Breast Augmentation Research Articles

Does the Usage of Drains Create a Risk of Surgical Site Infection During Breast Surgery?

Aim: Drains are used to avoid hematoma, seroma and infection in breast surgery. A topic of debate in breast surgery research is the probability of surgical sites becoming infected through retrograde contamination. In this study, we aimed to determine whether drains cause surgical site infections by using drain tip cultures.
 Material and Methods: This study included 162 breasts of 99 patients who had undergone breast surgeries, including augmentation, reduction, reconstruction and gynecomastia, with the same surgeon. Data on the patients’ demographic characteristics, clinical findings, antibiotherapies, types of surgeries and drain features, such as type, duration of use, output volume and tip cultures, were collected retrospectively. 
 Results: The study included 99 patients—3 male, 96 female—with a mean age of 37.84. The mean body mass index was 24.5. Seven breast augmentations, three gynecomastia surgeries, 37 breast reconstructions with implants, three breast reconstructions with latissimus dorsi flaps and 49 reduction mammoplasties were performed. We did not observe infectious symptoms, such as fever, hyperemia, abscess or hematoma, in any of the patients. Fifty-six Jackson–Pratt® drains and 106 Hemovac drain tip cultures were evaluated. The mean follow-up duration was 7.16 days, and the mean output volume was 224.66 cc. The drain tip cultures of all the patients were negative.
 Conclusions: According to our analysis, drains did not cause retrograde contamination or surgical site infection.

Breast implant removal and simultaneous aesthetic optimization : Possibilities, technical considerations and outcome analysis

Breast augmentation is currently the leading aesthetic surgical procedure worldwide. Thus, there is ahigh prevalence of women with breast implants demanding serious know-how and expertise concerning long-term complication management. Breast implant carriers can suffer from problems and pathologies making implant removal the best solution. The authors of this article have also been confronted more and more with the unspecified complex of symptoms named breast implant disease (BID), also called breast implant illness (BII). The treatment of choice for BID is implant removal. Analysis of problems and solutions regarding implant removal. Specific patient analysis according to patients' breast and body configuration. Technical considerations for surgery and preoperative planning. Evaluation of the authors' techniques. Evaluation of all patients over aperiod of 3 years requesting implant removal after esthetic augmentation mammoplasty at the authors' department. All patients were treated according to their specific demands regarding breast shape after implant removal. They either received additional mastopexy, lipofilling or both or simple implant removal without further intervention. Demographic, implant-specific, perioperative and postoperative data have been evaluated for all patients. Additionally, all patients were asked to complete aquestionnaire regarding satisfaction and outcome. We observed atrend for more satisfied patients with less invasive procedures (simple implant removal or simultaneous lipofilling vs. explantation and mastopexy ± lipofilling, 1.8vs. 2.0 or 2.6, p = 0.198). Patients' average scoring was better if they suffered from an implant rupture (1.55 vs. 2.17, p = 0.053). Overall, ahigh patient satisfaction has been observed for all procedures. Breast implant carriers can suffer from problems and pathologies making implant removal the best solution. Exactly these patients, consulting their doctor for those problems and questions seem to profit from implant removal. Simultaneous lipofilling and mastopexy of the breast are good options to nevertheless generate an esthetically pleasing result.

Pyoderma gangrenosum with severe systemic features, after augmentation mammoplasty

AbstractWe report a rare life‐threatening presentation of postsurgical pyoderma gangrenosum (PG) after augmentation mammoplasty in a 32‐year‐old woman. Six days after surgery, the patient presented with fever and erythema at surgical wounds. In view of a suspected postsurgical infection, the patient was first treated with antibiotics and removal of breast protheses. In spite of this treatment, in a few days the patient developed a state of shock with multiorgan failure. The antibiotic coverage was broadened several times and multiple extensive surgical debridement with resection of the mammary glands were performed but did not improve the clinical situation. Twelve days after admission, the diagnosis of PG with systemic features was suspected and clinical improvement was observed within 24 h of methylprednisolone administration. PG can mimic the cutaneous and systemic features of necrotizing wound infection of surgical site. Biopsy and culture are critical to differentiating necrotizing neutrophilic dermatosis from necrotizing infection. The diagnosis of this less common form of PG is challenging and this case highlights how the frequent misdiagnosis with infection may result in ineffective antibiotic treatment and how the unnecessary surgical debridement may prolong and exacerbate the condition.

