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Background: Gender dysphoria is defined as a feeling of distress resulting from the incongruence between the sex assigned at birth and the gender identity, lasting longer than 6 months. In individuals with gender dysphoria, gender-affirming hormone therapy (GAHT) may improve quality of life (QoL). Objectives: We aimed to assess perceived QoL, to compare QoL scores between trans women and men and to identify possible contributing factors related to GAHT in a sample of transgender women and transgender men. Methods: In this cross-sectional study, transgender women and men were recruited by availability sampling from a national transgender health service. Individuals over 18 years old with a confirmed diagnosis of gender dysphoria receiving medically prescribed GAHT for at least 6 months were consecutively included. Also included were trans men who had undergone mastectomy and trans women who had received breast augmentation surgery. Individuals who had undergone gender affirmation surgery (specifically genital surgery) or with uncontrolled clinical/psychiatric conditions at the time of the initial assessment were excluded. Sociodemographic, physical, and hormone data were collected from all participants. The WHOQOL-BREF questionnaire was used to evaluate QoL. A total of 135 transgender individuals were invited. Seventeen individuals with previous genital surgery (12.6%) and five who refused to participate (3.7%) were excluded. Therefore, 113 patients were enrolled and completed the study (60 trans women and 53 trans men). Results: QoL scores did not differ between trans women and trans men. In trans women, greater breast development and stable relationships, and higher body mass index were associated with higher QoL domain scores. In trans men, higher domain scores were found in individuals in a stable relationship, with increased body hair, engaging in physical activity, and being employed. Conclusion: Data from this study suggest that GAHT-related physical characteristics, such as breast development in trans women and increased body hair in trans men, are similar between groups, are associated with higher QoL scores, and that sociodemographic parameters may impact these associations. Healthcare providers might consider these factors when planning interventions to improve QoL in transgender individuals. [ABSTRACT FROM AUTHOR]

Background: Testicular prostheses implantation may be used for neoscrotal augmentation in transgender men. In current literature, explantation rates range from 0.6% to 30% and most are a result of infection or extrusion. Information on the surgical path of individuals after prosthesis explantation is scarce. Aim: To assess the frequency and success rate of testicular prosthesis implantation after previous explantation due to infection or extrusion. Methods: All transgender men who underwent testicular prosthesis explantation between January 1991 and December 2018 were retrospectively identified from a departmental database. A retrospective chart study was conducted, recording demographics, surgical and prosthesis characteristics, reoperations, and outcomes. Results: A total of 41 transgender men were included who underwent testicular prosthesis explantation in the study time period. Of these, 28 (68%) opted for new prosthesis implantation. Most explanted prosthesis had a volume ≥30cc and were replaced with an equally sized one. The postoperative course was uneventful in 19 out of 28 (68%) individuals. Explantation of one or both prostheses occurred in 7 out of 28 (25%) individuals, because of infection (n¼3, 11%) or extrusion (n¼4, 14%). Patients that experienced complications had more often a history of smoking (p¼0.049). The explantation rate was lower if a smaller or lighter prosthesis was reimplanted (p¼0.020). Discussion: Most patients opt for testicular prosthesis implantation after previous explantation due to extrusion or infection. Explantation rates are higher than after the primary implantation procedure. Results of current study can be used to inform individuals on postoperative outcomes. [ABSTRACT FROM AUTHOR]

Breast plastic surgery is one of the main surgical items in the clinical work of plastic surgery. It is a more common and mature plastic surgery at home and abroad. The current status and existing problems of domestic breast plastic surgery are reviewed. This paper focused on the hot issues of such as aesthetic effect of double-ring reduction mammaplasty, breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), multidisciplinary treatment of breast reconstruction, endoscope-assisted axillary biplane implant augmentation mammoplasty, autologous granular fat transplantation and polyacrylamide hydrogel removal after augmentation mammaplasty. [ABSTRACT FROM AUTHOR]

Complex regional pain syndrome (CRPS) is a regional, neuropathic pain disorder, with disproportionate symptoms, that does not respect dermatomes or nerve distribution. A 28-year-old female patient with personal history of two breast augmentation surgeries consulted for breast reduction after dissatisfaction with the size and form of her breasts. Breast reduction was undertaken with prosthesis exchange. During the first 10 days, she presented swelling, hyperesthesia, and burning pain mainly around her left breast. An ultrasound showed seroma collection which was drained in two occasions. She was referred to physical therapy to desensitize and initiate additional treatment for symptoms. Three weeks after surgery, bilateral pain persisted, as well as hyperesthesia, edema, and local hyperthermia; thus, referral to an anesthesiologist specialized in pain management with a CRPS type II diagnosis was undertaken which confirmed the diagnosis and additional analgesics were initiated. A week into treatment, she referred decreased signs and symptoms in her breasts. During the second month, symptoms decreased and medication was gradually lowered. At the end of the third month, medication was suspended and she began her normal activities with no symptoms. This case report highlights the importance of clinical suspicion of CRPS. Signs and symptoms should be interpreted in a timely fashion to allow a prompt treatment and speedy recovery. Level of evidence: Level V, risk study. [ABSTRACT FROM AUTHOR]

