Breast Lift Algorithm for the Treatment of Breast Implant Illness Requiring Implant Removal.

BACKGROUND: The recommendation of breast lift surgery in the setting of patients requiring breast implant removal is twofold. First, a breast lift is indicated for patients who present with breast mound or nipple-areolar complex ptosis. Second, a breast lift is indicated to accommodate the forecasted redundancy in skin and breast ptosis created by implant explantation. The most popular approaches to mastopexy include the inferior and superior pedicled breast lifts. We present a surgical algorithm with diagrams and cases clarifying mastopexy approaches for patients desiring breast implant removal in patients presenting with breast implant illness syndrome. METHODS: An algorithm was developed to explain the process for selecting the ideal pedicle approach for mastopexy and implant removal surgeries. RESULTS: Three cases are presented to illustrate the application of each pedicle under different presentations and goals. CONCLUSIONS: Advantages of an inferior pedicle include the capacity for unlimited lifting of the nipple-areola complex and for preservation of maximal breast mound volume. Its disadvantages include the inability to remove the breast capsule simultaneously and contraindicated if the lower breast pole is contracted. The advantages of a superior pedicle include the ability to remove the entire capsule and to eliminate lower breast pole if it is contracted. Its disadvantages include limitations to how high the nipple-areola complex can be lifted and the inability to preserve maximal breast mound volume. With the current trend for the request of implant removal in patients presenting with breast implant illness syndrome, the algorithm presented may assist surgeons with selecting the ideal breast lift and implant removal approach. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Optical Coherence Tomography in the Evaluation of the Scalp and Hair: Common Features and Clinical Utility.

BACKGROUND AND OBJECTIVE: Early diagnosis and treatment of hair loss disorders is vital in providing patients with improved psychological outcomes. Non-invasive imaging with optical coherence tomography (OCT) may be useful in characterizing and managing alopecia. Despite expanding clinical applications of OCT in dermatology, guidelines demonstrating in vivo features of normal and alopecic scalp images remain scant. This pilot study aims to provide an atlas of OCT findings of healthy and alopecia subjects, explore diagnostic quantitative endpoints of alopecia, and compare epidermal thickness and follicular density between scalp regions. STUDY DESIGN/MATERIALS AND METHODS: A total of 32 patients (19-76 years old) were enrolled in the study, including healthy patients (n = 6), and patients with scarring alopecia (n = 12) or non-scarring alopecia (n = 14). An in-line fiber-based swept source OCT was used to image five scalp locations at baseline and 6-month visits. Three investigators evaluated each image for gross features, epidermal thickness, and follicular density. RESULTS: Only data from baseline imaging analysis is discussed in this manuscript. Qualitative differences of OCT images are identified in sample images from healthy scalp and each subtype of alopecia studied. Scarring alopecia is characterized by significantly increased epidermal thickness (average Image J pixel units 32 ± 2 compared with non-scarring alopecia [average 28 ± 3] and control [average 27 ± 3]) (P = 0.022) and decreased follicle count (average 35 ± 5 in a 5 × 7 mm2 area compared with control (50 ± 3) and non-scarring patients (47 ± 6)) (P = 0.0052). Scalp location had no impact on epidermal thickness (P = 0.861) or follicular density (P = 0.15). CONCLUSION: OCT holds promise as a non-invasive technique to further characterize and objectively measure alopecia. Larger sample sizes and longitudinal data are needed to improve reliability and determine if additional distinction between alopecia subtypes and treatment monitoring is possible. Lasers Surg. Med. © 2020 Wiley Periodicals, Inc.

The effect of melanin on in vivo optical coherence tomography of the skin in a multiethnic cohort.

BACKGROUND: Noninvasive real-time assessment of living tissue is quickly becoming invaluable for bolstering histologic and dermatoscopic measures of cutaneous conditions. While many skin researchers have explored the utility of noninvasive imaging in inflammatory and malignant skin conditions, there is yet to be a definitive and direct assessment of the effects of melanin on the quality of optical coherence tomography (OCT) imaging and its accuracy in multiethnic patient populations. We conducted a study to evaluate the effects of melanin on the quality of in vivo OCT imaging. METHODS: Volunteers of all Fitzpatrick skin types were imaged once in five skin regions. Images were analyzed for quality, defined quantitatively as depreciation of light as it passes through the depth of skin, and qualitatively as depth and contrast ranked by blinded clinicians. RESULTS: Our analysis of sixteen subjects shows that there is a significant difference in quantitative OCT image quality between light (Fitzpatrick I-III) and dark (IV-VI) skin types for both epidermal (p 0.0328) and dermal levels (p 0.0021). However, there was no significant difference in qualitative blinded rater measures of image clarity (p 0.11) or perceived depth (p 0.13). CONCLUSION: Based on our definition of image quality, our study shows that OCT images taken from darker skin types have slightly lower quality than those taken from lighter skin. However, because blinded rater assessment showed no differences in clarity or perceived depth, we conclude that OCT may be used without hesitation for manual visualization of skin and its appendages in all Fitzpatrick skin types. Further studies are required to more extensively characterize the effects of melanin on OCT imaging. Lasers Surg. Med. 51:407-411, 2019. © 2019 Wiley Periodicals, Inc.