Augmentation Mammaplasty Research Articles

Comparing Round and Anatomically Shaped Implants in Augmentation Mammaplasty: The Experts' Ability to Differentiate the Type of Implant.

Comparing Round and Anatomically Shaped Implants in Augmentation Mammaplasty: The Experts' Ability to Differentiate the Type of Implant.

Reply: Comparing Round and Anatomically Shaped Implants in Augmentation Mammaplasty: The Experts' Ability to Differentiate the Type of Implant.

Reply: Comparing Round and Anatomically Shaped Implants in Augmentation Mammaplasty: The Experts' Ability to Differentiate the Type of Implant.

Review of 494 Consecutive Breast Augmentation Patients: System to Improve Patient Outcomes and Satisfaction.

Breast augmentation continues to be one of the most common surgical procedures performed by plastic surgeons. As implant options expand, controlling the numerous variables required for a successful result will prove increasingly challenging. The purpose of this study was to outline specific steps that can be taken during the patient consultation and during surgery to decrease complications and improve overall patient satisfaction and patient outcomes. A retrospective review of 494 consecutive patients who underwent primary augmentation mammaplasty performed by a single surgeon was undertaken. Surgical outcomes were recorded and compared with previously published results. Patient satisfaction was measured using the BREAST-Q Augmentation Module. Patients were followed for an average of 6 months (range, 0-45 months). Of the 494 patients, 1.3% developed capsular contracture. Other complications included 0.6% asymmetry, 0.4% malposition, 0.2% hematoma, and 0.2% rippling. The median BREAST Q score for the patient's overall satisfaction with outcome was 86%. The median BREAST Q score for patient's satisfaction with the plastic surgeon, medical team, and office staff was 100% in each case. The median score for psychological well-being, physical well-being, and sexual well-being was 100%, 90%, and 88%, respectively. The system outlined in this study showed very low rates of complications and high scores for patient satisfaction. Following a system like this will become increasingly important as breast augmentation continues to become more popular, implant options continue to expand, and social media continues to be used by patients to share surgical experiences.

Abstract: The July Effect: Admission Quarter as a Risk Factor for Postoperative Complications Following Common Plastic Surgical Procedures

INTRODUCTION: There is a large amount of literature investigating the effects of patient, hospital, and surgical team characteristics on surgical complication rates. Despite this, the academic quarter in which the surgery takes place has not been examined for similar associations. This study seeks to assess admission quarter as a predictor of increased rates of surgical complications for a group of common plastic surgical cases. METHODS: This was a retrospective analysis of the ACS-NSQIP database between 2005 and 2014 for patients undergoing implant and/or flap-based breast reconstruction, breast revisions, augmentation mammaplasty, mastopexy, breast capsulectomy, nipple reconstruction, or abdominoplasty. Patients were identified by CPT codes. Univariate logistic regression models were utilized to identify potentially significant associations. Variables significant upon univariate study were subjected to multivariate logistic regression models to assess the relationship between admission quarter and various postoperative complications, controlling for confounding variables. RESULTS: We identified 41,239 patients who underwent the aforementioned plastic surgery procedures. Univariate regression models were created to assess the relationship between admission quarter and various postoperative complications, including wound, cardiac, pulmonary, thromboembolic, renal, return to Operating Room (OR), and any complications. Wound complication (p=0.012), return to OR (p=0.030), and any complication (p=0.0181) were found to be significant, with increased rates of all three complication categories in the third quarter of the academic year. These three complication types were subsequently analyzed via logistic regression analysis to adjust for confounding variables. Upon analysis, wound complications was elevated in Q3 vs Q1 (OR=1.16, p=0.034), Q3 vs Q2 (OR=1.19, p=0.013) and Q3 vs Q4 (OR=1.22, p=0.005). Return to OR was elevated in Q3 vs Q4 (OR=1.19, p=0.014). Any Complication was elevated in Q3 vs Q4 (OR=1.17, p=0.003). For the occurence of both Return to OR and Any Complication, Q1, Q2, and Q3 displayed differences that were not significant at α=0.05. CONCLUSION: This study elucidated the quarterly patterns of various postoperative complications for a group of common plastic surgery procedures. Quarter 3 was revealed to have higher rates of wound complications than any other quarter upon both univariate and multivariate logistic regression. This study provides compelling evidence for the need of further investigation to identify and address the underlying cause or causes.

