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Discussion on: Basic Strategies of Augmentation Mammoplasty in Patients with Tendencies of Pectus Excavatum and Carinatum. Aesthetic Plast Surg 2023; 47:61-62. [PMID: 36478199 DOI: 10.1007/s00266-022-03197-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 12/13/2022]
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Yoo G, Jeon HH, Rha EY, Ko JG, Baek SO, Lee JY, Jeong JY. The changes of distance between nipples following correction of women pectus excavatum. Sci Rep 2023; 12:20265. [PMID: 36624098 PMCID: PMC9829671 DOI: 10.1038/s41598-022-24768-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/21/2022] [Indexed: 01/11/2023] Open
Abstract
The breasts in women pectus excavatum patients frequently appear to be slanting medially along the inclination of the distorted ribs. This study aims to evaluate changes in the distance between the nipples and to find out whether medially slanting breasts are corrected in women pectus excavatum patients following modified Nuss procedure. This case series analysis enrolled 22 young women patients with pectus excavatum between October 2011 and September 2020. We measured all the patients' distances from the sternal midline to the right and left nipples, based on chest computerized tomography. We calculated the distances between nipples as being the sum of the right and left distances. The mean age of patients was 16.50 ± 4.73 years, and the follow-up periods were 35.59 ± 20.23 months. The postoperative Haller indices (2.89 ± 0.43) were significantly lower than the preoperative Haller indices (5.14 ± 1.96) (p = 0.000). The distances between the nipples before and after Nuss procedure were 145.17 ± 17.73 mm and 172.29 ± 19.11 mm, which is a significant increase following surgery. (p = 0.000). Our results demonstrated that skeletal correction with modified Nuss procedure in pectus excavatum increased the distance between nipples, indicating that medially slanting breasts had been corrected.
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Affiliation(s)
- Gyeol Yoo
- grid.411947.e0000 0004 0470 4224Department of Plastic and Reconstructive Surgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hui Hyung Jeon
- grid.411947.e0000 0004 0470 4224Department of Plastic and Reconstructive Surgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eun Young Rha
- grid.411947.e0000 0004 0470 4224Department of Plastic and Reconstructive Surgery, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jun Gul Ko
- grid.411947.e0000 0004 0470 4224Department of Plastic and Reconstructive Surgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Oon Baek
- grid.411947.e0000 0004 0470 4224Department of Plastic and Reconstructive Surgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jun Yong Lee
- grid.411947.e0000 0004 0470 4224Department of Plastic and Reconstructive Surgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Yong Jeong
- grid.411947.e0000 0004 0470 4224Department of Thoracic and Cardiovascular Surgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 56, Dongsu-Ro, Bupyeong-Gu, Incheon, Seoul, 21431 Republic of Korea
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Ravanbakhsh S, Farina JM, Bostoros P, Abdelrazek A, Mi L, Lim E, Mead-Harvey C, Arsanjani R, Peterson M, Gotimukul A, Lackey JJ, Jaroszewski DE. Gender differences in objective measures of adult patients presenting for pectus excavatum repair. Ann Thorac Surg 2021; 114:1159-1167. [PMID: 34600903 DOI: 10.1016/j.athoracsur.2021.08.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/02/2021] [Accepted: 08/30/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Women have a reported incidence of pectus deformities 4-5 times less than men. Gender differences have not been well studied. METHODS A retrospective review was performed of adult patients (≥18 years) who underwent a pectus excavatum repair at Mayo Clinic in Arizona (January 1, 2010-December 31, 2019). RESULTS In total, 776 adults underwent pectus repair with 30% being women. Women presented older (mean age 35 vs 32 years, p=0.007) and more symptomatic. Despite this, women performed better on cardiopulmonary exercise testing (higher VO2 max and O2 pulse). Women had more severe deformities (Haller index 5.9 vs 4.3, p<0.001). However, in 609 patients undergoing attempted primary minimally invasive pectus repair, intraoperative fractures/osteotomies occurred equally between genders with the majority occurring in patients ≥30 years of age (11.5% in ≥30, 1.7% in <30, total 7%). Women were also less likely to require 3 bars for repair (12% vs 42%, p<0.001). Hospital length of stay and postoperative complication rates were not significantly different. Postoperatively women reported a greater daily intensity of pain, but only on the initial postoperative day used significantly more opioids than men. Cardiopulmonary exercise testing in 142 patients undergoing baseline and postoperative evaluation at bar removal showed equal and significant benefits in both genders. CONCLUSIONS Women presented for pectus excavatum repair older and with greater symptoms and severity. Despite this, women required fewer bars, with no significant differences in length of stay or complications. Cardiopulmonary benefits of repair were significant and equal for both genders.
