research Articles

Male-to-Female Genital Reassignment Surgery: A Retrospective Review of Surgical Technique and Complications in 60 Patients.

Patients with male-to-female gender dysphoria (GD) require multidisciplinary assessment and management. Nowadays, more and more patients decide to undergo genital reassignment surgery (GRS) to have aesthetic and functional external female genitalia. Different techniques of this procedure have been described. Orchiectomy, penile disassembly, creation of a neovaginal cavity, repositioning of urethral meatus, and clitorolabioplasty may be identified as the five major steps in all of these techniques. We conducted a retrospective study of 60 patients who underwent genital reassignment procedure for male-to-female GD at our department between November 2008 and August 2013 with a minimum follow-up of 1 year. Data were collected on surgical technique, postoperative dilations protocol, complications, and functional and aesthetic outcomes. We describe and critically evaluate the surgical technique used in our department. Follow-up ranged from 14 to 46 months. Two patients developed late neovaginal stricture, and two patients experienced rectovaginal fistulae (one required surgical revision with dermal porcine graft placement). Minor complications occurred in 13 patients and included urethral stenosis, partial wound dehiscence, and minor bleeding. Secondary aesthetic revision surgery was performed in 13 cases. GRS can provide good functional and aesthetic outcomes in patients with male-to-female GD. However, despite a careful planning and meticulous surgical technique, secondary procedures are frequently required to improve the function and appearance of the neovagina.

Clinical and Imaging Findings and Postoperative Esthetic Results in Patients with Single or Bilateral Coronal Synostosis

Clinical and Imaging Findings and Postoperative Esthetic Results in Patients with Single or Bilateral Coronal Synostosis

Applications of navigation for orthognathic surgery.

Stereotactic surgical navigation has been used in oral and maxillofacial surgery for orbital reconstruction, reduction of facial fractures, localization of foreign bodies, placement of implants, skull base surgery, tumor removal, temporomandibular joint surgery, and orthognathic surgery. The primary goals in adopting intraoperative navigation into these different surgeries were to define and localize operative anatomy, to localize implant position, and to orient the surgical wound. Navigation can optimize the functional and esthetic outcomes in patients with dentofacial deformities by identifying pertinent anatomic structures, transferring the surgical plan to the patient, and verifying the surgical result. This article discusses the principles of navigation-guided orthognathic surgery.

Aplicaciones y ventajas estéticas de la reducción interproximal de esmalte

Resumen. Durante los últimos años, el porcentaje de adultos que busca tratamiento ortodóncico ha ido en aumento. Con estos pa- cientes las demandas estéticas y las condiciones orales complican el tratamiento. El enfoque multidisciplinario con miras a realizar tratamientos más conservadores que eviten sacrificar dientes sanos es una de las metas en estos pacientes. La utilización de métodos como el desgaste dentario interproximal es una alternativa preventiva y terapéutica que, realizada con cuidado y conocimiento, no causa daño a los dientes y tejidos periodontales, facilita la corrección del apiñamiento y mejora las formas dentales y triángulos negros. Además, brinda resultados más estables, funcionales y estéticos para los pacientes.DOI: http://dx.doi.org/10.16925/od.v10i18.723

Delayed versus Delayed-Immediate Autologous Breast Reconstruction: A Blinded Evaluation of Aesthetic Outcomes.

BackgroundThe technique of delayed-immediate breast reconstruction includes immediate insertion of a tissue expander, post-mastectomy radiation, followed by reconstruction. The aesthetic benefits of delayed-immediate reconstruction compared to delayed reconstruction are postulated but remain unproven. The purpose of this study was to compare aesthetic outcomes in patients following delayed and delayed-immediate autologous breast reconstruction.MethodsA retrospective analysis was performed of all patients who underwent delayed or delayed-immediate autologous breast reconstruction by the senior author from 2005 to 2011. Postoperative photographs were used to evaluate aesthetic outcomes: skin quality, scar formation, superior pole contour, inferior pole contour, and overall aesthetic outcome. Ten non-biased reviewers assessed outcomes using a 5-point Likert scale. Fisher's Exact and Wilcoxon-Mann-Whitney tests were used for comparative analysis.ResultsPatient age and body mass index were similar between delayed (n=20) and delayed-immediate (n=20) cohorts (P>0.05). Skin and scar quality was rated significantly higher in the delayed-immediate cohort (3.74 vs. 3.05, P<0.001 and 3.41 vs. 2.79, P<0.001; respectively). Assessment of contour-related parameters, superior pole and inferior pole, found significantly improved outcomes in the delayed-immediate cohort (3.67 vs. 2.96, P<0.001 and 3.84 vs. 3.06, P<0.001; respectively). Delayed-immediate breast reconstruction had a significantly higher overall score compared to delayed breast reconstructions (3.84 vs. 2.94, P<0.001). Smoking and the time interval from radiation to reconstruction were found to affect aesthetic outcomes (P<0.05).ConclusionsPreservation of native mastectomy skin may allow for improved skin/scar quality, breast contour, and overall aesthetic outcomes following a delayed-immediate reconstructive algorithm as compared to delayed breast reconstruction.

