Common Plastic Surgery Procedures Research Articles

A Modified Periareolar Auto-augmentation Mastopexy: Using an Inferolaterally Pedicled Tongue-Shaped Parenchymal Flap.

The increasing demand for correcting ptosis has made mastopexy one of the most common procedures in plastic surgery. While various techniques have been developed, clinical outcomes often require refinement. In this study, we employed an inferolaterally pedicled, tongue-shaped parenchymal flap to perform auto-augmentation mastopexy via periareolar approach. Periareolar double-ring incisions were designed, de-epithelialization was performed between the inner and outer circles. Following subcutaneous separation of the breast parenchyma, an inferolaterally based, tongue-shaped parenchymal flap was elevated and rotated to fill posterior space of the breast, raising the nipple-areola complex (NAC). The parenchyma on both sides of the incision was sutured together to reduce the breast base and enhance central breast projection. The breast measurements and BREAST-Q scores were used to assess clinical outcomes and patients' satisfaction. Patients were also asked to rate their nipple sensation. A total of 34 female patients were retrospectively analyzed after being treated with our modified auto-augmentation mastopexy technique from January 2016 to June 2023. All patients healed without postoperative complications such as poor wound healing, hematoma, infection, or nipple necrosis. Four patients reported decreased nipple sensation postoperatively. Breast measurements revealed improved projection, nipple elevation, and significant reductions in both mammary base width and areola diameter. BREAST-Q scores indicated significant improvements in postoperative breast satisfaction and quality of life. Our modified periareolar auto-augmentation mastopexy provides a viable solution for patients with mild to severe breast ptosis, excluding cases with insufficient breast volume, seeking breast ptosis correction without synthetic materials or implants. This technique delivers natural, aesthetically pleasing results, significantly enhancing both patient appearance and quality of life. 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 .

Specialists Versus Trainees: Long-Term Secondary Deformity After Unilateral Cleft Lip Repair.

Unilateral cleft lip repair is a common procedure in plastic and reconstructive surgery to restore both function and aesthetics. The long-term outcomes of these surgeries can be influenced by various factors, including the experience and position of the surgeon performing the procedure. This study aims to investigate whether there is a significant difference in long-term secondary deformities based on whether the surgery was performed by a specialist or a trainee. This is a retrospective cross-sectional study among unilateral cleft lip patients based on their data records. The study aims to assess the long-term secondary deformity in relation to the position of the surgeon (specialist or trainee) in patients who underwent unilateral cleft lip repair surgery at the Reconstructive Sciences Unit at Hospital Universiti Sains Malaysia (HUSM). Of the 50 patients, the majority (74%) were operated on by a specialist with more than five years of experience. Only 13 patients (26%) were operated on by trainees in the plastic and reconstructive surgery training program. Long-term secondary deformity had no significant relationship with the surgeon's position (chi-squared (χ2)(1) = 5.89, p = 0.08). Long-term secondary deformities were less likely following unilateral cleft lip repair performed by a specialist or senior surgeon. However, the relationship between these secondary deformities and the surgeon's position (specialist or trainee) was statistically insignificant. Therefore, this study urges trainees to be more involved in simple cleft surgeries to enhance their surgical skills and achieve the best outcomes.

A Novel Approach to Incision Marking in Abdominoplasty Using 3D Printing Technology: A Description of Technique.

Abdominoplasty is one of the most common plastic surgery procedures used to improve the appearance and contour of the abdominal region. Despite advances in surgical techniques, achieving optimal aesthetic results with minimal scarring remains a challenge. In this study, we describe a feasible approach to incision marking in abdominoplasty using a three-dimensional-printed incision marking tool. This technique with open source nature has the potential to revolutionize the field of plastic surgery and enhance patient satisfaction. Further studies are needed to confirm our findings and explore the potential applications of three-dimensional printing technology in other aesthetic procedures.

Preconditioning Strategies for Improving the Outcome of Fat Grafting.