Huge Fibrin Accumulation after Augmentation mammoplasty with similar clinical features Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)

Huge Fibrin Accumulation after Augmentation mammoplasty with similar clinical features Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)

Using Machine Learning to Select Breast Implant Volume.

In breast augmentation surgery, selection of the appropriate breast implant size is a crucial step that can greatly affect patient satisfaction and the outcome of the procedure. However, this decision is often based on the subjective judgment of the surgeon and the patient, which can lead to suboptimal results. The authors aimed to develop a machine-learning approach that can accurately predict the size of breast implants selected for breast augmentation surgery. The authors collected data on patient demographic characteristics, medical history, and surgeon preferences from a sample of 1000 consecutive patients who underwent breast augmentation. This information was used to train and test a supervised machine-learning model to predict the size of breast implant needed. The study demonstrated the effectiveness of the algorithm in predicting breast implant size, achieving a Pearson correlation coefficient of 0.9335 ( P < 0.001). The model generated accurate predictions in 86% of instances, with a mean absolute error of 27.10 mL. Its effectiveness was confirmed in the reoperation group, in which 36 of 57 patients (63%) would have received a more suitable implant size if the model's suggestion had been followed, potentially avoiding reoperation. The findings show that machine learning can accurately predict the needed size of breast implants in augmentation surgery. By integrating the artificial intelligence model into a decision support system for breast augmentation surgery, essential guidance can be provided to surgeons and patients. This approach not only streamlines the implant selection process but also facilitates enhanced communication and decision-making, ultimately leading to more reliable outcomes and improved patient satisfaction.

A multimetric health literacy analysis of online gender affirmation surgery materials: From facial to genital surgery

The transgender patient population is expanding, and gender affirming surgery (GAS) volume is increasing. Accurate, comprehensive, and easily navigable resources on GAS are lacking. We aim to evaluate the readability of online materials for specific gender affirming surgical procedures to identify mechanisms of improving information access for transgender patients. "Facial feminization", "facial masculinization", "MTF breast augmentation", "FTM chest masculinization", "MTF vaginoplasty", "metoidioplasty", and "FTM phalloplasty" were searched on Google. Per keyword, the first 75 text-containing results were included. Text was analyzed for reading difficulty using the Flesch-Kincaid Reading-Ease (FKRE) test and grade level using the Flesch-Kincaid Grade Level (FKGL) formula, Gunning Fog Index (GFI), Simple Measure of Gobbledygook (SMOG), and Coleman-Liau Index (CLI). Scores were compared using independent t-and ANOVA tests (α=0.05). Mean readability scores (FKRE 37.44) and grade-levels (FKGL 12.87, GFI 15.61, SMOG 11.91, CLI 15.00) correlated with college-level difficulty. Masculinizing surgical materials were more difficult to read than feminizing ones (p≤0.023). Top surgery materials were easier to read than facial and genital surgery materials (p≤0.013). Specifically, chest masculinization resources were more difficult to read than those for breast augmentation (p≤0.006). No differences were found between facial feminization and masculinization surgery resources, nor between resources for different gender affirming genital surgeries. Online GAS materials are written above the recommended 6th grade reading-level, with resources for transgender men being significantly more challenging to understand. Improving readability of online resources can help overcome barriers to care for the transgender patient population.