High patient satisfaction of 96.55% from HDL procedures was achieved, indicating efficacy of this procedure. PR035P ADDRESSING MENTAL WELLNESS AND SUPPORT IN ORTHO-PLASTIC TRAUMA PATIENTS Fraser Donaldson, Mohit Jain, Alistair Mccombe, Andrea Holek, Veneshree Nair and Kristian So... Cairns Hospital, QLD B Purpose: b The importance of mental wellness and social support is becoming increasingly recognized with respect to patient outcomes following traumatic injury. A collaborative effort to optimize patient care in the ED through education plays an integral role in patient outcomes. B Results: b Of the 45 patients identified, 68.9% had day-case procedures and 4 patients had direct surgical complications (2 bleeding, 2 wound infections). Some patients did not undergo salvage due to infectious burden, implant exposure or patient preference. [Extracted from the article]

Polyacrylamide hydrogel (PAAG) was developed in the 1980s as an injectable filler for breast augmentation and tissue contour improvement, but its potential risk for oncogenesis and the frequent occurrence of chronic complications after injections led to the prohibition of its further use as an injectable material. Although breast augmentation with PAAG injections was mostly performed in China and Eastern Europe, the migration of patients and long-term complications of the procedure made it a global concern. Herein, we describe the case of a 49-year-old woman who immigrated to Korea after undergoing breast augmentation via PAAG injection in China, and complained of persistent mastodynia and retraction of both breasts. Surgical treatment was undertaken, along with removal of the PAAG and total capsulectomy of the fibrous capsule containing the gel through an inframammary fold incision. We share our experience of diagnosing and treating this case, and present a literature review.

Purpose: The posterior cruciate ligament (PCL) is an important stabilizer of the knee and can be damaged in up to 20% of ligamentous injuries. Numerous techniques for surgical treatment have been described in the literature with none shown to be clearly superior. The aim of this study was to assess the 2-year outcomes of PCL repair with suture tape augmentation. Methods: Seventeen patients undergoing PCL repair with suture tape augmentation were prospectively followed up for a minimum of two years. One patient was lost to follow-up leaving sixteen patients in the final analysis (94.1%). Indications for this procedure were acute Grade III PCL ruptures, symptomatic chronic tears and PCL tears as part of a multi-ligament injury. Exclusion criteria were patients with retracted PCL remnants or poor tissue quality. Patient-reported outcomes were measured using the Knee Injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analogue Pain Scale (VAS-pain), Veterans RAND 12 Item Health Survey (VR-12) and Marx Activity Scale. Patients with any postoperative complications were identified. Mean differences between the outcomes pre-operatively and at two years postoperatively were evaluated using paired t-tests with significance set at p < 0.05. Results: The mean KOOS at 2 years was 87.0, 75.5, 93.0, 69.6 and 54.2 for pain, symptoms, ADL, sport/recreation and QOL respectively. These improved significantly from 60.2, 49.8, 65.0, 33.0 and 34.2 preoperatively (p < 0.05). The mean WOMAC scores at 2 years were 91.0, 78.3 and 93.0 for pain, stiffness and function respectively. These improved significantly from 63.0, 51.7 and 65.0 preoperatively (p < 0.01). The VAS score improved from 3.0 to 0.8 (p < 0.01) and the VR-12 score improved from 34.9 to 50.9 at 2 years (p < 0.001). However, the Marx activity scale decreased from 8.7 pre-injury to 6.3 at 2 years (N.S.). One patient (6.3%) suffered a re-rupture. Conclusion: PCL repair with suture tape augmentation demonstrates satisfactory patient reported outcome measures at minimum 2-year follow-up. These figures compare favorably with success rates described in the literature for PCL reconstruction techniques. Therefore, PCL repair with suture tape augmentation is an effective treatment option in selected patients. Level of evidence: IV [ABSTRACT FROM AUTHOR]

