Striae distensae after breast augmentation

Low Molecular Weight Hyaluronic Acid Added to Six Specific Amino Acids in the Treatment of Striae Alba (SA): An Observational Study

Striae distensae or stretch marks are a common complaint among women and can be distressing. The present study aimed to assess the efficacy of a mixture of low molecular weight hyaluronic acid and six amino acids when applied with a specific intradermal injection technique known as intra-mural fluid technique. A clinical study was carried out in 32 patients (with a dropout rate by 9.4%) with striae distensae alba (SA) in one or more of the following anatomical areas: breast, abdomen, inner thigh, trochanteric area, gluteal area, posterior supra-iliac area, and lumbar area. Product efficacy was assessed by the investigator using the Global Aesthetic Improvement Scale, while a Likert scale was used to evaluate to score the treatment tolerability and a QoL stretch marks questionnaire was used to investigate the patients' self-body image. The treatment was effective in improving the appearance of SA fifteen days after the second treatment and 6 months after the first treatment (and after a total of 4 treatments). The product efficacy and tolerability were also perceived by the patients during each treatment session. Our results suggest that the test treatment is a valid treatment option to decrease the appearance of SA. 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 https://www.springer.com/00266.

Comparing Energy-Based Devices for Striae Improvement: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Striae distensae (SD) are cutaneous lesions that are caused by hormones or mechanical stress leading to rapid expansion of skin. Therefore, SD are now a cosmetic concern. However, improving SD is notoriously difficult. Among different treatments, energy-based devices (EBDs) are much more effective and controllable.

OBJECTIVE

The aim of this review was to determine the most effective type of EBD for improving the appearance of striae.

MATERIALS AND METHODS

The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The population comprised patients suffering from striae. Different types of EBDs used to improve striae were compared. The primary outcome of the reduction in the width of striae was evaluated. A random-effects model was performed. The means and standard deviations were extracted.

RESULTS

Eighteen randomized controlled trials were included. The network meta-analysis revealed that after a comparison among the 4 types of EBDs, no significant differences were observed in the reduction of striae width.

CONCLUSION

Radiofrequency, ablative lasers, nonablative lasers, and intense pulsed light are all effective treatments for reducing the striae width. None of them was superior to the others. However, radiofrequency and ablative lasers may have the highest chance of improving the appearance of striae.

Exercise after Breast Augmentation: A Randomized Controlled Trial

BACKGROUND

There are limited scientific data regarding the impact of exercise after breast augmentation surgery. Recommendations range from a few weeks to a few months of physical activity avoidance. To decide whether early exercise after breast augmentation is safe, a prospective randomized trial was designed to measure complications, scar quality, and patient-reported outcomes in this setting.

METHODS

The present study was a randomized controlled trial to investigate the effects of early exercise (1 week after surgery) on postoperative complications, scar quality, and patient-reported outcome (BREAST-Q). All women undergoing primary breast augmentation surgery in the authors' institution were randomized to either standard restrictions or exercise. The three primary outcomes measured were the presence of a complication and reoperation, scar quality, and patient-reported outcome.

RESULTS

A total of 225 participants were included in the final analysis. No differences were found among the groups for age (p = 0.66), implant size (p = 0.56), or implant pocket (p = 0.29); complication rates did not change between the control (7.5 percent) and exercise groups (6.9 percent). When assessed 12 months after surgery, the scar quality was comparable between the groups (29.9 control and 29.6 exercise, p = 0.204). Intervention groups (exercise) performed better on the BREAST-Q Augmentation Module: Satisfaction with Outcome score (66.3 control and 83.4 exercise, p < 0.01).

CONCLUSIONS

Early exercise following primary breast augmentation does not increase complication or reoperation rates or cause a reduction in scar quality after 1 year. In addition, a patient-reported outcome showed improvement in the exercise groups.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, II.

Striae Distensae: Scars without Wounds

SUMMARY

Striae distensae, or stretch marks, are common linear lesions of atrophic skin characterized histologically by epidermal atrophy, absent rete ridges, and alterations in connective tissue architecture. Hormonal excess, mechanical stress, and genetic predisposition are all associated with striae distensae, but their exact pathogenesis remains unknown. Despite a multitude of options, no single treatment has yet proven effective. In this article, the authors describe an up-to-date overview of striae distensae in terms of their etiology, pathophysiology, and therapeutic options. Further research is required to better elucidate their pathophysiology and to develop targeted effective treatments.

