Safely Shaping the Breast After Implant Removal and Total Intact Capsulectomy Using the Mammary Imbrication Lift and Fixation Technique.

Background: Implant-based breast augmentation is one of the most popular plastic surgery procedures performed worldwide. As the number of patients who have breast implants continues to rise, so does the number of those who request breast implant removal without replacement. There is little in the current scientific literature describing total intact capsulectomy and simultaneous mastopexy procedures. Objectives: Here, the authors present their current method using the mammary imbrication lift and fixation technique after explant and total capsulectomy. Methods: Between 2016 and 2021, a total of 64 patients (mean age: 42.95 years; range, 27-78 years) underwent the described mammary imbrication lift and fixation technique with bilateral breast implant removal and total capsulectomy. Results: Mean follow-up was 6.5 months (range, 1-36 months). Postoperative complications included minor cellulitis in 1 patient (1.6%), late onset hematoma with infection in 1 patient (1.6%), fat necrosis and pulmonary embolism in 1 patient with prior history of thromboembolic events (1.6%), and breast scar irregularity in 4 patients (6.2%) who required subsequent minor scar revision or steroid injections. Two patients (1.6%) underwent revision surgery with bilateral breast fat grafting to improve shape and add volume. Conclusions: The mammary imbrication lift and fixation technique described here can safely and simultaneously be performed with a total intact capsulectomy and explant procedure. This technique avoids wide undermining, intentionally opening the capsule, performing subtotal capsulectomy, and preserving blood supply to the breast tissue and nipple with low complication rates.

Cultural perspectives in facial allotransplantation.

Facial allotransplantation is a clinical reality, proposed to provide improved functional and aesthetic outcomes to conventional methods of facial reconstruction. Multidisciplinary efforts are needed in addressing not just the surgical and immunological issues but the psychological and sociological aspects as well. In view of this, an international survey was designed and conducted to demonstrate that attitudes toward facial allotransplantation are highly influenced by cultural background. Of all countries surveyed, France had the highest percentage of respondents willing to donate their faces (59%) and Iraq had the lowest (19%). A higher percentage of respondents were willing to accepting a face transplant (68%) than donate their face after death (41%). Countries with a dominant Western population show greater percentages of willingness to accept a face transplant, as they exhibit more positive variables, that is, (1) acceptance of plastic surgery for disfigurement and for cosmetic reasons and (2) awareness to the world's first face transplant. Countries with a dominant Western population also show greater percentages of willingness to donate their faces after death, as they exhibit more positive variables, that is, (1) positive attitude to organ donation by being an organ donor themselves, (2) acceptance of plastic surgery if disfigured, and (3) awareness to the world's first face transplant. Although religion was sometimes cited as a reason for not donating their faces, data analysis has shown religion not to be a strong associating factor to willingness to donate a face after death.

Salvage of calvarial bone graft using acellular dermal matrix in nasal reconstruction and secondary rhinoplasty for frontonasal dysplasia.

Frontonasal dysplasia is a severe malformation composed of cranial, ophthalmic, nasal, upper lip, and palatal deformities. Reconstruction in these patients requires complex craniofacial efforts. A 19-year-old woman with frontonasal dysplasia was treated at our institution where she had undergone multiple prior reconstructive surgeries including facial bipartition and cantilevered calvarial bone graft for nasal reconstruction. She later presented with a palpable bone graft prominence, associated contour deformity, and an area of overlying paper-thin skin at the nasal tip. Although there was no ulceration, the threat of graft extrusion required immediate attention. The prominent bone graft tip was debrided, and the overlying soft tissue envelope was augmented using acellular dermal matrix. No surgical complication was encountered. The patient had successful salvage of the bone graft and a pleasing aesthetic outcome at 9 months of follow-up. The use of acellular dermal matrix has proven to be beneficial in the correction of nasal contour deformities given its soft, natural appearance, availability, affordability, and safety. Its use also avoids further donor site morbidity. We suggest acellular dermal matrix as a graft material in revision rhinoplasties for cases of acquired nasal contour deformity and threatened bone graft extrusion. This is the first report known to the authors using acellular dermal matrix during staged nasal reconstruction in a patient experiencing frontonasal dysplasia.

Pediatric craniofacial surgery: a review for the multidisciplinary team.