Background: Mammoplasty is the most common surgery used for breast augmentation (aesthetic plastic) and breast reconstruction (disease-related plastic) in women who have been diagnosed with and surgically treated for regional breast cancer with modified radical mastectomy. This study aims to examine the long-term effects of mammoplasty on the psychological well-being of women. Methods: Participants were 44 women aged 30–50 years (mean = 40.4 ± 5.9). They were divided into two groups based on the purpose of the breast surgery they underwent [augmentation surgery (AS) vs. reconstruction surgery (RS)] and the time that had elapsed since their surgery (≤3 vs. >3 years). Results: Our findings suggest that women who underwent AS reported a decline in their psychological well-being over time. The women who had undergone AS ≤3 and >3 years did not show any differences in emotional functioning, with the exception of the BREAST-Q scores on the satisfaction with breasts subscale. We examined the impact of mammoplasty on the satisfaction levels and well-being of women who had undergone RS (after MRM). They were less satisfied with their breasts than those who belonged to the AS group, confirming our hypothesis. However, this was true only among those who had undergone surgery ≤3 years earlier. Conclusions: In conclusion, our findings underscore the need to provide psychological support to those who have undergone breast AS and RS. Additionally, this study implies the need for personalized psychological interventions to improve the emotional adaptation process and enhance women's mental well-being. [ABSTRACT FROM AUTHOR]

Purpose: To assess precise topographic changes of the breast, objective documentation and evaluation of pre- and postoperative results are crucial. New technologies for mapping the body using digital, three-dimensional surface measurements have offered novel ways to numerically assess the female breast. Due to the lack of clear demarcation points of the breast contour, the selection of landmarks on the breast is highly dependent on the examiner, and, therefore, is prone to error when conducting before-after comparisons of the same breast. This study describes an alternative to volumetric measurements, focusing on topographic changes of the female breast, based on three-dimensional scans. Method: The study was designed as an interventional prospective study of 10 female volunteers who had planned on having aesthetic breast augmentation with anatomical, textured implants. Three dimensional scans of the breasts were performed intraoperatively, first without and then with breast implants. The topographic change was determined as the mean distance between two three-dimensional layers before and after augmentation. This mean distance is defined as the Topographic Shift. Results: The mean implant volume was 283 cc (SD = 68.6 cc, range = 210–395 cc). The mean Topographic Shift was 7.4 mm (SD = 1.9 mm, range = 4.8–10.7 mm). The mean Topographic Shifts per quadrant were: I: 8.0 mm (SD = 3.3 mm); II: 9.2 mm (SD = 3.1 mm); III: 6.9 mm (SD = 3.5 mm); IV: 1.9 mm (SD = 4.3 mm). Conclusion: The Topographic Shift, describing the mean distance between two three-dimensional layers (for example before and after a volume changing therapy), is a new approach that can be used for assessing topographic changes of a body area. It was found that anatomical, textured breast implants cause a topographic change, particularly on the upper breast, in quadrant II, the décolleté. [ABSTRACT FROM AUTHOR]

Background: There is still some debate about the best adipose processing method for autologous fat transfer procedures. This article reports a series of 66 fat grafting procedures using a novel fat processing technique that involves washing, "micronization," and decantation. Methods: We retrospectively reviewed the files of all patients operated on over a 2-year period by the two investigators. They underwent breast or buttock surgery that employed the novel fat processing technique for fat transfer. Complications and patient satisfaction were recorded, and fat resorption was qualitatively assessed based on clinical examination and photographs. Results: Data were retrieved from a total of 66 procedures performed on 43 patients: 17 breast augmentations, 8 buttock augmentations, and 41 breast reconstructions. Five patients also underwent concomitant facial fat grafting. The complications were one case of transient liponecrotic cyst in the breast, one case of transient areolar sensitivity reduction, and two cases of infection. The infections were reported in patients from the breast reconstruction cohort who had a history of radiotherapy. There was no complication associated with facial fat grafting. Patient satisfaction was achieved in 82.4 to 92.5% of cases depending on the study cohort. Fat resorption was graded as minimal to moderate in 95% of all cases. Conclusions: This retrospective study supports the safety and effectiveness of this novel fat processing method in breast and buttock surgeries. Further controlled studies are needed to compare its performance with that of other techniques. Level of evidence: Level III, therapeutic study [ABSTRACT FROM AUTHOR]

