Outcomes in Subfascial versus Subglandular Planes in Breast Augmentation: A Systematic Review and Meta-Analysis.

Breast augmentation is the most commonly performed aesthetic surgery procedure in women worldwide. The use of the subfascial plane has been suggested to decrease the incidence of capsular contracture compared to the subglandular plane, while simultaneously avoiding the complication of animation deformity in the subpectoral plane. The aim of this systematic review and meta-analysis was to compare the adverse outcomes of subfascial compared to subglandular planes in breast augmentation. This review was registered a priori on OSF (https://osf.io/pm92e/). A search from inception to June 2023 was performed on Medline, Embase, and CENTRAL. A hand search was also performed. All randomized and comparative cohort studies were included that assessed the use of the subfascial plane for breast augmentation. Outcomes evaluated included the incidences of seroma, hematoma, infection, rippling, capsular contracture, and revision surgery. Ten studies were included in this systematic review. Three randomized controlled trials and seven comparative cohort studies were used for quantitative synthesis. There was a significant difference favoring subfascial compared to subglandular planes in the incidence of hematoma, rippling, and capsular contracture. All included studies had high risk of bias. The current evidence suggests that the subfascial plane for breast augmentation decreases risk of capsular contracture, hematoma, and rippling compared to the subglandular plane. Further randomized evidence with high methodological rigor is still required to validate these findings.

Aesthetic Refinements in Male Chest Lifting.

The authors describe aesthetic refinements to the approach for male chest lifting in male patients with grade 3 gynecomastia and/or significant chest skin excess. An inferior pedicle is used to transpose the nipple-areolar complex allowing preservation of pigment and sensation, liposuction and direct excision are used to reduce volume and excess skin, and the resulting curvilinear scar along the inferior and lateral border of the chest provide a more masculine appearance. Early experience with this technique has shown it to be safe and effective. Perioperative management and the detailed steps of the procedure are outlined.

Vertical Scar Mastopexy With a Centrally Based Auto-Augmentation Flap.

The authors describe their technique for vertical scar mastopexy with a centrally based auto-augmentation flap. Since 2011, the authors have performed this procedure in 212 patients and found that this operative technique has allowed us to achieve reproducible aesthetic outcomes while minimizing complications. Vertical scar mastopexy with a centrally based auto-augmentation flap is an excellent procedure for patients with breast ptosis who desire improved breast shape and superior pole fullness without the use of a breast implant. The perioperative management and detailed steps of the procedure are outlined.

Evaluating Breast Reconstruction Reviews Using A Measurement Tool to Assess Systematic Reviews (AMSTAR).

BACKGROUND: Breast reconstruction is an important aspect in breast cancer treatment. METHODS: A comprehensive search of MEDLINE, Embase, and the Cochrane Library of Systematic Reviews was performed. Systematic reviews and meta-analyses that focused on breast reconstruction and were published between 2000 and 2020 were included. Quality assessment was performed using A Measurement Tool to Assess Systematic Reviews (AMSTAR). Study characteristics were extracted, including journal and impact factor, year of publication, country affiliation, reporting adherence to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, number of citations, and number of studies included. RESULTS: The average AMSTAR score was moderate (5.32). There was a significant increase in AMSTAR score (P < 0.01) and number of studies (P < 0.01) over time. There were no significant correlations between AMSTAR score and impact factor (P = 0.038), and AMSTAR score and number of citations (P = 0.52), but there was a significant association between AMSTAR score and number of studies (P = 0.013). Studies that adhered to the PRISMA statement had a higher AMSTAR score on average (P < 0.01). CONCLUSIONS: Systematic reviews and meta-analyses about breast reconstruction had, on average, a moderate AMSTAR score. The number of studies and methodological quality have increased over time. Study characteristics including adherence to PRISMA guidelines are associated with improved methodological quality. Further improvements in specific AMSTAR domains would improve the overall methodological quality.

Evaluating the Quality of Systematic Reviews and Meta-Analyses About Breast Augmentation Using AMSTAR.

