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Pouramin P, Dow T, Williams J. Exploring Complication Rates: A Comparative Study of Breast Reduction and Combined Breast Reduction with Abdominoplasty. Aesthetic Plast Surg 2024:10.1007/s00266-024-04040-y. [PMID: 38684537 DOI: 10.1007/s00266-024-04040-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/28/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Despite a trend towards combining abdominoplasty with breast reduction surgery, so called "mommy makeovers", the safety of this combined approach has been the subject of debate, with previous research yielding conflicting results. We evaluated the risk for complications and revision associated with adding abdominoplasty to bilateral breast reduction surgery. METHODS We conducted a 10-year single-center retrospective chart review of bilateral breast reduction patients in Nova Scotia. Univariate and multivariate analyses were performed to compare the risk for complication and revision in patients with bilateral breast reduction to those with a concomitant abdominoplasty. RESULTS Of the 1871 patients initially screened, 738 were included. 44 underwent a concomitant abdominoplasty procedure. Compared to the breast reduction alone group, patients with concomitant abdominoplasty were significantly older (47.5±9.9 vs. 42.8±13.2, p=0.004), had a higher BMI (28.1±4.4 vs. 25.8±3.1, p<0.001), and experienced longer operating room times (226±6 vs. 115±3 mins, p<0.001). In multivariate analysis, concomitant abdominoplasty did not increase the risk for breast-related (OR: 0.86 95%CI 0.43-1.7, p=0.668) or total complications (OR: 1.63, 95%CI 0.83-3.19, p=0.154). However, there was a trend towards an increased risk of breast revision (OR: 2.684, 95%CI 0.95-7.6, p=0.062) and a significantly increased risk of total revision (OR: 6.624, 95%CI 2.7-16.1, p<0.001). Moreover, patients with concomitant abdominoplasty experienced more follow-up visits (median: 4 vs. 3 visits, p=0.042). CONCLUSION In our single-center retrospective analysis, combining abdominoplasty with bilateral breast reduction did not increase the risk for breast, or total complications; however, it did increase the risk for total revisions. 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.
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Affiliation(s)
- Panthea Pouramin
- Faculty of Medicine, Dalhousie Medical School, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Todd Dow
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jason Williams
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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Toto V, Scarabosio A, Alessandri-Bonetti M, Albanese R, Persichetti P. Combined Surgery (Mommy-Makeover) Compared to Single Procedure (Abdominoplasty) in After-Pregnancy Women: A Prospective Study on Risks and Benefits. Aesthetic Plast Surg 2023; 47:2533-2542. [PMID: 37612475 DOI: 10.1007/s00266-023-03579-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 07/19/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Mommy-makeover is becoming very popular to help them reshaping their own bodies and restoring self-perception, hardly stressed by childbearing-related changes. However, debate exists in the literature concerning safety and aesthetic outcome in patients undergoing combined procedures. The study aims to shed a light on advantages and disadvantages in mommy-makeover technique compared to conventional abdominoplasty with a particular attention to psychological aspects. MATERIALS AND METHODS In total, 37 women were enrolled at Campus Bio-Medico Hospital in Rome between October 2019 and January 2022. All of the patients were eligible for both abdominoplasty only and mommy-makeover. We proposed to the patients both procedures explaining risks and benefits; then, based on the preference of the single patient, we performed either mommy-makeover (Group A) or abdominoplasty alone (Group B). In order to evaluate patients' satisfaction and safety, multiple questionnaires were administered 9-month postoperatively (BUT, POSAS, visual perception, etc.). RESULTS The sample analyzed was composed of 37 patients (treatment group = 18, control group = 19). In the pre-post comparisons of BUT-A performed, there were statistically significant differences recorded in both groups and for all observed variables. The significance values were all less than 1% (p < 0.01). CONCLUSIONS Combined surgery proved not to be inferior in terms of patient safety. At the same time, the effectiveness in improving diastasis-related symptoms is fully comparable with single surgery. Treatment group showcases a considerable superiority in terms of body-image perception improvement and overall patient satisfaction. 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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Affiliation(s)
