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Gender‐affirming care is treatment that recognizes and affirms the gender identity of transgender and gender‐diverse (TGD) individuals. Though not all TGD people choose to surgically transition, gender‐affirming surgeries (GAS) are an important part of many TGD people's transition. GAS can include a wide array of procedures aimed at aligning an individual's physical characteristics and gender identity. This review describes the most common procedures considered to be GAS, detailing important relevant considerations for each procedure. These include transfeminine procedures (i.e., breast augmentation, penile inversion vaginoplasty, orchiectomy, tracheal shave, and facial feminization); transmasculine procedures (i.e., chest masculinization, hysterectomy, phalloplasty, and metoidioplasty); and other procedures (i.e., fertility preservation and hair removal). Patient outcomes and the legal landscape for GAS are also discussed to contextualize these procedures within largest discourses surrounding gender‐affirming care. [ABSTRACT FROM AUTHOR]

Breast augmentation ranks among the most popular plastic surgery procedures. Yet, reports on post-operative patient-reported quality of life (QoL) and satisfaction remain conflicting. A systematic review was conducted following the PRISMA guidelines. Three databases were searched for eligible studies that reported pre-and/or post-operative Breast-Q™ augmentation scores for patient QoL (psychosocial, sexual, and physical well-being) and/or satisfaction. A total of 39 studies (53 patient cohorts and 18,322 patients) were included in the quantitative synthesis. The pairwise meta-analysis revealed significant improvements in patient-reported psychosocial (MD: +38.10) and sexual well-being (MD: +40.20) as well as satisfaction with breast (MD: +47.88) (all p < 0.00001). Physical well-being improved slightly after breast augmentation (MD: +6.97; p = 0.42). The single-arm meta-analysis yielded comparable results, with Breast-Q™ scores in psychosocial and sexual well-being as well as satisfaction with breast increasing from 37.2, 31.1, and 26.3 to 75.0, 70.6, and 72.7, respectively (all p < 0.00001). Physical well-being improved by 8.1 (75.8 pre-operatively to 83.9 post-operatively; p = 0.17). Subgroup analyses highlighted higher QoL and satisfaction following breast augmentation for purely esthetic purposes and alloplastic mammaplasty. Although patient-reported physical and sexual well-being increased in the long term, psychosocial well-being was the highest in the short term. Patient satisfaction with breast, psychosocial, and sexual well-being increased significantly after breast augmentation. In contrast, patient-reported physical well-being yielded ambivalent results, varying by mammaplasty technique and post-operative follow-up time. Plastic surgeons should be sensitized about our findings to refine eligibility criteria and gain a deeper understanding of the patients' perceived surgical experience. CRD42023409605. [ABSTRACT FROM AUTHOR]

Background: Cultural perspectives on physical attractiveness and aging vary worldwide, but there is a global demand for cosmetic procedures. Physical attractiveness is associated with increased self-confidence and perceived advancements in various areas, although the direct impact is not always clear. Dissatisfaction with breast shape can negatively impact self-esteem and marital relationships, even leading to divorce in some cases. Further research is needed to identify factors influencing women's decision-making, sociocultural influences on breast aesthetics perception, and financial considerations regarding breast augmentation surgery. Our study aims to identify the level of awareness about the risks and understanding the factors that influence woman’s decision-making regarding breast augmentation surgery. Methodology: This a cross-sectional study was designed to understand the factors that influence women's decision-making regarding breast augmentation surgery. Data was collected using a structured questionnaire administered via online surveys and analyzed using quantitative methods. Results: The study included 891 participants, the majority of respondents fall within the 21-30 age range, accounting for 53.8% of the total. 6.5% of the respondents have considered undergoing breast augmentation surgery. Over a third of the respondents (34.1%) have had surgery previously. 44.7% of participants had good knowledge score while 55.3% had poor knowledge score. 23.9% had high perception, 57.1% had moderate perception, and 19% had low perception. 34.3% of participants had high perception of benefits, 56% had moderate perception, and 9.7% had low perception. Conclusion: In conclusion, the decision to undergo breast augmentation surgery is influenced by a variety of factors. Societal pressure, media influence, personal body image and self-esteem, psychological factors, support from loved ones, financial considerations, and the expertise of the surgeon and surgical facility all play a role in a woman's decision-making process. Knowledge of breast augmentation surgery was significantly associated with age and annual income, while perception about the surgery was significant with age and nationality. [ABSTRACT FROM AUTHOR]

Introduction: Endoscopic‐assisted surgery for breast tumors has the advantage of inconspicuous scars, less breast volume loss, and nipple areolar distortion. A novel endoscopic‐assisted technique through inframammary fold for excision of fibroadenomas is presented. Materials and Surgical Technique: Endoscopic‐assisted excision of fibroadenoma(s) through inframammary fold was performed in four patients after informed written consent via three ports (12, 5, and 5 mm). Breast Cancer Treatment Outcome Score‐12 (BCTOS‐12) was used to evaluate patient satisfaction after surgery. Discussion: No intraoperative and wound complication was noted. On median follow‐up of 26.5 months, patients reported satisfactory responses to aesthetic and functional outcomes. No scar related complications were noted. Endoscopic‐assisted excision of fibroadenoma through inframammary fold can be a safe and feasible option with good aesthetic outcomes. [ABSTRACT FROM AUTHOR]

Background and Objectives: Mammary gland surgery has become very common, but there are complications of these operations, including the concept of breast implant illness (BII) in women with silicone gel breast implants (SBI), who suffer from various symptoms such as myalgia, arthralgia, fatigue, fever, dry eyes, or dry mouth. Silicone biomaterials are synthetic polymers that have their own physical and chemical properties and can exert their effect at the site of use and possibly on the general status of the body, causing inflammation and oxidative stress signs. The aim of the study was to examine components of the blood antioxidant system (AOS) of the mastopexy and breast augmentation patients before the operation, on the first post-op day, and 6 months after surgery. Materials and Methods: Healthy breast surgery patients (women aged 31 to 60 years without visible pathologies) were selected for the study and formed 2 groups: breast lift—mastopexy without silicone biomaterials (I group, 30 patients) and breast augmentation using silicone biomaterials (II group, 28 patients). All patients underwent standard preoperative tests. Glutathione peroxidase (GPxSe) and gamma-glutamyl transferase (GGT) in blood, selenium (Se), selenium protein P (SelPP), and total antioxidant status (TAS) in plasma were measured as AOS parameters. The concentration of vitamin D was also determined. A total of 174 blood tests were performed. Results: Overall, there were no differences in both groups in measured antioxidant system indicators over time; neither changes in objective nor subjective status were observed. However, baseline activity of GPxSe was relatively high but restored to normal values 6 months after surgery. In the mastopexy group, GPxSe decreased from 12,961.7 U/L by 18.9% to 10,513.4 U/L, and in the breast augmentation group, from 15,505.0 U/L by 25.1% to 11,265.5 U/L, which is a decrease of 18.9% and 25.1%, respectively. The patients did not note any complaints; other indicators of standard biochemical tests were within normal limits. Conclusions: The two types of surgical interventions, breast mastopexy and augmentation of the mammary glands, do not significantly impact blood AOS and are physiological in nature. [ABSTRACT FROM AUTHOR]

This document is a compilation of articles discussing various topics related to aesthetic plastic surgery. The articles cover a range of subjects, including breast implants, facial implants, regenerative medicine, and surgical techniques. The authors present their research findings, experiences, and insights into these areas of plastic surgery. The articles emphasize the importance of patient satisfaction, individualized treatment plans, and the use of advanced technologies in achieving desired outcomes. Overall, the document aims to provide library patrons with a comprehensive overview of the latest advancements and approaches in aesthetic plastic surgery. [Extracted from the article]