Therapeutic robot‐assisted neck dissection via a retroauricular or modified facelift approach in head and neck cancer: A comparative study with conventional transcervical neck dissection

In a previous study of robot-assisted neck dissection (RAND), we limited the indication for neck dissection in clinical N0 head and neck cancer. The purpose of this study was for us to present the comparison of the results of therapeutic RAND via a retroauricular or modified facelift approach with outcomes from conventional neck dissection in clinical node-positive head and neck cancer. This study involved a total of 53 patients who underwent neck dissection for head and neck cancer. Operative and pathologic parameters were assessed. The RAND and the conventional neck dissection group consisted of 20 and 33 patients, respectively. The mean operative time for the RAND group was significantly longer than that of the conventional neck dissection group. The mean number of retrieved lymph nodes in the RAND group was not significantly different from the conventional neck dissection group. Therapeutic RAND via a retroauricular or modified facelift approach was successful with satisfactory esthetic results in patients with node-positive head and neck cancer.

Applications of Fat Grafting in Facial Aesthetic Skeletal Surgery

Aesthetic skeletal surgery of the face is a powerful tool to alter the facial skeleton; the facial form is enhanced through the use of alloplastic implants and osteotomies of the facial bones. However, the ultimate aesthetic appearance is dictated by how the soft tissue envelope drapes over the altered skeletal foundation. Intraoperative and postoperative fat grafting enhances the final aesthetic result in patients who undergo skeletal aesthetic procedures. The authors describe cases in which selective fat grafting has been successful in optimizing facial soft tissue symmetry in patients undergoing skeletal aesthetic surgery of the face. A retrospective chart review of all patients who underwent aesthetic skeletal surgery of the face between November 1, 2003, and October 31, 2011, in the Department of Surgery at Georgetown University Hospital was performed, and any patient who required fat grafting either at the time of aesthetic facial skeletal surgery or in the postoperative period was identified (n = 21). Common indications for fat grafting and the surgical plans are reviewed and presented in this article. Twenty-one patients were identified who required 37 fat grafting procedures either at the time of aesthetic skeletal surgery of the face or in the postoperative period. The procedures most frequently requiring fat grafting were genioplasty, facial shape modifications, and facial symmetry improvement. Fat grafting most commonly corrected irregularities or asymmetries and improved the soft tissue contour overlying repositioned bone or alloplastic implants. Most patients were female (72%) with a mean age of 42 years (range, 4-58 years). There were 4 complications in total: 3 surgical site infections (managed conservatively in 1 patient and with incision and drainage in the remaining 2) and 1 hematoma requiring drainage and closure on the day of surgery. Knowledge of which procedures are likely to require fat grafting and the techniques for doing so can improve the plastic surgeon's ability to provide optimal aesthetic results following facial skeletal alterations.

Abstract P5-14-12: Cosmetic outcome is better after intraoperative radiotherapy compared with external beam radiotherapy: An objective assessment of patients from a randomized controlled trial