Deep brain neurostimulators (DBS) have enabled thousands of individuals to overcome movement disorders, thus offering them a new chance for social integration while enhancing their self-esteem. A classic DBS consists of a central implantable pulse generator (IPG) and its respective wires and leads that extend to the scalp to reach the brain. The classic positioning of the generator is currently subcutaneous, usually just below the clavicle or in the abdominal wall. As DBS systems are of a substantial size, this subcutaneous placement leads to unsightly and visible devices, particularly in thin patients. We report two cases of female patients who benefited from our technique to hide the IPG under the breast parenchyma. IPGs were placed through an inframammary incision in a subglandular pocket, similar to the technique used for implant-based breast augmentation. In the first case, the devices were implanted in a subglandular pocket and replaced 5 years later due to battery life limitation. In the second case, the devices were replaced from a subclavicular position to a submammary one. No major or minor complications were observed. Both patients reported an excellent level of satisfaction with the aesthetic and functional outcome. Despite the significant quality of life improvement of patients with DBS, the ideal implantation of the generator should also take into consideration the comfort and cosmetic aspects. Our approach has the potential to markedly improve the aesthetic outcome of such an intervention. Level of evidence: Level V, therapeutic study. [ABSTRACT FROM AUTHOR]

Introduction: Mammary augmentation is among the most popular types of cosmetic procedures and mammary prosthesis the most commonly accepted technique. A mammary prosthesis can be placed on transaxillary, periareolar, submammary incisions in subglandular, subpectoral, subfascial planes or in a combination of planes. Given the potential interaction between the prosthesis and the surrounding tissues, the plane in which the prosthesis is implanted has an important role among the factors affecting this interaction. The plastic surgeon decides on the incision and plane to be used by assessing the advantages and disadvantages. Materials and Methods: Prostheses were implanted in the subfascial plane in 47 patients who underwent augmentation mammaplasty. Round Moderate Plus or High Profile Cohesive II™ Gel implants were used. Device volumes ranged from 275 to 600 cc. Of the 47 procedures, 23 were performed over an axillary incision, 20 over an inframammary incision, and 4 over a periareolar incision. Endoscopic-assisted dissection was performed in all of the 23 cases in which transaxillary incision was used. Results: All 47 patients who underwent subfascial prosthesis implantation were followed up for a mean of 5 years (range: 2-7 years). Long-term results were satisfactory with few complications. The overall patient satisfaction rate was 89.3%, and none of the patients required an implant removal or change. None of the patients complained of severe pain, regardless of the type of incision, and resumed their daily activities on postoperative day 2. Conclusion: The subfascial augmentation technique provides good and long-term results. It requires longer operating times and is a more difficult technique compared to other planes. As the choice of incision does not largely affect the overall result, the position of the scar depends on the patient's preference, the properties of the implant, and the experience of the surgeon. The endoscopic assistance should be preferred when using the transaxillary approach. [ABSTRACT FROM AUTHOR]

Breast augmentation belongs to one of the most desired aesthetic surgeries worldwide. Even though silicone implants are used in the majority of breast enlargements, there are still patients treated with injectable fillers. Despite of a less invasive procedure, injectable materials often lead to serious complications. We present a case of a late inflammatory complication 20 years after an injection of unknown filler material. Regardless of early antibiotics treatment, the initial unilateral mastitis spread to the contralateral breast and both supraclavicular and axillar regions leading to a surgical revision and evacuation of the entirely consumed mammary glands. It is a surprising observation of a fast-expanding mastitis two decades after filler application. Breast augmentation belongs to one of the most desired aesthetic surgeries worldwide. Even though silicone implants are used in the majority of breast enlargements, there are still patients treated with injectable fillers. Despite of a less invasive procedure, injectable materials often lead to serious complications. We present a case of a late inflammatory complication 20 years after an injection of unknown filler material. Regardless of early antibiotics treatment, the initial unilateral mastitis spread to the contralateral breast and both supraclavicular and axillar regions leading to a surgical revision and evacuation of the entirely consumed mammary glands. It is a surprising observation of a fast-expanding mastitis two decades after filler application. [ABSTRACT FROM AUTHOR]

Breast surgery increases the risk for difficulties with milk production and breastfeeding. Research on lactation outcomes of breast augmentation with implants is reassuring, but reveals a significant risk of low milk production that varies with the type of surgery and position of the implants. Understanding the potential effects of breast implants on breastfeeding can help lactation professionals optimize outcomes for families with a history of augmentation mammaplasty. [ABSTRACT FROM AUTHOR]

Keywords: breast implants; case report; eczema; silicones EN breast implants case report eczema silicones 703 705 3 11/18/21 20211201 NES 211201 CASE REPORT A 53-year-old woman with no atopic background was referred for persistent diffuse, inflammatory, and itchy skin lesions that had started the previous year on her right breast and secondarily spread to the flanks, the arms, the neck, and eventually to the face (Figure 1A-C). Of interest, suspected ACD to silicone may be related to other components used during silicone manufacturing instead of silicone itself.5 Silicone breast implants have been used in reconstructive and aesthetic surgery for almost 60 years. [Extracted from the article]

