Aesthetic Units and Zones of Adherence, Relevance to Planning Incisions in Body Contouring Surgery.

Background: Aesthetic units (AUs) and zones of adherence (ZAs) have been previously noted in the face and torso. A systematic classification of common AUs and ZAs has not been previously described for the torso and extremities. Contour and scars are equally important in obtaining the best result. Therefore, the six principles to consider in body contouring surgery (BCS) are that the resulting scar be anchored at a zone of adhesion; at the interface of AUs; concealed within flexion or extension skin creases, or placed according to conventional usage and experience; positioned on the medial aspect of a limb; hidden when nude, topless, or in a variety of clothing such as one-piece and two-piece swimsuits, crop tops, short sleeves, etc; and positioned to avoid a contracture across a flexion joint crease or a dehiscence across the extension aspect of a joint. Methods: Images of male and female massive weight loss (MWL) patients with a history of MWL were reviewed and analyzed. Results: AUs and Zas are described and codified. An algorithm is provided to aid in planning incisions for BCS. Conclusion: With the increase in BCS after MWL, a classification of AUs and ZAs is considered useful in planning surgery and optimizing the aesthetic result.

Aesthetic Units and Zones of Adherence: Relevance to Surgical Planning in the Head and Neck.

Background: Aesthetic units (AUs) and zones of adherence (ZA) have been previously described in the face; however, a systematic classification of AUs and ZAs together with a unified approach to planning surgery has not been previously described for head and neck surgery. The five principles of surgical planning necessitate respect for AUs, ZAs, and flexion creases; correct scar orientation; and replacing tissue "like for like" by adhering to the four "Ts" of reconstruction (tone, texture, type, and thickness of skin and subcutaneous tissue). Methods: Images of male and female patients and stock images (from iStock) were reviewed and analyzed. Results: AUs and ZAs were described and tabulated. Conclusions: Surgical planning necessitates respect for AUs and ZAs and avoidance of maneuvers that will transgress aesthetic unit interfaces or eliminate AUs. An aesthetic atlas of AUs and ZAs is useful for planning surgery, preventing errors, and optimizing aesthetic results.

Simultaneous Salvage Auto-augmentation: Contemporary Strategy for Management of the Breast Explantation Patient.

The treatment of patients requiring explantation of breast prostheses is a complicated clinical issue, for which a consensus regarding the best way forward is still evolving. We believe that simultaneous salvage auto-augmentation (SSAA) is a viable option for the treatment of patients with explantation. Methods: Sixteen cases (32 breasts) were reviewed over a 19-year period. The management of the capsule is based on intraoperative findings and not on preoperative evaluation because of the poor interobserver correlation of Baker grades. Results: The mean age and clinical follow-up duration were 48 years (range: 41-65) and 9 months, respectively. We observed no complications, and only one patient underwent unilateral surgical revision of the periareolar scar, under local anaesthesia. Conclusions: This study suggests that SSAA with or without autologous fat injection is a safe option for women undergoing explantation, with potential aesthetic and cost-saving benefits. In the current climate of public anxiety regarding breast implant illness, breast implant-associated atypical large cell lymphoma, and asymptomatic textured implants, it is anticipated that the number of patients desiring explantation and SSAA will continue to increase.

Breast Auto-Augmentation: A Versatile Method of Breast Rehabilitation-A Retrospective Series of 107 Procedures.

BACKGROUND: Breast auto-augmentation (BAA) using an inferior pedicle dermoglandular flap aims to redistribute the breast tissue in order to increase the fullness in the upper pole and enhance the central projection of the breast at the time of mastopexy in women who want to avoid implants. The procedure achieves mastopexy and an increase in breast volume. METHODS: Between 2003 and 2014, 107 BAA procedures were performed in 53 patients (51 bilateral, 2 unilateral and 3 reoperations) with primary or secondary ptosis of the breast associated with loss of fullness in the upper pole (n=45) or undergoing explantation combined with capsulectomy (n=8). Six patients (11.3%) had prior mastopexy and 2 (3.7%) patients had prior reduction mammoplasty. The mean patients' age was 41 years (range, 19-66 years). All patients had preoperative and postoperative photographs and careful preoperative markings. Follow-up ranged from 6 months to 9 years (mean, 6.6 months). RESULTS: The range of elevation of the nipple was from 6 to 12 cm (mean, 8 cm). The wounds healed completely with no complications in 50 (94.3%) patients. Three patients had complications including 2 (3.7%) hematomas and 1 (1.9%) partial necrosis of the nipple-areola complex. Three (5.7%) patients were dissatisfied with the level of mastopexy achieved underwent a further procedure. No patient complained of scar hypertrophy. CONCLUSIONS: BAA is a versatile technique for women with small breasts associated with primary or secondary ptosis. It is also an effective technique for the salvage of breasts after capsulectomy and explantation.

Breast autoaugmentation.

A technique using a posteriorly based dermoglandular flap as an augmentation of the superior hemisphere of the breast combined with a periareolar mastopexy and vertical mastopexy is presented. The advantages of combining a periareolar mastopexy, in terms of reducing the length of the vertical scar and preventing areolar distortion, are explained.

Anchor thighplasty.

In the anchor thighplasty technique, the medial thigh lift is extended posteriorly into the infragluteal crease. The advantage is that the posterior thigh is lifted and ptosis of the caudal buttock can be corrected. Patients with buttock ptosis and medial thigh skin laxity without lateral thigh redundancy are ideal candidates.

A classification and algorithm for treatment of breast ptosis.

BACKGROUND: The Regnault classification of breast ptosis is insufficient for determining surgical strategies for different stages of ptosis. OBJECTIVE: A new clinical classification of breast ptosis is proposed that allows greater precision in the development of an appropriate surgical plan. METHODS: Breast ptosis is classified in 1-cm stages, beginning with stage A at 2 cm above the inframammary crease and continuing through stage E at 2 cm below the inframammary crease, with any level of ptosis beyond stage E defined as stage F. Increments of 1 cm were chosen because each level predicts a different amount of skin excision necessary to elevate the nipple-areolar complex to an ideal aesthetic level. An algorithm is provided for defining options for surgical management of the ptotic breast with and without augmentation and for the previously augmented breast. RESULTS: Seventy-three cases of breast ptosis were treated with augmentation mammaplasty, simultaneous areolar mastopexy breast augmentation, Wise mastopexy breast augmentation, and other procedures following the proposed classification system and treatment algorithm. CONCLUSIONS: The new system for staging of breast ptosis is simple and easy to remember and can assist in the planning and evaluation of surgery. (Aesthetic Surg J 2002;22:355-363.).