Background & Aims: Mammoplasty, a common cosmetic procedure involving breast augmentation and reduction surgeries, has gained global popularity. Recently, attention has shifted towards understanding the prevalence and significance of gastrointestinal (GI) symptoms following mammoplasty. This systematic review aims to consolidate existing literature to provide a comprehensive overview of the type and frequency of GI problems associated with various mammoplasty procedures. Methods: A systematic search of PubMed and Scopus databases was conducted until January 22, 2024, identifying observational and interventional studies examining GI symptoms post-mammoplasty. Inclusion criteria covered human studies, while exclusion criteria ensured specificity. Two independent investigators performed screening, and data extraction included study characteristics, surgical procedures, anesthesia methods, and interventions. Results: Nineteen studies, involving 2,487 subjects, were included in the review. Breast reconstruction emerged as the most studied procedure, followed by breast reduction, augmentation, mastectomy, and breast cancer surgery. Predominant GI symptoms included nausea and vomiting, with varying rates across mammoplasty types. Anesthesia modality influenced symptomatology, with general, local, and combined anesthesia associated with GI disturbances. Antiemetics, notably ondansetron and droperidol, showed variable efficacy. Non-pharmacological approaches, such as preoperative hypnosis, were explored for symptom management. Conclusions: Our systematic review reveals insights into GI symptoms post-mammoplasty, emphasizing the common occurrence of symptoms such as nausea and vomiting, alongside less frequent manifestations such as constipation, dry mouth, retching, abdominal pain, and tightness. Variations in symptom prevalence were noted across diverse mammoplasty surgeries, anesthesia methods, and the use of antiemetics, underscoring the complex nature of post-mammoplasty GI disturbances. [ABSTRACT FROM AUTHOR]

Striae distensae (SD) present in women undergoing further breast surgery such as augmentation or mastopexy, can impact dramatically on outcomes both aesthetically and functionally. No technique has been described to address these. We describe our novel technique for management including intra-dermal nano-fat graft at the time of breast augmentation or mastopexy, followed by post-operative CO2 laser. Twenty patients have been treated with this technique in order to improve aesthetic outcomes and reduce complications such as SD worsening, poor scarring and ptosis. Level of evidence: Level IV, Therapeutic [ABSTRACT FROM AUTHOR]

This document is a collection of abstracts from the ANZ Journal of Surgery, covering various topics in surgical history. The abstracts provide concise summaries of various historical figures, techniques, and materials used in surgery. Topics include the history and evolution of Doppler ultrasound, the contributions of Dr. Alexis Carrel to vascular surgery, the emergence of Virtual Surgical Planning (VSP) in head and neck surgery, the innovative work of plastic surgeon Archibald McIndoe during World War II, the development of nailbed repair techniques by Dr. Harry J. Buncke, the history of nasal reconstruction, and the establishment of plastic surgery in Australia and New Zealand during World War II. These abstracts offer valuable insights into the historical development of surgical practices and may be of interest to researchers and library patrons studying the history of medicine. [Extracted from the article]

Background and Objectives: The correction of breast hypertrophy and ptosis with implant placement has always posed a challenge for plastic surgeons. Various methods have been devised, yielding conflicting results. The purpose of this study is to describe our surgical technique of breast reduction with silicone implants, present the safety profile of the procedure, and report patient-reported outcomes. Materials and Methods: A retrospective review was performed on our case series of cosmetic breast surgery performed by the senior author between October 2020 and November 2023. Only patients who had over 300 g of breast tissue removed were included. The surgery and demographic characteristics were recorded. Patients were asked to complete a questionnaire about satisfaction with their breasts pre-operatively and after the surgery. Results: Over 745 cases were performed, and 25 were included in the analysis. In total, 78.3% of the patients presented with a Grade 3 ptosis. The mean implant size was 352.39 cc (range 300–455 cc). The breast tissue removed ranged from 312 to 657 g. The mean follow-up was 14.17 months. Only one case required revision surgery after developing capsular contracture and a waterfall deformity. Patients reported a statistically significant improvement across all domains of the questionnaire (p < 0.001). Conclusions: Breast reduction plus implants is a safe and effective alternative for patients with large ptotic breasts who wish to attain a full upper pole. It carries a similar risk profile to augmentation mastopexy and maintains its functional benefits in alleviating back, neck, and shoulder pain. [ABSTRACT FROM AUTHOR]

Women's choice to undergo breast augmentation surgery with silicone implants may develop into a choice to surgically remove them. In our paper, we employ dimensions of power relating to such decisions to elaborate differential knowledgeability as organizing the temporal dimension of the process and its potential for changing the meaning of a decision formerly taken. Until recently, the possibility of differential access to knowledge relating to silicone implants' hazards was not explored from a temporal perspective, thus leaving vague the weight of women's participation in digital platforms that constitute knowledge-supporting space. Our findings relate to a turning point in which increased knowledgeability manifests a change in women's perception of augmentation surgery as a risk and fed a reflexive process towards a decision to remove the implants surgically. The neoliberal discourse our research participants adopted to describe their experiences demonstrates self-critical perception; thus, their increased knowledgeability did not influence the balance of power between women and medical professionals. Our findings also relate to the development of emotional ambivalence post implants removal surgery, anchored in the research participants' separation from their culturally appreciated former appearance. [ABSTRACT FROM AUTHOR]

Breast cancer ranks among the most commonly diagnosed cancers worldwide and bears the highest mortality rate. As an integral component of cancer treatment, mastectomy entails the complete removal of the affected breast. Typically, breast reconstruction, involving the use of silicone implants (augmentation mammaplasty), is employed to address the aftermath of mastectomy. To mitigate postoperative risks associated with mammaplasty, such as capsular contracture or bacterial infections, the functionalization of breast implants with coatings of cyclodextrin polymers as drug delivery systems represents an excellent alternative. In this context, our work focuses on the application of a mathematical model for simulating drug release from breast implants coated with cyclodextrin polymers. The proposed model considers a unidirectional diffusion process following Fick's second law, which was solved using the orthogonal collocation method, a numerical technique employed to approximate solutions for ordinary and partial differential equations. We conducted simulations to obtain release profiles for three therapeutic molecules: pirfenidone, used for preventing capsular contracture; rose Bengal, an anticancer agent; and the antimicrobial peptide KR-12. Furthermore, we calculated the diffusion profiles of these drugs through the cyclodextrin polymers, determining parameters related to diffusivity, solute solid–liquid partition coefficients, and the Sherwood number. Finally, integrating these parameters in COMSOL multiphysics simulations, the unidirectional diffusion mathematical model was validated. [ABSTRACT FROM AUTHOR]

