ABSTRACT
The ability to directly harvest thin and superthin perforator flaps without jeopardizing their vascularity depends on knowledge of the microsurgical vascular anatomy of each perforator within the subcutaneous tissue up to the dermis. In this paper, we report our experience with ultrahigh-frequency ultrasound (UHF-US) in the preoperative planning of thin and superthin flaps. Between May 2017 and September 2018, perforators of seven patients were preoperatively evaluated by both ultrasound (using an 18-MHz linear probe) and UHF-US (using 48- and 70-MHz linear probes). Thin flaps (two cases) and superthin flaps (five cases) were elevated for the reconstruction of head and neck oncologic defects and lower limb traumatic defects. The mean flap size was 6.5×15 cm (range, 5×8 to 7.5×23 cm). No complications occurred, and all flaps survived completely. In all cases, we found 100% agreement between the preoperative UHF-US results and the intraoperative findings. The final reconstructive outcomes were considered satisfactory by both the surgeon and the patients. In conclusion, UHF-US was found to be very useful in the preoperative planning of thin and superthin free flaps, as it allows precise anticipation of very superficial microvascular anatomy. UHF-US may represent the next frontier in thin, superthin, and pure skin perforator flap design.
ABSTRACT
BACKGROUND: In the literature on nipple-sparing mastectomy (NSM) with one-stage immediate implant reconstruction, contralateral symmetrisation has drawn little attention, with many surgeons still performing standard cosmetic mammaplasty procedures. However, standard implant-based mammaplasty usually does not result in proper symmetry with the mastectomy side, especially regarding breast projection, overall shape, and volume distribution. METHODS: We retrospectively reviewed 19 consecutive patients undergoing unilateral NSM with immediate prosthetic reconstruction and contralateral simultaneous symmetrisation by using the tailored reduction/augmentation mammaplasty technique between June 2012 and August 2013. RESULTS: The average follow-up time was 13 months (range, 10-24 months). No major complications, such as infection, haematoma, and nipple-areola complex necrosis, were experienced. CONCLUSIONS: Our experience suggests that simultaneous contralateral symmetrisation with tailored reduction/augmentation mammaplasty after unilateral immediate implant reconstruction after NSM facilitates durable and pleasant symmetric outcomes.
Subject(s)
Female , Humans , Breast Implants , Breast , Follow-Up Studies , Mammaplasty , Mastectomy , Mastectomy, Subcutaneous , Necrosis , Retrospective StudiesABSTRACT
Nowadays autologous fat transplant represents an effective cell therapy, due to the fact that a fraction of the lipoaspirate consists of adipose-derived adult stem cells. In this study we retrospectively report the two-year experience of 41 patients treated with autologous fat transplant to repair different breast- related problems. A postoperatively 3 months interval follow-up was performed in association to imaging follow-up, using ultrasound as first step. According to the grading scale, we report the results assisted by the plastic surgeons and the patients. A total of 68 breasts were treated in 65 operations. 38 patients were treated unilaterally and 15 patients bilaterally. In the follow- up we evaluate the clinical outcome using a grading scale consisted of 5 crescent grades, from 1 to 5, based on the patient's satisfaction and on the clinical evidence of the achievement of the desired target. A percentage of 70.7% are classified with a grade over 3. Among 12 patients, one developed small liponecrotic lesion. We confirm that placing small aliquots of fat in the recipient site strongly reduce the phenomenon of liponecrosis on sonography. Thus, our experience confirms that this procedure is an easy, safe, effective and reliable surgical procedure also in the breast.