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Background The aim of a mastopexy is to raise the breast projection, tighten the skin envelope, and place the nipples in an optimal position in projection to the inframammary fold. This procedure is often combined with prosthetic implants or an autoimplant. Given the current increasing demand for the use of autologous tissue, we evaluated mastopexies combined with either an autoimplant or prosthetic implant in terms of patient satisfaction and long-term results. Methods We evaluated 34 patients who underwent a mastopexy with simultaneous breast prosthesis or an autoimplant. During follow-ups we obtained standardized breast measurements, BREAST-Q score, and pre- and postoperative photographs to perform photometric measurements. Results BREAST-Q score of patients that underwent autoimplant-mastopexies revealed a higher patient satisfaction with significant differences in satisfaction with breast appearance (69±18 vs. 55±16, P=0.03) and outcome (71±18 vs. 48±26, P=0.009). Regarding breast shape, photometric evaluations presented a significantly different breast shape with higher upper pole fullness in augmentation-mastopexy patients. No statistical significance between long-term results and complication rates could be observed in either patient groups. Conclusions The BREAST-Q score implies a higher overall long-term satisfaction in patients that received autoimplant-mastopexy with similar long-term results compared with augmentation-mastopexy. Nevertheless, individual decision-making is necessary and should be based on the degree of ptosis, existing breast volume, previous operations, and patients' preferences regarding postoperative breast shape and projection.

Background The deep inferior epigastric perforator flap (DIEP) has gained widespread popularity in autologous breast reconstruction due to its natural aesthetic results and muscle-sparing design. However, donor site results regarding aesthetic outcome are often less favorable. Despite several studies on surgical technique and improvements of flap harvest, only a small number of studies addressing donor site aesthetic exist. Methods A systematic review was performed on donor site aesthetic after DIEP flap harvest according to the PRISMA guidelines. Secondary interests were abdominal wall morbidity and complication rates in general. The following electronic databases were included to identify relevant studies: Medline, Embase, PubMed, Cochrane, and Web of Science. Results The search yielded 95 articles for full-text analysis, with only four key studies found on donor site aesthetic specifically. Regarding complication rates, the overall rate of abdominal hernia ranges from 0 to 7.1%. Abdominal bulging occurs in 2.3% to 33%. Besides abdominal wall integrity, wound dehiscence (12-39%), seroma (1-48%), hematoma (1-15%), infections (1-12%), fat necrosis (0-11%) and umbilical necrosis (2-3%) significantly impair donor site aesthetic. Conclusions This systematic review reveals that the topic of donor site aesthetic and potential improvement of results has largely been neglected in the past decade. This study provides a thorough evaluation of potential problems that plastic surgeons may encounter and includes recommendations to improve results.

Background: The radial forearm flap (RFF) is known for its excellent and reliable results regarding defect coverage though donor site morbidity represents a persisting problem. Integra is widely used in reconstructive surgery. This study aims to assess long-term outcomes regarding functionality and cosmesis after donor site coverage with respect to esthetic appearance, scar quality, and wrist function as well as ability to work after donor site coverage with Integra and split-thickness skin. Methods: The prospective follow-up exam, after a mean time of 23.8months, enrolled 13 patients. Identification of patients' comorbidities and evaluation of the subjective esthetic outcome, sensibility, cold intolerance, and scar instability was assessed by a questionnaire. In clinics, designed Pinch test assessed scar tissue mobility over the flexor tendons. The Vancouver Scar Scale (VSS) was calculated; wrist function and grip strength were determined. Results: The satisfaction score for the esthetic appearance of the donor site was in average 3.42 ± 0.44. Two patients experienced an unstable scar and cold intolerance. The VSS resulted in a value of 4.2 representing a good result. The pinch test revealed an average scar mobility of 8mm without any tendon adhesions. Active range of motion of the wrist was equal to the non-operated site as was grip strength. The pinch test showed a significant negative correlation with the VSS making it a reliable tool to measure scar quality. Conclusion: Long-term results show an esthetic and functional successful defect coverage of the RFF donor site by the use of Integra and split-thickness skin. Level of Evidence: Level IV, therapeutic study.