A Safe and Simple Method of Augmentation Mastopexy

Introduction: Combining breast augmentation with mastopexy has historically been considered challenging, with concerns about complications and suboptimal aesthetic outcomes. However, recent data suggest that the combined procedure can be performed safely and effectively. Materials and Method: This article presents a technique for augmentation mastopexy that aims to minimize complications and is safe to perform. The technique focuses on preserving a robust blood supply, minimizing lower breast contour bottoming out, maintaining upper pole fullness, reducing the risk of recurrent ptosis, minimizing scar burden, and avoiding periareolar scar widening. Precise preoperative and intraoperative markings are crucial for achieving long-lasting results. The use of tailor tacking and marking the vertical excess with the patient in an upright position provides a reliable method for determining the amount of soft tissue resection required. Results: The results are shown in the postoperative photographs at 10 days, 1 month, and 3 months, respectively. These are compared with the preoperative photographs of the patient’s features. Discussion: The technique incorporates the use of an implant placed in the dual-plane subpectoral pocket to address upper pole flatness and provide structural support in the lower pole. The article emphasizes the importance of preserving Cooper’s ligaments during skin resection to maintain the supportive role of the skin. Vertical wedge resection of the lower pole is employed to reconstruct the breast cone and create a strong vertical fibrous band, which contributes to the long-term shape and support of the breast. The article also discusses techniques to mitigate nipple-areolar complex widening and emphasizes the importance of patient selection based on specific criteria. Conclusion: Overall, the authors present a safe and simple technique for augmentation mastopexy that aims to achieve long-lasting results with minimal complications. The authors advocate for careful patient selection and adherence to their methodology, which incorporates principles of preserving blood supply, maintaining breast contours, and minimizing scar burden.

FRI397 An Unusual Case Of Galactorrhea- Think About Breast Implants !

Abstract Disclosure: P. rimal: None. C. Musurakis: None. J.L. Gilden: None. Introduction: Elevation of prolactin (PRL) levels can occur due to physiologic or pathologic disorders of lactotroph cells. The most common causes for hypersecretion and resulting galactorrhea (GAL), a milky breast discharge, are pregnancy, breast feeding, hypothyroidism, chronic kidney disease, medications, chest wall trauma, or even stress. Although GAL is a rare complication after breast augmentation or reconstruction surgery, it can be bilateral, ipsilateral or contralateral, and is thought to be self-limiting. GAL can be cosmetically and psychologically distressing. The treatment depends on identifying the underlying cause, severity of symptoms, and can be medical, surgical, and might even necessitate breast implant removal. Clinical case: A 34-year-old Latina female G3P2 AB1 with prediabetes (BMI=22), history of gestational diabetes, and migraine headaches, was referred to the endocrine clinic for elevated PRL levels and 2 years of persistent GAL. Although originally regular, she had 3 months of menometrorrhagia following a COVID booster. She denied recent pregnancy, breast-feeding, breast masses, hirsutism, symptoms of thyroid disorders, chest wall trauma, infection, or symptoms of pituitary dysfunction. She was not taking medications associated with PRL elevation. Upon further evaluation, she reported frequently massaging the bilateral cosmetic breast implants to avoid formation of scar tissue. Lab evaluation showed initial PRL elevation of 35.8 ng/mL (nl=2.8-29.2); with normal LH=10.9 mIU/mL(nl 1.9-12.5) and FSH =4.9 mIU/mL(nl 2.5-10.2); estradiol=200.89 pg/mL(19.5-144.2); progesterone &amp;lt;0.5 ng/mL(nl &amp;lt;0.8);urine pregnancy test negative, HCG normal &amp;lt;2.6 mIU/mL (nl 2.6-4.2) ; ACTH=14 pg/mL (nl 0-47); AM cortisol=13.33 mcg/dL; salivary cortisol=&amp;lt;0.03 and 0.05 mcg/dL(nl 0.004-0.56); free testosterone=3.2 pg/mL(nl 0.1-6.4); SHBG =83.55 nmol/L(nl 17.69-138.26) total testosterone slightly elevated 50 ng/dL (nl 2-45); DHEAS=215 mcg/dL(nl 35-430); normal thyroid tests [(TSH 1.06 uIU/mL(0.550-4.780 ), free T4=1.05 ng/dL(0.76-1.46) Thyroid peroxidase antibody 28 U/mL(0-60)], Pelvic Ultrasound-benign right ovarian cyst and left ovary with subcm. follicles. Normal MRI of pituitary. Mammogram-dense breasts with bilateral implants. A Repeat PRL was 20.4 ng/mL with monomeric PRL normal at 8.6 (3.2-25.2 ng/mL), and later 13.70 ng/mL after stopping massaging of the breasts. The etiology of GAL was attributed to the breast implants with massaging, after excluding all other potential causes. Conclusion: Although other etiologies for galactorrhea should be considered, breast implants with manipulation must always be thought of as a possibility. This case highlights the importance of taking a thorough and complete medical history when evaluating all patients with galactorrhea. Presentation: Friday, June 16, 2023

