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The authors present a case of late postoperative infection after augmentation gluteoplasty in a 32-year-old pregnant woman. The case is unique in that it is the first documented example of a gluteal implant infection in a pregnant woman and because the infection was not preceded by trauma to the anatomic region.

Background The fat-regulating hormones, adiponectin, ghrelin, and leptin, have been studied extensively with the hope that some therapeutic modality might be gleaned from their augmentation or blockade. The authors studied levels of ghrelin, adiponectin, and leptin after liposuction in obese male Zucker rats. In addition, they altered the fat and carbohydrate content of the rats' postoperative diets to determine whether diet affects hormonal levels and/or liposuction outcome. Methods Thirty-five male, obese Zucker rats were divided into four experimental groups. Group I (n = 10) was fed a low-fat/low-carbohydrate diet; group II (n = 10) was fed a regular chow diet; and group III (n = 10) was fed a high-fat/high-carbohydrate diet. Five additional rats served as the baseline, unoperated group. The experimental rats underwent subcutaneous liposuction, and for 6 weeks they were then fed their experimental diets starting on day 0. Experimental rats were euthanized on day 42 and blood was sampled for hormonal, triglyceride, and cholesterol levels. Results Triglyceride levels were significantly higher in the high-fat/high-carbohydrate group compared with the regular chow and low-fat/low-carbohydrate groups, indicating an effect of diet on systemic circulation after liposuction. Ghrelin levels decreased significantly and leptin levels demonstrated an increasing trend after liposuction. Adiponectin levels did not demonstrate any change with alteration in diet or liposuction. Conclusions Liposuction may prove to offer patients medically therapeutic benefits through hormonal alterations. After liposuction, diet plays an important role in weight gain.

Background The transcription factor nuclear factor-κB (NF-κB) plays an essential role in inflammation. To date, no studies have investigated the effect of inhibiting NF-κB–mediated inflammation on normal cutaneous wound healing. We tested this by locally administering an adenovirus recombinant that constitutively expresses a super-repressor isoform of inhibitory-κB (IκB) into rats undergoing a well-established model of dorsal wound healing. Methods Seventy-two Sprague-Dawley rats underwent insertion of a sponge-pump construct into a dorsal subcutaneous pocket. One group of rats received pumps filled with the adenovirus expressing I-κB (rAd-Iκb), a second group received pumps filled with adenovirus expressing green fluorescent protein (GFP) (rAd-gfp), and a third received pumps filled with normal saline (NS). Rats were killed in groups of 6 on days 1, 3, 5 and 7 postoperation. The wound fluid was analyzed for nitrite/nitrate (NOx) and tumor necrosis factor-alpha (TNF-α) concentrations. The wound fluid was assayed for hydroxyproline (OHP) content, an index of reparative collagen deposition. Results Administration of rAd-Iκb for 7 days resulted in higher collagen deposition (OHP) compared with the rAd-gfp and NS groups. NOx levels were significantly higher in the rAd-gfp group on day 1 and marginally so on day 5. TNF-α quantitation analysis found no significant difference among the 3 groups. Conclusion IκB expression through an adenoviral vector in the cutaneous wound may improve rodent healing, as shown by increased collagen deposition, through decreased inflammation. This mechanism appears to be TNF-α independent. Inhibition of NF-κB may reduce inflammation by reducing the local NOx concentrations.

Background Several studies have attempted to define the dimensions of an aesthetically pleasing eyebrow. However, these dimensions represent the views of plastic surgeons and cosmetologists, not necessarily the general public. We hypothesized that many patients who present to their plastic surgeon for periorbital rejuvenation actually want their eyebrows to be in a more natural position than was represented in the studies we surveyed. Objective A study was designed to define the dimensions of an aesthetically pleasing eyebrow from the perspective of the general public. This was achieved by surveying individuals in our local community. Methods One hundred individuals were surveyed and asked to rank 27 photographs (including photographs of pre- and postoperative patients and of models) on a scale of 1 to 10 and grade each photograph as either “attractive” or “unattractive”. Each survey taker provided extensive background information. The photographs receiving the highest number of points and “attractive” grades were then analyzed for eyebrow dimensions. The following distances were measured: medial canthus (MC) to medial eyebrow (ME), lateral limbus (LL) to lateral eyebrow (LE), and eyebrow arch position (EAP) to eye width (EW). Ratios were determined using the EW for comparison. We also evaluated the EAP in relation to the LL. Results The eyebrow dimensions (mean ± SD) of the most highly ranked female photographs were as follows: MC-ME:EW ratio 0.573 ± 0.126, LL-LE:EW ratio 0.668 ± 0.083, and EAP:EW 0.703 ± 0.1. The eyebrow dimensions (mean ± SD) of the most highly ranked male photographs were as follows: MC-ME:EW ratio 0.547 ± 0.177, LL-LE:EW ratio 0.58 ± 0.171, and EAP:EW 0.63 ± 0.175. The EAP in relation to the LL was found to be 0.925 ± 0.884 cm lateral to the LL in women, and 1.05 ± 1.04 cm lateral to the LL in men. Conclusions Previously published dimensions of an aesthetically pleasing eyebrow, as defined by plastic surgeons and cosmetologists, differ from dimensions currently defined as attractive by the general public in our study.