Autologous fat grafting is a common procedure in plastic, reconstructive, and aesthetic surgery. However, it is frequently associated with an unpredictable resorption rate of the graft depending on the engraftment kinetics. This, in turn, is determined by the interaction of the grafted adipose tissue with the tissue at the recipient site. Accordingly, preconditioning strategies have been developed following the principle of exposing these tissues in the pretransplantation phase to stimuli inducing endogenous protective and regenerative cellular adaptations, such as the upregulation of stress-response genes or the release of cytokines and growth factors. As summarized in the present review, these stimuli include hypoxia, dietary restriction, local mechanical stress, heat, and exposure to fractional carbon dioxide laser. Preclinical studies show that they promote cell viability, adipogenesis, and angiogenesis, while reducing inflammation, fibrosis, and cyst formation, resulting in a higher survival rate and quality of fat grafts in different experimental settings. Hence, preconditioning represents a promising approach to improve the outcome of fat grafting in future clinical practice. For this purpose, it is necessary to establish standardized preconditioning protocols for specific clinical applications that are efficient, safe, and easy to implement into routine procedures.

Is Piezosurgery Associated with Improved Patient Outcomes Compared to Conventional Osteotomy in Rhinoplasty? A Systematic Review and Meta-Analysis of RCTs.

Background: Rhinoplasty is a common plastic surgery procedure with evolving surgical techniques. This systematic review and meta-analysis compares the outcomes of piezosurgery versus conventional osteotomy in rhinoplasty. Methods: A comprehensive search of six databases yielded 12 randomized controlled trials (RCTs) comparing piezosurgery (292 cases) to conventional osteotomy (338 cases) in rhinoplasty patients. The examined outcomes included postoperative edema, ecchymosis, complications, pain (using the Visual Analogue Scale-VAS), and operative time. Subgroup analyses were conducted based on the assessment timepoint, surgical approach, and outcome grade. The risk of bias was evaluated using the revised Cochrane tool. Results: Piezosurgery showed a significant reduction in the degree of postoperative edema (second and seventh postoperative days) and ecchymosis (second, fourth, and seventh postoperative days). The external approach in piezosurgery demonstrated greater benefits for both outcomes. Piezosurgery was associated with a significant reduction in overall complications, especially mucosal injuries, compared to conventional osteotomy, with no significant difference regarding postoperative hemorrhage. A significant reduction in pain scores and the need for analgesia was observed with piezosurgery. No significant difference was found in operative time. Conclusions: Piezosurgery offers significant benefits in patient outcomes, with similar operative time between both techniques. However, long-term investigations are still needed.

Abstract PO1-20-08: Primary breast implant-associated squamous cell carcinoma with subsequent TEMPUS testing and failure of immunotherapy