Background: BellaGel® is the only cohesive silicone gel-filled breast implant from a Korean manufacturer, and it was first developed in 2005. It was approved by the CE in 2008, thus becoming the first Asian breast implant available in the EU. We conducted this study to assess the safety of BellaGel® in patients receiving augmentation mammaplasty. Methods: We evaluated a consecutive series of 239 patients (478 breasts) who received esthetic augmentation mammaplasty using the BellaGel® (round smooth, round textured, round nanotextured, and anatomical textured types of implant) (HansBiomed Co. Ltd., Seoul, Korea) at three clinics in Korea (JW Plastic Surgery Center, BS The Body Plastic Surgery Clinic and Grace Plastic Surgery Clinic) during a period from December 1, 2015 to January 31, 2018. Results: A total of 239 patients with a mean age of 33.1 ± 8.5 years old were followed up during a mean period of 399.58 ± 232.71 days, where there were no cases of capsular contracture in our clinical series of the patients. Other complications include one case (0.4%) of seroma, three cases (1.3%) of hematoma, and one case (0.4%) of infection. Moreover, there were no significant differences in the cumulative incidences of complications between the four types of the BellaGel® (χ2 = 2.322, df = 3, P = 0.508). Furthermore, the cumulative Kaplan-Meier survival rate was estimated at 0.979 (95% CI 0.961–0.997). Conclusions: Our results indicate that the BellaGel® is such a safe breast implant that surgeons might consider using it for esthetic augmentation mammaplasty. Level of evidence: Level III, risk/prognostic study. [ABSTRACT FROM AUTHOR]

Silicone breast implants are commonly used materials in plastic surgery for breast augmentation and reconstruction and the most severe complication of silicone implants are capsule contraction which occurs in 40% of patients. The aim of our study is to evaluate how the amniotic membrane alters the capsule formation effects of silicone 24 wistar rats were used in the study. We placed a bare silicone block into the left side (Subgroup A) and single layer amniotic membrane coated silicone block into the right side (Subgroup B) of the rats back. The rats were then separated into three groups and in group 1 rats were euthanized after 3 weeks, in group 2 after 12 weeks and in group 3 after 24 weeks. Then capsule thickness, fibroblast and lymphocyte cell counts were evaluated for each sample. In Group 2 and group 3, the capsule thickness in Subgroup B was detected to be statistically significantly lower than that in Subgroup A. In Group 1, 2, and 3, the lymphocyte count in the capsule tissue taken from Subgroup B was lower than Subgroup A but the difference was not statistically significant. In Group 2 and 3, the fibrocyte count detected in the capsule tissue in Subgroup B was found to be statistically significantly lower than Subgroup A. the amniotic membrane was demonstrated to reduce capsule thickness by the antifibrinolytic effect in our study. [ABSTRACT FROM AUTHOR]

Background Breast-conserving treatment has become the standard treatment in early breast cancer; its goal is to provide a treatment as effective as mastectomy with the added benefit of a preserved breast. However, it is sometimes difficult to achieve good cosmetic results, particularly in patients with breast cancer located in the upper inner quadrant, for which the traditional conservative surgery results in a deformed breast. Aim The aim was to compare prospectively the oncoplastic outcome of lower pedicle mammoplasty and round block techniques for early-stage breast cancers in the upper inner quadrant. Patients and methods This is a prospective, randomized study on 20 female patients who were diagnosed in the upper inner quadrant to have early breast cancer and are candidates for oncoplastic breast surgery. The study was conducted at Ain Shams University Hospitals. Approval of the Ethics Committee and written informed consent from all participants were obtained. Patient selection was achieved through a number of inclusion and exclusion criteria. Results There is a significant difference between the two groups. Inferior pedicle mammoplasty needs longer operative time and postoperative hospital stay and drainage days with more intraoperative blood loss in comparison to the round block technique. As regards postoperative complications, inferior pedicle mammoplasty has more wound complications such as wound infection and dehiscence than the round block technique. Conclusion Early breast cancer patients with lesions in the upper inner quadrant are candidate for either inferior pedicle mammoplasty or round-block technique. Round-block technique is safer for them, as morbidity is lower, better cosmoses, no need for contralateral summarization, and fewer complications, so no delay in radiotherapy and inferior pedicle mammoplasty needs more surgeon experience. [ABSTRACT FROM AUTHOR]

Background: Breast augmentation is the most common -cosmetic surgical procedure in the USA, with nearly 300,000 women undergoing surgery annually. National incidence rates predict that among women undergoing breast augmentation each year, approximately 35,000 will eventually be diagnosed with breast cancer, in particular individual BRCA1/2 germline mutant carriers. Case Report: Our case introduces a novel method of implant coverage after immediate post-mastectomy reconstruction in augmented patients. A novel "capsular flap" (flap of the pre-existing old capsule) is isolated and refolded to cover the outer lower portion of the implant. Conclusion: Tailored surgical approaches can be offered to those patients previously augmented and requiring mastectomy after breast cancer diagnosis. [ABSTRACT FROM AUTHOR]

