Complications and Surgical Treatment of Breast Augmentation Using Autologous Fat Transfer and Fillers.

BACKGROUND: Breast augmentation with autologous fat grafting or hyaluronic acid injection requires minimal loss of healthy tissue. With an increasing trend of breast augmentation with these fillers, accompanying complications have also increased. Patients with complications often complain of induration, cyst formation, calcification, and infection, which require surgical treatment. We will discuss these complications and their surgical treatment through our experience of cases. METHODS: This retrospective study included 20 patients who all required surgical treatment due to breast augmentation complications such as induration, cyst formation, calcification, and infection, and who visited us between May 2007 and June 2018. The patients' ages ranged from 25 to 63, and the mean age was 39.9. The material used for breast augmentation was fat for 17 cases, and hyaluronic acid, paraffin, and silicon for one case each. The results were analyzed through plastic surgeons at our hospital. RESULTS: We performed a zigzag incision in the peri-areola margin to 17 of 18 patients for complications of autologous fat grafting and hyaluronic acid injection. The one excluded patient required an adipo-fascial flap from an inframammary fold incision. For one patient with silicon injection complication and one patient with paraffin injection complication, each required mammary gland resection. CONCLUSIONS: A zigzag incision in the peri-areolar margin was useful for treating complications of breast augmentation with autologous fat grafting and hyaluronic acid injection. All cases resulted in inconspicuous fine scars, with high patient satisfaction. However, this incision was insufficient to remove injected silicon and paraffin.

Correction of recurrent inverted nipples with the Sakai method.

An inverted nipple is a congenital condition that can be corrected with established surgical methods, although recurrence sometimes occurs. The correction of recurrent inverted nipples is challenging because of scars and fibrosis caused by previous surgical treatments. The authors treated 14 patients with 25 recurrent inverted nipples with the Sakai method. All patients were observed for more than 6 months. All of the resulting nipples were acceptable and fit into the normal nipple shapes described by Kim et al (Plast Reconstr Surg. 2006;118:1526-1531) (ie, rectangular, omega, round, cap, or slanting). Although the Sakai method is not new, it may be a useful option not only for ordinary inverted nipples but also for the correction of recurrent inverted nipples.

New nipple-sharing technique that preserves the anatomic structure of the donor nipple for breastfeeding.

BACKGROUND: Although nipple-sharing in unilateral breast reconstruction is no longer a new technique, it offers the potential for an excellent match with the contralateral natural nipple. It also is particularly useful for cases in which a local flap elevation for nipple reconstruction likely would lead to complications. However, the established nipple-sharing techniques cannot be applied to patients who wish to preserve breastfeeding functionality even if the technique would otherwise be considered favorable. To overcome this obstacle, the authors devised a new nipple-sharing technique that does not damage the anatomic structure of the donor nipple for breastfeeding. This report presents this new technique as an option for nipple reconstruction. METHODS: The new technique consists of harvesting tissue by the circumcision method of nipple reduction and grafting the tissue in a spiral configuration. RESULTS: The reported technique has been performed for nine patients. All the reconstructed nipples have retained their projection and their suitability as matches for the contralateral nipples throughout a maximum follow-up period of 5 years. CONCLUSIONS: The new technique allows nipple-sharing to be applied while preserving the anatomic structure of the donor nipple for breastfeeding.

Using multidetector row computed tomography to evaluate baggy eyelid.

BACKGROUND: Baggy eyelids, formed by intraorbital fat herniation in the lower eyelids, are a sign of aging observed in the midface. This study aimed to identify the cause of baggy eyelids by evaluating the relationship between orbicularis oculi muscle thickness, orbital fat prolapse length, and age using multidetector row computed tomography (MDCT). METHODS: The 34 patients in the study ranged in age from 20 to 79 years. The patients were divided into three age groups: 20-29 years, 30-54 years, and 55-79 years. Orbicularis oculi muscle thickness and orbital fat prolapse length were measured using reconstructed computed tomography (CT) images. RESULTS: The orbicularis oculi muscle was found to be significantly thinner in the oldest group. Likewise, orbital fat prolapse was found to be significantly more prominent in the oldest group. A strong and significant negative correlation was found between orbicularis oculi muscle thickness and orbital fat prolapse length (r = -0.78; P < 0.001) and between orbicularis oculi muscle thickness and age (r = -0.77; P < 0.001). A strong and significant positive correlation was found between orbital fat prolapse length and age (r = 0.78; P < 0.001). CONCLUSIONS: The use of MDCT provides insight into the detailed changes associated with aging that take place within the lower eyelids. This study objectively demonstrated that the major factors associated with baggy eyelids include orbicularis oculi muscle thickness, orbital fat prolapse length, and age. Decreased orbicularis oculi muscle thickness leads to the orbital fat prolapse.

Transposition technique for correction of a malpositioned nipple-areola complex after reconstruction following a nipple-sparing mastectomy: a case report.

We developed a novel transposition technique for the correction of an asymmetric nipple-areola complex (NAC) due to breast mound reconstruction after a nipple-sparing mastectomy. The technique was composed of a rotation flap and an advancement flap. In this study, we describe a case of a 35-year-old woman with a malpositioned NAC located at the upper lateral position with a vertical scar in the lateral area of the breast treated by this technique, with a follow-up period of 12 years. In this case, established techniques were difficult to apply as there were thin underlying subcutaneous tissue and scars near the NAC. This technique may be useful in such a case and is an additional option in the correction of a malpositioned NAC from the upper lateral position to the ideal position on a breast mound.

Cosmetic reconstruction after resection of breast cancer: use of the ELD-MC flap and EVRAM flap.

Breast reconstruction following the resection of breast cancer with inadequate residual chest-wall tissue may be performed with an implant or a myocutaneous flap, such as the latissimus dorsi or a rectus abdominis. Among a variety of operative procedures, each method has advantages and disadvantages. The insertion of a silicone-bag prosthesis is the easiest method, but the prosthetic implant sometimes has complications, such as unfavorable capsular contracture formation around the implant, rupture, infection, or exposure. We therefore use an extended latissimus dorsi myocutaneous (ELD-MC) flap with some amount of surrounding subcutaneous fat from the lumbar area, and avoid the use of any implant with an MC flap. Also, for the reconstruction and correction of infraclavicular and axillary depression, we use the extended vertical rectus abdominis myocutaneous (EVRAM) flap. This method uses the skin and fat on both sides of the umbilicus as a lenticular flap vascularized by only one of the rectus abdominis muscles. The patients are satisfied with the outcome because symmetry and good breast volume can be obtained. There have been no functional or anatomical defects of the donor area. No abdominal hernia after an EVRAM flap has resulted to date. Both the ELD-MC and EVRAM flaps can be successfully used for cosmetic breast reconstruction after the resection of breast cancer.