Abstract Primary squamous cell carcinoma of the breast is a rare entity, and there are a limited number of cases in the literature describing squamous cell carcinoma arising from breast implants. It has been hypothesized that these implant-associated cancers may arise from epithelialization of the implant capsule followed by chronic inflammation. None of the cases in the literature were treated with immunotherapy. We present a case of an aggressive, primary sarcomatoid squamous cell carcinoma of the breast arising from a breast implant that was treated unsuccessfully with simultaneous chemotherapy and immunotherapy following TEMPUS testing. Introduction: Breast augmentation is the most common plastic surgery procedure performed worldwide, with more than 300,000 done in the United States every year. While breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is extensively discussed in recent literature, other breast implant-associated cancers are rarer and less studied. Breast implant-associated squamous cell carcinoma (BIA-SCC) specifically is an extremely rare complication of breast augmentation and no guidelines for treatment exist. The American Society of Plastic Surgeons (ASPS) released a statement on BIA-SCC on 9/2022 following a safety communication from the FDA, and it is recommended health care providers submit case reports of BIA-SCC to a patient registry. Case study: We present the case of a female patient who underwent bilateral breast augmentation in 2006 with Mcghan textured, pre-pectoral, areolar saline implants. In 2022, she presented with swelling and a lump in her breast and underwent bilateral breast implant removal with capsulectomy. Pathology showed triple negative sarcomatoid squamous cell carcinoma of the right breast capsule. TEMPUS testing on the breast biopsy revealed a PIK3CA mutation and PD-L1 negative status. Her case was discussed with a multi-disciplinary team including plastic surgery, multiple oncologists, and radiation oncology and her clinical picture was determined to be most consistent with BIA-SCC. Based on the KEYNOTE-522 study, she was determined to be a candidate for neoadjuvant therapy with pembrolizumab and chemotherapy as she was newly diagnosed, previously untreated, nonmetastatic, and had a triple negative tumor. She received two cycles of carboplatin, paclitaxel, and pembrolizumab but unfortunately rapidly progressed with chest wall extension, multiple new pulmonary nodules, worsening lymphadenopathy, right ventricular tumor thrombus, and new malignant pleural effusion and was transitioned to hospice. Discussion: Seven cases of BIA-SCC, one case of squamous cell carcinoma (SCC) after liquid silicone injection augmentation, one case of squamous metaplasia on the breast implant capsule, and one case of epithelization of the breast implant capsule have been previously described in the literature (Table 1). None of the available cases of BIA-SCC report TEMPUS testing, and none of the patients were treated with immunotherapy. The origin of BIA-SCC is unclear, but several theories have been described including chronic inflammation leading to conversion of epithelial tissue on the capsule to SCC. It is unknown how the breast implant capsule might become epithelialized to begin with – introduction of epithelium intraoperatively during augmentation, rupture of epidermal cysts, existence of epithelium in the area from a childhood injury or from birth, or epithelization from chronic shear forces from the augmentation or leakage of the implant are all possibilities. With the ongoing data gathering through the FDA patient registry, we will continue to learn more about these rare cancers and potentially get further insight into their origins. Table 1 An overview of cases of BIA-SCC in the literature Citation Format: Emily Podany, Katherine Clifton. Primary breast implant-associated squamous cell carcinoma with subsequent TEMPUS testing and failure of immunotherapy [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-20-08.

Rhinoplasty is a Common Procedure in Plastic Surgery

Rhinoplasty is a surgical procedure that solves aesthetic and functional problems of the nose, such as a protruding nasal septum, humped nose or deviated septum. The nose is the most visible organ on the human body and is therefore the most exposed to the views of others, and for this reason an increasing number of people decide to correct it. In addition to the external deformation, there are also deformations of the internal structures of the nose that cause difficulty breathing

Dynamic alterations in M2 macrophage subtypes enhance flap expansion efficiency and tissue regeneration.

Dilatation of soft skin tissue is a common surgical procedure in plastic surgery. M2 macrophages play a critical role in reducing inflammation, promoting epithelial and vascular endothelial cell proliferation, enhancing collagen synthesis in fibroblasts, and orchestrating extracellular matrix remodelling by promoting angiogenesis, epithelialisation, and fibrosis. Macrophages improve flap survival by promoting microangiogenesis and collagen remodelling. However, the role of macrophages in flap expansion has not yet been investigated. Improving the expansion efficiency of dilatation flaps and promoting flap vascularisation are the pressing problems in the fields of plastic and reconstruction surgery. In the present study, we used a mouse model to assess the effects of macrophage activation on skin expansion, thickness, ultrastructure, intradermal angiogenesis, and collagen and cytokine levels. Our findings revealed dynamic changes in the macrophage content and subtypes within the expansion flaps. The enrichment of M2 macrophages significantly enhanced the efficiency of flap expansion, vascularisation, and collagen synthesis. Our findings underline the pivotal role of M2 macrophages in tissue regeneration at the molecular and biochemical levels. These findings provide a basis for improving flap expansion efficiency using M2 macrophages.

