Successful breastfeeding after breast reduction surgery or mastopexy: A retrospective comparative study.

Breastfeeding has been widely encouraged by health care systems for many years. Breast reduction or mastopexy, are very frequent procedures often performed on young women. The main objective of this study is to evaluate the impact of breast surgery on breastfeeding by comparing the success rate of breastfeeding in operated women versus unoperated women. Secondary objectives are to evaluate the breastfeeding success rate according to the surgical technique or the weight resected. A retrospective comparative study was conducted. Women of childbearing age who underwent breast reduction surgery or mastopexy at Henri-Mondor Hospital were contacted to answer a questionnaire about their pregnancies. Two hundred nine patients answered and two groups of patients were constituted, a preoperative group of 104 women who had a pregnancy before surgery and a postoperative group formed by 61 women who had a pregnancy after surgery. Breastfeeding success rate was 82% in the preoperative group versus 41% in the postoperative group. A statistically significant difference was found on the success rate of breastfeeding, as well as the rate of exclusive breastfeeding, with significantly lower rates in the postoperative group. In contrast, there was no significant difference between the different pedicles used, neither according to the weight of the resected gland. The cause of failure in the postoperative group was in most cases insufficient milk. Breast reduction surgery or mastopexy seems to have negative impact on the ability of operated women to breastfeed. This impact is multifactorial so these results should be interpreted with caution and further studies are needed to improve the management of these patients.

The Use of Posterior Auricular Fascia Graft (PAFG) for Slight Dorsal Augmentation and Irregular Dorsum Coverage in Primary and Revision Rhinoplasty: A Prospective Study.

INTRODUCTION: Augmentation and coverage of irregularities of the nasal dorsum remain a challenge in rhinoplasty. Different techniques have been described in the current literature for this purpose. The aim of this study is to assess and illustrate the author experience and outcomes using the posterior auricular fascia graft (PAFG) for dorsal camouflage and augmentation in primary and revision rhinoplasty. MATERIAL AND METHODS: A prospective bicentric study was conducted, including patients with slight dorsal deficiencies and/or with dorsal irregularities following hump resection, trauma or previous rhinoplasty receiving PAFG to improve the rhinoplasty outcome. To objectively assess the graft resorption rate, MRI was performed 2 weeks and 18 months after surgery. To investigate patient satisfaction, the preoperative and 1-year postoperative scores obtained using the rhinoplasty outcomes evaluation (ROE) scale were compared. The scores following a normal distribution obtained for each patient were compared using a paired t-test. RESULTS: Forty-five patients were enroled in this study. Average follow-up duration was 35.4 months. Patients' age ranged from 17 to 57 years. No cases of infection or major graft resorption were observed. No postoperative scars were visible at the donor site. All patients were satisfied after surgery, and a statistically significant difference between pre- and postoperative scores (p<0.0001) was observed. CONCLUSION: This study showed that PAFG is a reliable technique for dorsal camouflage and slight augmentation in primary and revision rhinoplasty. The procedure is safe, easy and quick and only requires a small learning curve. LEVEL OF EVIDENCE II: 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 .

The Thoracodorsal Artery Perforator Flap for the Treatment of Hidradenitis Suppurativa of the Axilla: A Prospective Comparative Study.

BACKGROUND: Hidradenitis suppurativa (HS) is a common chronic condition that is often resistant to conservative treatment and requires a wide and aggressive surgical approach to prevent recurrence. A prospective study was performed comparing the outcomes of thoracodorsal artery perforator (TDAP) flap-based reconstruction and secondary intention closure (SIC) after wide local excision (WLE) of axillary HS. METHODS: A prospective study was conducted on 68 patients with stage 3 axillary HS. Thirty-three patients underwent a WLE procedure and were left to heal by secondary intention (SIC group), and 35 patients underwent immediate reconstruction with a homolateral TDAP flap (TDAP group). Inpatient stay, healing time, postoperative complications rate, and pain were analyzed in both groups, comparing preoperative shoulder function (using Constant-Murley shoulder outcome score) and quality of life (using a dermatology life quality index) with postoperative shoulder function and quality of life. RESULTS: Patients receiving TDAP flaps had significantly faster recovery, fewer complications, and fewer overall number of procedures than those who underwent SIC. All patients reported an improved quality of life after their operation. The TDAP group showed significantly more improvement than the SIC group ( P < 0.001). Patients receiving TDAP flaps reported a significant reduction in pain and discomfort and better shoulder function compared with patients in the SIC group ( P < 0.001). CONCLUSIONS: WLE and TDAP flap-based reconstruction for axillary stage 3 HS provide optimal postprocedural functional results with a low complication rate. Complete remission of the disease was observed after the procedure. Despite the relatively slow learning curve of this procedure, the authors strongly recommend this technique as a very good option for the management of stage 3 axillary HS. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Face Transplant: Indications, Outcomes, and Ethical Issues-Where Do We Stand?