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Affiliation(s)
| | | | - Peter Bostoros
- Department of Cardiothoracic Surgery, Mayo Clinic Arizona
| | | | - Lanyu Mi
- Department of Cardiothoracic Surgery, Mayo Clinic Arizona
| | - Elisabeth Lim
- Department of Cardiothoracic Surgery, Mayo Clinic Arizona
| | | | - Reza Arsanjani
- Department of Cardiothoracic Surgery, Mayo Clinic Arizona
| | | | | | - Jesse J Lackey
- Department of Cardiothoracic Surgery, Mayo Clinic Arizona
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Casar Berazaluce AM, Jenkins TM, Garrison AP, Hardie WD, Foster KE, Alsaied T, Tretter J, Moore RA, Fleck RJ, Garcia VF, Brown RL. The chest wall gender divide: females have better cardiopulmonary function and exercise tolerance despite worse deformity in pectus excavatum. Pediatr Surg Int 2020; 36:1281-1286. [PMID: 32940825 DOI: 10.1007/s00383-020-04738-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Pectus excavatum (PE) is a chest wall deformity of variable severity and symptomatology. Existing female-specific literature highlights breast asymmetry and cosmetic reconstruction. We sought to evaluate gender differences in cardiopulmonary function. METHODS Cardiac MRIs, pulmonary function tests (PFTs), and cardiopulmonary exercise tests (CPETs) were reviewed in 345 patients undergoing preoperative evaluation for PE. Regression modeling was used to evaluate associations between gender and clinical endpoints of cardiopulmonary function. RESULTS Mean age was 15.2 years, 19% were female, 98% were white. Pectus indices included median Haller Index (HI) of 4.8, mean depression index (DI) of 0.63, correction index (CI) of 33.6%, and Cardiac Compression Index (CCI) of 2.79. Cardiac assessment revealed decreased right and left ventricular ejection fraction (RVEF, LVEF) in 16% and 22% of patients, respectively. PFTs and CPETs were abnormal in ~ 30% of patients. While females had deeper PE deformities-represented by higher pectus indices-they had superior function with higher RVEF, LVEF Z-scores, FEV1, VO2 max, O2 pulse, work, and breathing reserve (p < 0.05). CONCLUSION Despite worse PE deformity and symptomatology, females had a better cardiopulmonary function and exercise tolerance than males. Further research is needed to assess the precise mechanisms of this phenomenon and postoperative outcomes in this population.
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Affiliation(s)
- Alejandra M Casar Berazaluce
- Department of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC2023, Cincinnati, OH, 45229, USA
| | - Todd M Jenkins
- Department of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC2023, Cincinnati, OH, 45229, USA
| | - Aaron P Garrison
- Department of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC2023, Cincinnati, OH, 45229, USA
| | - William D Hardie
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Karla E Foster
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Tarek Alsaied
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Justin Tretter
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Ryan A Moore
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Robert J Fleck
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Victor F Garcia
- Department of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC2023, Cincinnati, OH, 45229, USA
| | - Rebeccah L Brown
- Department of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC2023, Cincinnati, OH, 45229, USA.