Background: Although many techniques of reduction mammaplasty are currently in use, a prospective study quantitating the sensation of the nipple-areolar complex (NAC) after the performance of specific techniques has not been performed. Objective: The purpose of this study was to quantitate the postoperative sensation of the NAC after reduction mammaplasty and to compare the results on the basis of the orientation of the vascularized pedicle. Methods: We tested 42 patients divided into 4 groups: medial pedicle (9 patients), inferior pedicle (8 patients), free nipple transfer (8 patients), and a control group (17 patients). The specific mammaplasty technique chosen was based on the preoperative assessment and the estimated volume of resection. A Wise pattern approach was used in all cases. NAC sensation was quantified with the use of the Pressure Specified Sensory Device (Sensory Management Services LLC, Baltimore, MD). Results: We detected no significant difference in the volume of reduction between the free nipple group and the medial pedicle group (P =.14). NAC sensation in the free nipple transfer group was significantly lower than either of the pedicle techniques and control group in all areas of testing (P < 0.001), whereas the medial and inferior pedicle groups had no significant sensory differences in NAC sensation (P < 0.001). Conclusions: The medial pedicle technique is safe and reliable and can be used for large-volume reduction mammaplasty to optimize sensation of the NAC.

Although many techniques of reduction mammaplasty are currently in use, a prospective study quantitating the sensation of the nipple-areolar complex (NAC) after the performance of specific techniques has not been performed.The purpose of this study was to quantitate the postoperative sensation of the NAC after reduction mammaplasty and to compare the results on the basis of the orientation of the vascularized pedicle.We tested 42 patients divided into 4 groups: medial pedicle (9 patients), inferior pedicle (8 patients), free nipple transfer (8 patients), and a control group (17 patients). The specific mammaplasty technique chosen was based on the preoperative assessment and the estimated volume of resection. A Wise pattern approach was used in all cases. NAC sensation was quantified with the use of the Pressure Specified Sensory Device (Sensory Management Services LLC, Baltimore, MD).We detected no significant difference in the volume of reduction between the free nipple group and the medial pedicle group (P =.14). NAC sensation in the free nipple transfer group was significantly lower than either of the pedicle techniques and control group in all areas of testing (P0.001), whereas the medial and inferior pedicle groups had no significant sensory differences in NAC sensation (P0.001).The medial pedicle technique is safe and reliable and can be used for large-volume reduction mammaplasty to optimize sensation of the NAC.

There is a paucity of information in the literature that focuses on quality-of-life issues after mastectomy with breast reconstruction in elderly women. The purpose of this study was to review the authors' experience with breast reconstruction after mastectomy in women older than 65 years of age. Emphasis was placed on the types of reconstructions, outcomes, and evaluation of issues related to quality of life. Between July 1997 and July 2001, 316 consecutive women (400 reconstructions) with breast cancer underwent mastectomy with reconstruction at the authors' institution. Of these women, 24 (28 reconstructions) were at least 65 years old. Mean patient age was 69.3 years (range, 65-77 years). Methods of breast reconstruction included two-stage implant reconstruction (50%), free tissue transfer (transverse rectus abdominis musculocutaneous or deep inferior epigastric perforator flap, 25%), pedicle transverse rectus abdominis musculocutaneous flap (14%), or a latissimus dorsi musculocutaneous flap (11%). Outcomes were assessed with the use of a self-reported questionnaire (SF-36) addressing health-related quality of life, body image, and physical functioning. With respect to overall quality-of-life issues after reconstruction, older patients with breast reconstruction scored higher (better outcomes) than age-matched general population patients and previously reported mastectomy-only patients (>55 years) in all surveyed areas. Specifically, study patients reported dramatic increases (better outcomes) in the subscales that are strongly influenced by one's mental health. However, when compared with prior data for younger patients undergoing mastectomy and reconstruction, the older patients scored lower (worse outcomes) in the areas related to physical function. The older patients maintained superior scores (better outcomes) over the younger patients in the subscales influenced by one's mental health.