SAT677 Use Of An Anti-obesity Medication In A Transgender Woman Pursuing Body Mass Index Requirements For Gender-affirming Surgery

Abstract Disclosure: J.M. Taormina: None. A.H. Gilden: None. S.J. Iwamoto: None. Introduction: Obesity prevalence is higher in transgender and gender diverse (TGD) adults compared to the general population. TGD people experience gender minority stress and disparities in lifestyle factors, socioeconomic status and medical comorbidities that likely contribute to excess weight. Gender-affirming hormone therapy (GAHT) has also been associated with increased body weight; oral estrogen with an antiandrogen is associated with increased fat mass and decreased lean mass. Many surgery centers enforce body mass index (BMI) requirements for gender-affirming surgeries (GAS) that limit access for TGD patients with obesity. The most effective and affirming weight management strategies for TGD patients have yet to be determined. Bariatric surgery has been identified as a treatment to address obesity prior to GAS; however, surgical weight loss can delay GAS for 3 years. While anti-obesity medications (AOMs) are effective, literature is needed supporting their use in TGD patients prior to GAS. Clinical Case: We report the case of a 40-year-old transgender woman with BMI 39.6 kg/m2, prediabetes, mixed hyperlipidemia, hypertension, non-alcoholic steatohepatitis (NASH) and congenital solitary kidney who presented for weight loss to qualify for gender-affirming bilateral breast augmentation. Her surgeon required a presurgical BMI &amp;lt;35.0 kg/m2. She had no prior GAS or bariatric procedures. She was taking intramuscular estradiol valerate, oral progesterone, spironolactone, and omeprazole without a history of prior AOM use. She was counseled on lifestyle modification, including recommendations for a reduced calorie diet, regular aerobic and resistance physical activity and sleep hygiene. Given history of prediabetes and NASH and superior mean weight loss with semaglutide compared to other FDA-approved AOMs, she was started on semaglutide 0.25 mg subcutaneously weekly with monthly dose escalation. In 3 months, she lost 17.7 kg or 13.9% total body weight with BMI 34.1 kg/m2. Complications addressed during treatment included acute kidney injury from poor water intake as a potential medication side effect; medication supply issues; limited engagement in physical activity due to lack of social safety, body dysmorphia and wish to limit upper body muscle mass for her desired body contour. Clinical Lessons: This case highlights (1) the need for increased access to affirming weight management services for TGD patients with obesity pursuing GAS and (2) the potential role of AOMs in assisting TGD patients in reaching presurgical BMI targets. Whether BMI requirements for GAS lead to improved surgical outcomes needs additional research. Perspectives on and the impacts of BMI requirements for GAS deserve exploration. Further studies are also needed to evaluate the needs of TGD patients in weight loss interventions and the effects of weight loss and AOMs on GAHT management. Presentation: Saturday, June 17, 2023

Selected aesthetic medicine treatment in patients with autoimmune diseases - a literature review