Matching Procedures at the Time of Immediate Breast Reconstruction: An American College of Surgeons National Surgical Quality Improvement Program Study of 24,191 Patients.

The purpose of this study was to assess for compounded risk of postoperative morbidity with the addition of a simultaneous contralateral breast matching procedure at the time of mastectomy and immediate breast reconstruction. 2005 to 2012 American College of Surgeons National Surgical Quality Improvement Program databases were used to identify cases of mastectomy and immediate breast reconstruction with and without simultaneous contralateral breast matching procedures. Matching procedures included mastopexy, reduction mammaplasty, and augmentation mammaplasty. Thirty-day postoperative morbidity was assessed using univariable and multivariable logistic regression. Of 59,766 mastectomy patients, 24,191 (40 percent) underwent immediate breast reconstruction: 903 (3.7 percent) underwent matching procedures and 23,288 (96.3 percent) did not. Univariable logistic regression demonstrated that the matching procedure group had statistically significantly higher overall morbidity (OR, 1.288; 95 percent CI, 1.022 to 1.623; p = 0.032). Although surgical and systemic morbidity did not differ significantly, the matching procedure group demonstrated higher risk for superficial surgical-site infection (OR, 1.57; 95 percent CI, 1.066 to 2.31; p = 0.022), reconstruction failure (OR, 1.69; 95 percent CI, 1.014 to 2.814; p = 0.044), and pulmonary embolism (OR, 2.54; 95 percent CI, 1.01 to 6.37; p = 0.048). Controlling for possible confounders, multivariable logistic regression rendered the relationship between matching procedure and complications insignificant (OR, 1.17; 95 percent CI, 0.92 to 1.48; p = 0.2). These data suggest that preoperative comorbidities and other patient-related factors may have a larger influence on postoperative morbidity than the addition of a contralateral matching procedure alone. Therapeutic, III.

Abstract: Reverse Abdominoplasty, a Viable Option for Breast Reconstruction

INTRODUCTION: The reverse abdominoplasty was first described in the 1970’s, and since then, it has been described for reconstruction of thoracic wall defects, upper abdominal wall contouring, and augmentation mammaplasty.1 It has received little attention in the literature, it can however be a useful method of breast reconstruction in a select group of patients, such as those who are obese. We present a series of 3 patients who underwent post-mastectomy breast reconstruction with the reverse abdominoplasty flap after being found unsuitable for other methods of breast reconstruction. METHODS: Three patients underwent breast reconstruction with reverse abdominoplasty, and complication and Breast-Q data were obtained prospectively. Patient 1 is a 55-year-old lady with a body mass index (BMI) of 48.30, who underwent 2 stage bilateral breast reconstruction with reverse abdominoplasty and insertion of tissue expanders. Patient 2 is a 49-year-old lady with a BMI of 38.40, who underwent 2 stage bilateral breast reconstruction with reverse abdominoplasty and insertion of tissue expanders. Patient 3 is a 36-year-old lady with a BMI of 28.00, who underwent reverse abdominoplasty to correct a unilateral partial mastectomy defect. RESULTS: Patients 1 and 3 did not experience any post-operative complications, and Patient 2 experienced minor wound healing problems. All three patients were satisfied with their outcomes, everyone having significant improvements in the Breast-Q scores across various domains. CONCLUSION: Although not for everyone, we present a safe and satisfactory option for breast reconstruction, when other usual methods of breast reconstruction are not available, especially in the obese patient group. DISCLOSURE/FINANCIAL SUPPORT:Supported by Flinders University Postgraduate Research Scholarship (to Dr. Eugene Koh). None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. REFERENCES: 1. Halbesma GJ, van der Lei B. The reverse abdominoplasty: a report of seven cases and a review of English-language literature. Annals of plastic surgery. 2008;61(2):133–137.