Impact of Sociodemographic and Hospital Factors on Inpatient Bilateral Reduction Mammaplasty: A National Inpatient Sample Analysis

Background: Although reduction mammaplasty remains a common procedure in plastic surgery, its interaction with sociodemographic and economic disparities has remained relatively uncharacterized on a nationwide scale. Methods: Patients who underwent reduction mammaplasty were identified within the 2016–2018 National Inpatient Sample databases. In addition to clinical comorbidities, sociodemographic characteristics, hospital-level variables, and postoperative outcomes of each patient were collected for analysis. Statistical analyses, including univariate comparison and multivariate logistic regression, were applied to the cohort to determine significant predictors of adverse outcomes, described as extended length of stay, higher financial cost, and postoperative complications. Results: The final patient cohort included 414 patients who underwent inpatient reduction mammaplasty. The average age was 45.2 ± 14.5 years. The average length of stay was 1.6 ± 1.5 days, and the average hospital charge was $53,873.81 ± $36,014.50. Sixty (14.5%) patients experienced at least one postoperative complication. Black race and treatment within a nonmetropolitan or rural county predicted postoperative complications (P < 0.01). Black race, lower relative income, and concurrent abdominal contouring procedures also predicted occurrence of extended length of stay (P < 0.01). Hospital factors, including larger bed capacity and for-profit ownership, predicted high hospital charges (P < 0.05). Severity of comorbidities, measured by a clinical index, also predicted all three outcomes (P < 0.001). Conclusion: In addition to well-described clinical variables, multiple sociodemographic and economic disparities affect outcomes in inpatient reduction mammaplasty.

Fibrosis Management Algorithm in Secondary Liposculpture.

Liposuction is considered one of the most common procedures in plastic surgery. However, major postoperative complications such as visceral injury, fluid overload, and necrotizing fasciitis still occur. Likewise, minor complications such as ecchymosis, seromas, infections, and contour irregularities that do not threaten the life of the patient do generate significant dissatisfaction. Current evidence regarding the management of fibrosis after previous liposuction remains limited. The objective of this article is to standardize a management algorithm based on the extensive experience and successful results of the primary author (G.M.). Patients who underwent secondary liposculpture between August 2022 and May 2023 were evaluated prospectively. Inclusion criteria comprised females between 18 and 60 years old, nonsmokers, with a BMI < 35 kg/m2 and a history of previous body contouring surgeries. Identification of the patient's skin condition and subcutaneous lesions in the adipose tissue were obtained in detail. Statistical analysis of preoperative and postoperative medical photographs was also performed with the Fiji Biological image analyzer. Photographic analysis of preoperative and postoperative photographs showed a statistically significant difference between the areas affected by fibrosis (P < .001). The most frequent clinical findings were depressions in 99% of the females (74), followed by soft nodules in 95% (70), hard nodules in 81% (61), adhesions in 47% (35), and finally cutaneous bursas in 4%. Our classification system and management algorithm for fibrosis and contour irregularities is a safe and reliable tool. Results were objectively verified, yielding statistically significant outcomes.

Assessment of Harms Reporting Quality in Randomized Controlled Trials of Aesthetic Rhinoplasty: A Systematic Review.

Rhinoplasty is one of the most common aesthetic plastic surgery procedures. Complications can lead to both aesthetic and functional impairments. The Consolidated Standards of Reporting Trials (CONSORT) Harms statement was developed to promote improved reporting of harm across randomized controlled trials (RCTs). The aim of this systematic review is to assess harms reporting quality across RCTs on aesthetic rhinoplasty. A literature search was conducted in Ovid MEDLINE and Embase databases (January 1, 2005 to August 4, 2023). RCTs which compared 2 or more interventions in rhinoplasty with primarily aesthetic indications and assessed patient-important outcomes were included. The reporting quality was assessed by following a 40-item checklist endorsed by the 2022 CONSORT Harms Extension update. A total of 58 RCTs met the inclusion criteria. Fifteen RCTs addressed harms of treatment in some capacity. Overall, the reporting quality across RCTs was poor, with a median CONSORT Harms score of 33% (range, 16%-83%). A reporting adherence of ≥50% was met by only 8 studies. There was no significant difference in reporting adherence between studies based on journal endorsement of CONSORT or industry vs nonindustry funding sources (P > .05). A high journal impact factor was significantly associated with a higher reporting quality (P = .044). CONSORT Harms reporting adherence was poor across the majority of included RCTs. Future trials on aesthetic rhinoplasty should aim to follow the reporting recommendations endorsed by the CONSORT Harms statement to increase transparency and minimize heterogeneity in harms reporting across studies.

