Surgical practices of cosmetic breast augmentation by implants among 411 French plastic surgeons.

INTRODUCTION: Breast augmentation is one of the most frequently performed cosmetic surgeries in the world. However, there is no standardized surgical procedure for performing breast augmentation. Many modalities exist for this surgery which may explain why practices vary greatly from one surgeon to another. The aim of this study was to evaluate current practices of breast augmentation by implant in France and changes in practices among French plastic surgeons. MATERIAL AND METHODS: This observational study was conducted between February 2020 and January 2021. An online questionnaire with 62 questions was sent to 729 French plastic surgeons. The questions concerned: the population of surgeons interviewed, pre-operative aspects, surgical technique and post-operative management. RESULTS: 411 plastic surgeons responded, 5.1% of surgeons impose a nicotine screening test on patients. 99.76% and 95.59% reported that they used silicone gel implants and round prostheses. All used smooth or micro-textured shells. The inframammary approach was the most used by 66.2% of plastic surgeons. The implants placed were between 250 and 300 cc on average and were mainly placed in "Dual plane" by 42% of surgeons. In order to reduce bacterial contamination, 26% of surgeons soaked the implants in a povidone-iodine solution and 23% used an insertion sleeve. The most frequent early complication was hematoma, while capsular contracture was a late complication. CONCLUSION: This study provides new data on current surgical practices of breast augmentation in France, allowing more informed choices and opening up perspectives for more standardized practices in the future.

Coverage losses of substance in the shoulder.

Losses of substance of the shoulder are less common than elsewhere in the upper limb. They arise essentially from tumors (sarcomas), infectious diseases (hidradenitis) or traumatic events, (burns). The objectives of reconstruction depend on whether the losses of substance are located on the curve of the shoulder or in the axillary area. There exist numerous regional solutions, including perforator, propeller, pedicled and free flaps. The donor region may be the thorax (latissimus dorsi, serratus anterior), the back (trapezium, scapular or subscapular flaps, occipito-cervico-thoracic flap), the anterior surface of the thorax (pectoralis major or minor, supraclavicular, perforators of the acromiothoracic artery, delto-pectoral flap) or arm (brachial lateral or medial). Multitissular reconstructions are also possible in regional and pedicled form, as well as microanastomosed flaps in exceptional conditions.

A preoperative cotininury test for abdominoplasty reduces peri-operative complications.

BACKGROUND: Smoking induces complications in plastic surgery, in particular wound healing delays. Despite a 4-weeks' abstinence asking before and after surgery, some patients denied or hid their consumption. The aim of this study was to evaluate the effectiveness of a cotininury detection test in terms of improvement in outcomes after an abdominoplasty. MATERIAL AND METHODS: This retrospective cohort study included patients who underwent an abdominoplasty with umbilical transposition and lipoaspiration. Current smokers were asked to stop smoking 4 weeks before and after surgery. After 2013, we performed a preoperative cotininury test for patients having abdominoplasty, with a cancellation of surgery in case of positive result. We analyzed the test's effectiveness on delayed healing and on other complications. RESULTS: Two hundred and thirty-five patients were included; 80 were tested and 21,3% had a positive test. There was significantly less delayed healing in the "screening" group than in the "no screening": 20,3% versus 41,5% (P=0,002). Alike, complications were significantly less frequent in the "screening" group than in the "no screening": 18,1% versus 42,3% (P<0,001). CONCLUSION: The routine use of the cotininury test in preoperative abdominoplasties significantly reduces risk of delayed healing and other serious complications. It is an objective test, which is simple, quick and non-invasive. Smoking cessation must be at least 4 weeks before and after the surgery. Following medical advice to cease smoking by the surgeon and anesthetist, referral to an appropriate tobacco-addiction specialist clinic may be helpful for the patient who has difficulty stopping smoking.

Anatomy of the cutaneous lymphatic system of the trunk: a clinico-anatomical study of 90 cutaneous melanomas.