- Vito Toto
- Policlinico Universitario Campus Bio-Medico, Rome, Italy
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Schafer RE, Blazel MM, Nowacki AS, Schwarz GS. Risk of Complications in Combined Plastic Surgery Procedures Using the Tracking Operations and Outcomes for Plastic Surgeons Database. Aesthet Surg J 2023; 43:1384-1392. [PMID: 37128702 DOI: 10.1093/asj/sjad124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/22/2023] [Accepted: 04/24/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Combining multiple surgical procedures into a single operative session is widespread in the field of plastic surgery; however, the implications of this practice are not fully understood. OBJECTIVES This study compared 30-day complication rates associated with combined plastic surgery procedures with the rates for index procedures. METHODS This retrospective cohort analysis utilized the Tracking Operations and Outcomes for Plastic Surgeons database from 2016 to 2020 to identify the 3 most frequent combinations of augmentation mammaplasty, reduction mammaplasty, trunk liposuction, mastopexy, and abdominoplasty. RESULTS The 30-day overall complication rate was 5.0% (1400 of 26,771 patients), with a higher complication rate for combined procedures compared with index (7.6% vs 4.2%, adjusted odd ratio [aOR], 1.91 [95% CI, 1.61-2.27], P < .001). There were no significant differences in complication rates for abdominoplasty or mastopexy combinations compared with index. Complication rates for reduction mammaplasty combinations compared with index were not statistically different after controlling for demographics (aOR, 1.02 [95% CI, 0.61-1.64], P = .93). Higher rates of minor and major complications were observed for combinations of trunk liposuction (aOR, 4.84 [95% CI, 3.31-7.21), P < .001) and augmentation mammaplasty (aOR, 1.60 [95% CI 1.13-2.22], P = .007) compared with index. CONCLUSIONS Combinations with trunk liposuction or augmentation mammaplasty present with increased risk of complications compared with index, controlling for demographics. Abdominoplasty and mastopexy may be combined with other plastic surgery procedures without increased risk to patients. The complication risk of reduction mammaplasty combinations is mediated by other variables, suggesting the need for shared surgical decision-making when recommending these combinations to patients. LEVEL OF EVIDENCE: 4
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Netshiongolwe TT. Radial Nerve Palsy Due to Blood Pressure Cuff Compression after Prolonged Combined Plastic Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5321. [PMID: 37811352 PMCID: PMC10558225 DOI: 10.1097/gox.0000000000005321] [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: 04/25/2023] [Accepted: 08/18/2023] [Indexed: 10/10/2023]
Abstract
As plastic surgery procedures become safer and more popular, the number of patients undergoing cosmetic surgery will rise. A recent trend in plastic surgery has been a rise in combining multiple procedures in a single setting. Such an approach has the advantage of lower surgical cost to the patient and affords the patient a reduced downtime from work. Although the complication profile of patients undergoing plastic surgery is well documented, combining procedures prolongs operation time, which has been associated with a significant increase in the risk of complications. Our case report describes a patient who presented with a wrist drop and paraesthesia in the radial nerve distribution 1 day postoperatively after prolonged combined breast reduction and abdominoplasty procedures. The patient was diagnosed with radial nerve neuropraxia through electromyography. She was reassured, treated by an occupational therapist and showed complete recovery within 3 months. Surgeons offering combined procedures for plastic surgery should be aware of the risk of nerve injury associated with prolonged blood pressure cuff monitoring and take precautionary measures to prevent this risk.
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Affiliation(s)
- Thendo T. Netshiongolwe
- From the Department of Plastic and Reconstructive Surgery, Mankweng Hospital, University of Limpopo, Polokwane, South Africa
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Bravo FG. Invited Discussion on: Quality of Life and Concurrent Procedures in Truncal Body Contouring Patients: A Single-Center Retrospective Study. Aesthetic Plast Surg 2021; 45:1628-1632. [PMID: 33693982 DOI: 10.1007/s00266-021-02192-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/13/2021] [Indexed: 01/19/2023]
Affiliation(s)
- Francisco G Bravo
- Private Practice, Clinica Gomez Bravo, c/Claudio Coello 76, 28001, Madrid, Spain.