Liposuction Port-Site Protection: Necessity or Needless Expense?

Liposuction is the most common cosmetic plastic surgery procedure in the United States, and lipo-aspiration for fat grafting is gaining in popularity. The results are effective, but complications include seroma, contour irregularities, skin necrosis, and even death. Scarring, dehiscence, and infection at the port site, although minor, are a common and less-discussed problem. To date, no study has examined the local complication profile of patients treated with and without port-site protection. To evaluate the efficacy of silicone port protectors to decrease local complications after liposuction. A retrospective review was performed on 60 consecutive patients treated for cosmetic liposuction or autologous fat transfer between August 2022 and March 2024. The first 30 patients underwent tumescent-based lipo-aspiration without port-site protectors and the following 30 with placement of a segment of suction tubing to protect the skin. Records were reviewed to determine patient demographics, amount of tumescent and aspirate, and complications at the port site. Sixty patients completed the study. There were no significant differences in patient demographics and surgical data between groups. Ten patients in the unprotected group and 2 in the protected group experienced port-site complications (33.3% vs 6.7%, P = .0093). Significantly more patients in the unprotected group experienced wound dehiscence (P = .0095), and there was a trend toward more patients requiring steroid injections and excisions and reclosures (P = .088 and .167, respectively). In this cohort, patients treated with a port protection device suffered fewer local complications, requiring less wound management, steroid injections, and revisions.

Sequential breast and nipple-areolar complex reconstruction after soft tissue necrosis following augmentation mastopexy: a case report

Breast augmentation mastopexy is a common procedure in cosmetic plastic surgery. Augmentation mastopexy has proven to be a relatively safe operation, but surgeons should be aware of and able to cope with disastrous complications such as soft tissue necrosis and nipple loss. The most important consideration in breast reconstruction is the recovery of breast shape and symmetry, as well as the maintenance of the shape of the nipple-areolar complex without any complications. We experienced a case of sequential breast and nipple-areolar complex reconstruction, in which the purse-string suture technique was used to repair medium-sized circular defects accompanied by nipple loss in the central area of both breasts and to preserve the shape of both breast mounds. Modified CV flaps were performed for left nipple reconstruction, and the Elsahy method and the purse-string suture technique were used to reconstruct the right nipple. Tattooing was performed on both breasts for areolar reconstruction. Through sequential reconstruction, the patient achieved satisfactory aesthetic results. In medium-sized, round defects on the central breast accompanied by nipple loss, the pursestring technique is a simple and effective reconstructive option that enables maintenance of the breast mound shape without requiring additional incision or distortion of surrounding structures.

Treatment with selective transcatheter arterial embolization of a ruptured profunda artery perforator after internal thigh liposuction: a case report