Background: Feminizing gender-affirming hormone therapy (GAHT) for transgender individuals traditionally includes estradiol and androgen deprivation. Research has demonstrated that breast size as a result of GAHT in transgender women is often limited. Therefore, transgender women often choose to undergo breast augmentation surgery. Progesterone is important for breast development in cisgender women during puberty. A potential role for progesterone in breast development in transgender women has not been investigated in a randomized controlled experimental set-up. The primary objective of this study is to explore the effects on breast volume of addition of oral progesterone to GAHT with estradiol in transgender women after vaginoplasty or orchiectomy. Secondary objectives include assessment of safety, satisfaction, mood, sleep and sexual pleasure. Methods: This is a non-blinded, non-placebo, randomized controlled trial using a factorial design in adult transgender individuals assigned male sex at birth who have undergone GAHT for at least one year and underwent vaginoplasty or orchiectomy. The study design allows for rapid assessment of potential synergistic effects of various dose combinations of estradiol and progesterone on breast volume change: Ninety participants will be randomized into six groups of 15 subjects each, receiving either the baseline dose of estradiol, the baseline dose of estradiol and progesterone 200 mg daily, the baseline dose of estradiol and progesterone 400 mg daily, twice the baseline dose of estradiol, twice the baseline dose of estradiol and progesterone 200 mg daily or twice the baseline dose of estradiol and progesterone 400 mg daily, all for a duration of 12 months. The main study parameters include changes in breast volume as determined by 3D measurements. Participants will be followed-up with laboratory testing including serum progesterone concentrations as well as surveys for satisfaction, mood, sleep quality and sexual pleasure. Discussion: This study will indicate whether progesterone is safe and of additional value with regard to breast volume change in transgender individuals receiving feminizing GAHT. The results of this study will be useful for innovation of feminizing GAHT. Trial registration: WHO International Clinical Trials Registry Platform: EUCTR2020-001952-16-NL; date of registration: 12 December 2020 https://trialsearch.who.int/Trial2.aspx?TrialID=EUCTR2020-001952-16-NL. [ABSTRACT FROM AUTHOR]

Background: The task of promoting patient safety and aesthetically pleasing results, without exceeding anatomical limitations or compromising surgical outcomes, is one of the biggest challenges plastic surgeons face today. Methods: This is a multicenter, single-surgeon retrospective study evaluating the long-term safety and aesthetic results of Motiva Ergonomix® implants in 325 consecutive female recipients undergoing bilateral primary breast augmentation procedures, predominantly performed with a minimal incision approach between 2 and 3.5 cm. As a secondary benefit of the study, we aim to provide insight into modern patient needs and desires expressed during the pre-operative implant selection process, and data collected evaluating patient satisfaction rates using a pre-operative and post-operative Breast-Q questionnaire and a Patient and Observer Scar Assessment Scale (POSAS). Results: Between 2015 and 2019, six hundred and fifty Ergonomix® implants were implanted into 325 consecutive patients undergoing primary breast augmentation with a mean minimal incision length of 2.9 cm (range 2–3.5 cm). The mean follow-up time was 14 months with a range of 6 to 48 months. Over the 5 years, a total of 7 complications were reported among 325 patients with an overall complication rate of 2.15% and an overall reoperation rate of 1.23% (N = 2). Conclusions: Ergonomix® implants can provide a favorable choice for balancing both safety and aesthetics in primary breast augmentation procedures. Level of evidence: III, Risk/Prognostic Study [ABSTRACT FROM AUTHOR]

Bilateral reduction mammoplasty (BRM) aims to alleviate macromastia-related symptoms in women. This procedure involves a T-Junction suture at the medial inframammary fold that encompasses 12%-39% of wound breakdowns mainly due to reduced perfusion. Continuous diffusion of oxygen (CDO) may enhance breast tissue oxygenation to prevent such complication. We explored the feasibility of this therapy. A 4-wk feasibility-pilot randomized controlled trial of women undergoing BRM was conducted. By internal randomization (left/right side), participants received standard of care (SOC) in one breast using topical skin adhesive, while their other breast received SOC + CDO at the T-junction covered by a silicon sheet (sCDO), or CDO directly to the T-Junction skin (dCDO). Feasibility outcomes included protocol delivery, outcome measurement, device-related adverse events, and device acceptability. Exploratory outcomes were T-Junction SatO 2 and deoxyhemoglobin assessed with near-infrared spectroscopy and wound dehiscence. Sixteen participants (age = 33 ± 8 y; body mass index = 34.34 ± 5.85 kg/m2) were recruited, conforming n = 32 breasts (SOC, n = 16; dCDO, n = 10, sCDO, n = 6). At 4 wk, protocol delivery was 93.7%, outcome measuring 100%, and device-related adverse events 0%. Device acceptability showed an 85.4% strong agreement for attitude toward use, 78.2% perceived ease of use, and 77.7% perceived usefulness. Breasts undergoing sCDO showed higher SatO 2 (P < 0.001), whereas lower deoxyhemoglobin (P < 0.001) compared to all other breast groups. However, wound dehiscence was not different between groups (P = 0.66). Self-applied CDO to the T-Junction is feasible, safe, and acceptable, in patients undergoing BRM. In a proper wound environment, CDO may enhance breast tissue oxygenation. However, it is unclear whether CDO leads to decreased wound dehiscence. This study showed reproducibility for larger randomized trials. [ABSTRACT FROM AUTHOR]

Aim • To compare the efficacy of arthroscopic debridement and olecranon fossa augmentation plasty in patients with elbow osteoarthritis. Methods • Eighty-four patients with elbow osteoarthritis admitted to our hospital were randomly divided into two groups with 42 cases in each group. Patients in the control group received expanded olecranon fossa plasty, while those in the observation group underwent arthroscopic debridement. Then the elbow joint function, VAS score, stress level, and incidence of complications were compared between the two groups. Results • The MEPS score, ROM level, and VAS score, as well as the expression of TNF-α, IL-6, and ACTH between the two groups, were significantly different before and after surgery (P<.05). Moreover, compared to patients in the control group, the MEPS score and ROM level of patients in the observation group were higher than those in the control group after six months since surgery, while VAS score, the levels of TNF-α, IL-6, and ACTH were lower on the second day after surgery (P<.05). Conclusion • Arthroscopic cleaning is more helpful in improving elbow joint function and alleviating pain in patients with osteoarthritis of the elbow compared to olecranon fossa augmentation and reconstruction surgery. [ABSTRACT FROM AUTHOR]

Background: One-stage mastopexy-augmentation is a challenging method for surgeons and there is no clear consensus on the number of sessions, methods, and complications. We aimed to contribute to the discussions on single-session mastopexy-augmentation by comparing the results of two different methods we performed, with each other and with the results of previous studies. Methods: The cases in which we applied the prosthesis implantation from the inferior part of the vertical incision and from the breast fold between the years of 2000 and 2017 were collected in the first group, and the cases in which we carried out the vertical line implant insertion and tailor tuck method after 2017 in the second group. Results: Our results in both groups were comparable with those of recent studies in the literature, albeit complication and reoperation rates were statistically lower in the second group, despite the use of larger volume implants. Conclusions: We believe that in single-session mastopexyaugmentation operations, the tailor tack method may be safer than previously described conventional vertical applications in terms of complication and revision operation rates and the possibility of using larger volume implants. Level of Evidence: Level II, therapeutic study. [ABSTRACT FROM AUTHOR]

Background: Ptosis and volume atrophy of the breasts are common symptoms for various ages of women and may induce a considerable amount of stress in daily life. Periareolar augmentation mastopexy is an effective procedure for such conditions, and planning the new nipple position is very important. Aim: To provide a simple, straightforward planning and walkthrough of this operation in a journey to find the ideal level of breast lifting for natural upper fullness. Materials and methods: From January 2019 to December 2021, a total of 193 patients with volume deflation and ptosis of the breast received periareolar augmentation mastopexy in our institute. We retrospectively reviewed data on demographics, surgical procedures, outcomes, and complications. Results: All operations were done with periareolar incisions, and the mean follow-up period was 29.48±9.11 months. The Likert scale of outcome satisfaction scored 9.02±0.61. Complications were minimal, and no symmastia or bottoming out occurred. Conclusion: We present our basic strategies of periareolar augmentation mastopexy with a slight modification of the design. We believe that lifting the nipple to 3–4cm above the inframammary fold (IMF) (making the top of the areola about 5–6 cm above the IMF) yields satisfactory aesthetic results. [ABSTRACT FROM AUTHOR]