BACKGROUND: Breast augmentation is one of the most commonly performed cosmetic surgeries worldwide. Therefore, it is imperative to have evidence with high methodological quality to guide clinical decision making. OBJECTIVES: To evaluate the methodological quality of the systematic reviews (SRs) focused on breast augmentation. METHODS: A comprehensive search of MEDLINE, Embase, and the Cochrane Library of Systematic Reviews was performed. SRs that have a particular focus on breast augmentation and were published in the top 15 plastic and reconstructive surgery journals were included. Quality assessment was performed using a measurement tool to assess systematic reviews (AMSTAR). Study characteristics were extracted including journal and impact factor, year of publication, country affiliation of the corresponding author, reporting adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, number of citations, and number of studies included. RESULTS: Among the 22 studies included for analysis, the mean AMSTAR score was moderate (5.55), with no SR achieving good quality (AMSTAR score of ≥9). There were no significant associations between AMSTAR score and journal impact factor, number of citations, year of publication, or number of included studies. Studies that reported adherence to PRISMA guidelines on average scored higher on the AMSTAR tool (P = 0.03). CONCLUSIONS: The methodological quality of reviews about breast augmentation was found to be moderate, with no significant increase in studies or quality over time. Adherence to PRISMA guidelines and increased appraisal of SRs about breast augmentation using methodological assessment tools would further strengthen methodological quality and confidence in study findings.

The Safe Resumption of Elective Plastic Surgery in Accredited Ambulatory Surgery Facilities During the COVID-19 Pandemic.

BACKGROUND: On March 11, 2020, the World Health Organization declared the novel Coronavirus-19 (COVID-19) a worldwide pandemic, resulting in an unprecedented shift in the Canadian healthcare system, where protection of an already overloaded system became a priority; all elective surgeries and non-essential activities were ceased. With the impact being less than predicted, on May 26, 2020, elective surgeries and non-essential activities were permitted to resume. OBJECTIVES: The authors sought to examine outcomes following elective aesthetic surgery and the impact on the Canadian healthcare system with the resumption of these services during the COVID-19 worldwide pandemic. METHODS: Data were collected in a prospective manner on consecutive patients who underwent elective plastic surgery procedures in 6 accredited ambulatory surgery facilities. Data included patient demographics, procedural characteristics, COVID-19 polymerase chain reaction (PCR) test status, airway management, and postoperative outcomes. RESULTS: A total of 368 patients underwent elective surgical procedures requiring a general anesthetic. All 368 patients who underwent surgery were negative on pre-visit screening. A COVID-19 PCR test was completed by 352 patients (95.7%) and all were negative. In the postoperative period, 7 patients (1.9%) had complications, 3 patients (0.8%) required a hospital visit, and 1 patient (0.3%) required hospital admission. No patients or healthcare providers developed COVID-19 symptoms or had a positive test for COVID-19 within 30 days of surgery. CONCLUSIONS: With appropriate screening and safety precautions, elective aesthetic plastic surgery can be performed in a manner that is safe for patients and healthcare providers and with a very low risk for accelerating virus transmission within the community.

Hot Topics in Breast Surgery.

Since the first implant-based breast surgeries were performed nearly 70 years ago, breast augmentation it has changed drastically. As understanding of breast augmentation has advanced, so too have the technologies and techniques used to improve results and minimize the risk of complications in breast implant surgery. This article reviews some of the novel techniques and technologies used today in breast augmentation surgery. How these tools and techniques will withstand the test of time remains to be seen, but they no doubt will add to the fascinating and ever-evolving history of breast augmentation.

Does Implant Surface Texture Affect the Risk of Capsular Contracture in Subglandular Breast Augmentation and Breast Augmentation-Mastopexy?