Background: Breast drooping usually results from two concomitant factors: breast parenchymal involution, which leads to volume loss, altogether with a progressive laxity of the skin envelope which becomes inelastic and flabby (means so loose). The authors propose a double-flap technique which includes transposition of inferiorly based dermoglandular tissue underneath a superiorly based flap to achieve a central projection and upper fullness altogether with raising the inframammary crease. Methods: From May 2016 to November 2018, 25 patients underwent a double-flap autoaugmentation mammoplasty performed by the authors. Ages ranged from 25 to 45 years. All patients were nonsmokers and had body mass indexes (BMI) of less than 30. The mean follow-up period was 18 months All cases have had grade III breast ptosis with a broad-base, flappy breasts with deficient central projection. All patients aimed at having an augmented, elevated breast without insertion of a silicon implant. Results: A total of 23 cases showed a significant improvement in breast contour and central projection, with overall satisfaction to both patient and surgeon. Two cases progressed to an implant augmentation subsequent to the mastopexy. One patient had postoperative seroma that were managed with frequent aspirations. The nipple areola complex (NAC) wounds passed smoothly in all cases without any complications regarding the vascularity or wound infection. Conclusions: The double-flap autoaugmentation mastopexy is a method of breast reshaping that adopts a concept of glandular rearrangement. In properly selected patients with adequate breast volume and moderate skin elasticity, with mild to moderate ptosis, who refuse a prosthetic implant insertion, this procedure safely and adequately restores the youthful conical breast appearance. Level of evidence: Level IV, therapeutic study. [ABSTRACT FROM AUTHOR]

The internet is a knowledge technology and market place, ingrained in everyday social life, which provides an avenue to examine social and gendered relationships. This paper examines a particular gendered arrangement, how breast augmentation is offered to women on internet websites. Breast augmentation is rapidly becoming the most popular cosmetic surgery for Western women. We identified and analysed the content of 20 New Zealand websites offering breast augmentation surgery. Analysis documented two major issues that dominated website presentations. The first positioned breast augmentation as a solution to a deficient breast. Reworking the breast allows possibilities for women to construct revised subjectivities, within socially constrained and gendered norms, dominated by idealized female forms. The second positioned breast augmentation as an elective choice of neoliberal consumerism, constrained by gendered expertise, and a lack of information about the risks and complications of this surgery. We reveal how cosmetic surgery websites selling breast augmentation are complex medicalized sites, raising important issues for further research. [ABSTRACT FROM AUTHOR]

Background  Traditionally, surgical quality outcomes are assessed using a 30-day postoperative window. For breast cancer patients undergoing free tissue transfer for breast reconstruction, we sought to describe the distribution of and specific risk factors for early and late readmissions within a 0- to 90-day postoperative period. Patients and Methods  The Nationwide Readmissions Database was used to conduct a retrospective cohort study. Breast cancer patients undergoing free tissue transfer for breast reconstruction were identified using International Classification of Diseases -9 diagnosis and procedure codes. Ninety-day readmissions related to infection or wound complications were identified. Univariable and multivariable logistic regression models were used to identify patient risk factors for readmissions that occurred early (0–30 days) and late (31–90 days) after their index procedure. Results  In the weighted sample, we identified approximately 7,305 free flap breast reconstructions and a surgical wound-related readmission rate of 4.3% (n  = 312): 65.4% of the readmissions occurred early while 34.6% occurred late after surgery. The mean days to readmission was 26, and 75% of all readmissions occurred within the first 36 days after surgery. Variables independently associated with readmissions during the 0- to 90-day postoperative period included: history of chronic obstructive pulmonary disease (p  = 0.036), hypertension (p  = 0.03), obesity (p ≤ 0.001), and history of smoking (p  = 0.004). The variables independently associated with the early readmission period were the same as those identified for the 0- to 90-day postoperative period. The variables independently associated with late readmissions were different: history of depression (p  = 0.001) and history of smoking (p  = 0.001). Conclusion  The conventional 30-day hospital readmission rate classically used as a quality metric is overlooking a significant portion of admissions after free flap-based breast reconstruction. Different variables were found to be associated with readmission in the early versus late cohorts. Interventions targeting these variables could decrease readmissions and their associated costs. [ABSTRACT FROM AUTHOR]