&#x0D; &#x0D; &#x0D; Introduction Interest in cosmetic procedures has been increasing. Data on practices for correcting aesthetic deficits, including those caused by autoimmune diseases are limited. There are fears of disease reactivation and exacerbation of inflammation after surgery. Aim of the study The aim of the study was to investigate the potential influence and safety of aesthetic medicine treatment - hyaluronic acid, botulinum toxin and breast augmentation with implants in patients with autoimmune diseases. Materials and methods A search was conducted using PubMed and Google Scholar databases. Articles were searched in English using the following key words: autoimmune disease, immunogenicity, inflammation, connective tissue, aesthetic medicine. Results Hyaluronic acid is considered the best filler for cosmetic procedures, mainly due to its lack of immunogenicity. No clinical studies have identified contraindications to the administration of hyaluronic acid-based dermal fillers in patients with inflammatory diseases. Botulinum toxin is essential in alleviating involuntary functions currently associated with dystonia, spasticity, and autonomic disorders. The long-term safety of implants should be assessed concerning genetic and environmental factors and whether the autoimmune disease is in remission.Conclusion With the increasing number of aesthetic procedures using hyaluronic acid, there are more reports of potential adverse events. Most side effects are associated with hypersensitivity reactions. The use of hyaluronic acid products in patients with autoimmune diseases is controversial. However, no clinical studies have identified contraindications to the administration of hyaluronic acid-based fillers. Botulinum toxin is used for healing and pain control in patients with systemic sclerosis who have suffered phalangeal ulcers. Despite epidemiological studies conducted to assess the association between breast implants and autoimmune diseases the results remain inconclusive&#x0D; &#x0D; &#x0D;

Breast Augmentation in Transwomen: Can We have a Formula?

Background Breast augmentation in transwomen is a surgical challenge as there is no available guideline for preoperative assessment of breast implant size, which caters to them specifically. The aim of our study is to derive a formula for preoperative breast implant size estimation, which would remove the personal bias, help in one-to-one discussion, and better understanding, reducing operative time, cost, and revision surgery rate. Methods This is a retrospective study conducted from October 2018 to December 2020. We maintained a routine protocol for measurements in our patients, which has been previously published. Linear multivariate regression equation was applied to derive a formula using minimum of parameters, namely, CC (chest circumference at the inframammary fold [IMF]), POMP (circumference at the point of maximum projection of breast mound), and LOWERDIFF (lower value of difference in each breast between the stretched nipple [IMF] and the nonstretched nipple [IMF distance]). Results A total of 51 transwomen underwent surgery in this period. The mean volume of implant used was 354.51 mL. Complications consisted of pain and discomfort in six patients, delayed healing in two patients, and wound dehiscence in one. A formula for preoperative calculation of breast implant was obtained with these data. A mathematical correlation was found between complications encountered and the percentage by which the inserted implants exceeded the calculated size. Conclusion We could estimate the breast implant size preoperatively through a simple formula that require only four anthropometric measurements. This equation is a significant advantage for the surgeon and a useful tool for patient education. Its usefulness will be established if applied in prospective studies. From our study, it appears 9% above the calculated size is better avoided.

Comparison of Patient Education Materials Generated by Chat Generative Pre-Trained Transformer Versus Experts: An Innovative Way to Increase Readability of Patient Education Materials.

Improving patient education materials may improve patient outcomes. This study aims to explore the possibility of generating patient education materials with the assistance of a large language model, Chat Generative Pre-Trained Transformer (ChatGPT). In addition, we compare the accuracy and readability of ChatGPT-generated materials versus expert-generated materials. Patient education materials in implant-based breast reconstruction were generated by experts and ChatGPT independently. Readability and accuracy of the materials are the main outcomes. Readability of the materials was compared using Flesch-Kincaid score. Accuracy of the materials generated by ChatGPT was evaluated by 2 independent reviewers. Content errors are categorized into information errors, statistical errors, and multiple errors (errors more than 2 types). The content generated by experts had higher readability. The Flesch-Kincaid score is at the 7.5 grade for expert-generated materials, whereas the content generated by ChatGPT is at the 10.5 grade (despite ChatGPT being asked to generate content at the seventh grade level). The accuracy of ChatGPT-generated content is 50%, with most errors being information errors. ChatGPT often provides information about breast reduction or breast augmentation, despite being asked specifically about breast reconstruction. Despite its limitation, ChatGPT significantly reduced the time required to generate patient education materials. Although it takes experts 1 month to generate patient education materials, ChatGPT generates materials within 30 minutes. ChatGPT can be a powerful starting tool to generate patient education materials. However, its readability and accuracy still require improvements.