Background: The addition of face allotransplantation (FT) to the head and neck reconstructive surgery arsenal has started a true revolution. This study is aimed at providing an extensive analysis of the current practice of composite tissue allotransplantation. Moreover, a thorough description of pre-procedural, intra-operative, and post-procedural settings, indications, contraindications, outcomes, ethical considerations, and future perspectives is provided. Methods: The authors' experience was supplemented with a literature review performed by using the PubMed, MEDLINE, and Embase databases on 21 February 2022. The search terms used were "face transplantation indications", "face transplantation complications", and "face transplantation ethical issues". Results: The most recent achievements and long-term clinical sequelae of FT are classified and summarized. A large number of records (4435) were identified. Seventy-five articles were assessed for eligibility. Publications without new data and reports with a patient follow-up < 5 years were excluded. Nineteen articles met the criteria for inclusion. Conclusions: The most recent achievements in the field of FT may be combined with cutting-edge regenerative medicine procedures and innovative immunological processing. It is paramount to build strong international networks between the world FT experts in order to achieve higher-level outcomes and reduce the complication rate. Nevertheless, the utmost caution is required in patient selection, clinical assessment, strict follow-up, and rejection management.

The Objective Buttocks Assessment Scale: A New and Complete Method to Assess the Gluteal Region.

BACKGROUND: New treatment methods to improve and enhance the appearance of the buttocks require globally accepted scales for aesthetic research and patient evaluation. The purpose of this study was to develop a set of grading scales for objective assessment of the gluteal region and assess their reliability and validity. METHODS: Twelve photonumeric grading scales were created. Eleven aesthetic experts rated photographs of 650 women in two validation sessions. Responses were analyzed to assess interrater and intrarater reliability. The Rasch model was used as part of the validation process. RESULTS: All the scales exceeded criteria for acceptability, reliability, and validity. Overall interrater reliability and intrarater reliability were both "almost perfect" ( p = 0.15 and p = 0.16, respectively). CONCLUSION: Consistent outcomes between raters and by individual raters at two time points confirm the reliability of the Objective Buttocks Assessment Scale in female patients and suggest it will be a valuable tool for use in research and clinical practice.

Assessment of Patient Satisfaction Using a New Augmented Reality Simulation Software for Breast Augmentation: A Prospective Study.

Background: Breast augmentation is one of the most frequently performed plastic surgery procedures. Providing patients with realistic 3D simulations of breast augmentation outcomes is becoming increasingly common. Until recently, such programs were expensive and required significant equipment, training, and office space. New simple user-friendly programs have been developed, but to date there remains a paucity of objective evidence comparing these 3D simulations with post-operative outcomes. The aim of this study is to assess the aesthetic similarity between a pre-operative 3D simulation generated using Arbrea breast simulation software and real post-operative outcomes, with a focus on patient satisfaction. Methods: The authors conducted a prospective study of patients requiring breast augmentation. Patients were asked to assess how realistic the simulation was compared to the one-year post-operative result using the authors' grading scale for breast augmentation simulation assessment. Patient satisfaction with the simulations was assessed using a satisfaction visual analogue scale (VAS) ranging from 0 (not at all satisfied) to 10 (very satisfied). Patient satisfaction with the surgical outcome was assessed using the BREAST-Q Augmentation Module. Results: All patients were satisfied with the simulations and with the attained breast volume, with a mean VAS score of 8.2 ± 1.2. The mean simulation time took 90 s on average. The differences between the pre-operative and one-year post-operative values of the three BREAST-Q assessments were found to be statistically significant (p < 0.001). Conclusions: Three-dimensional simulation is becoming increasingly common in pre-operative planning for breast augmentation. The present study aimed to assess the degree of similarity of three-dimensional simulations generated using Arbrea Breast Software and found that the use of the software provided a very satisfying representation for patients undergoing breast augmentation. However, we recommend informing patients that only the volume simulation is extremely accurate. On the other hand, it is necessary to not guarantee an absolute correspondence regarding the breast shape between the simulation and the post-operative result.

Surgical treatment of clitoral phimosis.

The clitoris has a crucial role in the feminine pleasure. Chronic inflammatory dermatosis along with post-menopausal atrophy of the vulva and obstetrical traumas can cause clitoral phimosis, thereby compromising its function. Medical treatments exist depending on the etiology, but when irreversible scarring occur, a surgical treatment can be necessary to regain its function. We present here our surgical technique that achieves excellent functional results with low morbidity and the outcome of our patients in order to improve this sexual dysfunction.

One-step facial feminization surgery: The importance of a custom-made preoperative planning and patient satisfaction assessment.

BACKGROUND: The availability of more accurate techniques used for transgender surgery has resulted in an increased number of patients requesting facial feminization surgery (FFS). The aim of this study was to present the FFS pre-operative planning of the authors' male-to-female transsexual patients using photo-editing software, computer-aided design (CAD), modeling, and three-dimensional (3D) printing. MATERIAL AND METHODS: Twenty-five patients underwent FFS between November 2015 and May 2018. They were retrospectively included in this study, and their records were analyzed. Patients' 3D facial models were printed and used for an accurate preoperative planning and shown to the patients. To assess patient satisfaction, the preoperative, six-month, and one-year postoperative scores obtained using Satisfaction With Life Scale (SWLS) and Subjective Happiness Scale (SHS) were compared. The scores following a normal distribution obtained for each patient were compared using a paired t-test. RESULTS: The 3D model preparation mean time was 145±13.2 min. A total of 114 surgical procedures were carried out. The mean operative time was 420±23 min. Patients experienced no postoperative complication. All patients were very satisfied after surgery, with a significant difference between pre- and postoperative scores (p = 0.002; p = 0.03). CONCLUSION: With use of 3D modeling, surgeons are nearing a custom-made surgery era, especially required for complex procedures such as FFS. We suggest using 3D technology for a more accurate preoperative planning.