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Andrades P, Quispe D, Dominguez C, Jara R, Cisternas JP, Lobos G, Albornoz C, Danilla S, Erazo C, Sepulveda S. Winged Ribs: An Underestimated Problem That May Compromise Breast Augmentation Outcomes. Aesthetic Plast Surg 2019; 43:899-904. [PMID: 31087117 DOI: 10.1007/s00266-019-01385-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 04/23/2019] [Indexed: 01/09/2023]
Abstract
Chest wall shape is an important aspect to consider when planning a breast augmentation. Minor chest wall deformities are usually underestimated by the patient and surgeon and may compromise postoperative outcomes. Lower costal cartilage dysmorphia or winged rib is one of these minor underestimated chest wall deformities characterized by a visible and palpable cartilaginous prominence under the inframammary fold and causes discomfort in patients decreasing the satisfaction with the breast augmentation surgery. For these patients, the author utilized an innovative surgical technique that allows resection of the protruding cartilages and placement of breast implants through the same surgical incision. Six patients with winged ribs underwent breast augmentation and costal cartilage resection via this method and there were no intraoperative or early postoperative complications, and all patients were satisfied with the aesthetical result after 6 months of follow-up. The presented surgical technique has a short learning curve with excellent postoperative results. Cases are presented to demonstrate the improved postoperative chest wall contour combined with breast augmentation outcome.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 .
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Yasunaga Y, Tsuchiya A, Nakajima Y, Kondoh S, Noguchi M, Yuzuriha S. Three-Dimensional Simulation for Breast Augmentation of Female Asymmetric Pectus Excavatum: A Case Report. Aesthet Surg J Open Forum 2019; 1:ojz010. [PMID: 33791606 PMCID: PMC7671236 DOI: 10.1093/asjof/ojz010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Breast augmentation for women with asymmetric pectus excavatum (PE) has a characteristic problem in that surgeons need to select implants while considering the left-right difference in breast volume, contour, and position. We herein report a 33-year-old woman with severe asymmetric PE who presented with residual breast asymmetry after chest wall correction using the Nuss procedure. Her right breast appeared hypoplastic and the right anterior chest wall remained depressed. Augmentation of the right breast with a silicone implant was performed, selecting the inserted implant preoperatively with the assistance of three-dimensional (3D) simulation. The breast asymmetry and anterior chest wall depression were improved to a natural appearance. Three-dimensional simulation represents an advantageous way to preoperatively select optimal implants for breast augmentation in asymmetric PE women with breast asymmetry. Level of Evidence: 5
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Affiliation(s)
- Yoshichika Yasunaga
- Director of the Division of Plastic and Aesthetic Surgery, Ina Central Hospital, Ina, Japan
| | - Aya Tsuchiya
- Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yuta Nakajima
- Director of the Division of Plastic and Aesthetic Surgery, Ina Central Hospital, Ina, Japan
| | - Shoji Kondoh
- Director of the Division of Plastic and Aesthetic Surgery, Ina Central Hospital, Ina, Japan
| | - Masahiko Noguchi
- Director of the Division of Plastic Surgery, Nagano Children's Hospital, Azumino, Japan
| | - Shunsuke Yuzuriha
- Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine, Matsumoto, Japan
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Satake T, Muto M, Kou S, Sugawara J, Narui K, Kobayashi S, Ishikawa T, Maegawa J. Bilateral breast reconstruction and pectus excavatum correction: a case and review of the literature. EUROPEAN JOURNAL OF PLASTIC SURGERY 2019. [DOI: 10.1007/s00238-018-1449-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Intentional Lower Pole Rotation of Anatomic Breast Implants in Chest Wall Deformities. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 5:e1605. [PMID: 29632783 PMCID: PMC5889469 DOI: 10.1097/gox.0000000000001605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 10/24/2017] [Indexed: 11/27/2022]
Abstract
Several methods have been described for the correction of congenital thoracic wall deformities. Our aim was to investigate the feasibility and clinical results of using standard anatomic breast implants with modified anatomic positioning according to the defect in congenital thoracic wall deformities. Between 2014 and 2015, 5 patients diagnosed with pectus excavatum (PE, n = 4) or pectus carinatum (PC, n = 1) and breast asymmetry or hypoplasia were evaluated. In all patients, a submammary incision and dual-plane subpectoral placement of texturized, anatomic implants were performed. In patients with PE, the lower pole of the implant was positioned medially to compensate for the caved chest. In patients with PC, the lower pole of the anatomic implant was positioned laterally to compensate for the prominent sternum. Outcome measures were satisfaction, minor and major complications, and morbidity. The mean surgery time was 95 ± 14 minutes, and the mean implant volume was 287 ± 56 cm3 (273 ± 60 cm3 on the right side and 305 ± 60 cm3 on the left side). After a median follow-up of 25 months (range: 2-35), all patients healed uneventfully, and a satisfactory correction of the thoracic wall deformity was achieved. Thus, by adjusting the lower pole of anatomic breast implants in a horizontal plane according to the thoracic defect, we showed satisfactory results. Our technique has a low complication rate and can be recommended for the correction of mild to moderate PE or PC.
