A New Algorithm for Implant Choice in Aesthetic Breast Procedures Based on the Polytech Portfolio.

Background: Venous thromboembolism (VTE) is a significant cause of morbidity and mortality, particularly in the postoperative setting. Various risk stratification schema exist in the plastic surgery literature, but do not take into account variations in procedure length. The putative risk of VTE conferred by increased length of time under anaesthesia has never been rigorously explored. Aim: The goal of this study is to assess this relationship and to benchmark VTE rates in plastic surgery. Methods: A large, multi-institutional quality-improvement database was queried for plastic and reconstructive surgery procedures performed under general anaesthesia between 2005–2011. In total, 19,276 cases were abstracted from the database. Z-scores were calculated based on procedure-specific mean surgical durations, to assess each case’s length in comparison to the mean for that procedure. A total of 70 patients (0.36%) experienced a post-operative VTE. Patients with and without post-operative VTE were compared with respect to a variety of demographics, comorbidities, and intraoperative characteristics. Potential confounders for VTE were included in a regression model, along with the Z-scores. Results: VTE occurred in both cosmetic and reconstructive procedures. Longer surgery time, relative to procedural means, was associated with increased VTE rates. Further, regression analysis showed increase in Z-score to be an independent risk factor for post-operative VTE (Odds Ratio of 1.772 per unit, p-value < 0.001). Subgroup analyses corroborated these findings. Conclusions: This study validates the long-held view that increased surgical duration confers risk of VTE, as well as benchmarks VTE rates in plastic surgery procedures. While this in itself does not suggest an intervention, surgical time under general anaesthesia would be a useful addition to existing risk models in plastic surgery.

IntroductionGeneral surgery residency involves performing subspecialty procedures in addition to the core general procedures. However, the proportion of core general surgery versus subspecialty procedures during training is variable and its...

Sir:FigureLiposuction is the most performed procedure in plastic surgery.1 Tumescent liposuction uses a solute infiltration containing isotonic saline (sodium chloride 0.9%) and lidocaine/epinephrine and is carried out by operating room nurses before any intervention. This solution allows reduction of bleeding associated with liposuction. We report a case of a 24-year-old patient, without a medical history, who had excess fat localized to subtrochanteric regions. She underwent tumescent liposuction for aesthetic purposes. An error in the realization of the infiltration solution was identified: hypertonic saline (sodium chloride 3%) of close presentation, used for the sterilization of liver hydatid cysts, was substituted for normal saline. The next day, the patient showed signs of injured skin on the right thigh that evolved into cutaneous fat necrosis by 48 hours (Fig. 1). She did not present clinical or biological signs of infection. Her left thigh was not injured because it was infiltrated with another preparation. The lesions were extremely painful and required an opioid analgesic treatment. In total, three surgical procedures under general anesthesia were performed. The first was performed in the immediate aftermath, and the other two were performed at days 26 and 35. Ultimately, healing by secondary intention was preferred rather than skin grafting. The outcome was favorable and the wounds were healed completely by 110 days (Fig. 2). The patient has dystrophic sequelae in the right thigh.Fig. 1: Wounds at 3 days.Fig. 2: Wounds at 110 days.The trivialization of liposuction means that some forget that it is far from devoid of complications. The incidence of complications ranges from 0.1 to 9.3 percent.1,3–5 Contour irregularity is the most common, but infections and hematomas also occur. Moreover, serious complications have been reported, including pulmonary embolism, cerebral fat embolus, intestinal perforation, and also, rarely, death.1 Many cases of skin necrosis have been reported in the literature, but this is the first reported case attributable to hypertonic saline. The most common cause of extended skin necrosis remains septic necrotizing fasciitis.3 In our treatment plan, we decided to promote the scar retraction phenomenon with the hope of reducing the loss of substances to a minimum size. A skin graft would have been poorly integrated and ugly. Later, we will be able to offer a scar revision if necessary, with a prior step of expansion. The volume of infiltration recommended for tumescent liposuction varies from 1 to 3 liters per liter of adipose tissue extracted, with 500 mg of lidocaine and 1 mg of epinephrine per liter.5 To avoid such errors, it will be necessary to ask the nursing staff to keep the pocket of initial solute and to annotate the additions at each step. Regarding the legal issue in the private sector, members of the operating room staff are the direct responsibility of the surgeon. Errors committed by staff can be directly attributed to the surgeon. In this instance, the patient began legal proceedings against the surgeon, and the proceedings are underway. In conclusion, certain acts of surgery seem perfectly controlled in terms of risk. However, this type of incident shows that they are unfortunately too commonplace because of repetition. We must remain cautious because even simple interventions can lead to severe complications.2 Benoit Chaput, M.D. Plastic and Reconstructive Surgery Unit, CHU Toulouse Rangueil, Toulouse, France Geraldine Fade, M.D. Plastic and Reconstructive Surgery Unit, CHU Bordeaux Pellegrin, Bordeaux, France Aymeric André, M.D. Jean Louis Grolleau, M.D. Ignacio Garrido, M.D., Ph.D. Plastic and Reconstructive Surgery Unit, CHU Toulouse Rangueil, Toulouse, France