Background Breast augmentation in transwomen is a surgical challenge as there is no available guideline for preoperative assessment of breast implant size, which caters to them specifically. The aim of our study is to derive a formula for preoperative breast implant size estimation, which would remove the personal bias, help in one-to-one discussion, and better understanding, reducing operative time, cost, and revision surgery rate. Methods This is a retrospective study conducted from October 2018 to December 2020. We maintained a routine protocol for measurements in our patients, which has been previously published. Linear multivariate regression equation was applied to derive a formula using minimum of parameters, namely, CC (chest circumference at the inframammary fold [IMF]), POMP (circumference at the point of maximum projection of breast mound), and LOWERDIFF (lower value of difference in each breast between the stretched nipple [IMF] and the nonstretched nipple [IMF distance]). Results A total of 51 transwomen underwent surgery in this period. The mean volume of implant used was 354.51 mL. Complications consisted of pain and discomfort in six patients, delayed healing in two patients, and wound dehiscence in one. A formula for preoperative calculation of breast implant was obtained with these data. A mathematical correlation was found between complications encountered and the percentage by which the inserted implants exceeded the calculated size. Conclusion We could estimate the breast implant size preoperatively through a simple formula that require only four anthropometric measurements. This equation is a significant advantage for the surgeon and a useful tool for patient education. Its usefulness will be established if applied in prospective studies. From our study, it appears 9% above the calculated size is better avoided. [ABSTRACT FROM AUTHOR]

Introduction: Among transgender, non-binary, and/or gender expansive (TNG) persons, interest in medical and/or surgical forms of gender affirmation is heterogenous, as is access to those forms of medically necessary health care. Yet, the literature characterizing TNG persons' interest in medical and/or surgical gender-affirming care, barriers to accessing that care, and how societal narratives and expectations impact TNG individuals' self-image and mental health, as well as their personal choices regarding gender-affirming care remains sparse. Here we present qualitative research exploring TNG participants' interest in gender-affirming care and how such interventions impact identity formation. Method: We conducted semi-structured qualitative interviews with a convenience sample of 54 TNG persons in the U.S. and Canada from Facebook pages used to recruit TNG research participants. One-hour interviews were conducted by an openly TNG researcher; participants were compensated. Results: The most frequently sought gender-affirming care was hormone therapy, followed by chest ("top") surgery, genital ("bottom") surgery, electrolysis, breast augmentation, hysterectomy, and voice training. Less commonly desired interventions included fertility preservation, facial feminization/masculinization, and vocal surgery. Participants described four main categories of access barriers: financial (e.g., cost of medical/surgical care, inadequate insurance), logistical (e.g., no local providers, gatekeeping policies around body size and mental health, pandemic-related delays), personal fears about sub-optimal outcomes (e.g., complications, loss of sensation, undesired esthetic and/or functional results), and societal discrimination (e.g., familial rejection, job loss, safety concerns). Participants reported primarily seeking this healthcare for social legibility, alleviating dysphoria/pursuing euphoria, and/ or gender exploration. All who sought gender-affirming care reported improved mental health—including depression, anxiety, dissociation, and eating disorders—and social relationships, though many struggled to find TNG-competent mental health providers. Conclusion: This work provides key insights into how gender-affirming care can contribute to improving mental health for TNG communities, which will assist health providers in optimally treating TNG patients. [ABSTRACT FROM AUTHOR]

Aquafilling® gel has been used in recent years as an alternative method to breast augmentation surgery. In this case report, we aimed to discuss radiological imaging findings and complications of Aquafilling® gel injection. Case: A 34-year-old lactating female patient presented with swelling and pain in the left breast. Ultrasonography showed massive septate fluid collections with dense content in both breasts and between the pectoral muscle fibers. On mammography, both breasts appeared dense with large mass opacities. On magnetic resonance imaging, extensive fluid-signal cystic areas were observed. Peripheral enhancement around the fluid in the left breast was present in the contrast-enhanced series. We learned from her anamnesis that Aquafilling® was applied to both breasts 5 years ago. Ultrasonography-guided sampling was performed from the cystic areas in the left breast and cytological examination revealed basophilic Aquafilling® material surrounded by diffuse inflammatory infiltrates. Breast augmentation history should be questioned in suspicious cases because Aquafilling® gel injection and its complications can present with a wide variety of symptoms and may mimic various other conditions on radiological imaging, such as cancer, abscess, granulomatous mastitis, and parasite infections. [ABSTRACT FROM AUTHOR]

Background: Implant rupture is one of the complications of breast augmentation surgery. The rupture of silicone implants is often insidious, potentially causing problems at any time. This is a case report of the rupture of 145-cc breast implants manufactured by Dow Corning Corporation and their removal at 40 years after augmentation. Case Presentation: A 70-year-old female patient was admitted for the removal of a lump in the upper and inner quadrants of the right breast. After a detailed examination, a rupture of the bilateral breast implants was diagnosed. Explantation without replacement was performed; the entire procedure proceeded smoothly. Immunohistochemical staining revealed siliconoma with lymphoid hyperplasia and calcification in the bilateral breasts with no signs of malignancy. Conclusions: Silicone breast augmentation is one of the most popular aesthetic surgical procedures worldwide. Therefore, it is important to educate patients on the need for close monitoring of their implants after augmentation through magnetic resonance imaging or ultrasound to facilitate early detection of any changes before a rupture occurs. Early detection of the implant rupture, in turn, will facilitate early and effective management. [ABSTRACT FROM AUTHOR]

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Implant-based breast reconstructions contribute considerably to the quality of life of breast cancer patients. A knowledge gap exists concerning the potential role of silicone breast implants in the development of so-called "breast implant illness" (BII) and autoimmune diseases in breast cancer survivors with implant-based reconstructions. BII is a constellation of non-specific symptoms reported by a small group of women with silicone breast implants. The Areola study is a multicenter retrospective cohort study with prospective follow-up aiming to assess the risk of BII and autoimmune diseases in female breast cancer survivors with and without silicone breast implants. In this report, we set out the rationale, study design, and methodology of this cohort study. The cohort consists of breast cancer survivors who received surgical treatment with implant-based reconstruction in six major hospitals across the Netherlands in the period between 2000 and 2015. As a comparison group, a frequency-matched sample of breast cancer survivors without breast implants will be selected. An additional group of women who received breast augmentation surgery in the same years will be selected to compare their characteristics and health outcomes with those of breast cancer patients with implants. All women who are still alive will be invited to complete a web-based questionnaire covering health-related topics. The entire cohort including deceased women will be linked to population-based databases of Statistics Netherlands. These include a registry of hospital diagnostic codes, a medicines prescription registry, and a cause-of-death registry, through which diagnoses of autoimmune diseases will be identified. Outcomes of interest are the prevalence and incidence of BII and autoimmune diseases. In addition, risk factors for the development of BII and autoimmune disorders will be assessed among women with implants. The Areola study will contribute to the availability of reliable information on the risks of BII and autoimmune diseases in Dutch breast cancer survivors with silicone breast implants. This will inform breast cancer survivors and aid future breast cancer patients and their treating physicians to make informed decisions about reconstructive strategies after mastectomy. This study is registered at ClinicalTrials.gov on June 2, 2022 (NCT05400954). [ABSTRACT FROM AUTHOR]