Split-thickness skin grafts (STSG) are still the gold standard for the treatment of most skin defects. Hence, there is an ongoing need to improve this procedure. For this purpose, we herein analyzed dermal matrices seeded with adipose tissue-derived microvascular fragments (ad-MVF) in a bradythrophic wound model. In additional experiments, the matrices were covered with autologous STSG 10 days after implantation. Green fluorescence protein (GFP) ad-MVF were isolated from C57BL/6-Tg(CAG-EGFP)1Osb/J mice and seeded onto collagen-glycosaminoglycan matrices. Non-seeded and prevascularized matrices were implanted into full-thickness skin defects on the skull of CD1 nu/nu mice for 21 days. Vascularization, lymphangiogenesis and incorporation of the matrices were analyzed using photo-acoustic imaging, trans-illumination stereomicroscopy, histology, and immunohistochemistry. The survival rate of STSG was assessed by planimetry. After 21 days, the density of microvascular and lymphatic networks was significantly higher in prevascularized matrices when compared to controls. This was associated with an improved implant integration. Moreover, prevascularization with ad-MVF allowed successful autologous skin grafting already at day 10, while coverage of non-seeded controls at day 10 resulted in STSG necrosis. In conclusion, ad-MVF represent powerful vascularization units. Seeded on dermal substitutes, they accelerate and enhance the healing of full-thickness skin defects and allow early coverage with STSG.

The micron-scale surface topography of implanted materials represents a complementary pathway, independent of the material biochemical properties, regulating the process of biological recognition by cells which mediate the inflammatory response to foreign bodies. Here we explore a rational design of surface modifications in micron range to optimize a topography comprised of a symmetrical array of hexagonal pits interfering with focal adhesion establishment and maturation. When implemented on silicones and hydrogels in vitro, the anti-adhesive topography significantly reduces the adhesion of macrophages and fibroblasts and their activation toward effectors of fibrosis. In addition, long-term interaction of the cells with anti-adhesive topographies markedly hampers cell proliferation, correlating the physical inhibition of adhesion and complete spreading with the natural progress of the cell cycle. This solution for reduction in cell adhesion can be directly integrated on the outer surface of silicone implants, as well as an additive protective conformal microstructured biocellulose layer for materials that cannot be directly microstructured. Moreover, the original geometry imposed during manufacturing of the microstructured biocellulose membranes are fully retained upon in vivo exposure, suggesting a long lasting performance of these topographical features after implantation.

Background Fat grafting has been gaining attention in tissue augmentation over the past decade, not only for lipofilling, but also for its observed regenerative properties and overall skin texture improvement. Objectives The aim of this study was to analyze the effect of nanofat grafting on scars, wrinkles, and skin discolorations in our clinic. Methods Nanofat was prepared by a standard emulsification and filtration protocol. The resulting liquid was injected intradermally or directly into the scar tissue. Skin quality was evaluated based on a scoring system, and patient satisfaction was documented. Three physicians compared and analyzed standardized pre- and posttreatment photographs in respect to general improvement of skin aesthetics. Results Fifty-two patients were treated with nanofat from November 2013 to April 2016. The mean (± standard deviation) posttreatment follow up was 155 ± 49 days and average volume of harvested fat amounted to 165 cc. The primary harvesting areas were the abdomen and flanks, and the injected volume of nanofat ranged from 1 to 25 mL (mean, 4.6 mL). A total of 40 scars (76% of all patient defects) were effectively treated as well as 6 patients with wrinkles, and 6 patients with discoloration. Posttreatment clinical evaluations showed a marked improvement of scar quality and a high patient satisfaction. The results in our clinic showed that nanofat grafting softened the scars, made discolorations less pronounced, and wrinkles appeared less prominent. Conclusions Nanofat grafting has been shown to have beneficial effects in the treatment of scars, wrinkles, and skin discolorations. Level of Evidence 4

Background: Buttock augmentation is gaining increasing popularity in aesthetic surgery. The relatively high incidence of complications after silicone implant placement lead to the increased use of lipofilling techniques, yielding variable results with respect to graft take rate and long-term stability. Platelet-rich plasma (PRP) has been shown to have beneficial effects on wound healing and angiogenesis in the past. Therefore, we aimed at investigating the long-term results and patient satisfaction after PRP-enriched lipofilling for buttock augmentation. Methods: Twenty-four bilateral gluteal augmentations with PRP-enriched autologous fat were performed. Additionally, contour shaping was achieved by liposuction of the adjacent zones. Post-operative results and complications were recorded, and satisfaction with buttock shape was estimated by a patient questionnaire. Results: Mean follow-up time was 44months, and mean amount of transferred fat was 481cc for both sides. No seroma or hematoma formation, infection or liponecrosis were reported during the post-operative follow-up. Subjective patient satisfaction in general increased from preoperatively to 3months postoperatively and declined only slightly in the long-term course. Satisfaction levels in general were specific for each patient. Patient recovery was quick, and the majority of patients returned to work within 10days after surgery. Conclusions: PRP-enhanced lipofilling of the buttocks proved to be a safe procedure including a low complication rate and consistent results. However, subjective patient expectations have to be taken into account when choosing the indication. Further large volume studies are needed to elucidate the potential and benefit of PRP in this context. Level of Evidence: Level IV, therapeutic study