Dear Editor, Extension contracture of the metacarpophalangeal (MCP) joints impairs the function of a hand. Graph: Figure 2.A 39-year-old woman (case #1 in Table 1) sustained a right 3rd and 4th metacarpal fracture with subsequent right 3rd MCP joint extension contracture. (a) Preoperative extension contracture of right 3rd MCP joint; (b and c) intraoperative closed view of the radial side of a RDMAF flap resurfacing the MCP joint capsule after capsulotomy; (d) at 6-months after surgery the MCP flexion was 80°. [Extracted from the article]

Background: Nipple-sparing mastectomy (NSM) is an alternative to skin-sparing mastectomy in appropriately selected patients. The aim of this study was to review our experience with NSM and to evaluate for oncologic safety.Study Design: Patients who underwent NSM at our institution from September 2008 through August 2017 were identified after IRB approval. Data included patient age, tobacco use, tumor size, hormone receptor status, lymph node status, radiation and chemotherapy use, incision type, and reconstruction type. Statistical analyses were performed using ANOVA and chi-square tests.Results: There were 322 patients who underwent 588 NSM (83% bilateral, 17% unilateral), including 399 (68%) for malignancy (Stage 0 [27%], I [44%], II [25%] and III [4%]). The overall rate of wound complication was 18.9%. Tobacco use increased complication (37.5% vs 16.3%, p < 0.001), as did adjuvant radiation therapy (31.4% vs 17.4%, p = 0.014). Patients with lymph node involvement and larger tumor size had a higher rate of complication (31.3% vs 17.2%, p = 0.016). Patients undergoing circumareolar incisions had a higher rate of complication than those undergoing lateral radial, inframammary fold, or curvilinear incisions (43.5% vs 17.4% vs 17.4% vs 14.3%, respectively, p = 0.018). Six (1%) local chest wall recurrences occurred during the follow-up period, none of which involved the nipple-areolar complex. Four patients (1%) suffered a distant recurrence.Conclusions: Most NSM performed at our institution are in patients with malignancy. The oncologic safety is confirmed by the low locoregional recurrence rate. Tobacco use and adjuvant radiation therapy remain the most significant risk factors for complication, highlighting the need for careful patient selection and patient counseling regarding modifiable risk factors and expected outcomes. [ABSTRACT FROM AUTHOR]

The article provides information on the legal obligation of health insurance companies for incurring insured persons medical costs for aesthetic surgery for surgical breast augmentation using breast augmentation plastic surgery, wound healing disorders and inpatient treatment. It points out to prosthesis implantation and costs of inpatient hospital treatment.

Study Question: What are the levels of breast development and satisfaction in women with a Disorder/Difference of Sex Development (DSD)?Summary Answer: Compared with normative data, women with DSD reached lower Tanner stages and reported less breast satisfaction.What Is Known Already: Women with DSD may have chromosomal and hormonal variations that can impact typical breast development. While much emphasis is placed on genital development in this group, little is known about breast development, satisfaction and their association.Study Design, Size, Duration: Data collection was part of the cross-sectional European multicenter dsd-LIFE study. Fourteen recruiting sites included 1040 participants between February 2014 and September 2015.Participants/materials, Setting, Methods: A total of 695 female-identifying participants were included (Turner n = 332, 46,XY DSD n = 141 and congenital adrenal hyperplasia n = 222), with a median age of 28 years. Clinical (i.e. history of hormone and surgical treatments, Tanner breast examination) and patient-reported (i.e. breast satisfaction, relationship status, sexual satisfaction and experienced femininity) data was collected by independent trained research staff. The relationship between breast development, satisfaction and femininity was assessed. Control data on breast development and satisfaction in women without DSD was retrieved from the literature.Main Results and the Role Of Chance: Of the 695 participants, 61% had received estrogen replacement and 51% puberty induction therapy, whereas 2% had received breast augmentation surgery. Approximately 65% of participants had reached Tanner breast stage 5, which is substantially less than the general population (90%). Breast satisfaction was lower than normative data as well (P < 0.001, Cohen's d = 0.45). Breast size and breast satisfaction were associated with feelings of femininity.Limitations, Reasons For Caution: Limitations include the sample representativeness (e.g. regarding the clinical heterogeneity) and the limited in-depth knowledge on (prior) hormonal regimens. Furthermore, no (matched) control data was collected as part of this study.Wider Implications Of the Findings: In order to support the psychosexual well-being of women with DSD, enhancing breast development by sufficient hormone replacement and possible augmentation surgery is advocated. The scope of DSD management should be beyond genital development only and consider breasts as well.Study Funding/competing Interest(s): The study was funded by the European Union Seventh Framework Program (FP7/2007-2013) under grant agreement no. 305 373. There are no competing interests.Trial Registration Number: German Clinical Trials Register: Registration identification number: DRKS00006072. [ABSTRACT FROM AUTHOR]