BackgroundHemorrhage is an uncommon complication of liposuction that may be trauma-induced by the cannula on the subcutaneous perforators. It usually resolves spontaneously with external compression and results in mild to moderate ecchymosis on the liposuction site. However, in sporadic cases, active bleeding may persist and require urgent intervention for hemostasis.Case presentationWe report the case of a 60-year-old White female who developed a massive hematoma in the hour following liposuction of the right internal thigh, with active bleeding in the subcutaneous plane reported on contrast-enhanced computed tomography. The initial angiogram was conducted in the right common femoral artery and showed active bleeding from a profunda artery perforator. After careful selective catheterization of the feeding artery using a 2.0-French microcatheter, 0.3 mL of Onyx 34 was injected. Control angiography showed no immediate complication and confirmed the exclusion of the pseudoaneurysm. No postoperative event occurred. Blood pressure and hemoglobin levels remained stable throughout the episode.ConclusionsAlthough liposuction is a very common procedure in plastic surgery, hemorrhagic complications may occur and require urgent hemostasis. This case suggests a vital place for interventional radiology in the management of hemorrhagic complications after liposuction.

Topical Tranexamic Acid Does Not Reduce Hematoma in Reduction Mammaplasty: A Double-Blind Randomized Controlled Trial.

Breast reduction mammaplasty is among the most common procedures in plastic surgery, with a 1% to 7% postoperative hematoma incidence reported. Tranexamic acid (TXA) has been shown to reduce perioperative bleeding and need for transfusion when administered intravenously or topically, but it remains underused in plastic surgery. This study aims to investigate whether topical administration of topical TXA reduces postoperative hematoma following breast reduction mammaplasty. A double-blind randomized controlled trial of 98 patients (196 breasts) undergoing bilateral primary reduction mammaplasty at a single academic institution was performed. Patients were used as internal matched controls, with one breast randomized to receive 1000 mg of topical TXA before closure, and the other receiving saline. All members of the surgical team and the patient were blinded as to which breast received the study drug. Postoperative complications, including hematoma within 30 days of surgery, drain outputs, and duration of drain use, were compared between treatment and placebo breasts. The overall hematoma rate was 1.5%. There was no significant association between application of TXA and development of a hematoma ( P = 0.56) or other complications. The hematoma rate of patients enrolled in the trial was similar to the overall rate of hematoma during the study period (1.5% versus 2.4%; P = 0.511). In a multivariate model, TXA was not significantly associated with differences in drain output after controlling for resection weight, age, and duration of drain use ( P = 0.799). No adverse effects or thromboembolic events from TXA were observed. Topical application of TXA does not decrease the incidence of hematoma following reduction mammaplasty. Therapeutic, I.

Health Literacy in Oculofacial Plastic Surgery: A Literature Review.

Patient satisfaction following oculofacial cosmetic procedures depends on preoperative expectations, which may be influenced by online material. Patients with poor health literacy are particularly vulnerable to misinformation and low-quality resources. However, few studies have evaluated the quality of online information on common oculofacial plastic surgeries and procedures. This study aimed to review the literature on the readability and quality of online material related to oculofacial plastic surgery. We conducted a systematic search of the PubMed/MEDLINE database and included 10 studies in our review. Among the readability scores reported in these studies, the lowest was 10, representing a tenth-grade reading level. Furthermore, the online materials were often rated as "poor" quality based on multiple grading scales. Our systematic review of the literature demonstrates that online materials covering common oculofacial plastic surgery procedures are consistently of poor quality and exceed the recommended readability level. Therefore, considering these online materials that influence patient expectations could enable oculofacial plastic surgeons to better tailor their preoperative counseling.

Ethnic Rhinoplasty: A Middle East-Centered Patient Satisfaction Survey Using the FACE-Q Questionnaire.