PURPOSE: The cutaneous lymphatic system of the trunk is a complex network, the anatomical knowledge of which remains unclear. The lymphatic system plays a major role in the dissemination of lymphophilic cancers like melanomas. The aim of this study was to improve our knowledge, optimize the care of patients with cutaneous tumors of the trunk, and to use our clinical experience of the topography of pathologic lymph nodes related to cutaneous melanomas and depicted by lymphoscintigraphy. MATERIALS AND METHODS: This prospective study included 90 consecutive patients who had primary resection of cutaneous melanoma of the trunk between June 2011 and January 2015. All patients had lymphatic mapping by lymphoscintigraphy, followed by sentinel lymph node procedure. We compared data of lymphatic imaging (lymphoscintigraphy and SPECT-CT) and surgery. We divided the trunk into 36 regions based on cutaneous anatomical landmarks to determine the topography of the lymphatic system for each tumor. RESULTS: Our study showed cutaneous lymphatic drainage of melanomas of the trunk in 16 different areas. This drainage could be single or multiple. We observed that drainage could be controlateral in medial regions of the trunk, and lymphatic pathway could be retrograde. This drainage could be bilateral for medial regions and mainly into axillary areas for regions above L1 level. Posterior regions of the trunk had more diversity of drainage areas than anterior regions. CONCLUSIONS: Cutaneous lymphatic drainage of the trunk was not limited to axillary and inguinal areas, showed interindividual variability, and was single or multiple, unilateral or bilateral, and unpredictable.

Use of adipose tissue and stromal vascular fraction in hand surgery.

Adipose tissue is an abundant source of various cell types including not only adipocytes, but also progenitor and endothelial cells from thestroma. Interest in adipose tissue has surged since the identification in 2001 of adipose-derived stem cells (ADSCs) and of the stromal vascular fraction (SVF) obtained from adipose tissue by enzymatic digestion and centrifugation. SVF has been proven effective in ensuring tissue regeneration, thus improving tissue trophicityand vascularisation. These effects have generated strong interest among both physicians and surgeons, particularly in the field of hand surgery. Several applications have been developed and used, for instance to treat Dupuytren's contracture, systemic sclerosis-related hand lesions, and skin ageing at the hand. Other uses are being evaluated in clinical or animal studies. The objective of this article is to review the capabilities of adipose tissue and their current and potential applications in hand surgery.

[Annular lipoatrophy of the ankles treated by fat grafting: Case report and review of the literature]. / Lipoatrophie annulaire des chevilles traitée par autogreffe de tissu graisseux : à propos d'un cas et revue de la littérature.

INTRODUCTION: Annular lipoatrophy of the ankles is a rare disease. Eleven cases are described in the literature. CASE REPORT: We report the case of a 10-year-old girl having an annular lipoatrophy of the ankles. The clinical history begins with the appearance of inflammatory infiltrated nodules at the two legs, which have evolved in a few months to a circumferential lipoatrophy of the ankles. Laboratory studies showed a very high antistreptolysin O titer, concluding streptococcal origin of this hypodermitis. After two years of stable lesions, the patient received two sessions of fat injection. RESULT/DISCUSSION: A satisfactory outcome of the adipocyte graft was observed with reconstitution of shapely legs, stable over time. Eleven cases described in the literature are found. It is a pediatric pathology seen predominantly in female children. The evolution towards lipoatrophy is systematic with or without treatment initiated at the inflammatory phase. We first discuss the management of aesthetic sequelae of this disease. CONCLUSION: Fat grafting appears to be a good indication for the treatment of the cosmetic sequelae seen in annular lipoatrophy of the ankles.

[Abdominoplasty complications: particularities of the post-bariatric patients within a 238 patients series]. / Complications des abdominoplasties: particularités des patients post-bariatriques au sein d'une série de 238 patients.

BACKGROUND: Obesity is one of the health issues that is recently worldwide increasing, as well as in France. Variety of procedures of bariatric surgery have been developed over the past decade and are performed for morbid obesity hence. The demand of plastic surgery increased for body contouring and reshaping after dramatic weight loss, in which the abdominoplasty is considered as one of the most common procedures. The purpose of this study is to clarify the differences between the post-bariatric patients and others, and their influence on the occurrence of complications following abdominoplasty. PATIENTS AND METHODS: Retrospective study involving a group of post-abdominoplasty patients collected from the same center between January 2000 and December 2010. RESULTS: Among 238 reviewed patients' files; 114 of them are post-bariatric patients, and 124 are non-bariatric patients. Several differences were found between these two groups of patients including the maximum BMI, BMI at the time of surgery, the rates of cardiovascular risk factors, and a longer operative time in the post-bariatric group. The complication rate in these patients was significantly higher (55.3% against 26.6%) with mainly healing problems. Major maximum weight, obesity at the time of surgery, long operative time and postoperative drainage system are all considered as risk factors, which carry high rate of complications. CONCLUSION: It appears that abdominoplasty in post-bariatric patients requires specific care because of particularities inherent in this population.