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Huber KM, Zimmerman A, Dayicioglu D. Improvement in Existing Chest Wall Irregularities During Breast Reconstruction. Cancer Control 2018; 25:1073274817744461. [PMID: 29318956 PMCID: PMC5933572 DOI: 10.1177/1073274817744461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Mastectomies for both cancer resection and risk reduction are becoming more common. Existing chest wall irregularities are found in these women presenting for breast reconstruction after mastectomy and can pose reconstructive challenges. Women who desired breast reconstruction after mastectomy were evaluated preoperatively for existing chest wall irregularities. Case reports were selected to highlight common irregularities and methods for improving cosmetic outcome concurrently with breast reconstruction procedures. Muscular anomalies, pectus excavatum, scoliosis, polythelia case reports are discussed. Relevant data from the literature are presented. Chest wall irregularities are occasionally encountered in women who request breast reconstruction. Correction of these deformities is possible and safe during breast reconstruction and can lead to improved cosmetic outcome and patient satisfaction.
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Affiliation(s)
- Katherine M Huber
- 1 Division of Plastic Surgery, Department of Surgery, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Amanda Zimmerman
- 1 Division of Plastic Surgery, Department of Surgery, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Deniz Dayicioglu
- 1 Division of Plastic Surgery, Department of Surgery, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
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10
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Zambacos GJ. Commentary on: Challenging Breast Augmentations: The Influence of Preoperative Anatomical Features on the Final Result. Aesthet Surg J 2016; 36:321-3. [PMID: 26843097 DOI: 10.1093/asj/sjv191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2015] [Indexed: 11/13/2022] Open
Affiliation(s)
- George J Zambacos
- Dr Zambacos is a plastic surgeon in private practice in Athens, Greece
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Bayram Y, Zor F, Karagoz H, Kulahci Y, Afifi AM, Ozturk S. Challenging Breast Augmentations: The Influence of Preoperative Anatomical Features on the Final Result. Aesthet Surg J 2016; 36:313-20. [PMID: 26420774 DOI: 10.1093/asj/sjv181] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Achieving satisfactory results may be difficult in augmentation mammaplasty patients in the presence of breast, chest wall, or vertebral deformities. These deformities have not been classified previously, and the impact of each deformity or combination of deformities has not been defined. OBJECTIVES The aims of this study are to determine the complicating factors in augmentation mammaplasty, to classify these factors according to their influence on surgical outcome, and to develop an identification system for simplifying the recognition of challenging cases. METHODS We retrospectively analyzed photographs and records of 100 consecutive patients who underwent augmentation mammaplasty. We observed suboptimal results in 18 cases. Preoperative deformities of the breast, chest wall, and vertebra were recorded in order to determine which factor or factors had complicated the surgeries. Eventually, the relationship between suboptimal surgical results and complicating factors was evaluated. RESULTS We observed that some deformities alone caused suboptimal results, whereas others did not. Deformities that caused suboptimal results alone were called major complicating factors, and any others were called minor complicating factors. We observed that suboptimal results were also obtained in patients who had four minor complicating factors. Patients who had suboptimal results because of major or minor complicating factors were considered challenging cases. CONCLUSIONS In this study, complicating factors for augmentation mammaplasty were defined and classified as major or minor depending on their effect on the surgical outcome. We suggest an identification system that simplifies the recognition of challenging cases in breast augmentation.