51P Nanoengineered sonosensitive platelets for synergistically augmented sonodynamic breast tumour therapy by glutamine deprivation and cascading thrombosis

51P Nanoengineered sonosensitive platelets for synergistically augmented sonodynamic breast tumour therapy by glutamine deprivation and cascading thrombosis

Breast implants malposition prevention after aesthetic augmentation mammoplasty

Prevention of breast implant malposition (BIM) after submuscular augmentation mammoplasty (SAMP) for hypomastia is an actual problem, as 4.7–5.2 % of women after primary SAMP and approximately 10 % after repeated SAMP require revision surgery due to this complication. The aim. To determine the effectiveness of prevention of BIM after SAMP by choosing the implant volume depending on the physique of women. Materials and methods. In 112 women, the choice of implant volume for SAMP was carried out in accordance with the High Five approach – the comparison group (Group C), in 46 women according to the developed algorithm – the main group (Group M). The algorithm took into account the risk of BIM in women of different physique depending on the implant volume. If a woman insisted on having a larger implant than was calculated, an additional internal bra was created. One year after SAMP, the amount of BIM was assessed according to the developed methodology, according to which BIM was characterised by the percentage increase in the area of the neo-osseous in relation to the area of the prosthesis. The following categories of BIM were distinguished: absent (insignificant) 1.5 % to 6.4 %, mild – 6.5 % to 10.4 %, moderate – 10.5 % to 20.0 %, significant – more than 20 %. Women's body type was assessed by the Pignet’s Index, which distinguished three categories: strong &lt;16, medium 16–25, and weak 26–35. In group M, the maximum possible implant volume with a low risk of BIM was considered to be for women with a weak physique – 360 ml, medium – 430 ml, strong – 650 ml. Results The mean percentage of BIM was significantly lower in group M (7.2±1.8 %) compared to group C (9.1±6.1 %), p=0.036. At the same time, the incidence of significant BIM significantly decreased from 18 (16.1 %) in group C to 2 (4.3 %) in group M, p=0.044. Moreover, patients in group M had BIM that could be classified as moderate, while in group P, 9 (50 %) women had moderate and 9 significant BIM. In the case of additional creation of an internal bra, there was no significant BIM in any case, the average value of this indicator was 6.3±1.6 % (no or mild BIM). Conclusion. The developed personalised approach to the choice of implant volume, taking into account the physique of women, significantly improves the results of SAMP and prevents significant BIM

Combined Multidisciplinary Gender-Affirming Surgery During the Covid-19 Pandemic: A Model to Optimize Access to Care, Resource Utilization andMedical Readiness forMilitary Patients.

