Sub-muscular Breast Augmentation Using Tumescent Local Anesthesia.

BackgroundTumescent local anesthesia (TLA) involves the infusion of a saline solution containing lidocaine and epinephrine into tissues to achieve localized anesthesia and vasoconstriction. While the use of TLA in sub-glandular augmentation mammoplasty has been documented, we present a modified TLA approach for primary sub-muscular breast augmentation in transgender patients based on our experience over the past years.MethodsBetween the years 2014 and 2021, we performed primary sub-muscular breast augmentation on 20 transgender patients under TLA and conscious sedation. The tumescent solution consisted of 25 mL of 2% lidocaine, 8 mEq of sodium bicarbonate, and 1 mL of epinephrine (1 mg/1 mL) in 1000 mL of 0.9% saline solution. Initially, the solution was infiltrated between the pectoral fascia and the mammary gland, and subsequently, during the surgery, under the pectoralis major muscle.ResultsThe average volume of tumescent solution infiltrated during TLA was 740 mL per breast. There were no reports of adrenaline or lidocaine toxicity, and no cases required a conversion to general anesthesia. Patients experienced no pain or discomfort during the preoperative infiltration or surgical procedure.Reoperations due to short-term complications never occurred. We observed a major complication rate of 5%, represented by 1 hematoma. Long-term complications comprised one case of implant dislocation and one occurrence of dystrophic scar formation. No cases of capsular contracture needing reoperation, asymmetry, and implant rupture occurred. In total, one individual (5%) requested larger implants. Follow-up time ranged from 30 days to 1 years.ConclusionsOverall, augmentation mammaplasty is a valuable choice for transgender women aiming to enhance their feminine characteristics and alleviate gender dysphoria. It is imperative for patients to conduct thorough research, grasp the potential pros and cons, and consult experienced healthcare professionals in transgender care. Additionally, tumescent local anesthesia (TLA) has proven to be a safe and efficient method for sub-muscular breast augmentation, providing effective pain control with minimal postoperative complications, resulting in high patient satisfaction.Level of Evidence IVThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

The PIP mammary prosthesis: A product recall study

BackgroundTumescent local anaesthesia (TLA) is a method of anaesthesia used for surgical procedures that involves the infusion of a saline solution containing lidocaine, sodium bicarbonate, and epinephrine. This anaesthetic technique is designed to achieve both vasoconstriction and anaesthesia. In this article, we present a modified TLA protocol specifically adapted for reduction mammaplasty, based on an analysis of clinical case histories collected over the past few years.MethodsDuring the period from 2012 to 2022, we performed a reduction mammaplasty procedure in 120 patients employing tumescent local anaesthesia (TLA). The composition of the tumescent solution included 25 mL of 2% lidocaine, 8 mEq of sodium bicarbonate, and 1 mL of epinephrine (1 mg/1 mL) in 1000 mL of 0.9% saline solution. The solution was injected diffusely throughout the mammary gland.ResultsThe average volume of tumescent solution infiltrated during TLA was 350 mL per breast. There were no cases of adrenaline or lidocaine toxicity, and no patients required conversion to general anaesthesia. No patient received sedation. Patients reported no pain or discomfort during pre-operative infiltration or during surgery.No reinterventions were necessary because of short-term complications. Among the complications, there were 4 cases of hematoma (3,3%), 3 cases of seroma (2,55%), 10 cases of wound dehiscence (8,3%), 5 cases of asymmetry (4,1%), 9 cases of T-junction breakdown (7,5%), 2 cases of (partial) nipple necrosis (1,6%), and 3 cases of liponecrosis (2,5%).No cases of infection or total nipple-areola loss were reported. The follow-up period was between 30 days and 1 year.ConclusionsReduction mammaplasty is a viable surgical option for women with macromastia seeking to enhance their physiognomy. It is imperative that patients fully understand the potential benefits and risks associated with the procedure and consult with healthcare professionals specialising in this field.The use of tumescent local anaesthesia (TLA) has been confirmed as a safe and effective methodology to perform reduction mammaplasty, ensuring adequate pain control with minimal post-operative complications and resulting in a high degree of patient satisfaction.Level of Evidence IVThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