BACKGROUND: Previous studies have reported decreased rates of capsular contracture associated with the use of textured surface breast implants placed in the subglandular plane during breast augmentation. However, since the publication of these studies, our understanding of the pathophysiology of capsular contracture, as well as the surgical techniques utilized to minimize bacterial contamination of the implant, have advanced considerably. OBJECTIVES: The purpose of this study was to re-evaluate the relation between implant surface texturization and capsular contracture rates for breast implants placed in the subglandular plane during primary breast augmentation. METHODS: Retrospective chart review was performed of all primary subglandular breast augmentation procedures involving the use of either smooth or textured round silicone gel implants, with or without simultaneous mastopexy. The primary outcome measures included clinically significant capsular contracture (Baker grade III/IV) and revision surgery for capsular contracture. RESULTS: Between 2010 and 2017, 526 patients underwent primary subglandular breast augmentation with either smooth (n = 212) or textured (n = 314) round silicone gel implants; 248 patients underwent breast augmentation, whereas 278 underwent breast augmentation-mastopexy. Average follow-up was 756 days in the textured group and 461 days in the smooth group. Five cases of capsular contracture were observed in the textured group, and 7 cases of capsular contracture were observed in the smooth group (P = 0.20). CONCLUSIONS: Smooth surface implants placed in the subglandular plane were not at a significantly increased risk of capsular contracture compared with textured surface implants. We suggest that adherence to a surgical technique focused on minimizing bacterial contamination of the implant is of greater clinical significance than implant surface characteristics when discussing capsular contracture.

The Impact of Skin Care Product Sales in an Aesthetic Plastic Surgery Practice.

BACKGROUND: Despite significant growth of the global skin care market, many plastic surgeons do not offer skin care products through their aesthetic practice. However, skin care products represent a significant potential revenue stream for plastic surgeons, not only by generating revenue from product sales but by improving patient retention over time and, in turn, generating additional surgical and nonsurgical revenue. OBJECTIVES: The purpose of this study was to determine the financial implications that skin care sales can have for an aesthetic surgery practice. Our hypothesis was that patients making skin care purchases would generate higher non-skin care revenue than patients not purchasing skin care products. METHODS: A retrospective chart review was performed of all purchases made within a single aesthetic surgery practice during a 6-year period (2012-2017). Pre-tax revenue ($CAD) from each category was recorded for any patient who made a purchase during the study period. RESULTS: A total 3785 patients purchased skin care products, 5088 patients purchased nonsurgical treatments, and 3504 patients underwent surgery. Average patient spending was $720.73 (skin care), $1272.63 (nonsurgical), and $10,048.34 (surgery), respectively. Overall, patients who purchased skin care generated more revenue from the purchases of nonsurgical treatments and surgery than patients who did not purchase skin care products. CONCLUSIONS: Skin care sales not only generate revenue, but over time these patients spend more on nonsurgical and surgical treatments than patients who do not purchase skin care. Skin care is an important adjuvant to nonsurgical and surgical treatments that should be considered by all aesthetic surgeons.

Periareolar Augmentation-Mastopexy.

The authors describe their surgical technique for single-stage periareolar mastopexy with subglandular breast augmentation. They have performed this procedure in 85 patients since 2009 and found that this operative technique has allowed them to achieve reproducible outcomes in a single-stage procedure. Periareolar mastopexy with subglandular breast augmentation is an excellent procedure for patients who desire a larger breast size and who present with mild to moderate nipple ptosis with a paucity of excess skin in the lower pole of the breast. This article will review the perioperative management and detailed steps of the procedure and outline its indications for utilization and some of the common complications the authors have encountered.

Posterior Vaginoplasty With Perineoplasty: A Canadian Experience With Vaginal Tightening Surgery.

Following vaginal trauma, most commonly vaginal delivery, women may experience vaginal laxity as a result of local tissue stretching and separation of the pelvic floor musculature. In addition to this generalized sensation of laxity, women may complain of decreased sexual satisfaction, gaping of the perineum, and excessive vaginal secretions. Since 2014, the authors have used a posterior vaginoplasty with perineoplasty technique for the surgical management of vaginal laxity. To date, the authors have performed surgical vaginal tightening in 30 consecutive patients and found that the posterior vaginoplasty with perineoplasty technique has allowed us to achieve reproducible outcomes with no postoperative complications. This article will review the authors' approach to patients presenting for surgical vaginal tightening and the authors' experience to date, including our preoperative screening, perioperative management, and detailed steps of the procedure.