Scar Assessment After Breast Augmentation Surgery with Axillary Incision versus Inframammary Fold Incision: Long-Term Follow-Up in Chinese Patients

The inframammary fold (IMF) incision is widely used in Western countries for breast augmentation surgery, whereas the axillary incision is the dominant approach used in China, because many Chinese surgeons believe that the Asian population has a higher risk of developing hypertrophic scars. However, comparative data of scar assessment through different incisions in Chinese patients are scarce. The aims of the study were as follows: (1) to evaluate the outcomes of scar assessment using the Vancouver scar scale (VSS), combined with patient satisfaction scoring, in the scar assessment after breast augmentation surgery; (2) to compare the long-term cosmetic effects of surgical scars between axillary and IMF incisions. Consecutive patients coming to our department for follow-up care at least 1year after primary breast augmentation surgeries with axillary and IMF incisions between January 1, 2014 and December 31, 2014 were included in the research. Internal consistency, inter-rater reliability, and convergent validity were examined for the VSS and patient satisfaction scoring. The baseline characteristics and scar scores were tested using the Mann-Whitney U-test and Student's t test between the two groups. Sixty-one patients underwent implantation surgeries through the axillary incisions, and 17 patients through the IMF incisions. There were no significant differences in age, follow-up time, body mass index, implant volume, or implant projection between groups. Reliability and validity of the VSS and patient satisfaction scoring were satisfactory. The scores of pigmentation were higher in the IMF group than those in the axilla group with statistical significance (P<0.05). The scores of other subscales, overall VSS scores, and patient satisfaction were not statistically significant. The scars were significantly longer in the axilla group compared with the IMF group (P<0.05). The VSS combined with patient satisfaction scoring constitutes an effective tool to evaluate incision scars after augmentation mammaplasty. Scars in the axilla and IMF can achieve comparable cosmetic effects and patient satisfaction in Chinese women. Chinese patients with proper indications can receive breast augmentation surgery through the IMF incision, with fewer risks and less trauma, and get satisfactory scar appearance as through the axillary incision. 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 .

Commentary on: An Anatomic Appraisal of Biplanar Muscle-Splitting Breast Augmentation.

Thank you very much to the editors for the invitation to comment on the cadaveric study, “An Anatomic Appraisal of Biplanar Muscle-Splitting Breast Augmentation.”1 I commend the authors for going back to the anatomy lab to further elucidate the nuances associated with this relatively new approach to breast augmentation. This laboratory study aims to identify a safe zone for performing the biplanar muscle-splitting (BMS) augmentation mammaplasty. I would like to offer my compliments and complements. First let me compliment the authors on a well-structured study and an honest presentation of the weaknesses of the study and areas for future research. Let me also say that I have no personal experience with the BMS technique. Before delving into the merits of the article, it is instructive to revisit the pectoral nerve anatomy to avoid confusion interpreting the literature and this study. The anatomy of the pectoral nerves is a bit confusing. The classic description has the pectoralis major innervated by two nerves; the lateral pectoral nerve and the medial pectoral nerve.2-7 Some authors describe three separate nerves.8-11 One author describes four different nerves.12 The nomenclature can cause confusion as well, anatomists name the nerves according to their origin from the brachial plexus. Unfortunately the course of the medial pectoral nerve is lateral to the lateral pectoral nerve. A very detailed and wonderfully illustrated study of the pectoral nerves by David et al deserves special attention by any aspiring surgeon of the pectoral region.9 In it, they describe a superior, middle, and inferior branch consistently found during 26 brachial plexus dissections. Most importantly the upper two branches (classically referred to as the …

Comparison of long-term changes in breast surface measurements after augmentation mammaplasty: silicone versus saline implants

Comparison of long-term changes in breast surface measurements after augmentation mammaplasty: silicone versus saline implants

Postaugmentation Galactocele Without Periareolar Incision and 8 Years After Pregnancy.

