Practice Trends in the Management of Asymptomatic Breast Reconstruction Patients with Textured Implants: A Survey Analysis.

Despite the increasing prevalence of breast implant associated anaplastic large cell lymphoma, there remains a paucity of literature guiding management of asymptomatic patients with textured breast implants. This risk can be anxiety provoking in breast reconstruction patients given their history of cancer or increased future risk. The purpose of this study is to evaluate current practice trends when managing the concerned asymptomatic patient following textured implant-based breast reconstruction. Methods: An electronic survey was distributed to members of the American Society of Plastic Surgeons, regarding management of asymptomatic breast reconstruction patients with textured devices. Anonymous responses were collected, and statistical analysis was performed. Results: A total of 304 responses were received. Of respondents, 237 (92%) have managed asymptomatic patients with textured devices. Historically, the overwhelming majority (89%) used textured devices; however, only 25% report current use. Regarding management of asymptomatic breast reconstruction patients, 87% recommend conservative management, while 13% recommend surgical management. When surgery is performed, 16.3% of respondents elected for implant exchange, 33.8% recommended implant exchange with partial capsulectomy, and 49.8% elected for implant exchange with total capsulectomy. Evaluation of practice patterns based on demographics demonstrated statistically significant differences in current use of textured devices and management of acellular dermal matrix. Conclusions: Despite decreased current use, there is a significant population of asymptomatic breast reconstruction patients with a history of textured devices concerned for risk of breast implant associated anaplastic large cell lymphoma. This survey demonstrates ongoing variability in surgeon recommendations regarding conservative and surgical management of these patients and the need for continued development of evidence-based guidelines.

Management of Asymptomatic Patients With Textured Breast Implants: A Survey Analysis of Members of The Aesthetic Society.

BACKGROUND: The management of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) has been well established. However, there is minimal data and significant variability in the management of asymptomatic textured implant (ATI) patients. OBJECTIVES: The purpose of this study was to survey members of The Aesthetic Society on management of ATI patients in order to understand trends in practice patterns. METHODS: Members of The Aesthetic Society were queried via an electronic survey regarding management of ATI patients. Anonymous responses were collected by QualtricsXM (SAP, Walldorf, Germany) survey software. Descriptive statistics were used to examine the data, reported as frequencies. All analyses were performed with IBM SPSS Statistics 26. RESULTS: The survey was sent to 2149 active and candidate members of The Aesthetic Society with a total of 470 responses (21.87% response rate). For ATI patients presenting with concerns regarding BIA-ALCL risk, 88.8% of respondents educate the patient with clinical follow-up and/or imaging. The other 11.2% of surgeons recommend implant removal with variability in capsulectomy technique. For ATI patients requesting surgery, 42.5% of respondents educate the patient with clinical follow-up and/or imaging. The majority of surgeons (57.6%) recommend removal of the implant, with 30% recommending total capsulectomies. CONCLUSIONS: There is considerable variability in how members of The Aesthetic Society manage ATI patients who request surgery. Future regulatory agency and professional society collaborative efforts should continue to aim for generation of high-level scientific data to aid in the counseling and management of ATI patients.

Defining Ideal External Female Genital Anatomy via Crowdsourcing Analysis.

BACKGROUND: Despite existing anthropometric data in the literature regarding the variation of female external genital anatomy, the ideal aesthetic characteristics have yet to be defined. OBJECTIVES: The authors utilized crowdsourcing to better evaluate preferred anatomic characteristics of external female genitalia. METHODS: Fifty-six total images were digitally created by altering the proportions of the labia minora, labia majora, and clitoral hood. Images with differing ratios were presented in pairs to Amazon Mechanical Turk (Seattle, WA, USA) raters. Three different experiments were performed with each varying 2 of the 3 image characteristics to permit 2-factor modeling. The Bradley-Terry-Luce model was applied to the pairwise comparisons ratings to create a rank order for each image. Preferences for each anatomic variable were compared with chi-squared tests. RESULTS: A total of 5000 raters participated. Experiment 1 compared differing widths of the labia majora and labia minora and determined a significant preference for larger labia majora width and mid-range labia minora width (P = 0.007). Experiment 2 compared labia minora width vs clitoral hood length and showed a statistically significant preference for wider majoras (P < 0.001) but no significant preference in clitoral hood length (P = 0.54). Experiment 3 compared clitoral hood length vs labia minora width and showed a statistically significant preference for mid-range labia minora widths (P < 0.001) but no significant preference in clitoral hood length (P = 0.78). CONCLUSIONS: Raters preferred a labia majora to labia minora width ratio of 3:1 with minimal preference in clitoral hood length.