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Calvert JW, Rovelo MO, Orlando MV, Kwon E. Autologous Costal Cartilage Harvest for Rhinoplasty with Simultaneous Breast Surgery: A Safe and Efficient Technique. Aesthet Surg J 2020; 40:NP480-NP490. [PMID: 31957807 DOI: 10.1093/asj/sjaa016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Autologous costal cartilage is frequently required for revision rhinoplasties and for challenging primary rhinoplasties. Patients undergoing a concomitant breast surgery can have costal cartilage harvested through their breast surgery incisions, thereby obviating an additional rib harvest scar. The safety and efficacy of this approach has yet to be described. OBJECTIVES The aim of this study was to evaluate the outcomes, safety, and results of a new technique, described here, for harvesting costal cartilage during a concomitant breast operation. Specifically, the rates of capsular contracture and rhinoplasty revisions were of great interest. METHODS A retrospective review was performed evaluating the senior author's experience with this technique. Data collected included patient demographics, operations performed, operative time, perioperative morbidity, and postoperative complications. Rates of capsular contracture and rhinoplasty revisions were compared with national averages. RESULTS A total of 31 female patients were included. Ten (32.3%) breast complications occurred. There were 6 (19.4%) rhinoplasty complications, comprising 1 infection and 5 revisions. The capsular contracture rate was 6% and the rhinoplasty revision rate was 16%. Both of these rates are comparable to independent breast surgeries and rhinoplasties. There were no cases of perioperative mortality or major morbidity. CONCLUSIONS Combining breast surgery and rhinoplasty surgery allows for autologous rib harvest through the breast surgery incisions. This is a safe technique that results in outcomes similar to either procedure performed alone. In addition, the patient is spared an additional surgery and donor site scar. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Jay W Calvert
- Roxbury Clinic and Surgery Center, University of Southern California, Los Angeles, CA
| | - Millicent O Rovelo
- Roxbury Clinic and Surgery Center, University of Southern California, Los Angeles, CA
| | - Marc V Orlando
- Roxbury Clinic and Surgery Center, University of Southern California, Los Angeles, CA
| | - Edwin Kwon
- Roxbury Clinic and Surgery Center, University of Southern California, Los Angeles, CA
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Rosenfield LK, Davis CR. Evidence-Based Abdominoplasty Review With Body Contouring Algorithm. Aesthet Surg J 2019; 39:643-661. [PMID: 30649214 DOI: 10.1093/asj/sjz013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Abdominal contour deformities are an aesthetic challenge to the plastic surgeon. Patients present with diverse clinical histories, multiple comorbidities, and unique aesthetic demands. Weight loss, previous pregnancy, and aging are 3 principal indications for abdominoplasty. Bariatric surgery has increased demand for body contouring procedures. This heterogeneous patient cohort means a "one-size-fits-all" abdominoplasty is not appropriate. Precise evaluation, evidence-based decision-making, and artistic acumen are required while balancing patient goals with safe, realistic, and long-lasting aesthetic outcomes. This article reviews surgical options for abdominal body contouring, providing an evidence-based treatment algorithm for selecting the appropriate procedure for each patient to maximize clinical and patient reported outcomes.
