Single Staged Mastopexy With Autologous Fat Grafting: An Alternative to Augmentation Mastopexy With Implants.

BACKGROUND: Improving the ptotic breast with mastopexy and restoring upper pole fullness with augmentation continues to be a challenging issue for plastic surgeons. Autologous fat grating (AFG) for shaping and contouring of implant augmented breasts has shown positive outcomes with few complications. OBJECTIVES: The objective of this study was to evaluate our experience with combined mastopexy and fat grafting for women with existing breast ptosis who prefer not to receive prosthetic breast implants but do desire volume enhancement. METHODS: A retrospective review of patients undergoing a single staged mastopexy with AFG, from 2006 to 2017, was performed. Inclusion criteria were women with breast ptosis or tuberous breasts desiring improved breast shape and volume. Patients were excluded if they were undergoing implant removal before the procedure. Clinical aesthetic outcomes were assessed by fellow plastic surgeons according to the Telemark Breast Scoring system. RESULTS: A total of 284 breasts, in 140 women, underwent a single staged mastopexy with AFG. The mean amount of fat grafted per breast was 299.4 mL (range, 50-710 mL). There were no surgical site infections, hematomas, or seromas. There were 3 major and 8 minor (0.06%) postoperative breast complications. A total of 13 plastic surgeons, of the 183 invited (7.1%), completed the breast outcomes survey. Regarding each category, there was significant improvement (P ≤ 0.0001) in upper pole fullness, ptosis, overall aesthetics, and symmetry postoperatively. CONCLUSIONS: AFG combined with mastopexy is not associated with significant postoperative complications and results in excellent breast aesthetic outcomes.

Neoumbilicoplasty with a Superiorly Based Abdominal Skin Flap.

We propose a neoumbilicoplasty technique that can be applied when the umbilical stalk becomes disrupted during an abdominoplasty. This case used surgical concepts that involved progressive thinning of the flap in a 3-cm radius around the neoumbilicus, with increased thinning toward the neoumbilical position. This was followed with suture tacking of the thinned abdominal flap to create a concavity around the neoumbilicus. A longer "U" shaped incision was created and also sutured down to abdominal wall to recreate an umbilical "floor" with the adjacent skin sutured to the superior-based flap to construct the walls of the neoumbilicus. An aesthetically pleasing umbilicus resulted with high patient satisfaction and a lack of postoperative complications. There were no additional scars extending beyond the umbilical region.

Periumbilical Perforator-Sparing Abdominoplasty in Patients With Abdominal Scars.

Abdominoplasty is one of the most common cosmetic surgical procedures. Patients who undergo abdominoplasties with abdominal scars are at an increased risk for skin necrosis and wound breakdown. To prevent further disruption of vascularity, the dissection and mobilization is often limited resulting in a suboptimal esthetic result. The periumbilical perforator-sparing technique allows for vascular preservation and adequate mobilization to produce excellent esthetic results in patients with abdominal scars.

Adipose Derived Cells and Tissues for Regenerative Medicine.

Adipose tissue is now recognized as a complex organ serving endocrine, immune, and metabolic functions. Adipose depots are composed of mature adipocytes as well as stromal vascular fraction (SVF) cells, a heterogeneous population of B and T lymphocytes, endothelial cells, macrophages, pericytes, smooth muscle, and stromal cells that can be isolated by enzymatic digestion. When placed into culture medium, a subset of the SVF cells can adhere to the plastic surface and expand in number. This latter population, known as "adipose-derived stromal/stem cells" (ASC), exhibits trilineage (adipo-, chondro-, osteo-) differentiation potential. There are currently more than 180 clinical studies underway worldwide exploring the regenerative medical application of SVF cells and ASC in a range of medical conditions. Plastic surgeons have a particular interest in the use of autologous fat and SVF enhanced fat for cosmetic and reconstructive surgical procedures. Orthopedic and craniofacial surgeons have begun to use ASC to treat bone and musculoskeletal defects with success. Furthermore, studies are underway to exploit the immunomodulatory function of ASC to treat immune-mediated disorders such as Crohn's disease. Indeed, it is postulated that adipose tissue and cells modulate tissue regeneration and inflammatory responses through their secretion of paracrine factors. Continued advances in this emerging field will require harmonization of international standards and guidelines defining the release criteria as well as the safety and efficacy of adipose-derived cells and tissues. Currently, there are no accepted standard guidelines for autologous fat harvesting technique, processing, or method of injection. Close collaboration between academia, industry, and regulatory authorities will be necessary to ensure that adipose-derived products are affordable and quality controlled throughout the globe.

Autologous fat grafting for treatment of facial atrophy in Behcet's disease: a case report.

Behcet's disease (BD) is an autoimmune & autoinflammatory disease of unclear etiology characterized by recurrent oral & genital ulcers as well as other systemic manifestations. A key pathogenesis is excessive inflammatory wound healing response. While descriptions of the cutaneous manifestations of disease are limited to short-term consequences such as extensive pustule and papule formation in response to minor tissue injury, the long-term consequences are significant fibrosis and scarring of epithelial tissue. We describe the case of a patient with Behcet's disease who presented with unilateral facial atrophy secondary to minor trauma to the oral mucosa. She was treated with autologous fat grafting. Though a rare disease, plastic surgeons should be aware of the entity of Behcet's disease and its complications of tissue atrophy that may require reconstructive surgery.