Preliminary Outcomes of Hypochlorous Acid as an Adjunct for Pocket Irrigation in Revision Aesthetic Breast Surgery.

BACKGROUND: Capsular contracture is a challenging problem for plastic surgeons despite advances in surgical technique. Breast pocket irrigation decreases bacterial bioburden. Studies have shown that hypochlorous acid (HOCl; PhaseOne Health, Nashville, TN) effectively penetrates and disrupts biofilms; however, there are limited clinical data regarding this irrigation in breast augmentation. OBJECTIVES: The aim of this study was to investigate the effects of HOCl pocket irrigation in revision breast augmentation by evaluating rates of capsular contracture recurrence, infection, and allergic reactions. METHODS: We performed an institutional review board-approved retrospective chart review of revision breast augmentation cases for Baker grade III/IV capsular contractures in which pockets were irrigated with HOCl. Data were obtained from 3 board-certified plastic surgeons. RESULTS: The study included 135 breasts in 71 patients, who ranged in age from 27 to 77 years (mean, 53.7 years). Follow-up ranged from 12 to 41 months (mean, 20.2 months). Postoperatively, there were 2 unilateral Baker grade III/IV recurrences at 13 months and 1 bilateral Baker grade II recurrence at 3 months. There were no infections or allergic reactions. The overall Baker grade III/IV capsular contracture recurrence rate was 0% at 12 months and 1.5% at 15 months. CONCLUSIONS: Breast pocket irrigation decreases bioburden, which may influence capsular contracture recurrence. We evaluated 3 varied applications of HOCl in revision aesthetic breast surgery and found a low capsular contracture recurrence rate and no adverse reactions. We plan to report our findings with HOCl in primary breast augmentation in the future, and other studies are being conducted on the efficacy of HOCl in aesthetic surgery.

Fondaparinux Significantly Reduces Postoperative Venous Thromboembolism After Body Contouring Procedures Without an Increase in Bleeding Complications.

BACKGROUND: It is well established that abdominoplasty confers a uniquely high risk of venous thromboembolism (VTE) complications. However, chemoprophylaxis is not routinely utilized due to the risk of bleeding complications. Fondaparinux, a factor Xa inhibitor FDA approved in 2001 for postoperative VTE prophylaxis, has emerged as a safe option for preventing VTE complications after high-risk surgeries. OBJECTIVES: The goal of this study was to examine the effectiveness and safety of fondaparinux for VTE chemoprophylaxis in patients undergoing abdominoplasty. METHODS: This is a single-center retrospective chart review from January 2008 to December 2014 of 492 patients who underwent abdominoplasty with or without an additional body procedure. Prior to 2011, no VTE chemoprophylaxis was utilized (n = 233). In 2011, the routine employment of postoperative chemoprophylaxis with fondaparinux was implemented (n = 259). Patient demographics and 2005 Caprini scores were evaluated. Primary outcomes included postoperative VTE and bleeding complications. RESULTS: There were no statistical differences in patient demographics or median Caprini score. The treatment group demonstrated a statistically significant reduction in the rate of VTE compared with the nontreatment group (0% vs 2.1%, respectively, P = 0.02). There was no statistically significant difference in the rate of hematoma requiring reoperation between the nontreatment and treatment groups (1.7% vs 2.3%, P = 0.76) or blood loss requiring transfusion (0% vs 0.8%, P = 0.5). CONCLUSIONS: Fondaparinux for VTE chemoprophylaxis after abdominoplasty is efficacious in decreasing the risk of VTE in this susceptible patient population without increasing the risk of postoperative bleeding complications.