Background: Due to risks of texturization, the use of textured breast implants has been diminishing worldwide and is expected to continue to decline. The crisis with textured devices raises the need to revisit the use of smooth round silicone gel (SRSG) implants and to discuss the results that can be achieved with this alternative. The article aims to exclusively analyze SRSG devices: the changes associated with implant profile and degrees of filling, how these changes correlate to certain aesthetic outcomes, and the predictability and stability of these results over time. Methods: The experimental component of this study investigated the effect of gravity on various profiles of SRSG implants when their position was changed. The study's clinical component was a retrospective analysis of primary retropectoral breast augmentation patients with a minimum 1-year follow-up after the procedure. Results: In the experimental setting upon changing position, the anatomic conformation in higher profile devices was more visible compared with their lower profile counterparts. Clinical results of 92 augmented breasts (46 patients) with various types of SRSG implants revealed a full scope of aesthetic outcomes. Desired results were achieved even in challenging scenarios. Breast shape and upper pole contour were predictable with reliable and stable control over time. The overall complication rate was comparable to other breast implant studies. Conclusions: With proper device selection and good surgical technique, any aesthetic outcome can be achieved in retropectoral placement while keeping also prioritizing patient safety. Moderate and moderate plus profile underfilled implants are recommended when anatomical results are intended. Level of evidence: Level IV, Therapeutic. [ABSTRACT FROM AUTHOR]

For decades, implant-based breast augmentation has been one of the most performed surgical procedures for cosmetic purposes around the world. Hence, novel manufactured implants should be critically investigated to prove them safe and effective. Here, the authors describe the first independently conducted clinical study on Nagor Impleo textured round breast implants. For this retrospective study, outcomes of 340 consecutive female patients undergoing primary cosmetic breast augmentation were analyzed. Demographic and surgical data as well as outcomes and complications were evaluated. Furthermore, a survey concerning effectiveness and aesthetic satisfaction after breast augmentation was examined. All 680 implants were placed in a submuscular plane with incisions at the inframammary fold. The main indications for surgery were hypoplasia and hypoplasia with asymmetry. The mean implant volume was 390 cc and the main type of projection was high profile. The most common complications were hematoma and capsular contracture (0.9 percent, respectively). The overall revision rate for complications was 2.4%. Additionally, almost all patients showed increased quality of life and aesthetic satisfaction after a breast augmentation. Hence, all patients would undergo breast augmentation again with these newly launched devices. Nagor Impleo implants demonstrate a low complication rate and high safety profile. Although high aesthetic satisfaction and quality of life results were achieved, analysis of an even larger series over a longer period of time would be beneficial to evaluate the reliability of this implant. [ABSTRACT FROM AUTHOR]

The nipple is the focal point of the human breast and serves important physiological, sexual, and aesthetic purposes. It can be affected by atopic, irritant, and allergic contact eczema, which often reduce the patient's quality of life. The objective of this article is to discuss the different types of nipple eczema and highlight relevant differential diagnoses and treatment options. A systematic search of PubMed was conducted to identify and critically appraise the existing literature on the topic. All articles on nipple eczema were considered eligible, regardless of publication date, language or study design. A final of 33 manuscripts on nipple eczema remained. The scarce literature and the limited number of high‐quality manuscripts impedes provision of structured data on nipple eczema. To securely reach the educative value of this manuscript, the systematic review was combined with a manual databank search and selected manual search of textbooks. The differential diagnosis of nipple eczema encompasses among others nipple psoriasis, nipple candidiasis and Paget's disease. In case of diagnostic uncertainty, swabs or biopsies are indicated. Treatment of nipple eczema needs to rapidly control the signs and symptoms of the disease, since it can have a negative effect on quality of life and can lead to premature arrest of breastfeeding. The key treatment step is starting with topical corticosteroids or calcineurin inhibitors, both of which are considered safe during lactation. Avoidance of provoking factors, such as repetitive friction, chemical agents, or allergens, can help. The use of nipple protection devices can be proposed for nursing women and sometimes adjusting of latch/suck positioning during breastfeeding is needed. Furthermore, patients should be advised to moisturize the nipple intensively and to switch to emollient wash products. Warm water compresses, black tea compresses or commercially available tannin containing topicals can provide comfort. [ABSTRACT FROM AUTHOR]

One-fourth of transgender and gender diverse (TGD) patients presenting for initial gender-affirming surgery (GAS) consult is denied surgery due to obesity. Many surgery centers enforce body mass index (BMI) requirements for GAS because of concerns about perioperative risks, cosmetic outcomes, and reoperation. TGD people experience gender minority stress and disparities in lifestyle factors that likely contribute to excess weight gain. Gender-affirming hormone therapy has also been associated with increased body weight. Effective and affirming weight management interventions for TGD patients with overweight and obesity are currently lacking. We report the case of a 40-year-old transgender woman with a BMI of 39.6 kg/m2 who presented for weight loss to qualify for gender-affirming bilateral breast augmentation, requiring BMI <35 kg/m2. In addition to lifestyle modification counseling, she was started on semaglutide with monthly dose escalation, leading to 13.9% weight loss with a BMI of 34.1 kg/m2 within 3 months. This case highlights the need for access to affirming weight management services for TGD patients pursuing GAS and the role of antiobesity medications in reaching presurgical BMI targets. Further studies should evaluate the needs of TGD patients in weight loss interventions and the effects of weight loss and antiobesity medications on gender-affirming hormone therapy. [ABSTRACT FROM AUTHOR]

Single-stage mastopexy-augmentation has been demonstrated to be a safe procedure. However, revisions may still be necessary. We evaluate 95 consecutive patients undergoing mastopexy-augmentation and introduce a new surgical technique for the procedure: the modified dual plane technique. In this retrospective study, 95 patients (mean age 34 ± 11 years) underwent mastopexy-augmentation between 2009 and 2019. The procedures were classified as subglandular, dual plane, or modified dual plane technique. The outcome measures included major and minor complications. A total of 19 patients underwent a subglandular procedure, 32 patients a dual plane procedure, and 44 patients a modified dual plane procedure. We observed a high overall complication rate in the subglandular group (n = 12, 63%), dual plane group (n = 15, 47%), and modified dual plane group (n = 10, 23%). Complications leading to implant loss/change occurred in seven patients in the subglandular group (37%), six patients in the dual plane group (19%), and no patient in the modified dual plane group. While we observed a high complication rate in patients undergoing mastopexy-augmentations, the modified dual plane technique was associated with a lower complication rate. [ABSTRACT FROM AUTHOR]

Background: Esthetic and reconstructive surgery routinely employs the utilization of silicone implants. Silicone's limited biocompatihility can lead to serious side effects, such as capsular contracture. A capsule forming around the implant is an inflammatory response to the presence of a foreign material; however, the precise cause of capsular contracture is unknown. This experimental study looks into the effects of the two most widely used powders in surgical gloves-talcum and comstarch-on capsule formation. Materials and Methods: Three circular silicone implants, each 1.5 cm in diameter and 2 mm thick, were implanted into pockets developed on the dorsums of 12 female rats, which were then randomly assigned to one of three groups. Group 1 received no powder in their implant pockets; Group 2 received 1.5 mg of talcum powder; and Group 3 received 1.5 mg of cornstarch powder. The capsules around the implants were histopathologically evaluated, their thicknesses were measured, and overall scores were determined after 4 weeks. Results: Although there were no statistically significant differences in the average capsule thickness measured across all four quadrants (P = 0.368), there were significant differences in the capsule score distributions across the control, talcum, and cornstarch groups (P = 0.026). Conclusion: The results of the study projects that powdered gloves (talc or cornstarch) contribute to exacerbated capsular inflammation forming around silicone implants. Therefore, powder-free gloves would be highly recommended during breast augmentation and reconstruction surgeries while handling implants. [ABSTRACT FROM AUTHOR]