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Affiliation(s)
- Lorne K Rosenfield
- University of California, San Francisco, CA
- Stanford University, Stanford, CA
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Michot A, Alet JM, Pélissier P, Grolleau-Raoux JL, Bodin F, Chaput B. Morbidity in combined-procedure associating abdominoplasty and breast surgery: A systematic review. ANN CHIR PLAST ESTH 2016; 61:e9-e19. [DOI: 10.1016/j.anplas.2015.07.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 07/24/2015] [Indexed: 10/23/2022]
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Khavanin N, Jordan SW, Vieira BL, Hume KM, Mlodinow AS, Simmons CJ, Murphy RX, Gutowski KA, Kim JYS. Combining abdominal and cosmetic breast surgery does not increase short-term complication rates: a comparison of each individual procedure and pretreatment risk stratification tool. Aesthet Surg J 2015; 35:999-1006. [PMID: 26163312 DOI: 10.1093/asj/sjv087] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2015] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Combined abdominal and breast surgery presents a convenient and relatively cost-effective approach for accomplishing both procedures. OBJECTIVES This study is the largest to date assessing the safety of combined procedures, and it aims to develop a simple pretreatment risk stratification method for patients who desire a combined procedure. METHODS All women undergoing abdominoplasty, panniculectomy, augmentation mammaplasty, and/or mastopexy in the TOPS database were identified. Demographics and outcomes for combined procedures were compared to individual procedures using χ(2) and Student's t-tests. Multiple logistic regression provided adjusted odds ratios for the effect of a combined procedure on 30-day complications. Among combined procedures, a logistic regression model determined point values for pretreatment risk factors including diabetes (1 point), age over 53 (1), obesity (2), and 3+ ASA status (3), creating a 7-point pretreatment risk stratification tool. RESULTS A total of 58,756 cases met inclusion criteria. Complication rates among combined procedures (9.40%) were greater than those of aesthetic breast surgery (2.66%; P < .001) but did not significantly differ from abdominal procedures (9.75%; P = .530). Nearly 77% of combined cases were classified as low-risk (0 points total) with a 9.78% complication rates. Medium-risk patients (1 to 3 points) had a 16.63% complication rate, and high-risk (4 to 7 points) 38.46%. CONCLUSIONS Combining abdominal and breast procedures is safe in the majority of patients and does not increase 30-day complications rates. The risk stratification tool can continue to ensure favorable outcomes for patients who may desire a combined surgery. LEVEL OF EVIDENCE 4 Risk.
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Affiliation(s)
- Nima Khavanin
- Ms Khavanin and Mr Mlodinow are Medical Students, Dr Jordan is a Resident, Ms Vieira is a Clinical Researcher, and Dr Kim is an Attending Physician, Northwestern University, Feinberg School of Medicine, Chicago, Illinois. Mr Hume is the TOPS Registry Administrator and Mr Simmons is a TOPS Registry Clinical Research Associate, Arlington Heights, Illinois. Dr Murphy is an Attending Physician, Lehigh Valley Health Network, Allentown, Pennsylvania. Dr Gutowski is a plastic surgeon in private practice in Northbrook, Illinois
| | - Sumanas W Jordan
- Ms Khavanin and Mr Mlodinow are Medical Students, Dr Jordan is a Resident, Ms Vieira is a Clinical Researcher, and Dr Kim is an Attending Physician, Northwestern University, Feinberg School of Medicine, Chicago, Illinois. Mr Hume is the TOPS Registry Administrator and Mr Simmons is a TOPS Registry Clinical Research Associate, Arlington Heights, Illinois. Dr Murphy is an Attending Physician, Lehigh Valley Health Network, Allentown, Pennsylvania. Dr Gutowski is a plastic surgeon in private practice in Northbrook, Illinois
| | - Brittany L Vieira
- Ms Khavanin and Mr Mlodinow are Medical Students, Dr Jordan is a Resident, Ms Vieira is a Clinical Researcher, and Dr Kim is an Attending Physician, Northwestern University, Feinberg School of Medicine, Chicago, Illinois. Mr Hume is the TOPS Registry Administrator and Mr Simmons is a TOPS Registry Clinical Research Associate, Arlington Heights, Illinois. Dr Murphy is an Attending Physician, Lehigh Valley Health Network, Allentown, Pennsylvania. Dr Gutowski is a plastic surgeon in private practice in Northbrook, Illinois
