Introduction of Breast Implants through the Abdominal Route: Analysis of a Cohort.

BACKGROUND: Simultaneous breast reshaping and abdominoplasty offer patients the opportunity to undergo body reshaping in a single surgical session involving one anesthesia induction and one incision. In Latin America, abdominal implant placement is an infrequently used technique, likely because there is little evidence on its efficacy and safety. This study aimed to evaluate the efficacy and safety of implant placement through the abdominal route. METHODS: A retrospective cohort was analyzed, including 350 records of patients who underwent abdominal breast implants from 2013 to 2021 with a minimum follow-up of 1 year. The procedure was performed under epidural anesthesia. RESULTS: No intraoperative complications were reported. After a minimum 12-month follow-up, complications were detected in 5% of cases; the most frequent was asymmetry (4.6%), followed by abdominal migration and one case of symmastia. During the follow-up period, no capsular contracture was detected in any case. A satisfaction percentage of 98.1% was obtained. The only independent factor associated with complications was distance from the sternal notch to the nipple-areola complex greater than 21 cm. CONCLUSION: In this case series, mammaplasty with abdominal implant placement was an effective and safe procedure, with reduced risk of infection or capsular contracture and no scarring in or near the breasts for patients with properly selected comorbidities. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Traumatic abdominal wall hernia: Case report of atypical origin.

INTRODUCTION AND IMPORTANCE: Traumatic abdominal wall hernia (TAWH) is an injury that occurs after an abdominal wall blunt trauma consisting of fasciomuscular rupture and does not present skin penetration. Documenting unique and rare clinical cases, such as traumatic hernia without skin penetration, enriches the medical literature and provides valuable information to identify innovative and optimised approaches for the treatment of similar cases in the future. CASE PRESENTATION: 48-year-old female with no significant medical history presented to the emergency room after being directly hit by a 1200 kg vehicle while standing in the street. Clinical examination revealed a TAWH with total elevation and total loss of insertion of all abdominal wall muscles on the right side, and no involvement of the overlying skin secondary to the mechanism of trauma. The patient agreed to surgical management after being thoroughly informed about the procedure. Surgical exploration was performed with the patient in a lateral position, and the incision was made over the hernia sac. A monopolar electrocautery was used to expose the iliac crest and fully visualize the defect before drilling through the iliac crest. Soft macroporous polypropylene mesh repair was guided through the iliac crest and abdominal wall using a suture and secured with knots. The patient showed a satisfactory and favorable progress. DISCUSSION AND CONCLUSIONS: The present surgical technique is recommended for atypical cases of high-strength TAWH.