While procedures in the abdomen for bowel obstruction and intestinal trauma have been described since antiquity, procedures with consistent outcomes to relieve these conditions was impossible. Since this landmark operation, South Australian surgeons have continued to forge the way in renal transplant surgery in Australia. THE SELDINGER TECHNIQUE: A REVOLUTION IN MEDICINE Jack Archer Wagga Wagga Base Hospital, New South Wales Swedish Interventional Radiologist Sven Ivar Seldinger invented the Seldinger technique in 1952. His procedures, and techniques have immensely contributed to the fields of paediatric hand surgery. SH061P CROSS-DISCIPLINARY INNOVATION: THE HISTORY OF MOHS SURGERY Jacqueline Nguyen St Vincent's Hospital Melbourne, Victoria In the 1930s, general surgeon Dr. Frederic E. Mohs developed the technique now known as Mohs micrographic surgery. [Extracted from the article]

For women who undergo cosmetic breast augmentation, their post-operative risk assessment may not match their pre-operative understanding of the involved risks and likelihood of revision surgeries. This may be due to the potential issues surrounding whether patients are being fully informed about all possible risks and related financial implications during the consent phases of patient/doctor consultation. To explore comprehension, risk preference, and perceptions of breast augmentation procedure, we conducted a recorded online experiment with 178 women (18–40 years) who received varying amounts of risk-related information from two experienced breast surgeons in a hypothetical first consultation scenario. We find patient's age, self-rated health, income, education level, and openness to experience to be significant factors impacting initial breast augmentation risk preferences (before receiving any risk information). Further, more emotionally stable patients perceived greater breast augmentation risks, were less likely to recommend breast augmentation, and were more likely to acknowledge the likelihood for future revision surgery. After providing women with risk-related information we find increases in risk assessment in all treatment conditions, and that increased amounts of risk information do decrease women's willingness to recommend breast augmentation. But that increased risk information does not appear to increase women's assessment of the likelihood of future revision surgery. Finally, we find some participant individual differences (such as education level, having children, conscientiousness and emotional stability) appear to impact risk assessment post receiving risk information. Continuous improvement of the informed consent consultation process is vital to optimising patient outcomes efficiently and cost-effectively. Greater acknowledgement and emphasis on disclosure of related risks and financial burden when complications arise is also important. As such, future behavioural research is warranted into the factors impacting women's understanding both prior to and across the BA informed consent process. • There is potentially an issue surrounding whether patients are being fully informed in cosmetic augmentation. • We find women's age, self-rated health, income, education & openness to experience, are all factors impacting preference. • After providing women with risk information we find increases in risk assessment in all treatment conditions. • Education, children, conscientiousness, and emotional stability appear to impact risk assessment post risk information provision. [ABSTRACT FROM AUTHOR]

Background The number of cosmetic and reconstructive surgeries that use breast implants is increasing in Korea. Recently, it has been reported that breast implant-associated anaplastic large-cell lymphoma is related to textured breast implants, and interest in classification according to the texture of breast implants is increasing. However, there is currently no clear and unified classification. In particular, the definition of "microtextured" is highly varied. In this study, we retrospectively investigated and analyzed the clinical outcomes of smooth and microtextured breast implants. Methods A retrospective chart review of all patients who underwent breast augmentation surgery with smooth and microtextured silicone gel implants between January 2016 and July 2020 was performed. We retrospectively analyzed implant manufacturer, age, body mass index (BMI), smoking status, incision location, implant size, follow-up period, complications, and reoperation rate. Results A total of 266 patients underwent breast augmentation surgery, of which 181 used smooth silicone gel implants and 85 used microtextured silicone gel implants. Age, BMI, smoking status, implant size, and follow-up period were not significantly different between the two groups. Similarly, complications and reoperation rates were not significantly different between the two groups. Conclusion It is important to provide information regarding the clinical risks and benefits of breast implants to surgeons and patients through a clear and unified classification according to the texture of the breast implant. [ABSTRACT FROM AUTHOR]

Background: Lawsonella clevelandensis is one recently documented anaerobic, which is partially acid-fast. Nevertheless, it is rarely found to be associated with human infections, especially in scope of plastic and cosmetic surgery before our patient who was performed breast augmentation with autologous fat grafting. Breast augmentation is becoming popular, the most common post-surgery complication of which is bacterial infection. Case presentation : A 29-year-old female who was found swelling in her right breast and fever after breast augmentation surgery with autologous fat grafting was administered. Before administration, she had been treated with antibiotics (details unknown) for more than 1 month without any significant improvements. After administration, she was treated with intravenous antibiotic empirically and repeated debridement via Vaccuum Sealing Drainage (VSD). And samples of the necrotic tissues and pus collected in surgery were sent for microbiological testing. However, routine examination failed. Thus samples were further collected and sent to Genoxor Medical & Science Technology Inc. (Shanghai, China) to conduct Next-Generation Sequencing (NGS). Surprisingly Lawsonella clevelandensis was determined. Accordingly, sensitive antibiotic was applied in concert with thorough debridement and drainage and finally her condition was completely reversed with wound closure gradually. Conclusion: Complications of breast augmentation with autologous fat graft are various, of which infection is most common. Rare pathogen such as Lawsonella clevelandensis infection in human is rare in clinical practice. Moreover, it is difficult to differentiate from non-tuberculous mycobacterium for its partial acid resistance, difficulty to culture and abscess formation. How to determine diagnosis of Lawsonella clevelandensis infection accurately come to be critical In our report, NGS is recommended as a useful method to identify the pathogen, which may provide us a novel tool for refractory wound. [ABSTRACT FROM AUTHOR]

Background: We conducted this study to assess preliminary 2-year safety outcomes of an implant-based augmentation mammaplasty using the BellaGel® SmoothFine in the context of the first Korean case of a medical device fraud. Methods: Our clinical series of the patients (n = 579; 1,158 breasts) received augmentation using the BellaGel® SmoothFine, Naturgel™, Motiva Ergonomix™, Eurosilicone Round Collection™, Natrelle® INSPIRA™, Natrelle® 410, Mentor® MemoryGel Xtra or Microthane®. The patients were evaluated for incidences of postoperative complications and Kaplan-Meier survival and hazards. Results: Overall, there were a total of 101 cases (17.4%) of postoperative complications; these include 31 cases (5.4%) of shape deformity, 21 cases (3.6%) of CC, 18 cases (3.1%) of early seroma, 8 cases (1.4%) of infection, 5 cases (0.9%) of early hematoma, 1 case (0.2%) of delayed hematoma, 1 case (0.2%) of rupture and 1 case (0.2%) of ripping. Moreover, there were also 15 cases (2.6%) of other complications. There were significant differences in incidences of postoperative complications between the breast implants from different manufacturers (P = 0.034). The Natrelle® 410 showed the longest survival (333.3±268.2 [141.5–525.1] days). A subgroup analysis showed that there were no significant differences in incidences of postoperative complications between the breast implants (P = 0.831). Moreover, the Natrelle® INSPIRA™ showed the longest survival (223.7±107.1 [-42.3–489.6] days). Conclusions: Here, we describe preliminary 2-year safety outcomes of an implant-based augmentation mammaplasty using the BellaGel® SmoothFine in the context of the first Korean case of a medical device fraud. [ABSTRACT FROM AUTHOR]