| | - Keith M Hume
- Ms Khavanin and Mr Mlodinow are Medical Students, Dr Jordan is a Resident, Ms Vieira is a Clinical Researcher, and Dr Kim is an Attending Physician, Northwestern University, Feinberg School of Medicine, Chicago, Illinois. Mr Hume is the TOPS Registry Administrator and Mr Simmons is a TOPS Registry Clinical Research Associate, Arlington Heights, Illinois. Dr Murphy is an Attending Physician, Lehigh Valley Health Network, Allentown, Pennsylvania. Dr Gutowski is a plastic surgeon in private practice in Northbrook, Illinois
| | - Alexei S Mlodinow
- Ms Khavanin and Mr Mlodinow are Medical Students, Dr Jordan is a Resident, Ms Vieira is a Clinical Researcher, and Dr Kim is an Attending Physician, Northwestern University, Feinberg School of Medicine, Chicago, Illinois. Mr Hume is the TOPS Registry Administrator and Mr Simmons is a TOPS Registry Clinical Research Associate, Arlington Heights, Illinois. Dr Murphy is an Attending Physician, Lehigh Valley Health Network, Allentown, Pennsylvania. Dr Gutowski is a plastic surgeon in private practice in Northbrook, Illinois
| | - Christopher J Simmons
- Ms Khavanin and Mr Mlodinow are Medical Students, Dr Jordan is a Resident, Ms Vieira is a Clinical Researcher, and Dr Kim is an Attending Physician, Northwestern University, Feinberg School of Medicine, Chicago, Illinois. Mr Hume is the TOPS Registry Administrator and Mr Simmons is a TOPS Registry Clinical Research Associate, Arlington Heights, Illinois. Dr Murphy is an Attending Physician, Lehigh Valley Health Network, Allentown, Pennsylvania. Dr Gutowski is a plastic surgeon in private practice in Northbrook, Illinois
| | - Robert X Murphy
- Ms Khavanin and Mr Mlodinow are Medical Students, Dr Jordan is a Resident, Ms Vieira is a Clinical Researcher, and Dr Kim is an Attending Physician, Northwestern University, Feinberg School of Medicine, Chicago, Illinois. Mr Hume is the TOPS Registry Administrator and Mr Simmons is a TOPS Registry Clinical Research Associate, Arlington Heights, Illinois. Dr Murphy is an Attending Physician, Lehigh Valley Health Network, Allentown, Pennsylvania. Dr Gutowski is a plastic surgeon in private practice in Northbrook, Illinois
| | - Karol A Gutowski
- Ms Khavanin and Mr Mlodinow are Medical Students, Dr Jordan is a Resident, Ms Vieira is a Clinical Researcher, and Dr Kim is an Attending Physician, Northwestern University, Feinberg School of Medicine, Chicago, Illinois. Mr Hume is the TOPS Registry Administrator and Mr Simmons is a TOPS Registry Clinical Research Associate, Arlington Heights, Illinois. Dr Murphy is an Attending Physician, Lehigh Valley Health Network, Allentown, Pennsylvania. Dr Gutowski is a plastic surgeon in private practice in Northbrook, Illinois
| | - John Y S Kim
- Ms Khavanin and Mr Mlodinow are Medical Students, Dr Jordan is a Resident, Ms Vieira is a Clinical Researcher, and Dr Kim is an Attending Physician, Northwestern University, Feinberg School of Medicine, Chicago, Illinois. Mr Hume is the TOPS Registry Administrator and Mr Simmons is a TOPS Registry Clinical Research Associate, Arlington Heights, Illinois. Dr Murphy is an Attending Physician, Lehigh Valley Health Network, Allentown, Pennsylvania. Dr Gutowski is a plastic surgeon in private practice in Northbrook, Illinois
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Coronado-Malagón M, Tauffer-Carrion LT. Jejunal perforation after abdominal liposuction, bilateral breast augmentation and facial fat grafting. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2013; 20:197-8. [PMID: 23997589 DOI: 10.1177/229255031202000307] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 54-year-old woman presented to the emergency department 24 h after undergoing abdominal liposuction, bilateral breast augmentation and facial fat grafting at a private plastic surgery clinic. She presented with the classic evolution of a bowel perforation secondary to abdominal liposuction. A computed tomography (CT) scan found free air in her abdominal cavity. Based on the CT scan and the persistent pain experienced by the patient, an abdominal laparatomy was urgently performed. A jejunum perforation was found and was treated with a resection of the affected segment followed by intestinal anastomosis. The patient had a successful recovery and was discharged seven days later. The present article also reviews the classical presentation of a bowel perforation following abdominal liposuction.
