Using Machine Learning to Select Breast Implant Volume.

BACKGROUND: In breast augmentation surgery, the selection of the appropriate breast implant size is a crucial step that can greatly impact patient satisfaction and the outcome of the procedure. However, this decision is often based on the subjective judgment of the surgeon and the patient, which can lead to suboptimal results. In this study, we aimed to develop a machine-learning approach that can accurately predict the size of breast implants selected for breast augmentation surgery. METHODS: We collected data on patient demographics, medical history, and surgeon preferences from a sample of 1000 consecutive patients who underwent breast augmentation. This information was used to train and test a supervised machine learning model to predict the size of breast implants. RESULTS: Our study demonstrated the effectiveness of the algorithm in predicting breast implant size, achieving a Pearson's correlation coefficient of 0.9335 (p <0.001). The model generated accurate predictions in 86% of the instances, with a Mean Absolute Error (MAE) of 27.10 ml. Its effectiveness was confirmed in the reoperation group, in which 36 of 57 (63%) patients would have received a more suitable implant size if the model's suggestion were followed, potentially avoiding reoperation. CONCLUSIONS: Our findings show that machine learning can accurately predict the chosen size of breast implants in augmentation surgery. By integrating our AI model into a decision support system for breast augmentation surgery, essential guidance can be provided to both the surgeons and patients. This not only streamlines the implant selection process but also facilitates enhanced communication and decision-making, ultimately leading to more reliable outcomes and improved patient satisfaction.

Exercise after Breast Augmentation: A Randomized Controlled Trial.

BACKGROUND: There are limited scientific data regarding the impact of exercise after breast augmentation surgery. Recommendations range from a few weeks to a few months of physical activity avoidance. To decide whether early exercise after breast augmentation is safe, a prospective randomized trial was designed to measure complications, scar quality, and patient-reported outcomes in this setting. METHODS: The present study was a randomized controlled trial to investigate the effects of early exercise (1 week after surgery) on postoperative complications, scar quality, and patient-reported outcome (BREAST-Q). All women undergoing primary breast augmentation surgery in the authors' institution were randomized to either standard restrictions or exercise. The three primary outcomes measured were the presence of a complication and reoperation, scar quality, and patient-reported outcome. RESULTS: A total of 225 participants were included in the final analysis. No differences were found among the groups for age (p = 0.66), implant size (p = 0.56), or implant pocket (p = 0.29); complication rates did not change between the control (7.5 percent) and exercise groups (6.9 percent). When assessed 12 months after surgery, the scar quality was comparable between the groups (29.9 control and 29.6 exercise, p = 0.204). Intervention groups (exercise) performed better on the BREAST-Q Augmentation Module: Satisfaction with Outcome score (66.3 control and 83.4 exercise, p < 0.01). CONCLUSIONS: Early exercise following primary breast augmentation does not increase complication or reoperation rates or cause a reduction in scar quality after 1 year. In addition, a patient-reported outcome showed improvement in the exercise groups. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Prospective Controlled Study of Chin Augmentation by Means of Fat Grafting.

BACKGROUND: Although fat grafting is a valuable tool for different areas of plastic surgery, its use in the chin area has never been evaluated. A variety of methods are available for adjusting suboptimal chin morphology, and they each present drawbacks. METHODS: A prospective controlled study was performed to evaluate whether fat grafting increases the chin volume and sagittal projection and to determine the magnitude and nature of the observed changes. Forty-two consecutive patients underwent chin augmentation by means of fat grafting between October of 2014 and January of 2016. All patient images were analyzed using a software program (Fiji package of ImageJ), which creates a three-dimensional version of the chin that is used to produce reliable estimates of the volume and gain in sagittal projection. RESULTS: All 42 patients showed an increase in the sagittal projection and total volume at 4 weeks and 6 months after surgery. The sagittal projection increased from 4 mm to 12 mm (average, 8.9 mm) and from 3 mm to 11 mm (average, 7 mm) after 4 weeks and 6 months, respectively. The total volume increase ranged from 3 to 11 ml (average, 8 ml) after 4 weeks and from 3 to 8 ml (average, 7.4 ml) after 6 months. CONCLUSION: Fat grafting to the chin area is a reliable method for improving chin volumes (to a maximum of approximately 10 cc in our study) and sagittal projections (to a maximum of approximately 11 mm in our study). CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Diagnosis and management of galactorrhea after breast augmentation.

