Striae distensae after breast augmentation.

BACKGROUND: One known but not fully understood complication after breast augmentation is the new onset of stretch marks (striae distensae) on the surgically treated breast. To date, all publications on this subject have been case reports. No report has fully described the actual incidence, risk factors, or management of striae distensae after breast surgery. METHODS: This study prospectively followed patients who underwent primary breast augmentation using silicone implants in a single group practice from 2007 to 2011. New-onset striae distensae were actively investigated. Time from surgery to the moment of striae onset, patient age, nulliparity, use of oral contraceptives, overweight, personal history of stretch marks, and other variables were evaluated. RESULTS: A total of 409 patients were included in the study. In 19 cases (4.6%), new-onset striae distensae after breast augmentation were observed. The population with striae distensae was significantly younger than the total population (29.56 vs 20.91 years; p=0.012). Striae distensae also were more common in nulliparous than in multiparous women (8.29 vs 0.52%; p=0.006), overweight women (17.77 vs 3.02%; p=0.016), women using oral contraceptives (7.89 vs 0.55%; p=0.008), and women with a personal history of stretch marks (8.97 vs 3.36%; p=0.031). No relation was shown regarding implant pocket type, size, or profile. CONCLUSION: Striae distensae may be a common but underreported complication after breast augmentation. In this series, striae distensae developed in 4.6% of the patients within 1 year after breast augmentation. Severity may vary from inconspicuous small marks (classifications 1 and 2) to wide red and active striae rubra (classifications 3 and 4). Nulliparity, use of oral contraceptives, overweight, personal history of stretch marks, and younger age were related to a higher incidence of striae distensae. The increased rates in these groups may be associated with their exposure to higher estrogen levels and the important role of this hormone in facilitating the formation of striae distensae. Further studies are needed to show whether changes in these risk factors (i.e., weight loss, contraceptive withdrawal) may help to decrease striae distensae rates is these populations. LEVEL OF EVIDENCE IV: 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 at www.springer.com/00266.

Peeling de gel de ácido tioglicólico 10%: opção segura e eficiente na pigmentação infraorbicular constitucional / 10% thioglycolic acid gel peels: a safe and efficient option in the treatment of constitutional infraorbital hyperpigmentation

Introdução: A hipercromia infraorbicular constitucional é dermatose comum, de difícil tratamento. Objetivo: Avaliar a melhoria clínica da pigmentação infraorbicular constitucional com cinco peelings seriados de ácido tioglicólico a 10% em gel. Métodos: 10 voluntárias do sexo feminino, entre 24 e 50 anos de idade, realizaram cinco sessões quinzenais de peeling de ácido tioglicólico 10% gel. Na primeira sessão, o produto foi deixado por dois minutos, acrescentando-se três minutos a cada uma das sessões subsequentes, tendo na última sido deixado por 15 minutos; 15 dias após a última sessão, foi aplicada escala de satisfação clínica, de 0 (ausência de melhora) a 10 (melhora total), tanto às pacientes quanto ao médico aplicador e a um médico avaliador-cego. Resultados: A média da satisfação clínica apontada pelas pacientes foi 7,8; a do médico aplicador, 7,6; e a do médico avaliador-cego, 6,8, sem diferenças estatísticas entre eles (p=0,065). Conclusão: Os peelings seriados de ácido tioglicólico 10% em gel são alternativa segura, eficiente e barata para a abordagem da pigmentação infraorbicular constitucional.

Introduction: Constitutional infraorbital hyperchromia (commonly called under-eye circles) is a common dermatosis that is difficult to treat. Objective:To evaluate the clinical improvement of constitutional infraorbital pigmentation resulting from the application of a series of five 10% thioglycolic acid gel peeling sessions. Methods: Patients were administered five successive 10% thioglycolic acid gel peel sessions, in 15- day intervals. In the first session, the product was left on for two minutes, with three minutes added in each subsequent session, culminating with 15 minutes of contact in the last session. Fifteen days after the last session, a satisfaction scale ranging from 0 (lack of improvement) to 10 (total improvement) was administered to the patients, to the dermatologist investigating the peelings, and to a blindevaluator medical doctor (a dermatologist that had not had taken part in the treatment sessions). Results: Study subjects (n=10) were females aged 24-50.The average clinical satisfaction presented by the patients, the investigator, and the blind-evaluator were 7.8, 7.6 and 6.8, respectively, with no statistically significant differences among them (p=0.065). Conclusion: The serial application of 10% thioglycolic acid gel peels is a safe, efficient, and costeffective treatment for constitutional infraorbital pigmentation.

Late infection following breast augmentation with textured silicone gel-filled implants.

BACKGROUND: Infection after insertion of a breast prosthesis is an uncommon but feared complication. Previously reported infection rates vary and include reconstructive and cosmetic patients. OBJECTIVE: We sought to define the infection rate and the presentation of postoperative infection in the patient with aesthetic breast augmentation. METHODS: A prospective analysis was undertaken of 288 patients who underwent aesthetic breast augmentation with textured silicone gel-filled implants between 1998 and 2002. Patients were monitored for clinical findings of infection, and microbiological analyses were performed for each case of infection. "Early infection" was defined as signs and symptoms of infection beginning 20 days or less post-surgery; "late infection" was defined as all cases with an onset more than 20 days post-surgery. Treatment was classified as antibiotic therapy only, conservative surgical intervention (with or without implant salvage), or implant explantation and replacement. RESULTS: Early infectious complications occurred in 6 of 288 women (2.08%). Late infection complications occurred in 10 of 288 women (3.47%). Late infection occurred more often and was more severe than early infection (P < .05). For the late infection group, the length of time to infection onset was between 20 and 280 days (average, 82 days). The length of time to infection was shown to be bimodal and organism-related. The group of infections caused by Enterobacter species had a significantly longer time of onset (P < .05) than the group caused by Staphylococcus aureus. CONCLUSIONS: There is strong evidence that late infections can occur in patients who have undergone aesthetic breast augmentation using textured silicone gel-filled implants. Further studies are needed to determine whether similar late infection rates affect patients with aesthetic breast augmentation who receive saline-filled implants.