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Affiliation(s)
- Yalcin Bayram
- Drs Bayram and Zor are Associate Professors and Dr Ozturk is a Professor, Department of Plastic, Reconstructive, and Aesthetic Surgery, Gulhane Military Medical Academy, Ankara, Turkey. Dr Karagoz is an Associate Professor, Department of Plastic, Reconstructive, and Aesthetic Surgery; GATA Haydarpasha Training Hospital, Istanbul, Turkey. Dr Kulahci is an Associate Professor, Department of Hand Surgery, Gulhane Military Medical Academy, Ankara, Turkey. Dr Afifi is an Assistant Professor, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - Fatih Zor
- Drs Bayram and Zor are Associate Professors and Dr Ozturk is a Professor, Department of Plastic, Reconstructive, and Aesthetic Surgery, Gulhane Military Medical Academy, Ankara, Turkey. Dr Karagoz is an Associate Professor, Department of Plastic, Reconstructive, and Aesthetic Surgery; GATA Haydarpasha Training Hospital, Istanbul, Turkey. Dr Kulahci is an Associate Professor, Department of Hand Surgery, Gulhane Military Medical Academy, Ankara, Turkey. Dr Afifi is an Assistant Professor, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - Huseyin Karagoz
- Drs Bayram and Zor are Associate Professors and Dr Ozturk is a Professor, Department of Plastic, Reconstructive, and Aesthetic Surgery, Gulhane Military Medical Academy, Ankara, Turkey. Dr Karagoz is an Associate Professor, Department of Plastic, Reconstructive, and Aesthetic Surgery; GATA Haydarpasha Training Hospital, Istanbul, Turkey. Dr Kulahci is an Associate Professor, Department of Hand Surgery, Gulhane Military Medical Academy, Ankara, Turkey. Dr Afifi is an Assistant Professor, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - Yalcin Kulahci
- Drs Bayram and Zor are Associate Professors and Dr Ozturk is a Professor, Department of Plastic, Reconstructive, and Aesthetic Surgery, Gulhane Military Medical Academy, Ankara, Turkey. Dr Karagoz is an Associate Professor, Department of Plastic, Reconstructive, and Aesthetic Surgery; GATA Haydarpasha Training Hospital, Istanbul, Turkey. Dr Kulahci is an Associate Professor, Department of Hand Surgery, Gulhane Military Medical Academy, Ankara, Turkey. Dr Afifi is an Assistant Professor, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - Ahmed M Afifi
- Drs Bayram and Zor are Associate Professors and Dr Ozturk is a Professor, Department of Plastic, Reconstructive, and Aesthetic Surgery, Gulhane Military Medical Academy, Ankara, Turkey. Dr Karagoz is an Associate Professor, Department of Plastic, Reconstructive, and Aesthetic Surgery; GATA Haydarpasha Training Hospital, Istanbul, Turkey. Dr Kulahci is an Associate Professor, Department of Hand Surgery, Gulhane Military Medical Academy, Ankara, Turkey. Dr Afifi is an Assistant Professor, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - Serdar Ozturk
- Drs Bayram and Zor are Associate Professors and Dr Ozturk is a Professor, Department of Plastic, Reconstructive, and Aesthetic Surgery, Gulhane Military Medical Academy, Ankara, Turkey. Dr Karagoz is an Associate Professor, Department of Plastic, Reconstructive, and Aesthetic Surgery; GATA Haydarpasha Training Hospital, Istanbul, Turkey. Dr Kulahci is an Associate Professor, Department of Hand Surgery, Gulhane Military Medical Academy, Ankara, Turkey. Dr Afifi is an Assistant Professor, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA
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Frey JD, Shapiro RL, Choi M. Implant-Based Breast Reconstruction in Patients with Connective Tissue Disease: A Case Report Demonstrating Safety and Efficacy in Marfan Syndrome. Aesthet Surg J 2015; 35:NP182-5. [PMID: 25782414 DOI: 10.1093/asj/sju159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2014] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jordan D Frey
- Dr Frey is a Resident and Dr Choi is an Assistant Professor at the Institute of Reconstructive Plastic Surgery, and Dr Shapiro is an Associate Professor and Director of Surgical Oncology in the Department of Surgery, NYU Langone Medical Center, New York, New York, USA
| | - Richard L Shapiro