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Affiliation(s)
- Martin Coronado-Malagón
- Emergency Room Service, Hospital Central Sur de Alta Especialidad (HCSAE) de PEMEX, Mexico City, Mexico
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Abstract
Breast reduction is a common cosmetic surgical procedure. It aims not only at bringing down the size of the breast proportionate to the build of the individual, but also to overcome the discomfort caused by massive, ill-shaped and hanging breasts. The operative procedure has evolved from mere reduction of breast mass to enhanced aesthetic appeal with a minimum of scar load. The selection of technique needs to be individualised. Bilateral breast reduction is done most often. Haematoma, seroma, fat necrosis, skin loss, nipple loss and unsightly, painful scars can be the complications of any procedure on the breast. These may result from errors in judgement, wrong surgical plan and imprecise execution of the plan. Though a surfeit of studies are available on breast reduction, very few dwell upon its complications. The following article is a distillation of three decades of experience of the senior author (L.S.) in reduction mammoplasty. An effort is made to understand the reasons for unfavourable results. To conclude, most complications can be overcome with proper selection of procedure for the given patient and with gentle tissue handling.
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Affiliation(s)
| | - Jerry R. John
- Department of Plastic Surgery, PGIMER, Chandigarh, India
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Egrari S. Outpatient-based massive weight loss body contouring: a review of 260 consecutive cases. Aesthet Surg J 2012; 32:474-83. [PMID: 22436234 DOI: 10.1177/1090820x12441618] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Massive weight loss (MWL), whether from bariatric surgery or self-directed efforts, has become an increasingly-frequent reason for which patients present for body-contouring procedures. As the incidence of post-MWL surgery has increased, there has also been an increase in the frequency of outpatient ambulatory techniques for complex procedures. OBJECTIVES The author describes his experience with MWL body contouring in an outpatient setting. METHODS A retrospective review was performed of 260 consecutive patients who presented to the author's clinic for post-MWL body contouring in the author's accredited outpatient clinic. Many patients (n=150) underwent concurrent operations, for a total of 544 procedures. All patients received general anesthesia delivered by a board-certified anesthesiologist, received rigorous perioperative education, and were discharged on the day of operation. RESULTS Of the 260 patients, 241 were women and 19 were men. The average patient age was 42 years (range, 19-70 years). Among the 544 procedures, the most common complication was minor wound separation. There were no wound infections and only one pulmonary embolism. There were no hospital readmissions and no deaths. CONCLUSIONS With judicious patient selection, standardized perioperative teaching, and appropriate anesthesia, practitioners' advanced knowledge about complex MWL operations can allow them to perform these procedures safely and effectively in an accredited outpatient setting. LEVEL OF EVIDENCE 4.
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DIEP flap donor site versus elective abdominoplasty short-term complication rates: a meta-analysis. Aesthetic Plast Surg 2012; 36:363-9. [PMID: 21858596 DOI: 10.1007/s00266-011-9804-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Accepted: 07/22/2011] [Indexed: 01/09/2023]
Abstract
BACKGROUND Although over the past decade the DIEP flap has emerged as one of the preferred choices for autologous breast reconstruction and the donor-site closure has much in common with the standard abdominoplasty technique, reports on comparisons of the complication rates between DIEP and elective abdominoplasty patients are not currently available. The purpose of this study was to compare DIEP donor-site and elective abdominoplasty short-term complications rates, in support of surgical choices. METHODS Searches of MEDLINE and CENTRAL for English language articles on DIEP and elective abdominoplasty (EA) published from January 1999 through December 2009 identified 33 studies that met the inclusion criteria and included 3,937 patients. A random-effects model was used to calculate the average complication rate in the literature. RESULTS The rate of seroma/hematoma in EA (16.1%, 95% confidence interval [CI] = 12.2-20.9%) was approximately four times the rate in DIEP flap patients (3.7%, 95% CI = 1.5-8.8%) was found from analyzing the data under a random-effects model. No substantial differences in the rates of infection, abdominal/umbilical necrosis, or wound dehiscence/delayed healing between the two series of patients were detected. CONCLUSIONS This meta-analysis reveals that DIEP donor-site complication rates were comparable to those in elective abdominoplasty, and, the rate of seroma in DIEP is an even lower than that of one of the most performed procedures in plastic surgery. We argue that patients presenting for a DIEP flap should be informed about this interesting comparison.
