Accurate Plane Fat Grafting in Gluteal Augmentation: An Anatomic Study.

BACKGROUND: The safety of gluteal fat grafting is a global concern in plastic surgery. OBJECTIVE: The goal of this study was to test whether fat grafting to the buttocks with Auto Stop Reach (ASR) technology prevents penetration from the subcutaneous space into the fascia and muscle layers of the buttocks. METHODS: Fat transfer simulation was performed with blue dye on 8 fresh tissue cadaver buttocks by 3 board-certified plastic surgeons (S.S.K., S.C., B.W.). An open control was utilized to visualize the process in the different anatomic layers, and all of the other procedures were performed blindly, akin to live surgery. After blue dye transfer reached maximum capacity (ranging from 400-800 mL per buttock), dissection of the anatomical layers of the buttocks was performed to determine the plane(s) of injection. RESULTS: Blue dye fat transfer injection to the buttocks did not penetrate the gluteal fascia or muscle layers from the subcutaneous space while using ASR. CONCLUSIONS: Auto Stop Reach technology supports the safety of gluteal fat transfer in the subcutaneous space by board-certified plastic surgeons.

Polydioxanone Monofilament Mesh: A Safety Net for Complex Breast Implant Revision Surgery.

BACKGROUND: Breast revision surgeries are complex cases requiring greater pocket control than primary surgeries. Intraoperative techniques to maximize pocket integrity are crucial to achieving an aesthetic result in revisions with implants. OBJECTIVES: Uniform utilization of a polydioxanone (PDO) internal support matrix in a high volume of revision-augmentation cases has, to our knowledge, never before been described. METHODS: A high-volume (n = 104) single-surgeon experience followed patient outcomes in consecutive cases from September 2020 to March 2022. Included in this cohort were patients undergoing revision-augmentations with vertical or wise-pattern mastopexies (n = 74), revision-augmentation without mastopexies (n = 25), and revision without implant exchange (n = 5). Each case employed at least 1 sheet of PDO mesh, with a small set (n = 4) receiving 2 sheets. Patients were followed up (range, 3-19 months), with 3 months minimum follow-up to assess outcomes. RESULTS: The average length of follow-up was 8.8 months. Patients in this cohort had undergone an average of 1.6 prior breast surgeries (range, 1-7). A total 89.4% of patients received an increase in implant volume (average change, +165.2 Cc); 87.5% of patients had favourable aesthetic outcomes, and 12.5% of patients were reoperated on (including reoperations for complications and/or aesthetic reasons). There were 13 complications in the cohort, and no mesh-related complications. CONCLUSIONS: PDO mesh is a safe and effective method of increasing pocket control in breast revision. Supplemental soft-tissue support allowed greater implant volumes to be employed, yielding high rates of patient satisfaction with breast shape, scarring, and long-term aesthetics.

"Never Trust the Skin": A Rationale for Using Polydioxanone Internal Support Matrix to Minimize Scarring in Primary Mastopexy-Augmentation-An Observational Study.

Background: The process of scar formation is complex and multi-factorial. Basic plastic surgery tenets focus on tension-free techniques to optimize aesthetic outcomes and minimize scarring. Objectives: Prophylactic use of a polydioxanone (PDO) internal support matrix in cosmetic mastopexy-augmentation to decrease scar burden has never before been described. Methods: A high volume (n = 41) single-surgeon mastopexy-augmentation experience (S.S.K.) followed scar quality in consecutive cases from June 2020 to July 2021. A minimum of 6 months of postoperative evaluation was required to assess scar quality. Fitzpatrick scores were also evaluated and compared. All surgeries in this study were performed in the dual plane using silicone gel implants, a superior or superomedial dermal pedicle blood supply, and a wise-pattern or vertical scar. Scar quality was evaluated by photography and scored according to an internally developed scar quality scale. Results: There have been no cases of hypertrophic or keloid scarring. All patients receiving mastopexy-augmentation with prophylactic PDO mesh have a favorable appearance with fine line scars, and the mean scar quality scale score across the cohort was 4.341/5. The mean Fitzpatrick scale score across the cohort was 2.97, and, of the patients who scored a 5 on the scar quality index, the mean Fitzpatrick scale score was 3.545. Conclusions: Prophylactic use of PDO internal support matrix in silicone gel mastopexy-augmentation offers further protection against poor scarring in patients across the Fitzpatrick scale, with varying degrees of skin quality, and across medium to high-volume implant augmentations. Patients who received PDO prophylaxis demonstrated a better-than-average scar appearance.