Sir: Galactocele is a rare breast augmentation complication. Addressing the risk factors involved, Harper et al1 found from previous galactocele reports that 100% of the implants were placed through periareolar incisions and 75% of patients either were on oral contraceptives at the time of their surgery or were lactating after pregnancy, with a remote history of augmentation mammaplasty. A recent retrospective study involving 832 patients and 3 (0.36%) cases of galactocele2 found that the use of a periareolar incision significantly increased the incidence of galactorrhea, but no mention toward increased risk of galactocele. We present a case of postaugmentation galactocele formation without periareolar incision and 8 years after her unique pregnancy. Our patient was a 26-year-old, gravida 1, para 0, abortus 1, without any significant medical or surgical history. She stopped oral contraceptives 30 days before and after surgery. An ultrasound scan showed 1 small (1.1 cm3) benign simple cyst in each breast. She underwent bilateral subglandular augmentation mammaplasty with 285 mL high-profile Silimed (Rio de Janeiro, Brazil) silicone gel implant and vertical, infra-areolar skin excess resection. She developed a painful enlargement of her left breast on postoperative day 17, without signs of inflammation or fever (Fig. ​(Fig.1).1). A postoperative ultrasound scan showed liquid collection around the implant but not suggestive of hematoma. A guided needle aspiration removed 89 mL of creamy fluid; the culture was negative for bacterial growth but biochemistry analyses concluded that it was breast milk. The patient was referred to a mastologist who started dopamine receptor agonist (bromocriptine), despite normal prolactin, for 2 weeks with no recurrence. Due to breast and implant pocket enlargement, the patient underwent revision surgery 6 months later to correct the left ptosis (Fig. ​(Fig.2)2) by skin resection, and the implant was moved to a dual plane pocket. The implant on the other side was also moved to the dual plane pocket due to breast symmetry. Fig. 1. Marked enlargement of the left breast at day 17 postoperatively. Fig. 2. Residual asymmetry due to left breast and implant pocket enlargement after galactocele’s treatment at 6 weeks postoperatively. Galactocele’s pathogenesis is still unknown, but obstruction of breast ducts associated with high levels of prolactin may play a significant role.3 Hyperprolactinemia may be due to intercostal nerve stimulation during surgery, leading to autonomic control over central neurogenic paths diminishing dopamine output into hypophysis’ portal circulation, increasing prolactin levels and milk secretion.4 Because our patient had none of the risk factors previously reported5 (periareolar incision, contraceptives intake, recent pregnancy or lactation, or hyperprolactinemia symptoms), we rely our etiopathogenesis hypothesis on duct obstruction because simple cysts were found preoperatively inside breast parenchyma. The treatment involved ultrasound-guided needle aspiration associated with dopamine agonist (bromocriptine) to halt hyperprolactinemia and milk production, which was successful with no recurrence. Other causes of hyperprolactinemia should be ruled out. Although it is rare, surgeons should be aware of this complication in augmentation mammaplasty. Considering the potential increased risk for galactocele, patients with previous thoracic or breast surgery, breast cysts, or spontaneous breast discharge should be assessed preoperatively for prolactin status to correct eventual disorders.

Surgical Timing and the Menstrual Cycle Affect Wound Healing in Young Breast Reduction Patients.

Young female subjects are known to have the highest baseline menstrual hormone levels of any female age group. Studies have found an association between hormone levels and wound healing. This has been researched in the orthopedic, gynecologic, and dermatologic literature, and more recently, in young patients undergoing augmentation mammaplasty. The purpose of this study was to determine whether the timing of surgery relative to the menstrual cycle plays a role in surgical complications following bilateral reduction mammaplasty. All female patients aged 25 years or younger with a documented last menstrual cycle undergoing a bilateral reduction mammaplasty from 2005 to 2013 were reviewed. Surgical timing and postoperative complications relative to the last menstrual cycle were recorded. The preovulatory phase referred to days 1 to 14 after the patient's last menstrual cycle, whereas the postovulatory phase referred to days 15 to 28. Forty-nine patients met inclusion criteria. Undergoing bilateral reduction mammaplasty during the postovulatory phase was associated with development of wound dehiscence and hypertrophic scarring (p < 0.005), which were the most common postoperative complications. Surgery in the preovulatory or postovulatory phase did not affect hematoma, seroma, wound infection, or nipple-areolar complex necrosis rates (p > 0.05). Age, race/ethnicity, body mass index, large resection mass, and medical comorbidities did not affect wound dehiscence or scar hypertrophy rates (p > 0.05). Young patients undergoing bilateral reduction mammaplasty during the postovulatory phase of the menstrual cycle have an increased risk of wound healing issues and poor scarring. This may be attributable to hormonal fluxes occurring during this phase and the already high hormone levels in this population.

