The Safety of Abdominal Contouring in the Presence of a Gastric Band.

Background: Gastric bands, specifically the Lap-Band, have been widely used for weight loss. However, little is known about the complications associated with abdominal contouring procedures in patients with Lap-Bands. This study aimed to determine the complication rates and consent processes for these procedures. Methods: We conducted a survey study of 300 members of the American Society of Aesthetic Plastic Surgery. Commonly performed abdominal contouring procedures included abdominal liposuction, abdominoplasty, and combined abdominoplasty with abdominal liposuction. Results: The overall infection rate was low (1%) and did not significantly differ between the procedural groups. Abdominoplasty and combined liposuction with abdominoplasty had significantly higher complication rates (4.7% and 10.5%, respectively) than liposuction alone (1%, P = 0.0004). Abdominoplasty procedures also had higher rates of port/tubing malposition (2.3%, P = 0.04) and system leaks (1.6%, P = 0.003). Approximately 59% of plastic surgeons provided written or dictated consent as part of the standard procedural consent to address the presence of the Lap-Band, whereas 8% of plastic surgeons provided a separate written or printed signed consent specifically related to the procedure in the presence of a Lap-Band. Conclusions: Our study supports the relative safety of aesthetic abdominal contouring procedures in patients with gastric bands but highlights the increased risk of complications in the presence of a Lap-Band. Surgeons should use careful dissection techniques to minimize complications and consider involving a bariatric surgeon, especially with abdominoplasty procedures. Surgical consent should explicitly outline the risks identified in this study to ensure that patients are fully informed.

Self-Reported Breast Implant Illness: The Contribution of Systemic Illnesses and Other Factors to Patient Symptoms.

Patients with self-reported breast implant illness (BII) report a range of systemic symptoms which they attribute to having breast implants. The etiology of self-reported BII is unknown. Some patients have limited resolution of symptoms despite implant removal, and the mechanism of persistent symptoms is unclear. Notably, there are a number of prevalent, chronic systemic illnesses and other factors which present with the most common physical symptoms of self-reported BII. Fibromyalgia, chronic fatigue syndrome, autoimmune disorders, and hypothyroidism often produce fatigue, joint and muscle pain, "brain fog," anxiety or depression, and hair loss in affected patients who may or may not have breast implants. Other factors such as anxiety with or without depression, perimenopause, aging, cigarette smoking/marijuana use, and prominent side effects from common medications are known to produce similar symptoms as those reported by patients concerned with BII. The possibility that patients with breast implants have an undiagnosed, chronic illness unrelated to breast implants should be considered as well as other factors which may produce similar symptoms. Plastic surgeons should be aware of the range of illnesses and factors which can produce physical symptoms similar to those of patients with self-reported BII. For patients in which a systemic illness or other factor is felt to play a contributory role to self-reported BII symptoms, referral to an internist or rheumatologist for a thorough history and physical examination to rule out conditions may be prudent before explantation. This may reduce the need for explantation if the etiology of systemic symptoms is found to be unrelated to breast implants.

Correlation between Capsular Contracture Rates and Access Incision Location in Vertical Augmentation Mastopexy.

BACKGROUND: Plastic surgeons commonly use one of three access incisions to place breast implants during vertical augmentation mastopexy, including inframammary, vertical, and periareolar. It is not known whether there is a correlation between capsular contracture and access incision location. The purpose of this study was to investigate in a single-surgeon series the incidence of capsular contracture associated with access incision locations in silicone vertical augmentation mastopexy. METHODS: Patients undergoing a vertical augmentation mastopexy between 2013 and 2017 were studied retrospectively. All patients underwent a standardized, dual-plane breast augmentation with smooth surface silicone gel implants. Patients were evaluated 1 year postoperatively by the Baker scale. RESULTS: A total of 322 patients met study criteria. Eighty-four had periareolar access, 86 had vertical access, and 152 had inframammary access. There were no differences in patient age or mean implant size between the groups. The capsular contracture rate of the periareolar group was 5.36 percent; in the vertical access group, 3.48 percent; and in the inframammary access group, 1.64 percent. Capsular contracture rates correlated inversely to the distance to the nipple-areola complex, with the periareolar access rates the highest, the vertical access rates intermediate, and the inframammary access rates the lowest. Inframammary incisions were associated with lower capsular contracture rates than periareolar incisions when performed in conjunction with vertical augmentation mastopexy ( p = 0.043). Vertical access capsular contracture rates were intermediate between periareolar and inframammary groups. CONCLUSION: Surgeons should take into consideration the capsular contracture rates associated with access incision location when planning or performing vertical augmentation mastopexy. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Higher Prevalence of Capsular Contracture with Second-side Use of Breast Implant Insertion Funnels.