BACKGROUND: A known but not fully understood complication of breast augmentation is galactorrhea. To date, all publications on this subject have been case reports. The purpose of this retrospective study was to examine a large group of consecutive patients who had undergone breast augmentation and identify the incidence of galactorrhea and galactocele, and the associated preoperative and intraoperative risk factors. The authors also evaluated the treatment algorithm used. METHODS: A retrospective chart review was performed on patients who underwent primary breast augmentation using silicone implants in a single group practice from 2008 to 2013. Logistic regression for rare events data was applied to evaluate the risk of galactorrhea according to the variables. RESULTS: The study included 832 patients (1664 implants) who had undergone breast augmentation. The follow-up period ranged from 12 to 52 months (mean, 15 months). Eight patients (0.96 percent; 95 percent CI, 0.42 to 1.89) experienced galactorrhea after breast augmentation during the follow-up period. All eight patients had bilateral involvement, and three (0.36 percent of the total and 38 percent of the galactorrhea cases) presented with a galactocele. Use of a periareolar incision, however, statistically significantly increased the incidence of galactorrhea among these patients. The authors' management algorithm proved to be an effective clinical course of action. CONCLUSIONS: Although galactorrhea is rare after breast augmentation, it can be disfiguring and devastating for the patient. This is the first longitudinal retrospective study on the subject. Adequate treatment and patient information are essential. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Transpalpebral brow lifting.

The combined-access brow lift described in this article is a limited-incision technique that can provide a cosmetic effect comparable to that produced by the coronal incision technique. It also allows safe direct visualization of anatomic structures comparable to that allowed by the endoscopic-assisted technique, but because it requires no endoscopic instrumentation, it is less expensive and takes less time to learn.

The triple-flap nipple-reduction technique.

BACKGROUND: Pure nipple hypertrophy (macrothelia) is a known but rare condition. Nevertheless, minor disproportions between nipple diameter or height and the areola are quite common. During breast surgery, the surgeon often faces the patient's wish to perform nipple reduction. However the methods described are difficult or have drawbacks. This article proposes a simple technique for both height and diameter, or height only, nipple reduction. METHOD: A technique consisting of the creation of 3 symmetrical triangular flaps in a "Y" fashion and excision of the core of the nipple was performed on 15 consecutive patients between 2001 and 2004. The esthetic results, scars, sensibility, erectility, and complications were evaluated. RESULTS: All patients presented good to excellent esthetic results, with inconspicuous scars. No major complications occurred in this series. Erectility function of the nipple was preserved in all 15 patients, which is a significant difference when compared with previously published techniques. Alterations in sensibility were temporary and were comparable with summarized alterations in representative published clinical series of both breast reduction and augmentation. CONCLUSION: The triple-flap nipple-reduction technique has the advantage of feasibility, applicable in both height and diameter nipple hypertrophy, with excellent esthetic results and the preservation of both sensibility and erectility.

Fluid resuscitation in liposuction: a prospective analysis of infiltrate-to-total aspirate ratios lower than used for the superwet technique.

BACKGROUND: Fluid management during liposuction appears to as much an art as it is a science. Because of different infiltration practices such as wet, superwet, and tumescent techniques, different fluid management guidelines are required. This has assumed greater significance as surgeons have undertaken aspirations with larger volumes (>/=4 l) and the potential complications of hypovolemia and fluid overload have materialized. METHODS: In this prospective study, 580 consecutive patients underwent liposuction using an average infiltrate-to-total aspirate ratio of 0.38. For all the patients, noninvasive hemodynamic parameters were assessed to evaluate a clinically based guideline for fluid management in liposuction. RESULTS: The average infiltrate-to-total aspirate ratio was 0.38 +/- 0.18 (range, 0.24-0.8). Total urine output was 1.63 ml/kg per hour (range, 1.06-3.4 ml/kg/h). The average postoperative heart rate was 92.16 beats/min, and the average postoperative mean blood pressure readings were 70.41 mmHg. The intraoperative fluid ratio, defined as the ratio of intraoperative intravenous fluid plus subcutaneous infiltrate to total aspirate, ranged from 0.98 to 2.1 (average, 1.25). The average percentage of body weight aspirated was 5.2% (range, 1.76-7.02%) CONCLUSION: This article presents a safe fluid management guideline based on experimental data from 580 patients who underwent liposuction using average infiltration-to-aspirate rates of 0.38. However, the calculated volumes from all the formulas should be viewed as educated guesses of the appropriate fluid load, and clinical judgment is essential.