Introduction: Breast augmentation with implants is one of the most performed procedures in plastic surgery all over the world. Despite its popularity, this procedure counts many complications that may require a revision, a replacement or a deposit of the implants. Aims: This study describe a new complication inherited to breast implants and through his observation, wonders about an ethiopathogeny relationship that may be nested with some fat degeneration problems and sarcopenia in the human body. Methods: The author made a clinical observation while replacing implants with capsular contracture noticing a thinning of the pectoralis major muscle and an embrittlement of its fibers with discoloration and yellowness of its corpus. Histopathology specimen were analyzed, photographed and data was collected and discussed. Results: Biopsies were performed on the pectoralis major muscle proving the fatty degeneration and corroborant the atrophy and the sarcopenia. The most common-sense reason was, according to the author, the implant weight and the mechanical pressure on the fibers that led to a cellular stress and a distortion in the regenerative process of the aggressed tissue. Conclusion: A new complication related to breast implants was described. The author request more research to consider an eventual extrapolation of this theory to explain the ethiopathogeny of some classical fatty degeneration processes and sarcopenia observed in different tissues of the human body.

There is widespread concern about possible long-term health effects among women who have received breast implants for cosmetic purposes; few studies have reported on the mortality patterns of such women. The authors examined cause-specific mortality in a cohort of 24,558 women with breast implants and 15,893 women who underwent other plastic surgery procedures in Ontario and Quebec, Canada, between 1974 and 1989. Deaths through 1997 were identified through linkage to the national mortality database. The authors compared the mortality of women who received implants with that of the general population by using standardized mortality ratios; Poisson regression was used to perform internal cohort comparisons. Overall mortality was lower among women who received breast implants relative to the general population (standardized mortality ratio = 0.74, 95% confidence interval: 0.68, 0.81). In contrast, higher suicide rates were observed in both the implant (standardized mortality ratio = 1.73, 95% confidence interval: 1.31, 2.24) and other plastic surgery (standardized mortality ratio = 1.55, 95% confidence interval: 1.07, 2.18) patients. No differences in mortality were found between the implant and other surgeries group for any of the 20 causes of death examined. Findings suggest that breast implants do not directly increase mortality in women. Further work is needed to evaluate risk factors for suicide among women who undergo elective cosmetic surgery.

The area of aesthetic surgery is constantly growing and evolving. All plastic surgery trainees are expected to have an understanding of common aesthetic procedures, techniques and potential complications. This chapter aims to cover the most commonly encountered aesthetic procedures in plastic surgery. This includes anti- ageing procedures such as face lift and blepharoplasty and breast cosmetic procedures. The management and care of post-massive weight loss patients and the subsequent body contour procedures are detailed.

Plastic surgery, encompassing both reconstructive and aesthetic procedures, is a field of medicine that not only enhances patients' external appearance but also significantly impacts their psychological well-being. The aim of this study is to evaluate the psychological consequences of plastic surgery, considering the effects of such interventions on self-esteem, self-worth, quality of life, and the potential risks associated with aesthetic procedures. Research indicates that procedures such as breast augmentation or rhinoplasty can lead to significant improvements in body image perception, increased self-confidence, and enhanced social and professional functioning. However, plastic surgery also carries potential risks, particularly for patients with psychological disorders such as body dysmorphic disorder or eating disorders, where the aesthetic outcomes may not meet expectations, potentially leading to a deterioration in mental health. A critical factor in preventing adverse effects is the careful selection of patients and the conduct of a thorough psychological assessment, which allows for the evaluation of realistic expectations and the identification of potential risks associated with surgery. This study emphasizes the necessity of a holistic approach to patient care, which considers both physical and psychological aspects, to ensure optimal and long-term therapeutic outcomes in plastic surgery.

A finite element model to accurately predict real deformations of the breast

Plastic Surgery of the Breast: A 75-Year Journey.