Commentary on: Asymmetry of Inframammary Folds in Patients Undergoing Augmentation Mammaplasty.

When patients present with reasonable symmetry in volume, base diameter, and inframammary fold position, breast augmentation can be a predictable, straightforward procedure. Unfortunately, this scenario is not the norm and dealing with preoperative asymmetries in all of these parameters can represent one of the biggest obstacles to providing outstanding results in breast augmentation. It is with this in mind that the findings of this paper prove noteworthy.1 Using computer evaluation software, and admittedly adhering to a strict standard for documenting symmetry, not a single patient in 111 consecutive women was found to be perfectly symmetric. In this patient cohort, differences noted from side to side were found in nipple position, volume, projection, base diameter, and most importantly the position of the inframammary fold. In this study, the right inframammary fold was …

Commentary on: Microbiologic Safety of the Transareolar Approach in Breast Augmentation.

The authors of this article systematically evaluate the bacteria present in the surgical field of a breast augmentation procedure in an attempt to dispel the notion that periareolar augmentation mammaplasty yields a higher rate of capsular contracture than do other approaches.1 The goal is to refute the notion that the breast harbors endogenous bacteria, which are here strictly defined beyond the scope of their original description.2 The concept of endogenous breast bacteria defines bacterial colonies present in significant concentrations and residing within the breast tissue, as opposed to being skin contaminants in the field. As originally described, these bacteria are present in the presumed-sterile surgical field (after skin sterilization) and are consistently identified across sample subjects. Although their exact location has yet to be proven, it is reasonable to imagine that they reside in the ducts, paths that are in fact exposed to the outside world in a similar fashion to the gastrointestinal and urogenital tracts. Even if the ducts harbor similar bacteria to that found on the skin, if that flora is remote from routine skin preparation, then the …

Potential costs of breast augmentation mammaplasty

Augmentation mammaplasty is one of the most common surgical procedures performed by plastic surgeons. The aim of this study was to estimate the cost of the initial procedure and its subsequent complications, as well as project the cost of Food and Drug Administration (FDA)-recommended surveillance imaging. The potential costs to the individual patient and society were calculated. Local plastic surgeons provided billing data for the initial primary silicone augmentation and reoperative procedures. Complication rates used for the cost analysis were obtained from the Allergen Core study on silicone implants. Imaging surveillance costs were considered in the estimations. The average baseline initial cost of silicone augmentation mammaplasty was calculated at $6335. The average total cost of primary breast augmentation over the first decade for an individual patient, including complications requiring reoperation and other ancillary costs, was calculated at $8226. Each decade thereafter cost an additional $1891. Costs may exceed $15,000 over an averaged lifetime, and the recommended implant surveillance could cost an additional $33,750. The potential cost of a breast augmentation, which includes the costs of complications and imaging, is significantly higher than the initial cost of the procedure. Level III, economic and decision analysis study.

Challenging Breast Augmentations: The Influence of Preoperative Anatomical Features on the Final Result.