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Gulcelik MA, Dogan L, Camlibel M, Karaman N, Kuru B, Alagol H, Ozaslan C. Early complications of a reduction mammoplasty technique in the treatment of macromastia with or without breast cancer. Clin Breast Cancer 2011; 11:395-9. [PMID: 21993009 DOI: 10.1016/j.clbc.2011.08.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 08/05/2011] [Accepted: 08/17/2011] [Indexed: 12/25/2022]
Abstract
UNLABELLED This study was planned to investigate the early postoperative complications of reduction mammoplasty done for benign or malignant reasons on 286 patients. Minor and major complication rates were 16.3% and 1.9%, respectively.There was no significant difference in terms of complications between the patients with and those without breast cancer. Body mass index was found to be the only factor associated with the complication rates. BACKGROUND This study was planned to investigate the early postoperative complications after reduction mammoplasty applied either for benign or malignant reasons and reliability of the technique with respect to wound healing. PATIENTS AND METHODS Two hundred and eighty-six reduction procedures were evaluated prospectively. Fifty-two patients underwent reduction mammoplasty for macromastia and 101 for macromastia with breast cancer. The wound complications were evaluated in 2 groups, as minor and major complications. Seroma, hematoma, surgical site infection, delayed wound healing, and minor wound dehiscence were included in the minor complication group. Severe complications, such as necrosis of nipple-areola complex and major incisional wound dehiscence, were included in the major complications group. RESULTS Mean (SD) age of the patients was 48.8 ± 10.3 years, mean (SD) body mass index was 29 ± 3.3 kg/m(2), and mean (SD) weight of resected specimen was 958 ± 72 g. Mean (SD) preoperative and postoperative volumes for each breast were 1245 ± 75 cm(3) and 436 ± 27 cm(3), respectively. Minor and major complication rates were 25/153 (16.3%) and 3/153 (1.9%), respectively. There was no significant difference in terms of complications between the patients with and without breast cancer. Body mass index was found to be the only factor associated with the complication rates. DISCUSSION Reduction mammoplasty is a surgical technique that has satisfactory cosmetic results in the treatment of macromastia. This technique also is safe in the treatment of breast cancer patients with macromastia and does not increase complication rates.
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Affiliation(s)
- Mehmet Ali Gulcelik
- Department of Surgery, Ankara Oncology Hospital, 12/34 Cukurambar, Ankara, Turkey.
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Bilateral sciatic neurapraxia following combined abdominoplasty and mastopexy. Plast Reconstr Surg 2010; 125:31e-32e. [PMID: 20048593 DOI: 10.1097/prs.0b013e3181c2a367] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Safety and efficacy of perforator flap breast reconstruction with combined intraabdominal procedures. Ann Plast Surg 2010; 64:144-50. [PMID: 20098096 DOI: 10.1097/sap.0b013e3181a2c6bd] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Genetic testing for BRCA mutations has led to greater needs for breast reconstruction and prophylactic gynecologic procedures. A retrospective review of all perforator flap breast reconstructions was performed over 5 years. A total of 316 flaps were performed on 232 patients. Nineteen patients had an intraabdominal procedure at the time of their breast reconstruction, including 8 unilateral and 11 bilateral reconstructions (22 flaps). The concomitant procedures incurred an additional mean operative time of 61 minutes. One arterial thrombosis occurred leading to a single flap failure (1/30, 3.3%). No significant differences were noted in complication rates between the combined group and those who did not have a simultaneous procedure (anastomotic complications 3.3% vs. 7.7%; failure rate 3.3% vs. 3.1%; abdominal wound 10.5% vs. 15%; fat necrosis 10% vs. 12.2%). The coordinated effort allowing simultaneous intraabdominal procedures and perforator flap breast reconstruction affords effective reconstruction for those requiring additional procedures without an increase in postoperative complication rates.