The "Mommy Makeover" is a combined plastic surgery procedure designed to address aesthetic concerns commonly experienced by women after pregnancy and breastfeeding. This procedure typically includes abdominoplasty and breast surgery. Traditionally, these surgeries are performed under general anesthesia, but the use of tumescent local anesthesia (TLA) combined with spinal anesthesia presents several advantages, including enhanced safety, effective pain management, and reduced postoperative complications. This study analyzes the outcomes of 62 patients who underwent Mommy Makeover surgery with TLA and spinal anesthesia from 2011 to 2023. The TLA solution was composed of 25 mL of 2% lidocaine, 8 mEq of sodium bicarbonate, and 1 mL of epinephrine (1mg/mL) diluted in 1000 mL of 0.9% saline solution. Spinal anesthesia was administered at the L1-L2 intervertebral level using 15-18 mg of ropivacaine in a 4 mL solution. The patient ages ranged from 25 to 74 years (mean age 47 years, standard deviation 10.236), and BMI ranged from 24 to 35 (mean BMI 29.5, standard deviation 2.379). A total of 62 abdominoplasties were performed, 61 were horizontal (5 of these included hernia repair), and 1 was vertical. Breast procedures included 10 augmentation mammaplasties, 5 mastopexies without implants, and 30 mastopexies with implants, and 17 reduction mammaplasties. Additionally, 22 liposuction procedures of the flanks were performed. Major complications occurred in 14.5% of patients, including 1 case of hemorrhage requiring reintervention, 5 hematomas, and 3 seromas. Minor complications included 6 cases of abdominal wound dehiscence and 4 cases of breast wound dehiscence. Tumescent local anesthesia combined with spinal anesthesia is a highly effective and safe method for performing combined abdominal and breast surgery in the context of a "Mommy Makeover." This technique provides significant benefits, including precise pain management, minimal postoperative side effects, and enhanced patient and surgeon satisfaction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Subfascial (SF) pocket breast augmentation (BA) has gained popularity, whereas the transaxillary approach (TAA) offers the benefit of an inconspicuous scar. Previous reports on both techniques involved limited follow-up/samples, and few clinical studies specifically address surgical technique and outcomes following primary and secondary BA. The purpose of this study was to assess outcomes from the SF TAA technique in a large series of patients who underwent primary and secondary BA. A retrospective cohort of patients who underwent BA between 1999 and 2024 was identified. The primary outcome was occurrence of incision and implant/pocket complications. Regression logistic analysis evaluated risk factors including age, body mass index, smoking, implant surface/volume, and fat grafting. The cohort contained 1015 patients (mean age, 28.5 ± 7.3 years), and the average follow-up was 77.6 ± 38.6 months. In primary BA, 212 patients (23.4%) experienced at least 1 complication, most frequently capsular contracture. More complications were seen in secondary BA ( P = 0.016). Multivariate regression identified body mass index less than 18.5 kg/m 2 as a significant risk factor for incision complications, whereas textured surface (OR, 2.70; P < 0.001) and implant volume greater than 350 cc (OR, 2.79; P < 0.001) were risk factors for implant/pocket complications. Despite extensive research on BA procedures, studies on SF TAA procedures are limited and have not analyzed long-term outcomes following primary/reoperative operations. These results demonstrate that SF TAA is a reliable technique, and the data are compatible with other studies using different BA approaches. Knowledge of the axillary and pectoralis fascia anatomy allows surgeons to safely implement the SF TAA technique and minimize risk. Therapeutic, III.