Facelift Performed Safely With Local Anesthesia and Oral Sedation: Analysis of 174 Patients.

BACKGROUND: Anesthesia for elective ambulatory procedures must provide appropriate pain control while minimizing perioperative risk. Local anesthesia in combination with oral sedation provides a safe office-based method of anesthesia for rhytidectomy. OBJECTIVES: The purpose of this analysis was to identify the incidence of traditional outcome parameters in ambulatory rhytidectomy performed with local anesthesia and oral sedation. METHODS: A retrospective chart review was performed on all patients who underwent office-based rhytidectomy under local anesthesia with oral sedation from February 2011 to May 2017. A total of 174 patients were included. The data collected included patient medical and surgical history, medications, body mass index, tobacco use history, operative time, technique, and concurrent procedures. All intraoperative and postoperative complications were recorded. RESULTS: One hundred and sixty-five patients were female (94.8%) and 9 were male (5.2%) a mean age of 57.6 years (SD ± 7.90). There were 46 complications, including 23 hematomas (13.2%), 6 seromas, 6 episodes of emesis, 5 infections, 4 scar deformities, and 2 ear deformities. Of the 23 hematomas, only 2 required operative evacuation with local anesthesia in the office procedure room. Twenty-one hematomas were small and managed with percutaneous needle aspiration, followed by surveillance. The 5 infections resolved after oral antibiotics only. There were no thromboembolic events or hospitalizations. CONCLUSIONS: The use of only local anesthesia in combination with oral sedation safely permits the performance of rhytidectomy with similar incidence of rhytidectomy-related complications without the risk related to general anesthesia.

Low Risk of Skin and Nipple Sensitivity and Lactation Issues After Primary Breast Augmentation with Form-Stable Silicone Implants: Follow-Up in 4927 Subjects.

BACKGROUND: Natrelle 410 implants (Allergan, Inc., Irvine, CA) are approved in the United States for breast augmentation, reconstruction, and revision. OBJECTIVES: To assess the risk of nipple and skin sensation changes and lactation issues in subjects receiving implants for primary breast augmentation and ascertain whether differences based on incision site exist. METHODS: We used 410 Continued Access study data to assess safety and effectiveness of devices implanted via inframammary or periareolar incision sites. Subjects were evaluated preoperatively and at 4 weeks, 6 months, and annually up to 10 years postoperatively. Lactation issues and nipple and skin sensation changes (hypersensitivity/paresthesia, loss of sensation) were assessed. RESULTS: The inframammary and periareolar cohorts comprised 9217 and 610 implanted devices, with mean follow-up of 4.1 years (range, 0-10.1 years) and 4.8 years (range, 0-10.1 years), respectively. In the inframammary cohort, risk of first occurrence of nipple sensation changes was 0.3% (95% CI: 0.2-0.5) at week 4 and month 6, and 0.4% (0.3-0.7) at year 10. Risk of skin sensation changes was 0.0% (95% CI: 0.0-0.2) at week 4, 0.1% (0.0-0.2) at month 6, and 0.1% (0.0-0.3) at all subsequent time points. No nipple or skin changes occurred in the periareolar cohort. Incidence of lactation issues was similar to that reported in postpartum women who did not have breast implants. CONCLUSIONS: We found that the risk of nipple or skin sensation changes and lactation issues is low and provide long-term safety and effectiveness data on subjects receiving implants for primary breast augmentation. LEVEL OF EVIDENCE 3: Therapeutic.

Aesthetic breast surgery: emerging trends and technologies.

The principle subdivisions of aesthetic breast surgery are: breast augmentation, mastopexy (breast lift), and reduction mammoplasty (breast reduction). In each of these subdivisions, emerging new technologies and trends have potential to change the management of specific aesthetic problems of the breast. Given the continued increasing popularity of aesthetic breast surgery, an understanding of these newer developments will assist all practitioners in communicating with their patients and colleagues.