Background: Single-stage augmentation mastopexy is popular approach in managing patients with ptosis and volume loss. Despite its growing popularity, there is still on-going debate about performing this procedure as a one-stage operation as opposed to two-stage procedure due to possible increase of significant complications when the single stage approach is used. Our study aims to analyse the safety of the approach by assessing the complication rate and subsequently investigate how these unfavourable outcomes were managed. Methods: Retrospective analysis included 85 patients who underwent single stage augmentation mastopexy by a single consultant surgeon. Complications were divided into major (admission < 30 days, non-cosmetic surgery under general anaesthesia (GA) > 30 days) and minor (not requiring admission < 30 days) and those with an unfavourable cosmetic outcome. Results: Sixty two percent (N = 53) underwent the single stage mastopexy and augmentation without experiencing any complications. 8% (N = 7) of the patients experienced major complication, requiring operation under GA; 18% (N = 15) experienced minor complications, all managed non-operatively. 14% (N = 12) patients were classified as having an unfavourable cosmetic result. 15% (N = 13) patients required a second operation under GA, and 6% (N = 7) required revision under local anaesthesia. Mean follow-up was 34 months. Higher complication rate was noted to be in higher ASA group (P = 0.04) and demonstrated tendency in higher rate with the use of greater volume implants (P = 0.06). Conclusions: Single-stage augmentation mastopexy remains a safe approach in selected patients, with the additional benefits of convenience and cost. Complication rates are comparable to the overall complication rates in 2-stage approach technique. Level of evidence: Level IV, Risk / Prognostic study. [ABSTRACT FROM AUTHOR]

This study of breast augmentations performed under local anesthesia with intercostal blocks and light sedation describes the outcomes and evaluates benefits and complications. From December 2005 until August 2019, 335 women consecutively underwent bilateral breast augmentation procedures. The anesthetic protocol consisted of an initial intravenous bolus of 1 mg midazolam and 0.25 mg alfentanil preoperatively. In 2017, this was changed to 2–4 mg midazolam intramuscularly, 1 mg midazolam intravenously, and 2.5 µg sufentanil intravenously. Intercostal blocks were injected at the midaxillary line into the intercostal spaces two to seven. The operating field was infiltrated with tumescent local anesthesia. Retrospective data extraction from patients' medical charts was done, registering demographics, dosage of anesthesia, surgical characteristics, complications, and reoperation rates. Two hundred and eighty-one women underwent primary augmentation and 54 had implant replacement. The most common complications included suboptimal cosmetic results, asymmetry, and healing-related problems. The overall rate of reoperation was 16.1% within an average follow-up period of 2 years, ranging from 0 to 12.5 years. The majority of the reoperations were due to cosmetic reasons. The change in anesthetic regime was associated with a significantly (p < 0.0001) decreased need for supplementary medication with no increased risk of complications. Breast augmentations in local anesthesia with intercostal blocks and light sedation can be performed safely and can serve as an alternative to procedures in general anesthesia. [ABSTRACT FROM AUTHOR]

The challenge in the operative therapy for enlargement of the male breast is to deal with the skin excess. Shape and scars are the major parameters after which patients assess their operative result. Therefore, we assessed the satisfaction rate among patients undergoing subcutaneous mastectomy at our institution with special regard to scar tissue formation and the postoperative appearance of the chest wall in dependence of the surgical approach (periarolar versus inframammary fold). The study includes n = 36 male patients who underwent subcutaneous mastectomy at AGAPLESION Markus Hospital Frankfurt/Main. Patient's satisfaction dependent with the appearance of the chest wall and scar formation was evaluated by a modified BREAST Q® questionnaire plus two male-based additional questions. There is no statistically significant difference in satisfaction with the operative result depending on the pattern of incision (periareolar versus submammary periareolar; 81.9% versus 75.5%) with the operative result. Evaluation of additional questions of the modified BREAST Q® questionnaire showed that 86% of the patients (n = 31) would rather have more scars and a flatter chest wall. A BMI >25 kg/m2 is accompanied by a higher risk for complications (p = 0.04). Periareolar incision is still the method of choice, if promising an aesthetic appealing result. When reaching its limits though, we showed that a flat and male-shaped appearance of the chest wall is priority for the patients and should therefore be for the surgeon as well. [ABSTRACT FROM AUTHOR]

Due to the inability to block the medial and lateral thoracic nerves, it is often used in conjunction with thoracic nerve block to better alleviate postoperative pain in breast augmentation surgery. Keywords: Serratus anterior plane block; Breast surgeries; Breast augmentation EN Serratus anterior plane block Breast surgeries Breast augmentation 1105 1107 3 06/27/23 20230801 NES 230801 Binggao Chai and Jianlong Du contributed equally to this work as co-first authors. Familiarity with breast innervation, the scope of surgical invasion, and the anatomical basis of local nerve block techniques can help choose an appropriate nerve block technique to better alleviate pain during breast augmentation surgery. [Extracted from the article]

The article discusses the alarming increase in mortality rates and complications associated with cosmetic surgery in Colombia. It highlights poor surgical techniques, inadequate patient selection, lack of professional training, and inappropriate facilities as contributing factors to these tragic events. Colombia is ranked ninth in the world as a destination for medical tourism, with 470,000 cosmetic surgeries conducted in 2022. The lack of accurate statistics and adverse event reports hinders the understanding of the situation. The article emphasizes the importance of meticulous anesthesia, proper patient selection, comprehensive assessment, and effective communication between anesthesiologists and plastic surgeons to improve patient safety. It calls for ongoing education, the adoption of state-of-the-art technologies, and strengthened regulations to reduce mortality and complications in cosmetic surgery. [Extracted from the article]

Autoimmune/auto-inflammatory syndrome induced by adjuvant (ASIA) is a pathological condition that could affect some women after breast augmentation surgery. ASIA presents with a large group of unspecific symptoms, which could deteriorate patients' physical and psychological well-being. Herein, we present a mini-review of this condition and report two patients with autoimmune disturbances emerging soon after silicone breast implantation. Breast implants are safe for most women, but they could potentiate autoimmune reactions and provoke subjective complaints in a minor group of susceptible patients. It is unclear if the autoimmune reactions in our cases developed de novo after silicone placement or if the adjuvant had just potentiated an underlying subclinical autoimmune disease. The patients insisted on preserving their breast implants; therefore, immunosuppressive therapy was applied with beneficial effects on clinical symptoms. Identifying high-risk patients and ensuring appropriate medical monitoring is possible via screening for several antibodies, e.g. anti-nuclear and anti-phospholipid antibodies, rheumatoid factor and antistreptolysin-O titer, in all patients planning breast augmentation surgery. In the case of ASIA, short- or long-term medical treatment could be a practical approach in patients who refuse breast implant explantation. The proper education of women about the possible risks and benefits of breast implantation surgery is essential for making an informed choice. [ABSTRACT FROM AUTHOR]

Background: The inframammary approach is one of the most commonly used incisions in breast augmentation. There are many suture methods for inframammary incisions; however, no one method has proven optimal. We modified the traditional three‐layer suture method according to the inframammary fold (IMF) cadaver dissection results. This study aims to investigate whether using a modified suture method can improve postoperative outcomes. Methods: Cadaver dissections were performed in order to clarify the anatomy of the IMF. From June 2013 to December 2017, a retrospective study of primary breast augmentation patients subjected to the inframammary approach was conducted. Patients were divided into two cohorts: the traditional suture method and the modified suture method. The patient's demographics, specifics of breast augmentation procedures, complications, and scar assessment were analyzed. Univariate and multivariable analyses were used to determine differences between the two cohorts. Results: One hundred eighty‐four patients were included: 75 patients were subjected to the traditional suture method, and 109 patients were subjected to the modified suture method. Wound‐related adverse events (p = 0.026) and IMF‐indented scarring (p = 0.014) were significantly different between the two groups. Multivariable analysis showed that the suture method was the most influential factor related to IMF‐indented scarring (OR = 16.9), followed by BMI (OR = 2.9). Conclusions: We defined a new suture method for the inframammary incision in primary breast augmentation. This modified suture method reduces the occurrence of wound‐related adverse events and IMF‐indented scarring. [ABSTRACT FROM AUTHOR]