Clinical accuracy and reproducibility of Portrait 3D Surgical Simulation Platform in breast augmentation.

BACKGROUND: Three-dimensional (3D) digital photography uses integrated image capture technology and rendering software to create 3D models. Volumetric measurements project simulated post-operative images prior to breast augmentation. OBJECTIVES: To evaluate the accuracy and reproducibility of breast volume measurements using the Portrait 3D Surgical Simulation Platform (Axis Three, Boston, Massachusetts). METHODS: Twenty-two patients underwent breast augmentation. 3D volumetric imaging analysis was performed by two independent observers preoperatively and at 6 weeks postoperatively. Simulated volumes were compared to actual implant volume using the Student's t test. Intra-observer reliability was evaluated by measuring internal consistency (Cronbach and 95% confidence interval [CI]) and test-retest reliability (intraclass correlation coefficient [ICC]) from the two observers' calculated volumes. RESULTS: Half (n = 11) of the patients received silicone implants and half saline; all were placed in the submuscular plane through an inframammary incision. No difference in volume estimation in preoperative or postoperative images (P = .49 and P = .14; and P = 1.0 and P = .37, in right and left breasts, respectively) was observed. The test-retest reliability between observers was excellent (ICC, 0.98; P < .001) and Cronbach's value (0.99; 95% CI 0.97-0.99; P < .001) demonstrated an excellent correlation. Regarding accuracy, difference in volume estimation between actual and simulated volumes varied between 0 to 106 mL (0 - 30%), with an absolute mean difference of 12.2% (42.5 mL). CONCLUSIONS: The Portrait 3D breast imaging system provides a highly reproducible 3D tool for measuring breast volume and simulating breast augmentation. Accuracy of the 3D models can vary up to 30% (mean 12.2%). This variability should be accounted for when using this technology to visually communicate with patients.

A case for the safety and efficacy of lipoabdominoplasty: a single surgeon retrospective review of 173 consecutive cases.

BACKGROUND: The combination of liposuction and abdominoplasty has been slow to be accepted, primarily due to a perceived higher incidence of complications associated with the procedure. There has also been extensive debate about the combined procedure's effects on flap vascularity and viability and the extent to which liposuction may be performed in conjunction with surgical abdominoplasty. OBJECTIVE: The authors present data from their four-year experience supporting lipoabdominoplasty as a safe and effective procedure for body contouring. METHODS: The authors retrospectively reviewed a case series of lipoabdominoplasties performed between 2004 and 2008 by the senior author (KK). A total of 173 consecutive patients who presented for abdominal contouring were included in the study. Each patient underwent a combined procedure beginning with liposuction utilizing the superwet technique, followed by an inverted V-pattern abdominoplasty. RESULTS: Of the patients included in this study, 171 (98.8%) were women and two (1.2%) were men. The average age of the patients was 41.53 years, and the average body mass index was 26. The average amount of total lipoaspirate from the flanks was 2166.09 mL, and the average specimen weight resected was 972.80 g. Complications included partial dehiscence/skin necrosis (12 patients; 6.9%), infection requiring antibiotic therapy and/or intervention (13 patients; 7.5%), suture spitting (one patient; 0.5%), seroma (six patients; 3.4%), major fat necrosis requiring local debridement (one patient; 0.5%), and skin flap necrosis requiring readvancement of the abdominal flap (two patients; 1.1%). There was a revision rate of 8.0%: two patients required additional liposuction to smooth out unevenness, five patients required scar revision, and seven patients had dog-ears requiring intervention. All revisions were performed under local anesthesia. There were also five instances of confirmed deep vein thrombosis (2.8%) and two cases of pulmonary embolism requiring hospitalization (1.1%). CONCLUSIONS: The senior author's (KK) lipoabdominoplasty technique, combined with his current preoperative and postoperative protocols, is believed to be a safe procedure that results in excellent cosmetic results. In contrast to some of the current literature, the data show a reduction of overall complications as compared to historical norms.

Perforator flaps: recent experience, current trends, and future directions based on 3974 microsurgical breast reconstructions.

Perforator flap breast reconstruction is an accepted surgical option for breast cancer patients electing to restore their body image after mastectomy. Since the introduction of the deep inferior epigastric perforator flap, microsurgical techniques have evolved to support a 99 percent success rate for a variety of flaps with donor sites that include the abdomen, buttock, thigh, and trunk. Recent experience highlights the perforator flap as a proven solution for patients who have experienced failed breast implant-based reconstructions or those requiring irradiation. Current trends suggest an application of these techniques in patients previously felt to be unacceptable surgical candidates with a focus on safety, aesthetics, and increased sensitization. Future challenges include the propagation of these reconstructive techniques into the hands of future plastic surgeons with a focus on the development of septocutaneous flaps and vascularized lymph node transfers for the treatment of lymphedema.