28 - Rhinoplasty: Dimensional analysis and planning

Multimodal analgesic protocols are increasingly favored over traditional opioid regimens due to decreased adverse side effects and reduced opioid consumption. Concomitant use of selective cyclooxygenase (COX)-2 inhibitor celecoxib and anticonvulsant gabapentin have been proposed to adequately control acute postoperative pain. To determine efficacy of postoperative pain control using nonopioid pain regimen vs traditional opioids for all aesthetic plastic surgery procedures. A retrospective chart review was performed on 462 consecutive outpatient plastic surgery procedures by a single surgeon between November 2015 and July 2017. Procedures in the historical control group (n = 275) received traditional postoperative narcotic, hydrocodone-acetaminophen. Patients in the more recent nonopioid study group (n = 187) received a pre-, peri-, and postoperative regimen of celecoxib and gabapentin. Similar demographic characteristics between the control and study groups were observed: mean age, 39.7 vs 39.5 years; BMI, 24.6 vs 24.4 kg/m2; and ratio of female patients 92.7% vs 92.4%. A significant reduction in rescue analgesia (meperidine 44.6% vs 14.9%, P < 0.001) and antiemetic use (ondansetron 24.2% vs 16.3%, P < 0.05; promethazine 17.0% vs 4.7%, P < 0.001) in postanesthesia recovery unit (PACU) was noted in the nonopioid group compared to the control. The average stay in PACU also decreased in the study group (82 ± 39 min vs 70 ± 22 min, P < 0.001). Both groups reported low numbers of adverse events and need for additional pain prescriptions. These findings were reproducible in the breast subgroup. This nonopioid regimen is as effective as traditional opioid use for acute postoperative pain control and decreased recovery time for outpatient aesthetic plastic breast surgeries.

This chapter reviews applications of ultrasound such as the detection of photoaging and frequent complications of cosmetic and plastic surgery procedures. Currently, ultrasound is a first-line imaging technique for the identification and management of these aesthetic procedures. Given the worldwide explosive growth of cosmetic and plastic surgery procedures, this chapter may help in dealing with these entities, which sometimes can be powerful simulators of other dermatologic conditions.

Aim: The aim of the study was to reveal the profiles of patients who underwent aesthetic procedures with out-of-pocket payments (public sales tariffs) between 2020 and 2023 at a public hospital in Samsun. Method: This descriptive study included 525 patients who underwent aesthetic surgery with out-of-pocket payments between 2020 and 2023 in a public hospital in Samsun. In the present study, the sociodemographic characteristics of the patients and the aesthetic procedures they underwent were analyzed. Results: In 2020-2023, 49,638 patients were admitted to the Plastic, Reconstructive and Aesthetic Surgery outpatient clinic. Surgical procedures were performed on 4,960 of these patients. Of the patients who underwent surgical procedures, 525 patients underwent invasive aesthetic procedures with out-of-pocket payments out of medical necessity. The mean age of the patients was 32.31±11.87 years, and 83.60% were female. 98% of patients are of Turkish origin. International patients came from Iraq, Azerbaijan and Germany. The most common aesthetic procedures performed were rhinoplasty, breast aesthetics and eyelid aesthetics. All the international patients had breast aesthetics. Conclusion: According to the results of the present study, the majority of those who underwent aesthetic procedures were young women. The most common aesthetic procedures were rhinoplasty and breast surgery. According to these results, it may be recommended that women who undergo plastic surgery be investigated in a larger population.

A Discussion of Conflicts of Interest in Plastic Surgery and Possible Remedies.

The opioid crisis in America has sparked a shift toward a multimodality perioperative pain regimen. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) in the perioperative period decreases opioid consumption and increases efficacy. However, many plastic surgeons avoid their use because of antiplatelet effects. The purpose of this article is to systematically review the plastic surgery literature to assess the risk of intraoperative or postoperative bleeding and hematoma formation. A systematic review of articles published in PubMed was performed in September 2018 to investigate the incidence of increased bleeding and hematoma formation with use of NSAIDs in the perioperative period in plastic surgery. All articles were reviewed for primary outcome measures, and a selective literature review was performed to examine perioperative NSAID use in other surgical subspecialties. Random-effect meta-analysis was performed. Our search yielded 806 total articles, with 15 meeting inclusion criteria, and this included 3064 patients (1679 with perioperative NSAIDs, 1385 with no NSAIDs). There was no significant difference in overall incidence of bleeding/hematoma in the treatment group versus control (no NSAIDs). The overall pooled odds ratio (OR) and corresponding 95% confidence interval were 1.20 and 0.73 to 1.97 (P = 0.48). When separated by drug administered across all plastic surgery procedures, there were no statistically significant differences in incidences of hematoma or increased bleeding with use of ketorolac (OR, 1.48 [0.86-2.56]; P = 0.57), ibuprofen (OR, 0.55 [0.14-2.14]; P = 0.87), or celecoxib (OR, 0.22 [0.02-2.52]; P = 0.39). When examining NSAID use in breast surgery, there was no statistically significant difference in incidence of hematoma or increased bleeding when combining all 3 drug types (OR, 1.39 [0.82-2.37]; P = 0.60). Some individual studies demonstrated trends toward increased bleeding/hematoma in reduction mammoplasties. Nonsteroidal anti-inflammatory drugs significantly improve pain control and decrease opioid use when used in plastic surgery. The majority of evidence in plastic surgery does not support an increased incidence of bleeding/hematoma with the use of perioperative NSAIDs.