Breast implant insertion funnels have become popular adjuncts to breast implant surgery to reduce access incision length and contact of the implant with the skin of the breast. Although labeled as single-use devices, due to cost considerations, many surgeons use a new breast implant insertion funnel with each patient rather than each breast. The purpose of this study was to evaluate the prevalence of capsular contracture of the first augmentation side and compare it to the second side utilizing one insertion funnel per patient. METHODS: Patients undergoing silicone breast augmentation or silicone augmentation mastopexy with smooth surface silicone implant and utilizing a breast implant insertion funnel were studied. Six hundred consecutive patients (1200 breasts) meeting the study criteria were evaluated. Memory Gel silicone breast implants were utilized for each patient and only patients undergoing augmentation with the same implant size were studied. Patients underwent augmentation with either inframammary or periareolar incisions. RESULTS: A total of 27 capsular contractures were noted, a rate of 2.25%. The rate of capsular contracture was significantly higher with the second-side use of insertion funnels (P = 0.0179). Of the capsular contractures noted, 25.9% occurred on the first side, whereas 74.1% occurred on the second side. Capsular contracture rates were higher on the second side for both access incision locations. Capsular contracture prevalence increased with reuse of the same insertion funnel for the same patient. CONCLUSION: Based on these findings, surgeons should consider utilizing implant insertion devices as single-use, to minimize the capsular contracture risk.

Management of a Common Breast Augmentation Complication: Treatment of the Double-Bubble Deformity With Fat Grafting.

The double-bubble deformity is one of the most common problems in breast augmentation, with or without mastopexy. Classically, open techniques have been used to treat this deformity, including elevation and reconstruction of the inframammary crease or parenchymal scoring. In this study, the author reports experience with a simple, closed technique of serial fat grafting procedures to treat the double-bubble deformity. Twenty-eight patients with double-bubble deformities were retrospectively evaluated. Fifteen patients had undergone primary augmentation, whereas 13 patients had undergone augmentation mastopexy. Eight patients presented with bilateral double-bubble deformity. Up to 3 sessions of fat grafting were performed on each patient, with a mean of 2.1 sessions required for patients in the series. An average of 27 cm3 of fat was injected with each treatment per breast. Fat was injected with a 1.5-mm blunt cannula into the subdermal and superficial breast tissue layers beneath the old inframammary fold. There were no oil cysts, infections, or donor site problems noted in the series. Twelve patients with limited breast tissue underwent magnetic resonance imaging examination at the conclusion of the fat grafting sessions, and no implant injury or disruption was noted. All patients were pleased with the results of treatment, and no revisional surgery was required. This study suggests that fat grafting is an effective treatment of the breast double-bubble deformity. The procedure allows the correction of a challenging deformity with a simple, closed technique which is safe and cost-effective.

Superior results using the islandized hemipalatal flap in palatoplasty: experience with 500 cases.

BACKGROUND: The double-opposing Z-plasty palatal repair, as reported by Dr. Furlow, is one of the most popular methods of primary cleft palate repair. However, the repair as originally described is difficult to perform on wide palatal clefts. The authors have modified the original repair by altering the hard palatal flap design to allow for better mobilization and improved closure of the cleft. METHODS: The authors performed a retrospective review of 500 consecutive children undergoing double-opposing Z-plasty cleft palate repairs with or without islandization of the hemipalate on its vascular pedicle over a 10-year period at Children's Hospital Los Angeles. Children were evaluated based on their age at the time of repair, extent of cleft, and occurrence of postoperative fistulas. RESULTS: Three hundred thirty-two children underwent pedicle lengthening and 168 children did not. The overall fistula rate in this series was 5.0 percent. When the experience of the five cleft surgeons in this series was combined, patients undergoing pedicle lengthening had significantly lower fistula rates (2.1 percent) than patients undergoing palatoplasty without pedicle lengthening (10.6 percent). Patient gender, age, and extent of clefting did not correlate with the rate of fistula formation in this study. There was only one partial flap loss, early in the authors' series. CONCLUSION: The authors' data suggest that a double-opposing Z-plasty palate repair performed with islandization results in lower postoperative fistula rates when compared with repair performed without islandization.