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The Pathophysiology of Venous Thromboembolism: Implications With Compression Garments. Ann Plast Surg 2009; 62:468-72. [DOI: 10.1097/sap.0b013e31818cd08c] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Farroha ASM, Hanna HSY. Is it safe to combine abdominoplasty and posterior vaginal repair in one surgical session? Indian J Plast Surg 2008; 41:133-7. [PMID: 19753251 PMCID: PMC2740505 DOI: 10.4103/0970-0358.44922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Many multiparous women complain of protruded and pendulous abdomens and vaginal outlet relaxation which affect their sexual relationships with their male partners. This study included 47 patients who had these complaints. Some of these patients were working outside the homes and all were mothers of 2–5 children. Due of their home and job responsibilities, they did not have enough time or money for multiple surgeries in more than one session.
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Pulmonary embolism after combined abdominoplasty and flank liposuction: a correlation with the amount of fat removed. Ann Plast Surg 2008; 60:604-8. [PMID: 18520191 DOI: 10.1097/sap.0b013e3181344470] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND We prospectively followed patients who underwent esthetic abdominoplasty and flank liposuction to determine the influence of the amount of fat removed on the occurrence of pulmonary embolism. MATERIALS AND METHODS We recruited patients undergoing abdominoplasties and flank liposuction and composed 2 groups according to the amount of fat removed, one of small resections (<1500 g) and the other of great resections (>1500 g). All patients received deep vein thrombosis prophylaxis. RESULTS Since January 2005, we enrolled 103 patients and registered 3 embolisms (2.9%). All occurred in nonsmokers, had no risk factor for deep vein thrombosis, and a resection weight greater than 1500 g (21.4%; 3/14). The calculated relative risk conferred by the amount of fat greater than 1500 g was 7.4. An association was also found with duration of surgery: all embolisms occurred in patients that underwent long operation (>140 minutes; 8.8%; 3/34) with a relative risk of 3.0. CONCLUSIONS The amount of fat removed during plastic surgery is a factor influencing the occurrence of pulmonary embolism in patients undergoing abdominoplasty/flank liposuction, and the duration of surgery is a concomitant factor. Should this data be confirmed, specific measures for prevention of this serious complication could be developed.
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Iljin A, Szymanski D, Kruk-Jeromin J, Strzelczyk J. The repair of incisional hernia following Roux-en-Y gastric bypass-with or without concomitant abdominoplasty? Obes Surg 2008; 18:1387-91. [PMID: 18368458 DOI: 10.1007/s11695-008-9488-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2008] [Accepted: 02/29/2008] [Indexed: 12/31/2022]
Abstract
BACKGROUND Incisional hernia, found in up to 25% of patients, is a typical complication of open bariatric surgery. METHODS Open Roux-en-Y gastric bypass (RYGB) was performed in 204 patients. They have been followed-up for at least 6 months. Thirty-two patients in whom incisional hernia was diagnosed were divided into two groups-they were scheduled for hernia repair or hernia repair with abdominoplasty. The surgery was performed, on average, 20 months after RYGB operation. Fourteen patients [mean body mass 86.4 kg, mean body mass index (BMI) 30.0 kg/m(2)] have had hernias repaired. The mean duration of hospital stay was 7.2 days. Hernia repair along with abdominoplasty was performed in 18 patients with mean body mass 89.4 kg and BMI 31.5 kg/m(2). The mean duration of hospital stay was 8.7 days. RESULTS Both examined groups were similar in body mass, BMI, age, and duration of hospital stay (p > 0.05), as well as gender distribution. The wound infection was diagnosed in six patients. CONCLUSION The simultaneous abdominoplasty does not prolong the time of hospital stay of the patients undergoing incisional hernia repair. Infection is the most frequent complication of incisional hernia repair.
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Affiliation(s)
- A Iljin
- Department of Plastic Surgery, Barlicki Hospital, Medical University of Lodz, Kopcinskiego 22, 90-153, Lodz, Poland.
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