ABSTRACT
CONTEXT: After massive weight loss, breast changes dramatically becoming ptotic, flat in the upper pole, with significant skin excess. After mastoplasty, often ptosis can recur and the upper pole can lose its fullness again. The technique described in this study treats breast deformities ensuring stable results and avoiding ptosis recurrence. AIM: To analyze a new modality of breast reshaping after massive weight loss, evaluating outcomes and complications as well as patient satisfaction. SETTINGS AND DESIGN: This was a case series. MATERIALS AND METHODS: Fifteen patients (all women, average age, 43.1 years) with bilateral breast ptosis after massive weight loss underwent mastoplasty: the technique included the creation of an inferior pedicle flap that was placed as a prosthesis under the pectoralis muscle and a superomedial pedicle flap containing the nipple-areola complex (NAC). Patients were followed up for at least 6 months, reporting any complications, and measuring the jugulum-NAC distance. Patients' satisfaction was also reported. STATISTICAL ANALYSIS USED: Nil. RESULTS: All patients were extremely satisfied with the breast volume, shape, symmetry, and ptosis correction. The new mammary contour and the distance between the jugular fossa and the nipple were stable during the follow-up and the upper pole maintained its fullness. No major complications were reported. CONCLUSION: Mastoplasty with submuscular autoprosthesis proved to be a safe and effective technique to treat breast deformities after massive weight loss because removed redundant tissue repositioned the NAC and filled the upper pole with stable results over time. A similar technique has not been described yet.
ABSTRACT
Massive weight loss (MWL) brachioplasty is frequently requested for the improvement of the appearance and function of arms. Despite its diffusion, this procedure can be associated with significant complications. Liposuction-assisted brachioplasty (LAB) preserves the vascular, nervous, and lymphatic network and reduces the incidence of postoperative complications. This retrospective cohort study is aimed at analyzing two different modalities of arm contouring after MWL by evaluating the outcomes and complications. Of 31 patients (all females, average age 43.5 years), 20 were managed with standard brachioplasty represented by a swallowtail scar and monobloc resection and 11 with brachioplasty combined with aggressive liposuction. Evaluated parameters included age, body mass index, method of weight loss, and complications rate. No statistical analysis was used. Major postoperative complications (reoperation, bleeding, or thromboembolism) were not reported in both groups. The incidence of minor complications (wound separation, wound infection, and seroma) was globally 42%; the incidence of complications was significantly lower in the LAB group (9% vs. 60%). The incidence of hypertrophic scarring or keloid was higher in the control group (55% vs. 18%). Most patients were satisfied after surgery: in the LAB group, 81.8% of the patients expressed a high degree of satisfaction and 18.2% a good degree of satisfaction after 4 months of follow-up. In our experience, the LAB should be preferred in MWL patients because it has a lower rate of complications and a faster recovery than the standard technique. Proper execution requires considerable technical skill and experience.
ABSTRACT
Extra-oral implants represent a valid alternative technique in aesthetic reconstruction of the craniofacial district in oncology surgery. Two female patients were selected; they were treated from December 2001 to June 2007 by implanting auricular epithesis. The age range was 27 years. They shared the same diagnosis: burns of the auricle-temporal region. The deformity in the auricle region and the complete absence of the pinna convinced the authors to choose this reconstructive method. Most patients showed a good stability of fixtures, epithesis and perimplants soft tissue, in some cases there has been a delay in the time to healing soft tissue perimplant and only one patient has removed the plant after 5 years cancer recurrence. No complications were observed, including bleeding and infections, in the postsurgery period. No report was made in any case of lesion of the facial nerve having the fixtures being positioned in the back and above the point of emergency.