A Rationale for Micro-textured Breast Implant Augmentation.

Background: Textured breast implants have been used in aesthetic breast surgery to decrease rates of malposition and capsular contracture. Recent concerns regarding breast implant-associated anaplastic large cell lymphoma (BIA-ALCL)'s link to textured devices have prompted many physicians to reevaluate their use. Objectives: The authors aimed to create an algorithm for when to use smooth vs micro-textured breast implants and provide their rationale for when micro-textured implants may be more beneficial. Methods: In total, 133 patients received primary augmentations performed by a single surgeon from January 2018 to December 2020; 84 patients received smooth implants and 49 patients received micro-textured implants. All surgeries were performed in the dual plane using an inframammary incision. Implant-related complications and scar malposition were recorded and compared between groups. Results: No significant difference in the prevalence of implant-related complications was found (3.57% for smooth devices and 2.04% for micro-textured devices [P-value 0.621257; 95% CI -0.06100 to 0.007467]). There were no cases of BIA-ALCL. A comparison of scar malposition rates between the smooth and micro-textured groups also revealed no statistically significant difference (15.4% for smooth devices and 8.16% for micro-textured devices [P-value 0.226156; 95% CI -0.1200 to 0.007467]). Patients in the micro-textured group proportionately had more anatomical risk factors for malposition. Conclusions: Micro-textured breast implants continue to be a safe and effective choice for patients. Micro-textured implants show a trend toward decreased scar malposition, although not statistically significant. Patients at high risk for malposition with micro-textured breast implants give similar results to patients at average risk for malposition with smooth implants.

Polydioxanone Internal Support Matrix: A Rationale for Prophylactic Internal Bra Support in Breast Augmentation.

Background: Textured breast implants have been used in aesthetic breast surgery to decrease the rates of implant malposition. A recent analysis of a large-volume single-surgeon experience found statistically similar rates of malposition in smooth vs micro-textured breast implants. Objectives: Prophylactic use of a polydioxanone (PDO) internal support matrix in breast augmentation was hypothesized to prevent scar malposition and increase pocket control. Methods: In total, 200 patients received silicone gel primary augmentations performed by a single surgeon from January 2018 to December 2020; 84 patients received smooth implants alone; 49 patients received micro-textured implants; and 67 patients received smooth implants plus PDO internal support matrix. All surgeries were performed in the dual plane using an inframammary incision. Implant-related complications and scar malposition were recorded and compared. Results: No significant difference in implant-related complication rates was found between shell types (3.57% for smooth devices alone and 2.04% for textured devices [P = 0.62; 95% CI -0.06 to 0.01]). There were zero complications in the smooth plus mesh study arm. A comparison of scar malposition rates between the smooth alone and textured groups revealed no significant difference (15.4% for smooth devices and 8.16% for textured devices [P = 0.23; 95% CI -0.12 to 0.01]). The smooth implant group with the prophylactic placement of PDO mesh had the lowest scar malposition rate of 4.48%, a significant difference compared with the smooth devices alone (P = 0.03; 95% CI -0.21 to -0.01). Conclusions: Micro-textured devices show a trend toward decreased scar malposition, although not significant. Prophylactic use of PDO internal support matrix in silicone gel breast augmentation is safe and has the lowest incidence of scar malposition.