Autologous Fat Grafting for the Treatment of Mild to Moderate Velopharyngeal Insufficiency.

BACKGROUND: To assess speech results following the treatment of mild to moderate velopharyngeal insufficiency (VPI) post cleft palate surgery with autologous fat grafting to the velopharynx. METHODS: A retrospective study was conducted on 9 consecutive patients who underwent velopharyngeal fat grafting for the treatment of VPI at the Red Cross War Memorial Children's hospital from 2010 to 2014. All the patients previously had primary palatoplasty performed and subsequently developed VPI. Patients were assessed pre- and postoperatively by an experienced speech and language therapist looking at perceptual speech and by 2 senior cleft surgeons interpreting lateral view videofluoroscopies. RESULTS: Eleven fat grafting procedures were performed on 9 patients and an average of 5.64 mL (range 1-7 mL) of autologous fat was transferred to the velopharynx. The average age at the time of operation was 6.5 years (range 3-14 years) with a follow-up period of 18 months (range 7-34 months). Most of the patients (7 out of 9) showed improved speech after fat grafting. One of the 7 patients had multiple procedures. The 2 who did not show speech improvement only had a single procedure. There were no complications related to the fat grafting procedure. CONCLUSION: This small study suggests that fat grafting either as a single procedure or as multiple procedures is an effective, safe, minimally invasive surgical alternative, and/or adjunct for the treatment of mild to moderate VPI in patients following cleft palate surgery and to the knowledge, is the first reported study from Africa.

A formula determining resection weights for reduction mammaplasty.

BACKGROUND: Reduction mammaplasty is a frequently performed plastic surgical procedure, yet preoperative assessment usually excludes an estimated resection weight. In this retrospective study, a formula was derived using regression analysis of routinely measured preoperative anthropomorphic measurements and intraoperative resection weights. METHODS: Data were collected from 214 consecutive breast reduction patients operated on at a tertiary referral center between January of 1993 and January of 2006. The operations were performed by 15 plastic surgeons using a variety of reduction pattern techniques. Four variables were recorded for each patient: notch to nipple distance, nipple to inframammary crease distance, body mass index, and age. Regression analysis was performed on the data to establish which preoperative measurements correlated most accurately with the resection weight. RESULTS: The following formula was established relating nipple to inframammary crease distance and notch to nipple distance measurement to the weight removed: Breast weight = (35.4 x notch to nipple distance + 60.66 x nipple to inframammary crease distance) - 1239.64. CONCLUSION: Use of this formula aids the surgeon with patient counseling, insurance company quotes, and intraoperatively in patients with asymmetry or those undergoing reconstruction, as a guide to resection weights.

A study of the patient factors affecting reconstruction after mastectomy for breast carcinoma.

Breast shape may be retained after surgery for breast cancer with either wide local excision (WLE) and radiotherapy or mastectomy (M) and immediate reconstruction (M+R). We determined the proportions of patients who would be suitable for these options, would accept them, and if they declined M+R their reasons for doing so. Over a 10-month period 177 women were assessed at a combined breast clinic by general and plastic surgeons and by radiation oncologists. A prospective record was made of the patient demographic data, the clinical decisions (and their reasons), and the patient choices (and their reasons). A transverse rectus abdominis myocutaneous flap was the commonest method of reconstruction. One hundred thirty-five (76%) were judged to be suitable for locoregional surgery. Of these M+R was offered to 83 patients, whereas 53 were not considered because of combinations of cosmetic considerations (31), risk factors (25), old age (13), and oncological factors (nine). Fifty-one of the 83 (61%) offered M+R declined it because they preferred a simpler procedure (34), regarded breast appearance as unimportant (15), preferred breast conservation (five), did not have a partner (three), felt that they were too old (two), or had religious reasons (two). Ultimately 69 (51%) underwent M, 34 (25%) WLE, and 32 (24%) M+R. There was no correlation between acceptance or not of M+R and age, race, employment, education level, or marital status. We conclude that many patients were suitable for M+R, but fewer than half accepted it; this decision was unrelated to age, race, employment, or marital status.