Functional and Therapeutic Indications of Liposuction: Personal Experience and Review of the Literature.

Liposuction is the most common cosmetic surgical procedure worldwide. It has evolved from being designed primarily for body contouring to becoming essential adjunct to various other aesthetic procedures, greatly enhancing their outcome. Despite its hard clear differentiation between an aesthetic and therapeutic indication for some pathologic conditions, liposuction has been increasingly applied to a gamut of disorders as a therapeutic tool or to improve function. In fact, liposuction has ceased to define a specific procedure and became synonymous to a surgical technique or tool same as the surgical knife, laser, electrocautery, suture material, or even wound-dressing products. At present, there seems to be an enormous potential for the application of the basic liposuction technique in ablative and reconstructive surgery outside the realm of purely aesthetic procedures. The present review contemplates the various nonaesthetic applications of liposuction, displaying the enormous potentials of what should be considered a basic surgical technique rather than a specific aesthetic procedure. Implications of this new definition of liposuction should induce third-party public payers and insurance companies to reconsider their remuneration and reimbursement policies.

An innovative procedure for the treatment of primary and recurrent capsular contracture (CC) following breast augmentation.

BACKGROUND: Capsular contracture (CC) is the most frequently reported complication following alloplastic breast augmentation. At present, none of the available preventive measures are effective, and various treatment modalities have been advocated. Reduction of the inflammatory process is critical for successful treatment. Late intracapsular glucocorticosteroid (GC) injections have been somewhat effective for the treatment, but the fine balance between the effectiveness of therapeutic GC dosages and their potential serious side effects is of utmost importance. OBJECTIVES: The authors investigate whether instillation of a rapid-acting water-soluble GC in the implant pocket during the early proliferative phase of wound healing is more effective than delayed instillation during the remodeling phase. METHODS: Between 2003 and 2009, 33 consecutive patients presenting with CC (Baker grades III and IV) were managed by capsulectomy with implant replacement and corticosteroid therapy immediately as well as 2 to 3 days later through an indwelling catheter left in place for that period. This delayed but early administration is a novel technique for GC injection. RESULTS: Complete correction of the contracture with no recurrence was achieved in all patients with a follow-up range of 2 to 10 years. CONCLUSIONS: This GC administration technique avoids the potential complications of long-term, slow corticosteroid release. It has a targeted anti-inflammatory effect, probably at a critical stage of the healing process, and could effectively prevent CC following alloplastic breast augmentation.

Tuberous breast: revised classification and a new hypothesis for its development.

The tuberous breast classification proposed by Grolleau does not account for a minor form of the deformity characterized by isolated nipple-areola protrusion with a normal breast base. We have observed this minor form in six patients with normal breast shape and in ten patients with hypertrophic breasts. We propose an anatomical and physiological hypothesis for the development of the mammary gland. The breast is subjected to hormonal influences as early as the prepubertal period. These influences result in thrusting forces with both horizontal (estrogen) and vertical (progesterone) vectors, unfortunately not always balanced and harmonious. Close observation of the anomaly in our patients substantiated the basic anatomical defect, namely, the structural congenital dermal weakness of the nipple-areola complex (NAC) already described in all forms of tuberous breast deformity. This weakness explains the morphologic anomaly and confirms that all types of tuberous breast deformity constitute a spectrum of a single entity. It indicates also that the classification of tuberous breasts should include, in addition to the three types (types I-III) already described, a fourth type (type 0) to describe isolated simple areola protrusion, either permanent or intermittent, that is associated with a normal mammary base. The revised classification of tuberous breasts and the proposed hypothesis of breast development allow better assessment of all possible variants of breast morphologic anomalies. In the six cases of isolated herniated NAC, the deformity was corrected through a perinipple approach (not circumareolar), with adequate stable correction of the deformity and minimal scarring.