Less Painful Tumescent Solution for Patients Undergoing Endovenous Laser Ablation of the Saphenous Vein

Background: Anesthetic management of severe post burn neck contracture is difficult, demanding due to fixed flexion deformity of neck, incomplete oral occlusion and insufficient mouth opening leading to difficulty in intubation. Patients undergoing contracture release, skin graft harvest under general anesthesia (GA) were compared with patients undergoing the same surgery under tumescent local anesthesia (TLA) technique.&#x0D; Methodology: Twenty-one patients with post burn neck contracture undergoing contracture release with split skin grafting under GA were compared with twenty-one patients undergoing the same surgery under TLA. Post-operative pain and satisfaction were assessed using 10 cm VAS (Visual Analogue Scale).&#x0D; Results: Demographic profile was comparable in both groups. Changes in intra-operative vital parameters remained insignificant. The average volume of tumescent solution used was 254.76 + 49.05ml. Blood loss was significantly decreased, postoperative pain relief was more than sixteen hours in thirteen patients and extended beyond twenty-four hours in six patients in the TLA group. Time for the first rescue analgesia was significantly lesser in the GA group and the average dose of injection tramadol used in the GA group was significantly higher within the first 24 h. Overall satisfaction in the TLA group was significantly higher than in the GA group.&#x0D; Conclusion: TLA can be used as sole technique for release of post burn neck contracture and harvest of split skin grafts with less blood loss and significantly better postoperative pain relief avoiding complications of general anesthesia.&#x0D; Key words: Tumescent local anesthesia; Post burn neck contracture; Skin graft harvest; General anesthesia&#x0D; Citation: Prasad MK, Jain P, Varshney RK, Khare A, Jheetay GS. Tumescent local anesthesia as an alternative to general anesthesia in the release of post-burn neck contracture and skin graft harvesting: A comparative study. Anaesth. Pain intensive care 2021;25(1):34–39.&#x0D; DOI: 10.35975/apic.v25i1.1434&#x0D; Received: 18 February 2020, Reviewed: 16 March 2020, Accepted: 30 April 2020

Introduction: In Germany the local anesthetic prilocaine has gained popularity for use in tumescent solutions. However, although prilocaine shows the lowest toxicity of the local anesthetics, the use of prilocaine in higher doses leads to methemoglobinemia. We report a clinical study that determines whether adequate local anesthesia can be achieved with low concentrations of prilocaine (less than 0.05%). Materials and Methods: Twelve patients from anesthesia risk groups ASA I and II participated in the study. The patients were medicated with 25 mg piritramide orally and with 1000 mg acetaminophen by suppository. By means of an infusion system and a pump syringe, tumescent solution was injected into the subcutis until the tissue was completely infiltrated. This initial injection used approximately two thirds of the total quantity of solution, and the remaining tumescent solution was injected roughly 30 minutes later, resulting in ultratumescence. A 0.038% solution of prilocaine was used. Two 3-L bags with additives were instilled as the standard for treatment. The total injection volume was 6.3 L. A total of 2400 mg of prilocaine was administered, which is 4 times higher than the recommended maximum dose for infiltration anesthesia using prilocaine with epinephrine. The subjective tolerability of the tumescent local anesthesia was measured by interview and documentation. Results: In all cases, it was possible to perform the liposuction using prilocaine in a concentration of 0.038%. Eight of the 12 patients needed supplemental intravenous doses of 3.75–11.25 mg of piritramide. Discomfort was reported by 3 patients during the infiltration and by 6 patients during liposuction. Two patients received analgesic during the infiltration, and 8 patients received analgesic during liposuction. All patients were ambulatory immediately following surgery. All patients were satisfied with the tumescent local anesthesia and would agree to using it again in liposuction. Discussion: The low concentration of prilocaine used in the tumescent solution (0.038%) proved sufficient for liposuction. The more dilute solution allows for a greater volume of the tumescent solution to be used without causing more side effects. The increased procedure time of up to 6 hours seems justified by the safety and efficacy of the technique.

Background:There is increasing evidence that lidocaine is toxic to adipocytes and their precursors, which can contribute to the variability in fat graft resorption. Erector spinae plane (ESP) block is a new technique to provide analgesia of the trunk and would avoid lidocaine at the fat graft donor site. The aim of this study was to compare the efficacy of ESP block versus tumescent local anesthesia (TLA).Methods:A retrospective review was performed for all patients who underwent autologous fat grafting from the abdomen at the University of New Mexico Hospital between February 2016 and March 2019. These patients received either ESP block or TLA during abdominal fat harvest. The primary endpoints were intraoperative, postoperative, and total morphine equivalents.Results:There was no difference in the mean intraoperative, postoperative, and total morphine equivalents administered between the ESP and TLA groups.Conclusions:ESP block is equivalent to TLA for analgesia when using an abdominal donor site for fat harvest. ESP block should be considered in fat-grafting cases to avoid the potential toxicity of lidocaine to the viability of adipocytes and preadipocytes.