Pediatric craniofacial surgery is a specialty that grew dramatically in the 20th century and continues to evolve today. Out of the efforts to correct facial deformities encountered during World War II, the techniques of modern craniofacial surgery developed. An analysis of the relevant literature allowed the authors to explore this historical progression. Current advances in technology, tissue engineering, and molecular biology have further refined pediatric craniofacial surgery. The development of distraction osteogenesis and the progressive study of craniosynostosis provide remarkable examples of this momentum. The growing study of genetics, biotechnology, the influence of growth factors, and stem cell research provide additional avenues of innovation for the future. The following article is intended to reveal a greater understanding of pediatric craniofacial surgery by examining the past, present, and possible future direction. It is intended both for the surgeon, as well as for the nonsurgical individual specialists vital to the multidisciplinary craniofacial team.

Chest wall reconstruction in thoracoabdominal ectopia cordis: using the pedicled osteomuscular latissimus dorsi composite flap.

Ectopia cordis is a rare congenital defect characterized by complete or partial displacement of the heart outside the thoracic cavity. Repair of ectopia cordis can present a reconstructive challenge often requiring a staged approach. Ideally, structural integrity and protection of the heart are restored using autologous tissues capable of growth. In addition, reconstruction of the thorax must proceed without compromise to pulmonary or cardiovascular stability. The following article describes repair of thoracoabdominal ectopia cordis in a patient with pentalogy of Cantrell. Reconstruction of the chest wall was accomplished using a musculoosseus composite flap involving segments of the 9th and 10th ribs and overlying pedicled latissimus dorsi muscle. This is the first report known to the authors of such a repair.

Vomer bone graft to augment the deficient cleft maxilla.

Patients with clefts of the lip and palate commonly develop maxillary hypoplasia. In addition to orthognathic surgery, augmentation of the anterior maxilla may be necessary in these patients to restore symmetry to the nasomaxillary complex. Bone graft may be obtained from numerous sites. All require a separate incision at the donor site and may result in additional morbidity.The authors describe a 16-year-old with a complete right unilateral cleft of the lip and palate who underwent maxillary advancement at the Le Fort I level. Pronounced sagittal deficiency of the maxilla necessitated osseous augmentation. The patient's deformity resulted in deviation of the superior vomer bone. This bone was of adequate quality to be used as an onlay graft for the maxilla. This is the first report documenting the use of vomer as a bone graft for maxillary augmentation.

Maximizing aesthetics and safety in circumferential-incision lower body lift with selective undermining and liposuction.

Circumferential dermolipectomy has been an effective means of reducing excess skin and fat after massive weight loss, however, regions of residual midabdominal and epigastric fat frequently confer a suboptimal contour, and often mediocre cosmetic results. Liposuction in association with lower body lift surgery has been regarded with caution, for fear of ischemia or necrosis of the undermined flaps as potential dire consequences. In this study, a theoretical and technical approach that maximizes safety and aesthetics in circumferential lower body lift after massive weight loss with contouring using liposuction is described and evaluated. Twenty-four patients were treated with follow-up ranging from 6 to 40 months (mean follow-up 17 months). All patients were treated with the resection of circumferential skin and fat maintaining a low-lying transverse suture line with a prone-to-supine approach. Dorsally, liberal liposuction is performed after the instillation of lidocaine-free wetting solution above and below the resection lines. Ventrally, the upper flap is elevated widely to the umbilical horizontal. The umbilicus is circumcised, and the dissection then progresses in a narrow column above the rectus sheaths to the xiphoid. Judicious subcostal undermining is performed, maintaining an intact bilateral subcostal "perforator zone" of 4 to 6 cm. Diastasis repair and anterior sheath plication are performed, and the umbilicus is anchored to the fascia. Wetting solution is instilled, and suction-assisted lipoplasty of the entire flap, particularly in the midline and in the region of the neo-umbilicus, is performed, removing excess fat and providing discontinuous lateral flap "undermining." There was 1 hematoma (4%) requiring re-exploration and 4 seromas (17%) treated with percutaneous aspiration. There was no infection, skin loss, or wound dehiscence. Unlike standard dermolipectomy procedures with wide undermining, the maintenance of a broad subcostal blood supply with selective direct undermining allows for liberal flap contouring with suction and the establishment of lower suture-line position. With this technique, liposuction can be safely used during lower body lift to maximize aesthetic outcomes.