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Background Implant malposition is a well-recognized complication of prosthetic breast implants. However, to date, no objective classification system has been described. Objectives The aim of this study was to perform a prospective trial of an objective and reproducible classification system for implant malposition formulated by analyzing retrospective data from a large cohort of patients with implant malposition. Methods The authors retrospectively analyzed the degree of medial/lateral and inferior/superior implant malposition relative to their optimal position within the breast footprint in a series of 189 breasts (n = 100 patients). An objective classification system for implant malposition was devised and then applied to a prospective cohort of 53 breasts in 28 patients with implant malposition. Results The degree of malposition in a single or combination of axes was categorized according to the distance (measured in centimeters) from the ideal breast footprint. The classification system incorporated the axis of malposition and distance to generate a treatment decision-making guide. Cases of Grade 1 malposition did not warrant surgical intervention, whereas surgical correction was warranted in all Grade 3 cases. In the combined patient cohort (n = 242 breasts, 128 patients), lateral, inferior, medial, and superior displacement ranged between Grades 1 and 3. There was no interobserver variability in the grades assigned to 9 out of 10 patients in the prospective group. Conclusions A simple and reproducible classification system for implant malposition has been created that allows surgeons to objectively record the extent of malposition, guides surgical decision-making, and can be used to document the results of any intervention. Level of Evidence: 3 [ABSTRACT FROM AUTHOR]

Superficial gluteal lipofilling is a fat grafting procedure performed to correct a trochanteric depression and buttock deflation. Brazilian butt lift (BBL) is a gluteal lipofilling procedure traditionally associated with exaggerated appearance and intramuscular fat transfer. The risk of mortality from fat embolism in BBL was previously reported as being 1:2500. The actual risk was later estimated to be nearer 1:15,000, which is similar to the mortality risk in abdominoplasty. There is increasing evidence regarding the safety of subcutaneous gluteal lipofilling. This has principally been related to new technologies, surgical techniques, and training being developed to avoid intramuscular injection of fat. The efficacy and benefits of intraoperative ultrasound for guiding the subcutaneous placement of fat and avoiding inadvertent deep lipofilling have been demonstrated. Other serious risks and complications must be considered in addition to mortality. These include hypothermia, sepsis, skin necrosis, and poor aesthetic results, as well as the much-publicized risk of fat embolism. Complications are better controlled and managed in strictly regulated healthcare settings. Patients seeking surgery at unregulated facilities or via medical tourism are deemed to be at higher risk of being exposed to these serious complications and/or inadequate subsequent management. [ABSTRACT FROM AUTHOR]

Background: Current literature clearly outlines the complication rates of liposuction in general; however, data specific to large-volume liposuction (LVL) remain unclear.Objectives: The authors aimed to synthesize the current evidence on the safety of LVL with this systematic review.Methods: A comprehensive search in the MEDLINE, EMBASE, and CENTRAL databases was conducted for primary clinical studies reporting on safety or complications related to aesthetic LVL from 1946 to March 2020. The primary outcome measure was the incidence of surgical complication, and the secondary outcome measure was changes in metabolic profile. Meta-analyses were conducted to pool the estimated surgical complication incidence and metabolic changes.Results: Twenty-three articles involving 3583 patients were included. The average aspirate volume was 7734.90 mL (95% CI = 5727.34 to 9742.45 mL). The pooled overall incidence of major surgical complications was 3.35% (95% CI = 1.07% to 6.84%). The most common major complication was blood loss requiring transfusion (2.89% [95% CI = 0.84% to 6.12%]) followed by pulmonary embolism (0.18% [95% CI = 0.06% to 0.33%]), hematoma (0.16% [95% CI = 0.05% to 0.32%]), necrotizing fasciitis (0.13% [95% CI = 0.04% to 0.29%]), and deep vein thrombosis (0.12% [95% CI = 0.03% to 0.27%]). No fat embolism or death was reported in the included studies. The pooled overall incidence of minor surgical complication was 11.62% (95% CI = 6.36% to 18.21%), with seroma being the most common minor complication (5.51% [95% CI = 2.69% to 9.27%]). Reductions in lipid profile, glucose profile, body weight, and hematocrit level were observed after LVL.Conclusions: The authors meta-analyzed and highlighted the complication rates specifically related to LVL in this study; however, the current data are limited by the lack of level 1 evidence.Level Of Evidence:4: [ABSTRACT FROM AUTHOR]

Background: Breast augmentation in primary or secondary patients with long lower pole lengths but appropriately sited nipples is at high risk of "bottoming out" following surgery. The lower pole mastopexy-augmentation (LPMA) was developed to correct long lower pole lengths or preempt bottoming out in breasts deemed at risk, avoiding the requirement for periareolar and vertical breast scar as well as minimizing the requirement for the utilization of synthetic mesh.Objectives: The goal of this short report was to analyze outcomes in patients who underwent the LPMA to determine its application and limitations.Methods: The author reviewed 12 consecutive cases of both primary and secondary situations over a 6-year period. Cases were objectively assessed according to the relationship of the nipple to the point of maximal breast projection on lateral view as well as the upper to lower pole breast proportions.Results: All cases provided good outcomes, with improvements in both the position of the nipple in relation to the point of maximal breast projection and with respect to the upper to lower pole breast ratios.Conclusion: LPMA is a useful addition to the armamentarium in dealing with complex situations in breast augmentation.Level Of Evidence:4: [ABSTRACT FROM AUTHOR]

Background: The reverse abdominoplasty is an effective technique for selected patients seeking treatment for upper abdominal tissue excess and laxity. Specifically, the procedure is particularly effective in patients who have previously undergone conventional abdominoplasty or liposuction and have residual upper abdominal contour problems. It is a versatile technique that may be combined with a number of adjunctive procedures, notably autologous breast augmentation with the excess upper abdominal tissue. Methods: The authors reviewed their experience with the reverse abdominoplasty in a series of 14 consecutive patients who underwent surgery over a five-year period. Patient case notes, as well as and pre- and postoperative clinical photographs, were analyzed. Furthermore, patients were directly questioned to assess their surgical result. Results: The mean age of the cohort was 56.6 years and the majority of patients had undergone previous abdominal or breast aesthetic surgery. A mean of 6 cm of upper abdominal tissue was excised, weighing a mean of 326 g. There were no major complications and only three patients had to undergo minor revisional surgery postoperatively. Conclusions: The authors present their surgical outcomes and discuss the indications, benefits, and lessons they have learned from their experience with this useful technique in relation to the published literature. The ideal candidate for this procedure appears to be a patient who is older, presents with excess upper abdominal skin, has had a previous conventional abdominoplasty, and who has existing inframammary scars. [ABSTRACT FROM AUTHOR]