[Staphylococcus lugdunensis necrotizing fasciitis after abdominal dermolipectomy: report of two cases and review of the literature]. / Fasciites nécrosantes à Staphylococcus lugdunensis après dermolipectomie abdominale : à propos de deux cas et revue de la littérature.

Necrotizing dermohypodermitis is a severe and potential fatal infection of soft tissues. We report two cases of 39- and 41-year-old patients operated of abdominal dermolipectomy and liposculpture after bariatric surgery. Because of a body mass index (BMI) less than 35kg/m(2), and trouble of interpretation of the SFAR recommendations, we have not achieved antibiotics. These patients presented an abdominal necrotizing dermohypodermitis at Staphylococcus lugdunensis, requiring wide excision of necrosis in emergency. The suites have been favorable after surgical and medical care. Perineal proximity, skin and subcutaneous peeling appear to be significant risk factors for this pathology. We suggest if case of abdominal dermolipectomy preventive measures in skin preparation and systematic antibiotics regardless of BMI. Indeed, the risk of a necrotizing dermohypodermitis recalls the importance of rigorous prevention and early diagnosis.

[Breast augmentation by Poly Implant Prothèses silicone implants: retrospective study about 99 patients. Rupture analysis and management]. / Augmentation mammaire par prothèses en gel de silicone de la marque Poly Implant Prothèses (PIP) : étude rétrospective de 99 patientes. Analyse des ruptures et prise en charge.

BACKGROUND: Breast augmentation is one of the most frequent intervention in plastic surgery. In March 2010, the Afssaps has withdrawn from the market all the Poly Implant Prothèses (PIP) silicone implants, the authors report a retrospective study of 99 patients who had breast augmentation by PIP implants. The aims of this work are to evaluate the ruptures observed with these implants and to propose a management. METHODS: We included in the study 99 patients and 192 silicone gel implants. The interventions were performed between 2005 and 2010. On 192 implants, 184 had a textured surface and eight a smooth one. According to the latest recommendations from the Afssaps, all patients had a clinical examination and an ultrasonography looking for rupture signs. MRI was performed in case of doubt. RESULTS: We found 23 ruptured implants: 18 intracapsular and five extracapsular ruptures, involving 17 patients. We also found 28 patients with axillary lymphadenopathy and eight patients with locoregional silicone spread. Finally, we found that 35 patients had chronic breast pains. CONCLUSION: Given our results, it seems reasonable to withdraw all the PIP silicone breast implants.

[Biometric and morphometric analyse of the umbilicus: about 70 cases]. / Analyse biométrique et morphométrique de l'ombilic. À propos de 70 cas.

PURPOSE OF THE STUDY: More than the first scar present from the birth, the umbilicus is the original and fundamental element, which characterizes the abdomen. It can be analyzed under various aspects: symbolic, artistic, anatomical and morphometric. Its place takes on all its importance in frame of the abdominal plastic surgery. We tried to measure how the position of the umbilicus varies with the age, the weight or the sex… to optimize our abdominoplasties. PATIENTS AND METHOD: We realized a study on the umbilicus from 70 persons to determine its abdominal position in the general population. Some objective measurements between bones projections and umbilicus were realized and analyzed with various parameters (weight, age especially…). Depth of the umbilicus, its situation compared the median line, its dimensions, were noted for each patient. RESULTS: Population was composed of 39 women and 31 men, 35.4 years on average. The umbilicus was measured one centimeter under the line joining the top of the iliac crest. In the group of men, its situated lower. We noted a positive correlation between body mass index (BMI) and height of the umbilicus. More the BMI increases, lower is the umbilicus (R=0,72, P<10(-5)). Similarly, the umbilicus is lower when the age increases (R=0,36, P=0,0022). Its average depth was 15 mm, correlated to BMI (R=0,60, P<10(-7)). Some data about dimensions and form were precised. CONCLUSION: This anatomical and morphometric study could allow a more precise determination of the position, dimensions and form of the umbilicus during abdominoplasty.