Meralgia paraesthetica represents a neuropathy involving pain, burning, tingling, and numbness in the distribution of the lateral femoral cutaneous nerve (LFCN) of the thigh, which is commonly due to nerve entrapment under the inguinal ligament. We report an unusual case of compression of the LFCN at the anterior surface of the sartorius muscle in a professional female soccer player. Intraoperatively, the LCFN was found to pass without major compression under the inguinal ligament, but was strained over a fibrous thickening of the superficial thigh fascia and the anterior medial border of the sartorius muscle 8cm caudal of the inguinal ligament. Excision of the fibrous tissue completely resolved the symptoms. In professional athletes, the LFCN should be explored along its entire course on the anterior thigh during operative decompression to rule out a distal muscular compression site. Level of evidence: Level V, therapeutic study

Cutaneous melanoma is the most deadly cutaneous neoplasm. In order to guide treatment decisions and follow-up of melanoma patients, guidelines for the management of melanoma in Switzerland were inaugurated in 2001 and revised in 2006 and 2016. Recent data on surgical and medical treatments from randomised trials necessitated modification of the treatment and follow-up recommendations.

BACKGROUND Silicone gel breast implants may silently rupture without detection. This has been the main reason for magnetic resonance imaging (MRI) of the augmented or reconstructed breast. The aim of the present study was to investigate the accuracy of MRI for implant rupture. METHODS Fifty consecutive patients with 85 silicone gel implants were included in the study. The mean age of the patients was 51 (range 21-72) years, with a mean duration of implantation of 3.8 (range 1-28) years. All patients underwent clinical examination and breast MRI. Intraoperative implant rupture was diagnosed by the operating surgeon. RESULTS Nineteen of the 50 patients suffered from clinical symptoms. An implant rupture was diagnosed by MRI in 22 of 85 implants (26%). In seven of 17 removed implants (41%), the intraoperative diagnosis corresponded with the positive MRI result. However, only 57% of these patients were symptomatic. Ultrasound imaging of the harvested implants showed signs of interrupted inner layers of the implant despite integrity of the outer shell. By microsurgical separation of the different layers of the implant shell, we were able to reproduce this phenomenon and to produce signs of implant rupture on MRI. CONCLUSION Our results show that rupture of only the inner layers of the implant shell with integrity of the outer shell leads to a misdiagnosis on MRI. Correlation with clinical symptoms and the specific wishes of the patient should guide the indication for implant removal.

Nicole Lindenblatt,1 Karem El-Rabadi,2 Thomas H Helbich,2 Heinrich Czembirek,3 Maria Deutinger,4 Heike Benditte-Klepetko5 1Division of Plastic and Hand Surgery, Department of Surgery, University Hospital Zurich, Zurich, Switzerland; 2Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna - General Hospital Vienna, 3Department of Radiology, Hospital Wiener Privatklinik, 4Department of Plastic and Reconstructive Surgery, Hospital Rudolfstiftung, Vienna, Austria; 5Department of Plastic and Reconstructive Surgery, Erasmus Medical Center, Rotterdam, the Netherlands Background: Silicone gel breast implants may silently rupture without detection. This has been the main reason for magnetic resonance imaging (MRI) of the augmented or reconstructed breast. The aim of the present study was to investigate the accuracy of MRI for implant rupture. Methods: Fifty consecutive patients with 85 silicone gel implants were included in the study. The mean age of the patients was 51 (range 21–72) years, with a mean duration of implantation of 3.8 (range 1–28) years. All patients underwent clinical examination and breast MRI. Intraoperative implant rupture was diagnosed by the operating surgeon. Results: Nineteen of the 50 patients suffered from clinical symptoms. An implant rupture was diagnosed by MRI in 22 of 85 implants (26%). In seven of 17 removed implants (41%), the intraoperative diagnosis corresponded with the positive MRI result. However, only 57% of these patients were symptomatic. Ultrasound imaging of the harvested implants showed signs of interrupted inner layers of the implant despite integrity of the outer shell. By microsurgical separation of the different layers of the implant shell, we were able to reproduce this phenomenon and to produce signs of implant rupture on MRI. Conclusion: Our results show that rupture of only the inner layers of the implant shell with integrity of t