- Dr Frey is a Resident and Dr Choi is an Assistant Professor at the Institute of Reconstructive Plastic Surgery, and Dr Shapiro is an Associate Professor and Director of Surgical Oncology in the Department of Surgery, NYU Langone Medical Center, New York, New York, USA
| | - Mihye Choi
- Dr Frey is a Resident and Dr Choi is an Assistant Professor at the Institute of Reconstructive Plastic Surgery, and Dr Shapiro is an Associate Professor and Director of Surgical Oncology in the Department of Surgery, NYU Langone Medical Center, New York, New York, USA
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13
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Pectus excavatum in adult women: repair and the impact of prior or concurrent breast augmentation. Plast Reconstr Surg 2015; 135:303e-312e. [PMID: 25626815 DOI: 10.1097/prs.0000000000000990] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Women present with pectus excavatum five times less frequently than men. Adult women may have additional, associated cosmetic factors, including hypoplastic or asymmetric breasts, or prior augmentation. The authors evaluated the impact of prior or concurrent cosmetic breast surgery in an adult female cohort undergoing repair of pectus excavatum deformity. METHODS A retrospective review was performed of women (≥18 years old) who underwent pectus excavatum repair at a single institution from January of 2010 to September of 2013. RESULTS Pectus excavatum repair was performed on 47 women with a median age of 35 years (range, 18 to 63 years). Mean pectus severity index was 6.2 (range, 3.1 to 16). All patients had physiologic symptoms as the primary purpose for seeking repair. Twenty patients (43 percent) presented with existing implants or the desire for implants at the time of repair. Fifteen patients (32 percent) had a history of implant placement including prior breast augmentation (n = 14) and/or pectus implant (n = 4). Concurrent augmentation (n = 5), breast implant exchange (n = 8), and/or removal of chest wall implants (n = 4) was performed during repair. Morbidity included one implant-related hematoma. Complications and hospital stay were not significantly different for patients undergoing primary repair alone versus those with prior or concurrent augmentation. CONCLUSIONS Breast cosmesis was a concern in nearly half of adult women presenting for pectus excavatum repair. The authors' experience suggests neither prior nor concurrent breast augmentation increases the risk of complications in repair. The authors recommend that cosmetic breast surgery be performed concurrently with pectus excavatum repair. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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14
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Correction of pectus excavatum with breast hypoplasia using simultaneous pectus bar procedure and augmentation mammoplasty. Ann Plast Surg 2013; 73:190-5. [PMID: 23486122 DOI: 10.1097/sap.0b013e31826a1a93] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Most women with asymmetric pectus excavatum suffer from hypoplastic breasts. Hence, aesthetic correction of pectus excavatum has to address thoracic wall deformity, breast hypoplasia, and asymmetry.In retrospective series, 21 patients with a diagnosis of pectus excavatum with hypoplastic breasts were corrected using the pectus bar procedure and subpectoral augmentation mammoplasty. Results were assessed by analyzing prospectively collected data and calculating pectus indices from computed tomographic scans. At 12 months postoperatively, cosmetic evaluations were performed by the patients and by an independent, board-certified plastic surgeon using score from 0 (very poor) to 4 (very good).Cosmetic results evaluated by plastic surgeon were good (3.33 ± 0.03) and patient satisfaction was high (3.52 ± 0.03). Furthermore, indices of pectus excavatum were corrected to near normal.The authors consider that the pectus bar procedure with subpectoral augmentation mammoplasty is useful for the aesthetic correction of pectus excavatum with hypoplastic breasts.
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