Background Rhinoplasty is a common and complex plastic surgery procedure. The evaluation of surgical success in rhinoplasty is primarily based on patient satisfaction. The purpose of the study is to assess the characteristics of patients who underwent rhinoplasty and their satisfaction using the FACE-Q questionnaire. Methodology This was a retrospective, cross-sectional study of patients who underwent primary rhinoplasty, septorhinoplasty, or a revision rhinoplasty from 2010 to 2020 at a single center. Patients were asked to complete the FACE-Q nose score pre and postoperatively. Patients also provided information on their sociodemographic characteristics, smoking status, alcohol consumption, number of rhinoplasty procedures, cause of revision, and respiratory symptoms before rhinoplasty. Results This study included 183 patients who underwent rhinoplasty between 2010 and 2020. The mean (SD) age of patients at surgery was 25.92 (8.69) years. There were 156 female respondents (85.2%) and 27 male respondents (14.8%). FACE-Q nose satisfaction scores increased significantly after surgery with a mean of 67.21 ± 22.3 (p = 0.000). The most common reason for revision surgery was tip dissatisfaction. Conclusions The findings of this study show that ethnic rhinoplasty, although a complex procedure, can lead to aesthetically pleasing outcomes in a complex population such as the Middle Eastern population.

Excess Opioid Medication and Variation in Prescribing Patterns Following Common Breast Plastic Surgeries.

Purpose: Excess opioid prescribing has societal impacts including addiction, dependence, and misuse. This study aims to investigate prescribing patterns and self-reported patient experiences with opioid use, pain control, and disposal of unused medication following common breast surgeries. Methods: A total of 46 patients undergoing 5 breast procedures were identified during a predefined 14-week period. All procedures were carried out at a single tertiary care hospital by 9 plastic surgeons. Provincial narcotic monitoring program provided linked prescription information for identified patients. All patients were invited to participate in a telephone interview regarding postoperative opioid use. Results: A total of 41.6% of patients received and filled an opioid prescription following a breast procedure. Hydromorphone was the most commonly prescribed narcotic. The average number of opioid tablets dispensed following breast procedures was 31.9. Four percent of breast patients required an opioid refill. A total of 75% of breast patients used at least 1 over-the-counter analgesic, most commonly acetaminophen alone. Average self-reported pain score and total pain period were not significantly different between those using opioids and those not. A total of 6.7% and 23.1% of patients report returning excess narcotics to a pharmacy, while the majority report still having or self-disposing of excess tablets. Conclusions: Opioids are prescribed in excess for the breast procedures we analyzed. The majority of unused opioids were noted to still be at home or disposed of inappropriately. This suggests a role for reviewing opioid-prescribing patterns for common plastic surgery procedures to reduce the burden of the ongoing opioid epidemic.

PLASTIC SURGERY AFTER BARIATRIC SURGERY: REVIEW OF THE LITERATURE

Plastic surgery is increasingly common for individuals who have undergone bariatric surgery and suffer from excess skin and tissue laxity. A literature review of studies from the past decade found that over 50% of bariatric surgery patients experienced excess skin in the arms and 75.5% experienced it in the abdomen. Plastic surgery can improve the quality of life for these patients by improving appearance and self-esteem. However, potential risks and complications such as infections, bleeding, and poor wound healing should be taken into account before the procedure. The most common plastic surgery procedures include abdominoplasty, breast surgery, brachioplasty, thigh lift, and face and neck lift.

The Moufarrege Total Submuscular Augmentation or How to Preserve Nipple Erogenous Sensation in Breast Augmentation

Breast augmentation is currently one of the most common plastic surgery procedures performed worldwide. However, patients who underwent this procedure always complain of postoperative sensory changes at the nipple areolar complex. The nipple nervous system includes a tactile sensation system and an erogenous sensation system, the latter being less described and commonly overlooked by plastic surgeons performing breast augmentations. The erogenous sensation is supplied by the IVth, Vth and VIth intercostal nerves who run laterally on the surface along the muscular aponeurosis. Both subpectoral (dual plane) breast augmentations and sub-glandular breast augmentations present a real and constant risk of damage to these nerves, resulting in a permanent loss of nipple erogenous sensation. In the Total Submuscular Breast Augmentation approach, the implant is inserted behind the four muscles: the external oblique, the serratus anterior, the pectoralis minor and the pectoralis major. This approach will preserve the three intercostal nerves responsible for the erogenous sensation of the nipple. In this article we describe the surgical technique and the advantages of the total submuscular breast augmentation.