Access to surgical care for gender-affirming surgery (GAS) has been a persistent challenge within the DoD due to long waiting lists, strict insurance requirements, and surgeon/subspecialty scarcity. These issues were magnified during the COVID-19 pandemic response, as limited resources led to postponement of "elective" surgeries. To remedy this, our center organized a multidisciplinary collaboration to perform simultaneous GAS. This model is necessary to optimize the quality-of-life and medical readiness for a particularly marginalized population within the U.S. Military who now constitute roughly 1% of all active duty personnel. In addition, one-stage surgery provides a feasible solution to streamlining care and decreasing DoD personnel health care costs. We present a case describing successful multidisciplinary surgical management of a transgender woman desiring multiple GASs. We include a comparative, cost-benefit analysis to emphasize the advantages of single-stage over multistage surgeries. Our patient is a 24-year-old active duty transgender female who underwent breast augmentation and fat harvesting with plastic surgery, which was immediately followed by simultaneous simple orchiectomy by urology and facial feminizing surgery with otolaryngology. Total operative time was 8.3 hours. Our patient was discharged on post-operative day 1 and had an uneventful recovery without complications. Keys to successful implementation included the judicious, coordinated use of local analgesia as well as the organization of separate operating room bedside tables and scrub techs for each team. Total convalescent leave time and temporary profile duration were reduced by 50% relative to the staged approach: 4 weeks and 3 months versus 8 weeks and 6 months, respectively. Of note, anesthesia provider fees total ∼$8,213 when surgeries are performed as three separate events. For one-stage surgery, anesthesia fees amount to only $1,063 (assuming ∼10 hour anesthesia time with a CRNA provider). Our case study demonstrates that one-stage multidisciplinary surgery can be accomplished without added risk to the patient. Judicious surgical planning, including having surgeons operating at the same time, reduces operative time and provides for efficient operating room utilization. Simultaneous GAS is an effective approach to improve access to surgical care for transgender patients. A single anesthetic enables patients to achieve their surgical goals sooner and to lessen their overall recovery time. This allows service members to return to duty sooner, supporting the Defense Health Agency mission to ensure a medically-ready force. This model should become the standard within MTFs across the DoD, as it promotes improved quality-of-life for patients, decreases personnel costs, and ensures medical readiness.

Technical and Clinical Differences Between Transgender and Cisgender Females Undergoing Breast Augmentation.

Gender-affirming surgery is a quickly expanding field. However, it is facing a shortage of specialized surgeons for a population exceeding 1.4 million individuals. Many studies comparing outcomes between cisgender and transgender patients fail to describe the technical differences of the operation. Breast augmentation in the transgender female patient involves important anatomical, technical, and clinical features that differ from the cisgender female. In this study, we aimed to describe and compare these characteristics between these 2 groups to better inform the new generation of gender-affirming surgeons. A retrospective cohort study of patients who underwent primary breast augmentation between 2009 and 2019 at a specialized tertiary center for transgender care was performed. Mastopexy, secondary augmentation, and reconstructive procedures were excluded. Demographic, operative, and clinical data were collected from medical records. All patients had a minimum of 1 year of follow-up after the initial surgery. Bivariate analysis was performed. A total of 250 cisgender females and 153 transgender females were included. The transgender group showed higher rates of smoking ( P < 0.0001), immunosuppression ( P < 0.0001), obesity ( P < 0.0001), mental health disorders ( P < 0.0001), and hypertension ( P = 0.002). Median base width ( P < 0.0001), sternal notch to nipple distance ( P < 0.0001), and implant size (500 mL [interquartile range, 425-600 mL] vs 350 mL [interquartile range, 325-385 mL]; P < 0.0001) were larger in transgender patients. Transgender patients also demonstrated a stronger correlation between implant size and body surface area ( r = 0.71, P < 0.0001). Readmission, reoperation, and complication rates were similar between the groups; however, transgender females had a higher incidence of surgical site infections (3.9% vs 0.4%, P < 0.013). Capsular contracture was the most common complication and indication for reoperation in both groups. There are important anatomical, clinical, and technical differences between reconstructive gender-affirming breast augmentation in transgender female patients and cosmetic breast augmentation in the cisgender female. The gender-affirming surgeon must know these differences to provide the best quality of care and help patients achieve better congruence between their gender identity and body image.

Rupture of 40-year-old silicone gel breast implants: a case report

BackgroundImplant rupture is one of the complications of breast augmentation surgery. The rupture of silicone implants is often insidious, potentially causing problems at any time. This is a case report of the rupture of 145-cc breast implants manufactured by Dow Corning Corporation and their removal at 40 years after augmentation.Case PresentationA 70-year-old female patient was admitted for the removal of a lump in the upper and inner quadrants of the right breast. After a detailed examination, a rupture of the bilateral breast implants was diagnosed. Explantation without replacement was performed; the entire procedure proceeded smoothly. Immunohistochemical staining revealed siliconoma with lymphoid hyperplasia and calcification in the bilateral breasts with no signs of malignancy.ConclusionsSilicone breast augmentation is one of the most popular aesthetic surgical procedures worldwide. Therefore, it is important to educate patients on the need for close monitoring of their implants after augmentation through magnetic resonance imaging or ultrasound to facilitate early detection of any changes before a rupture occurs. Early detection of the implant rupture, in turn, will facilitate early and effective management.