Abstract The randomised controlled TARGeted Intraoperative radioTherapy (TARGIT) Trial has demonstrated non-inferiority between the novel technique of TARGIT (intra-operative radiotherapy with Intrabeam ®) and conventional whole-breast external beam radiotherapy (EBRT) in women with early breast cancer, in terms of the primary outcome measure of risk of local relapse within the treated breast. As there are very low recurrence rates, cosmesis becomes an increasingly important outcome of breast conserving treatment with both surgery and radiotherapy. This study was performed to determine if the single high dose of TARGIT compared with EBRT leads to impaired cosmesis. A validated, objective assessment software tool for evaluation of cosmetic outcome was used. Frontal digital photographs were taken at baseline (before radiotherapy) and annually thereafter for up to five years. The photographs were analysed by BCCT.core which produces a composite score based on symmetry, colour and scar. A total of 342 patients were assessed, all over 50 years old with a median age at baseline of 64 years (IQR 59 to 68). The BCCT.core scores were dichotomised into Excellent and Good (EG), and Fair and Poor (FP). There were statistically significant increases in the odds of having an outcome of EG for patients in the TARGIT group compared with the EBRT group at year 1 (OR = 2.07, 95%CI 1.12 to 3.85, p = 0.021) and year 2 (OR = 2.11, 95%CI 1.0 to 4.45, p = 0.05). This objective assessment of aesthetic outcome in patients from a randomised setting demonstrates that those treated with targeted intraoperative radiotherapy have a superior cosmetic result compared with those patients who received conventional whole-breast external beam radiotherapy. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-14-12.

Surgical Management of Gynecomastia

The aim of the study was to evaluate the surgical management of gynecomastia focusing on techniques, complications, and aesthetic results. The authors also proposed an evaluation scale of the cosmetic results after the treatment. We conducted a retrospective analysis of 113 patients undergoing the surgery for gynecomastia in our department. Preoperative clinical evaluation included the grade of gynecomastia, its etiology, and side, whereas postoperative analysis concerned histologic findings, complications, and cosmetic results. Operative techniques included subcutaneous mastectomy through circumareolar approach in 94 patients, subcutaneous mastectomy with skin excision in 9 patients, inverted-T reduction mastopexy with nipple-areola complex (NAC) transposition in 6 subjects, and breast amputation through inframammary fold approach with free transplantation of NAC in 4 cases. Complications occurred in a total of 25 patients and did not differ statistically within Simon stages. The operative technique appeared to be the crucial determinant of good aesthetic outcome. The postoperative result of shape and symmetry of the NAC was not as satisfactory as postoperative breast size and symmetry. We showed that subcutaneous mastectomy using a circumareolar incision without additional liposuction provides a good or very good aesthetic outcome in patients with Simon grades I to IIa gynecomastia and that it is challenging to achieve a very good or even a good aesthetic outcome in patients with Simon grades IIb to III gynecomastia.

Cosmetic outcome after intraoperative radiotherapy or external beam radiotherapy for early breast cancer: An objective assessment of patients from a randomized controlled trial.

59 Background: The international randomised contolled TARGeted Intraoperative radioTherapy (TARGIT) trial has demonstrated non-inferiority between the novel technique of TARGIT (intra-operative radiotherapy with Intrabeam) and conventional whole-breast external beam radiotherapy (EBRT) in women with early breast cancer, in terms of the primary outcome measure of risk of local relapse within the treated breast. With very low recurrence rates, cosmesis becomes an increasingly important outcome of breast conserving treatment with both surgery and radiotherapy. This study was performed to determine if the single high dose of TARGIT leads to impaired cosmesis. Methods: A validated, objective assessment tool for evaluation of cosmetic outcome was used. Frontal digital photographs were taken at baseline (before TARGIT or EBRT) and yearly thereafter for up to five years. The photographs were analysed by BCCT.core software which produces a composite score based on symmetry, colour and scar. Results: 342 patients were assessed, all over 50 years old with a median age at baseline of 64 years (IQR 59 to 68). The scores were dichotomised into Excellent and Good (EG), and Fair and Poor (FP). There were statistically significant increases in the odds of having an outcome of EG for patients in the TARGIT group relative to the EBRT group at year 1 (OR = 2.07, 95% CI 1.12 to 3.85, p = 0.021) and year 2 (OR = 2.11, 95% CI 1.0 to 4.45, p = 0.05). Conclusions: Following an objective assessment of aesthetic outcome in patients from a randomised setting, this study demonstrates that those treated with targeted intraoperative radiotherapy have a superior cosmetic result compared with those patients who received conventional whole-breast external beam radiotherapy.