Quick absorption of adipose tissue grafts makes the outcomes less satisfactory for clinical applications. In the current study, adipose tissue grafts were mixed with adipose tissue-derived stem cells (ASCs) to improve retention of adipose tissue grafts and to make the clinical outcomes of fat grafting more reliable. Adipose tissue was either injected alone (conventional group) or mixed with ASCs (stem cell group) before injection. In both groups, adipose tissue was injected at the site of contour throughout layers of tissues till visual clinical symmetry with the opposite side was achieved. The volume of injected fat graft was measured after 72 hours and 6 months using a B-mode ultrasound device connected with a 12 MH frequency probe. The percentage reduction in the volume of injected fat, physician satisfaction scores (Ph-SCs), and patient satisfaction scores (P-SCs) were also recorded. After 6 months, there was significantly lower fat absorption in the stem cell group as compared to the conventional group. Mean physician and patient satisfaction scores were significantly improved in the stem cell group. No significant adverse effects were noted in any patient. Significantly lower absorption of graft due to the use of ASCs improves the clinical outcomes of conventional fat grafting for contour deformities of the face. The current preenrichment strategy is noninvasive, safe and can be applied to other diseases that require major tissue augmentation such as breast surgery. This trial is registered with NCT02494752. [ABSTRACT FROM AUTHOR]

Purpose: To compare clinically and histologically an allogeneic bone matrix to autogenous bone chips in the vertical ridge augmentation technique using titanium-reinforced e-PTFE membranes. Materials and Methods: The study protocol was designed to include patients with bilateral posterior mandibular partial edentulism. Patients were treated with a split-mouth design approach: each side was randomly assigned to the test group (titanium-reinforced e-PTFE membrane and allogeneic bone matrix) or to the control group (titanium-reinforced e-PTFE membrane and autogenous bone chips). Different clinical parameters including the amount of vertically regenerated bone (DSB) and biologic complications were recorded. Histomorphometric analysis and the bone-implant contact percentage were performed. Results: Five female patients were enrolled in the study. Ten edentulous sites were vertically augmented and 25 implants were inserted (13 test group, 12 control group) with a staged approach. In the test group no membrane was exposed. The mean bone regeneration was 4.70 mm (SD 0.48 mm). All 13 implants appeared clinically stable. In the control group, 1 membrane was exposed after 2 months. The mean crestal bone regeneration was 4.10 mm (SD 0.88 mm). All 12 implants were stable at the abutment connection. Nine biopsy specimens from the regenerated areas were evaluated. Vertical bone regeneration was evident in both groups since all the samples demonstrated trabecular bone with different degrees of maturation and mineralization in the regenerated area. Conclusion: Within the limits of this study based on 5 patients, it appears that the behavior of the allogeneic bone matrix is similar to that of autogenous bone chips when used for vertical ridge augmentation by means of guided bone regeneration techniques. Both grafts demonstrated analogous histologic characteristics. Nevertheless, long-term clinical studies are needed to confirm these preliminary results. [ABSTRACT FROM AUTHOR]

Residual glandular tissue (RGT) after risk reducing mastectomy (RRME) is associated with a risk of developing breast cancer for women with a familial predisposition. We aim to examine various surgery-related variables to make risk more easily assessable and to aid in decision-making. Pre- and postoperative breast MRI scans from 2006 to 2021 of patients with proven pathogenic mutation were included. The postoperative remaining skin flap was recorded using distance measurements at 8 equally distributed clockwise points and retromamillary. Each breast was volumetrized, as well as existing RGT. Patient-related covariates were further recorded and their influence on RGT was investigated uni- and multivariately. 81 patients (49 with BRCA1, 24 with BRCA2, 9 with other mutations), who were on average 39 years old, had 117 breasts analyzed. The mean follow-up was 71 months. In multivariate analysis, the independent variable skin flap thickness had a positive effect (p ≤ 0.01), while surgeon experience negatively affected RGT (p ≤ 0.05). The incision type was found to impact RGT as well, with nipple-sparing mastectomy (NSM) with inframammary fold incision leading to more RGT (p ≤ 0.01 – p ≤ 0.05), and skin-sparing mastectomy (SSM) with an inverted T incision leading to less (p ≤ 0.01). Different surgical variables have an impact on postoperative RGT, which is an important tool to quantify the risk of developing breast cancer after RRME. In order to effectively consider these variables in future preoperative/intraoperative management, they must be carefully taken into account. [ABSTRACT FROM AUTHOR]