Achieving satisfactory results may be difficult in augmentation mammaplasty patients in the presence of breast, chest wall, or vertebral deformities. These deformities have not been classified previously, and the impact of each deformity or combination of deformities has not been defined. The aims of this study are to determine the complicating factors in augmentation mammaplasty, to classify these factors according to their influence on surgical outcome, and to develop an identification system for simplifying the recognition of challenging cases. We retrospectively analyzed photographs and records of 100 consecutive patients who underwent augmentation mammaplasty. We observed suboptimal results in 18 cases. Preoperative deformities of the breast, chest wall, and vertebra were recorded in order to determine which factor or factors had complicated the surgeries. Eventually, the relationship between suboptimal surgical results and complicating factors was evaluated. We observed that some deformities alone caused suboptimal results, whereas others did not. Deformities that caused suboptimal results alone were called major complicating factors, and any others were called minor complicating factors. We observed that suboptimal results were also obtained in patients who had four minor complicating factors. Patients who had suboptimal results because of major or minor complicating factors were considered challenging cases. In this study, complicating factors for augmentation mammaplasty were defined and classified as major or minor depending on their effect on the surgical outcome. We suggest an identification system that simplifies the recognition of challenging cases in breast augmentation.

Asymmetry of Inframammary Folds in Patients Undergoing Augmentation Mammaplasty.

Variation in the anatomical position of the inframammary fold (IMF) in women remains poorly studied. The purpose of this study was to evaluate the incidence of asymmetry between IMF locations on the chest wall of women undergoing breast augmentation and to determine breast measurements associated with IMF asymmetry. Three-dimensional imaging analysis of the breasts was performed in 111 women with micromastia, using the Vectra Imaging System(TM). The following measurements were recorded: vertical distance between right and left IMF (inter-fold distance), vertical distance between nipples (inter-nipple distance), and difference between projection of right and left breasts in anterior-posterior direction. Asymmetry between the right and left IMF positions was found in the majority of patients (95.4%), with symmetry only found in 5 patients (4.6%). In the majority of patients (60.3%), the right IMF was located inferior to the left IMF with median inter-fold distance 0.4 cm (range, 0.1, 2.1 cm). In 39 patients (35.1%), the left IMF was located inferior to the right with median inter-fold distance 0.4 cm (range, 0.1, 1.7 cm). There was strong correlation between the degree of asymmetry of IMF and asymmetry of nipple areola complex (NAC) positions (r = 0.687, P < .01). The majority of women with micromastia demonstrate asymmetry of the IMF, which correlates with asymmetry of NAC location. The authors propose a classification system based on most commonly observed IMF locations as types I (right IMF inferior to left), type II (left IMF inferior to right) and type III (both IMF located on the same level). LEVEL OF EVIDENCE 4: Diagnostic.

Surveillance et changement des implants mammaires en gel de silicone : étude rétrospective a propos de 130 cas de rupture d’implants

A recent report from "Agence Nationale de sécurité du medicament et des produits de santé" (ANSM) assesses the rupture of silicone gel breast implants without proposing rules for follow-up and replacement of implants. To demonstrate that systematic follow-up surveillance of silicone breast implants could improve early diagnosis of ruptures; to propose a surveillance protocol based on the findings. This is a multicentric, retrospective study which reports cases of ruptured silicone gel breast implants from January 2006 to June 2014. Using Case-notes from ANSM and quotations from CCAM certificates, 130cases were gathered from 6 centers. The average time between implantation and the diagnosis of ruptures was 9.24 years (± 6.19). Forty cases of ruptured implants (30.8%) originated from original reconstruction or symmetrisation in the context of a breast carcinoma; and 90 (69.2%) originated from augmentation mammaplasty. The average length in reconstructive group was 6.97 years (± 3.33). The difference in the lifetime of the implants between both groups was statistically significant (P = 0.0291). A clinical abnormality led to an imaging assessment in only 19.7% of cases; rupture was thus mainly discovered incidentally either during a systematic breast screening (59.8%), or during a preoperative examination for an aesthetic surgery (20.5%) (P = 0.0082). The results suggest that implant ruptures of silicone gel breast implants are under diagnosed. Clinical follow-up seems insufficient to diagnose implant ruptures. Ultra sound surveillance (± MRI) could be proposed 4 years, 7 years and 10 years after the initial surgery. It does not seem appropriate to propose a systematic change of implant without the incidence of a rupture.