Role of lipomodelling in improving aesthetic outcomes in patients undergoing immediate and delayed reconstructive breast surgery

The objective of this article is to report our findings regarding large-volume fat transfer in patients who have undergone autologous breast reconstruction with the latissimus dorsi (LD) flap and/or implant-based reconstruction with subsequent lipomodelling for symmetrisation. We retrospectively collected data on all patients who have undergone lipomodelling from October 2008 to October 2011. Fat was harvested using a low-negative pressure syringe method and centrifuged at 3000 r.p.m. for 3 min. The purified fat was injected in 1 mL increments into multilayered microtunnels, starting from deeper layers and moving to superficial layers in the subcutaneous tissue. Patient satisfaction was assessed using validated Picker questions in a face-to-face consultation during follow-up visits, and the results were documented in the case notes. Thirty-one patients underwent lipomodelling following autologous breast reconstruction using the LD flap and implant-based reconstruction. Three patients in the study group had bilateral lipomodelling, and one patient required 3 lipomodelling sessions. Seven patients required 2 sessions, and 21 patients required a single session to achieve bilateral symmetry. The mean volume of fat that was harvested was 396 mL, and the mean injected volume of fat was 247 mL. Four patients (1 breast cancer recurrence, 2 patients with fat necrosis and 1 patient with oil cysts) developed postoperative complications. Twenty-nine patients (93%) were satisfied with the postoperative cosmetic outcome. Lipomodelling offers an additional tool to refine breast reconstructive surgery. This study demonstrates that large volumes of fat can be injected for sculpture optimisation and for reshaping reconstructed breasts with improved softness and a natural feel.

Raport wstępny dotyczący zastosowania nowego wspornika Baha® pokrytego hydroksyapatytem i nowej techniki chirurgicznej bez redukcji tkanki podskórnej

AimThe aim of the study is to investigate the implant stability, the soft tissue reaction and the aesthetic outcomes for Baha® system with hydroxyapatite coated abutment. MethodsSix patients are included in this study. All of them are implanted with BIA400 (with Hydroxyapatite coated abutment). The implantations were performed using linear incision. The surgery time was recorded. Implant stability quotient (ISQ) using resonance frequency analysis was scored. The assessment of the soft tissue reactions was performed using Holgers scale and the aesthetic outcomes were evaluated by surgeons according to the visual analogue scale (VAS). The assessment was performed intraoperatively, 1 and 3 weeks and 3 and 6 months after operation. ResultsISQ values recorded in the observed group were similar to previously reported with Branemark abutment. There was a significant decrease observed in the surgery time as comparing to experiences with titanium abutment. Moreover, according to the visual analogue scale, the aesthetic outcomes were very positive with the new abutment. ConclusionNew BIA400 Baha® system allows for faster surgery and improves aesthetic outcomes in patients. Further observations are needed in bigger groups of patients and for long-term results.

Cosmetic outcome after intraoperative radiotherapy or external beam radiotherapy for early breast cancer: An objective assessment of patients from a randomized controlled trial.

1110 Background: The international randomised contolled TARGeted Intraoperative radioTherapy (TARGIT) trial has demonstrated non-inferiority between the novel technique of TARGIT (intra-operative radiotherapy with Intrabeam) and conventional whole-breast external beam radiotherapy (EBRT) in women with early breast cancer, in terms of the primary outcome measure of risk of local relapse within the treated breast. With very low recurrence rates, cosmesis becomes an increasingly important outcome of breast conserving treatment with both surgery and radiotherapy. This study was performed to determine if the single high dose of TARGIT leads to impaired cosmesis. Methods: A validated, objective assessment tool for evaluation of cosmetic outcome was used. Frontal digital photographs were taken at baseline (before TARGIT or EBRT) and yearly thereafter for up to five years. The photographs were analysed by BCCT.core software which produces a composite score based on symmetry, colour and scar. Results: 342 patients were assessed, all over 50 years old with a median age at baseline of 64 years (IQR 59 to 68). The scores were dichotomised into Excellent and Good (EG), and Fair and Poor (FP). There were statistically significant increases in the odds of having an outcome of EG for patients in the TARGIT group relative to the EBRT group at year 1 (OR = 2.07, 95%CI 1.12 to 3.85, p = 0.021) and year 2 (OR = 2.11, 95%CI 1.0 to 4.45, p = 0.05). Conclusions: Following an objective assessment of aesthetic outcome in patients from a randomised setting, this study demonstrates that those treated with targeted intraoperative radiotherapy have a superior cosmetic result compared with those patients who received conventional whole-breast external beam radiotherapy.