Mammoplastie d’augmentation par injection d’hydrogel de polyacrylamide : rapport d’un cas récent et revue de la littérature

Polyacrylamide hydrogel (PAAG) is a filler that has been strictly prohibited in France for many years. It first appeared on the market in 1980, used as an injectable for breast and facial augmentation, mainly in Asia and Eastern Europe. Like many other materials, it has shown unfavourable results and complications due to a foreign body reaction. It was banned in 2006, but continues to be injected illegally. With the influx of migrants, we are faced with the problem of how to manage complications, which can occur more than a decade later. We report our experience of a recent case in our department that required complete removal of the product and iterative lipofilling, with a result that remains sub-optimal, and we systematically review the literature.

KNOWLEDGE AMONG SULAIMANIYAH POPULATION TOWARDS INJECTABLE FACIAL FILLERS

BackgroundAny operation that involves cosmetic correction and alteration of existing bodily features is referred to as a cosmetic procedure. It also covers surgical operations like liposuction, rhinoplasty, breast augmentation, and minimally invasive procedures like botulinum toxin injections and fillers.&#x0D; ObjectivesTo explore and evaluate participants’ personal and subjective views on facial fillers in the Sulaimani governorate.&#x0D; Patients and MethodsOne hundred and sixty-one participants were recruited over three months from 6 January 2022 to 8 April 2022; all the participants were approached with a questionnaire regarding their personal and subjective views on facial fillers, and informed consent was taken before participating.&#x0D; ResultsThe recruited population for the work includes 111 females and 60 males, with an F/M ratio of 1.85. The main reason listed by most of the participants (n=102, 69.56%) who have or are considering undergoing facial fillers are their concerns about visible ageing signs and facial appearance; the (n=29, 18.01%) listed that people’s influence and the fact that they compare themselves with other people and people from the social media has encouraged them to opt facial fillers.&#x0D; ConclusionHalf of the participants understood the procedure enough, although they needed more information regarding the facial fillers’ side effects. Most participants do not even feel they would need to hide that they have undergone any procedure, which is the ultimate level of acceptance.

A comprehensive evaluation of ChatGPT consultation quality for augmentation mammoplasty: A comparative analysis between plastic surgeons and laypersons

ObjectivesChatGPT has gained significant popularity as a source of healthcare information among the general population. Evaluating the quality of chatbot responses is crucial, requiring comprehensive and qualitative analysis. This study aims to assess the answers provided by ChatGPT during hypothetical breast augmentation consultations across various categories and depths. The evaluation involves the utilization of validated tools and a comparison of scores between plastic surgeons and laypersons. MethodsA panel consisting of five plastic surgeons and five laypersons evaluated ChatGPT's responses to 25 questions spanning consultation, procedure, recovery, and sentiment categories. The DISCERN and PEMAT tools were employed to assess the responses, while emotional context was examined through ten specific questions. Additionally, readability was measured using the Flesch Reading Ease score. Qualitative analysis was performed to identify the overall strengths and weaknesses. ResultsPlastic surgeons generally scored lower than laypersons across most domains. Scores for each evaluation domain varied by category, with the consultation category demonstrating lower scores in terms of DISCERN reliability, information quality, and DISCERN score. Plastic surgeons assigned significantly lower overall quality ratings to the procedure category compared to other question categories. They also gave lower emotion scores in the procedure category compared to laypersons. The depth of the questions did not impact the scoring. ConclusionsExisting health information evaluation tools may not be entirely suitable for comprehensively evaluating the quality of individual responses generated by ChatGPT. Consequently, the development and implementation of appropriate evaluation tools to assess the appropriateness and quality of AI consultations are necessary.