Clinical efficacy of dual plane breast augmentation using perinipple incision

Objective To study the technology and the result of dual plane breast augmentation using nipple margin vertical incision of areola. Methods Totally 60 cases of augmentation mammaplasty were involved in this study. The nipple margin vertical incision of areola was applied obliquely into the breast through the pectoralis major fascia. The rib starting point of pectoralis major were cut off, medial to the side of the sternum. Under the pectoralis major the cavity was peeled according to the preoperative design range. Based on the different situation of the breast types Ⅰ, Ⅱ, Ⅲ, dual plane breast augmentations were stripped respectively. After implanting the breast prosthesis, the upper part of the prosthesis was under the pectoralis major and the lower part was under the mammary gland. Results The 60 patients were all after childbearing, 20 of whom underwent type 2 dual plane breast augmentation, 4 underwent type 3 double plane and the rest underwent type 1 double plane. After 3 months to 2 years follow-up, all cases got satisfactory results, except 1 case of postoperative hematoma and 1 case appeared capsular contracture. Conclusions The nipple margin vertical incision of areola can complete types Ⅰ, Ⅱ, Ⅲ dual plane breast augmentation operation, at the same time it can correct mild-to-moderate mastoptosis. Key words: Augmentation mammoplasty; Mammary areola; Perinipple; Incision

Combining Abdominal and Cosmetic Breast Surgery Does Not Increase Short-term Complication Rates: A Comparison of Each Individual Procedure and Pretreatment Risk Stratification Tool

Combined abdominal and breast surgery presents a convenient and relatively cost-effective approach for accomplishing both procedures. This study is the largest to date assessing the safety of combined procedures, and it aims to develop a simple pretreatment risk stratification method for patients who desire a combined procedure. All women undergoing abdominoplasty, panniculectomy, augmentation mammaplasty, and/or mastopexy in the TOPS database were identified. Demographics and outcomes for combined procedures were compared to individual procedures using χ(2) and Student's t-tests. Multiple logistic regression provided adjusted odds ratios for the effect of a combined procedure on 30-day complications. Among combined procedures, a logistic regression model determined point values for pretreatment risk factors including diabetes (1 point), age over 53 (1), obesity (2), and 3+ ASA status (3), creating a 7-point pretreatment risk stratification tool. A total of 58,756 cases met inclusion criteria. Complication rates among combined procedures (9.40%) were greater than those of aesthetic breast surgery (2.66%; P < .001) but did not significantly differ from abdominal procedures (9.75%; P = .530). Nearly 77% of combined cases were classified as low-risk (0 points total) with a 9.78% complication rates. Medium-risk patients (1 to 3 points) had a 16.63% complication rate, and high-risk (4 to 7 points) 38.46%. Combining abdominal and breast procedures is safe in the majority of patients and does not increase 30-day complications rates. The risk stratification tool can continue to ensure favorable outcomes for patients who may desire a combined surgery. 4 Risk.

Commentary on: transaxillary endoscopic breast augmentation with shaped gel implants.

There has been longstanding resistance to the transaxillary approach to breast augmentation because of a perceived lack of technical control. There is a growing body of literature, however, that suggests many of these views may be outdated and inaccurate. In their recent review article entitled “Evidence Based Medicine: Augmentation Mammaplasty,” Lista and Ahmad suggested that either inframammary or transaxillary incisions were preferred for breast implant placement.1 Their article did not distinguish between the endoscopic and nonendoscopic transaxillary approaches. Two single-surgeon, large patient series supporting the nonendoscopic approach have recently been reported by Mills et al and Gryskiewicz and LeDuc and showed low complication and reoperation rates.2,3 Additionally, Gryskiewicz and LeDuc reported higher patient satisfaction scores reported by transaxillary patients compared with inframammary patients.3 To address the need for added technical control in transaxillary breast augmentation, the addition of endoscopic assistance was initially reported by Price et al in a series of patients undergoing saline implant placement in a partial subpectoral pocket.4 Long-term experience has since shown that endoscopic assistance has allowed for tissue visualization and control of creation of the device pocket in a way that matches the inframammary approach in how the partial subpectoral tissue pocket is created in preparation for implant placement.5 Mills et al compared available data on transaxillary breast augmentation outcomes in …