OP191: Robot-assisted modified radical neck dissection via a retroauricular or modified face lift approach in clinically N+ head and neck cancer: A comparative study with the conventional transcervical neck dissection

Purpose In our feasibility study of robot-assisted neck dissection (RAND), we limited the indication for elective neck dissection (ND) in clinical N0 head and neck cancer. With growing experiences of RAND, we saw potential for therapeutic RAND in positive neck without extracapsular spread (ECS). In this study, we aim to compare the results of therapeutic RAND via a retroauricular (RA) or modified face-lift (MFL) approach with conventional transcervical ND in head and neck cancer. Materials and methods This study involved a total of 53 patients who underwent therapeutic ND for head and neck cancer at the department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea, from May 2010 to July 2012. Patients themselves decided whether the RAND or the conventional open ND would be performed for the treatment of neck metastasis with the information of the advantages and the disadvantages of both procedures. The following variables were assessed: age, gender, body mass index, primary site, TNM stage, operative parameters, pathologic parameters, perioperative complications, and satisfaction of scar. Results The RAND group consisted of 17 males and three females, with a median age of 62.5 years. The conventional ND group consisted of 30 males and three females, with a median age of 63.0 years. The mean operation time for ND of the RAND group was longer than that of the conventional ND group (186 ± 37 vs 150 ± 23) (p = 0.000). The mean number of retrieved lymph nodes in the RAND group (41.60 ± 12.47) showed no significant difference from that in the conventional ND group (44.39 ± 14.35) (p = 0.474). There were no significant differences in the development of postoperative complications between the RAND group and the conventional ND group. The score of satisfaction scar was significantly higher in the RAND group than in the conventional ND group (p = 0.023). The median follow-up periods were 8.0 month in the RAND group and 9.3 month in the conventional ND group. Conclusions Therapeutic RAND via a RA or MFL approach was feasible and successful, with satisfactory aesthetic results in patients with N+ head and neck cancer. This RAND technique via a RA or MFL approach may be applied to the selected cases by an experienced surgeon.

A Modified Surgical Method of Lower-Face Recontouring

In general, the width of the lower face is determined by four parts: the mandible, the masseter muscle, the buccal fat pad, and the subcutaneous fat. In this article, we introduce a modified surgical method to reshape the outline of round faces that have no significant overgrowth or eversion of the lower jawbone. The procedure includes dissection of the masseter muscle and partial lipectomy of the buccal fat pad through the same intraoral small incision. The patients were satisfied with the aesthetic outcome of both the profile and frontal view. Follow-up of more than 6months shows no prospective complications. This method yields an optimal aesthetic result in patients who have a round face without significant overgrowth or eversion of the lower jawbone. 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 .

Odległe wyniki estetyczne chirurgicznego leczenia wrodzonych zniekształceń nosa – porównanie oceny pacjenta i chirurga

IntroductionNose as the most projected face structure focuses the biggest people's attention. Nasal localization causes that even its small deformities are visible and subjected to different opinions. Rhinoplasty is one of the most common procedures in plastic surgery and at the same time one of the most difficult operation in facial surgery.The aim of this research is to analyze the long-term aesthetic results of rhinoplasty in congenital nose deformities in evaluation performed by surgeon and patient. Material and methodThe study was carried out in the group of 50 patients operated on in the Department of Plastic, Reconstructive and Aesthetic Surgery due to congenital nose deformity. The group consisted of 38 women and 12 men, aged from 27 to 56 years. Long-term aesthetic results’ evaluation was performed on the basis of clinical examination done by doctor and questionnaire filled in by patients and surgeon. ResultsEvaluation of long-term results after aesthetic rhinoplasty in patients’ opinion qualified the effects as very good in 70%. In surgeon's opinion such a result was obtained in 62% of patients. Satisfactory result of performed operation was marked by 92% of patients while surgeon qualified results as a satisfactory in the group of 88%. Reoperation was considered by 12% of patients and doctor such a necessity reflected in 10%. ConclusionsSatisfactory results of rhinoplasty in congenital nose deformities are possible to obtain while taking the degree and type of deformity into consideration and choosing proper surgical method. Surgical procedures in congenital nose deformities give good aesthetic results in patients’ and as well as surgeon's opinions. Doctor evaluates surgical results in more critical way.