We describe our experience with tumescent local anesthesia for excision and flap procedures in the treatment of pilonidal disease. Forty consecutive patients with symptomatic pilonidal disease were treated. Tumescent solution was prepared by mixing one volume of a lidocaine (20 mg/ml) and adrenaline (0.0125 mg/ml) combination with 9 volumes of lactated Ringer's solution. The final solution was infiltrated gradually and liberally, first subcutaneously and then into the skin. The end point was swollen and firm skin. After excision, the area was filled with an advancement flap or a rotational flap. The study group consisted of 37 men (92.5%) and 3 women (7.5%); mean age, 27 (range, 18-61) years. The amount of injected solution ranged from 60 mL to 140 mL (mean, 100 mL; dose interval, 2-4 mg/kg). No additional anesthesia or sedation was needed, and no complications were observed during the procedure. Half of the patients were discharged on the day of the operation, half on the next day. Follow-up ranged from 13 to 37 months. Patients returned to daily activities after a mean of 10.5 (range, 2-30) days. Primary healing occurred uneventfully in 28 patients (70%); wound healing complications occurred in 12 (30%). No flap necrosis was observed. Thirty-seven (92.5%) patients reported satisfaction with the procedure. Recurrence was observed in 3 patients (7.5%). Excision and flap procedures for sacrococcygeal pilonidal disease can be performed under tumescent local infiltration anesthesia with acceptable results, without requiring regional or general anesthesia.

Reporting a fatality during tumescent liposuction

Volumetric Evaluation of the Mammary Gland and Pectoralis Major Muscle following Subglandular and Submuscular Breast Augmentation: Correction

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

Animation deformity or breast distortion during pectoralis muscle contraction following subpectoral breast augmentation is a known entity, but its prevalence and significance remain unclear. The purpose of this study was to identify the incidence and severity of animation deformity as well as its effect on patient satisfaction and interference with certain activities. All procedures were performed by the senior author using a variation of a previously described dual-plane technique. The first part of this study was an evaluation of breast distortion by a group of independent observers in a series of 40 consecutive patients who underwent primary subpectoral breast augmentation. The second part of the study was a questionnaire sent to 195 consecutive patients asking about overall satisfaction, degree of animation deformity, and whether there was interference with any activities. Of the 40 patients' photographs that were evaluated, 9 (22.5%) had no distortion, 25 (62.5%) had minimal distortion, 4 (10%) had moderate distortion, and 2 (5%) had severe distortion. Of the 195 questionnaires, there were 69 responses, a 35% response rate. Fifty-six (82%) described mild to no distortion, 7 (10%) were moderate, and 5 (7%) were severe. According to the survey, the most common activities that were problematic were lifting weights and exercising (24 and 19%, respectively). Only one (1%) patient stated that she would not recommend subpectoral positioning. Although animation deformities do exist, nearly all patients in this study would still choose subpectoral positioning. Patients who may be better candidates for subglandular placement are those for whom exercise is central to their daily living. As a result of this study, surgeons and patients should have more accurate and reliable information regarding the significance of animation deformity after subpectoral breast augmentation.

Liposuction has become one of the most commonly performed cosmetic surgical procedures. A natural offspring of liposuction, liporecycling, has simultaneously been developed as an effective procedure in soft-tissue augmentation. The graft material for this procedure is collected during reduction liposuction performed with tumescent anesthesia. The tumescent solution allows for the use of specially designed microcannulas. In this way, pure fat cells are harvested that can easily be used immediately or frozen and kept for future subdermal reinjection through small syringes. The results in soft-tissue augmentation and facial rejuvenation are comparable to those of collagen injection but show a number of significant advantages.