Background: The popularity of aesthetic breast surgery in China results in greater demand for assessing risk factors for complications and mortality. Objectives: To determine the incidence and independent risk factors for postoperative complications following aesthetic breast surgery in China. Methods: A retrospective cohort study on 4973 patients who had aesthetic breast surgery between 2012 and 2021 was performed. Postoperative complications include minor complications (incision healing impaired, hematoma, or fat liquefaction) and surgical site infection (SSI), which were recorded within 30 days after surgery. The follow-up time was expanded to 1 year only after prosthesis implantation procedures. Potential risk factors including age, weight, length of hospital stay, operation time, volume resection, incision location, and other clinical profile information were evaluated. Results: Among 4973 patients who underwent aesthetic breast surgery, the minor complication rate was 0.54%, and SSI was 0.68%. Augmentation with prosthesis implantation had the highest SSI rate (4.23%), which was significantly associated with increasing age (relative risk [RR] 1.12; P < 0.01) and periareolar incision (RR 5.87, P < 0.01). After augmentation with autologous fat transplantation, postoperative antibiotic use (RR 6.65, P < 0.01) was an independent risk factor for SSI. After adjusting for weight, volume resection over 1500 g (RR 14.7, P < 0.01) was an independent risk factor for SSI of reduction–mastopexy surgery. The complication rate of reduction mammaplasty (1.01%) and gynecomastia correction was lower (0.75%), and there was no record of complication in mastopexy procedures (n = 161). Conclusion: The incidence of postoperative complications following aesthetic breast surgery is low. Risk factors for complications mainly include increasing age, perioperative antibiotic use, periareolar incision, and extensive volume resection. Much more attention should be focused on those high-risk patients in clinical practice to decrease breast infection. Level of Evidence IV: 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. [ABSTRACT FROM AUTHOR]

Background: Breast augmentation is one of the most demanded procedures in plastic surgery and one of the most commonly performed by plastic surgeons. However, a bibliometric analysis of breast augmentation has not been published in recent years. The current study aimed to use a bibliometric analysis to conduct a qualitative and quantitative evaluation of breast augmentation research and provide the research trends and hotspots in this field. Methods: Publications on breast augmentation research were extracted from the Web of Science core collection database. VOSviewer 1.6.18 was used to assess co-authorship, co-occurrence, citation of countries, institutions, authors, and journals, as well as hotspot keywords. Results: On February 8, 2022, 4637 records of breast augmentation research published from 1985 to 2021 were collected. The bulk of the retrieved studies were original research articles (n = 2235, 48.20%). A total of 1053 (22.71%) papers were open access. The annual publication output increased annually. The USA was the driving force in this field and had a strong academic reputation. The top-contributing institution was the University of Texas MD Anderson Cancer Center (2.37%, with 110 publications). Plastic and reconstructive surgery (998 publications, 21.52%) published the most research in this field and was also the most frequently co-cited journal (22,351 citations, total link strength (TLS): 409,301). Clemens MW (68 publications, 1.47%) was the most prolific author, and Spear SL (1456 citations, TLS: 27,231) was the most frequently co-cited author. The research hotspots included the following four aspects: safety and effectiveness of breast implants, implant-based breast reconstruction, breast cancer incidence after breast implantation, and breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL). The research trends were BIA-ALCL, implant-based breast reconstruction, BREAST-Q, acellular dermal matrix, capsular contracture, and autologous fat grafting. Conclusion: The present study provides a panoramic view of breast augmentation research in plastic and reconstructive surgery. This novel comprehensive bibliometric analysis can help researchers and nonresearchers alike to rapidly identify the potential partners, research hotspots, and research trends within their areas of interest. Level of Evidence III: 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. [ABSTRACT FROM AUTHOR]

The use of Aquafilling can be associated with a variety of health complications. The filler is an inflammatory process trigger at the site of tissue contact. The aim of this study was to semiquantitatively compare the immunohistochemical expression of E-cadherin and N-cadherin in tissue material from two groups of patients. The first group underwent surgical removal of Aquafilling from the breast, while the second was subjected to breast augmentation with implants or breast lifts (control group). The study group consisted of tissue samples from 16 patients who had Aquafilling removed, while the control group comprised samples from 16 patients who underwent breast augmentation with implants or breast lifts. Histopathology, immunohistochemistry and morphometric analyses were performed, taking into account the number of immunopositive cells and also the immunohistochemical reaction area for E-cadherin and N-cadherin. There were significantly more immunopositive N-cadherin cells in both groups. The immunohistochemical reaction area for N-cadherin did not differ between the two groups. However, the immunohistochemical reaction area for E-cadherin was significantly larger in the test group than in the control group. Moreover, the reaction area for N-cadherin was significantly smaller than that for E-cadherin. In the control group, no significant differences were detected between the immunohistochemical reaction area for N-cadherin and E-cadherin. Immunohistochemical evaluation of N-cadherin and E-cadherin tissue expression may be useful in assessing early cell junction changes. Furthermore, semiquantitative morphometric analysis allows these alterations to be more precisely determined. [ABSTRACT FROM AUTHOR]

Breast augmentation is one of the most frequently performed cosmetic surgeries in the world. However, there is no standardized surgical procedure for performing breast augmentation. Many modalities exist for this surgery which may explain why practices vary greatly from one surgeon to another. The aim of this study was to evaluate current practices of breast augmentation by implant in France and changes in practices among French plastic surgeons. This observational study was conducted between February 2020 and January 2021. An online questionnaire with 62 questions was sent to 729 French plastic surgeons. The questions concerned: the population of surgeons interviewed, pre-operative aspects, surgical technique and post-operative management. 411 plastic surgeons responded, 5.1% of surgeons impose a nicotine screening test on patients. 99.76% and 95.59% reported that they used silicone gel implants and round prostheses. All used smooth or micro-textured shells. The inframammary approach was the most used by 66.2% of plastic surgeons. The implants placed were between 250 and 300 cc on average and were mainly placed in "Dual plane" by 42% of surgeons. In order to reduce bacterial contamination, 26% of surgeons soaked the implants in a povidone-iodine solution and 23% used an insertion sleeve. The most frequent early complication was hematoma, while capsular contracture was a late complication. This study provides new data on current surgical practices of breast augmentation in France, allowing more informed choices and opening up perspectives for more standardized practices in the future. [ABSTRACT FROM AUTHOR]

Background: Although there is a rationale supporting that preoperative showering with 2% or 4% chlorhexidine gluconate (CHG) would decrease skin bacterial colonization, there is no consensus that this practice reduces the risk of surgical site infection (SSI). Objectives: Analyze the skin concentration of CHG after preoperative showering associated with the traditional skin preparation with CHG 4% for breast surgery. Methods: Randomized controlled trial that included 45 patients, all candidates for augmentation mammaplasty, allocated into three groups (A: no preoperative showering; B: one preoperative showering; C: two preoperative showering with CHG 4%) in a 1:1:1 ratio. Skin swabs collection was performed right before the surgical incision. The samples were, then, sent to spectrophotometry in order to determine the skin concentration of CHG at the beginning of surgery. Results: The age ranged from 18 to 61 years, with a mean of 37 years old. Group C had the lowest median concentration (0.057) followed by group B (0.060) and group A (0.072), however, with no statistical significance. The areola was the place with the lowest median concentration level (0.045), followed by the axilla (0.061) and the inframammary fold (IMF) (0.069). Still, when comparing the distribution of the sites, a statistically significant difference was found only between the axilla and the areola (p = 0.022). Conclusion: Preoperative showering with CHG 4% did not increase the concentration of this agent on the skin surface right before the surgical incision. Level of evidence IV: 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. [ABSTRACT FROM AUTHOR]