Aesthetic Outcome in Patients after Polymethyl-Methacrylate (PMMA) Cranioplasty: A Questionnaire-Based Single Center Study

Aesthetic Outcome in Patients after Polymethyl-Methacrylate (PMMA) Cranioplasty: A Questionnaire-Based Single Center Study

Analysis of 3D Soft Tissue Changes After 1- and 2-Jaw Orthognathic Surgery in Mandibular Prognathism Patients

Orthognathic surgery has the objective of altering facial balance to achieve esthetic results in patients who have severe disharmony of the jaws. The purpose was to quantify the soft tissue changes after orthognathic surgery, as well as to assess the differences in 3D soft tissue changes in the middle and lower third of the face between the 1- and 2-jaw surgery groups, in mandibular prognathism patients. We assessed soft tissue changes of patients who have been diagnosed with mandibular prognathism and received either isolated mandibular surgery or bimaxillary surgery. The quantitative surface displacement was assessed by superimposing preoperative and postoperative volumetric images. An observer measured a surface-distance value that is shown as a contour line. Differences between the groups were determined by the Mann-Whitney U test. The Spearman correlation coefficient was used to evaluate a potential correlation between patients' surgical and cephalometric variables and soft tissue changes after orthognathic surgery in each group. There were significant differences in the middle third of the face between the 1- and 2-jaw surgery groups. Soft tissues in the lower third of the face changed in both surgery groups, but not significantly. The correlation patterns were more evident in the lower third of the face. The overall soft tissue changes of the midfacial area were more evident in the 2-jaw surgery group. In 2-jaw surgery, significant changes would be expected in the midfacial area, but caution should be exercised in patients who have a wide alar base.

Aesthetic outcome in patients after polymethyl-methacrylate (PMMA) cranioplasty — a questionnaire-based single-centre study

Objectives: Acquired skull deformities are common and most likely treated surgically by cranioplasty. Since data on patient aesthetic outcome after cranioplasty are rare in literature, we aimed to assess patient satisfaction after polymethyl-methacrylate (PMMA) cranioplasty in this study using a questionnaire.Methods: A patient questionnaire was developed to evaluate the grade of satisfaction after surgery. After approval by the institutional ethical review board, we were allowed to send to all 115 patients, who received a cranioplasty from 2001 to 2008 at the University Hospital of Zurich, our questionnaire once to retrospectively analyze the patient response together with the patient hospital records.Results: Out of 115 patients, 36 patients were lost to follow-up and our questionnaire was sent out once to 79 patients. Sixty-three of 79 patients replied to the questionnaire (79·7%) and 16 did not reply. Seventeen declined to participate in this study and out of the remaining 46 patients (58·2%, 18 women, mean age 54 years, range 20–83 years), who agreed to participate in this study, 22 (47·8%) judged their cranioplasty to be aesthetically ‘excellent’, 16 (34·8%) ‘favorable’ and 4 (8·7%) ‘poor’. Another four patients (8·7%) were not satisfied, asking for a surgical revision. Patient age and gender was not related to the assessment of the aesthetic result. A higher satisfaction grade was found in patients with primary PMMA cranioplasty compared to PMMA cranioplasty implanted during a second surgery (Fisher’s exact test, P = 0·031). A dent was strongly associated with absence of satisfaction (P<0·01, Fisher’s exact test).Conclusion: Our questionnaire was suitable to assess patient satisfaction after cranioplasty. Localization of cranioplasty showed to be an important factor of aesthetic outcome, especially in the fronto-temporal region where a carefully planned reconstruction should be performed to guarantee an excellent grade of satisfaction after surgery.

Evaluation of Clinical Outcomes and Aesthetic Results after Autologous Fat Grafting for Contour Deformities of the Reconstructed Breast

Autologous fat grafting is gaining widespread acceptance for the management of soft-tissue deformities of the reconstructed breast. However, published data on long-term outcomes and aesthetic results of fat grafting to the breast are lacking. The purpose of this study was to review the authors' early experience of fat grafting in the correction of acquired contour deformities after postmastectomy breast reconstruction. A detailed retrospective review of 49 patients who underwent fat grafting to 68 reconstructed breasts was carried out. Clinical outcomes were analyzed and aesthetic results were assessed with objective grading of preoperative and postoperative photographs by two independent, blinded plastic surgeons. On average, 67 cc of fat was injected into each breast per session. There were 111 fat injection procedures, as more than one injection was required in 51.5 percent of cases. Average follow-up time was 2.4 years. Complications occurred in 6.3 percent of procedures, including fat necrosis (3.6 percent), oil cysts (1.8 percent), and infection (0.9 percent). Aesthetic outcome was significantly improved across all measurements, including volume, contour, placement, and superomedial fullness (p<0.001 for all). Although further studies are required to provide surgeons with definitive guidelines for the implementation of this technique, fat injection is a safe intervention and significantly improves the aesthetic results in patients with contour deformities of the reconstructed breast. Therapeutic, IV.