Development of a clinical scale to assess the severity of striae distensae

BACKGROUND AND OBJECTIVE

There is no validated instrument to assess the clinical severity of striae distensae. Here, we aimed to develop a striae distensae severity scale.

MATERIAL AND METHODS

After a Delphi-based consensus, 15 items related to striae severity were assessed in 110 areas (breasts, abdomen, and buttocks) from 45 participants. The items were analyzed through a partial least squares model to select the most important variables. To assess the reliability of the scale, 43 areas were retested.

RESULTS

Of the 110 areas evaluated, 34 were breasts, 24 abdomens, and 52 buttocks. Striae were considered mild in 30% of the evaluations, moderate in 33%, severe in 21%, and extremely severe in 16%. The final model was composed by: width of the widest striae, width of the striae with the most frequent pattern, atrophy, number of affected quadrants, distribution (multiple or isolated), hypo or hyperchromia and topography. The scores of the scale demonstrated a high correlation with the clinical classification (rho = 0.77). There was a high agreement in the scores from the reassessed areas (intraclass correlation coefficient = 0.90).

CONCLUSION

An objective and reliable scale to assess the clinical severity of striae distensae on the breasts, abdomen, and buttocks was developed.

Cutaneous complications associated with breast augmentation: A review

Breast augmentation is one of the most popular and safe cosmetic procedures performed by plastic surgeons worldwide. Although breast implants are available in a number of different materials, silicone-filled implants remain the most common type. However, prior to the development of breast implants, various materials were injected into the soft tissues of the breasts to increase breast volume, which caused cutaneous complications and disfigurement. This review details the history of breast augmentation, the current methods used in augmentation surgery, and associated cutaneous complications.

Physiological Striae Atrophicae of Adolescence with Involvement of the Axillae and Proximal Arms

We report a 16-year-old adolescent male with multiple violaceous, atrophic, vertical linear striae isolated to the axillae and proximal arms of approximately one-year duration. In the past two years, he indulged in heavy weight-lifting. He experienced a growth spurt over the past few years. The patient was otherwise in good health and was not on any medications. Physiological striae atrophicae of adolescence where the striae were restricted to the axillae and proximal arms have very rarely been reported.

Fractional CO2 Laser Versus Intense Pulsed Light in Treating Striae Distensae

Context:

Striae distensae are linear atrophic dermal scars covered with flat atrophic epidermis. They may cause disfigurement, especially in females. Many factors may cause striae distensae such as steroids, obesity, and pregnancy. Although there is no standard treatment for striae; many topical applications, peeling, and light and laser systems have been tried.

Aims:

To evaluate and compare the efficacy of fractional CO₂ laser with intense pulse light in treating striae distensae.

Subjects and Methods:

Forty patients with striae distensae were recruited. Twenty of them were treated by fractional CO₂ laser and 20 were treated with intense pulse light. Length and width of the largest striae were measured pre- and post-treatment. Patient satisfaction was also evaluated and graded. Patients were photographed after each treatment session and photos were examined by a blinded physician who had no knowledge about the cases.

Results:

Both groups showed significant improvement after treatments (P < 0.05). Patients treated with fractional CO₂ laser showed significant improvement after the fifth session compared with those treated with ten sessions of intense pulsed light (P < 0.05) in all parameters except in the length of striae (P > 0.05).

Conclusions:

The current study has provided supportive evidence to the effectiveness of both fractional CO₂ laser and intense pulse light as treatments for striae distensae. Fractional CO₂ laser was found to be more effective in the treatment of striae distensae compared with intense pulse light.

Incidence and risk factors of Striae Distensae following breast augmentation surgery: a cohort study

Background

The significant increase in the popularity of breast augmentation surgeries has led to an increase in the number and types of complications; among these is the postoperative occurrence of Striae Distensae (SD). The objective of this study was to investigate the incidence of SD and describing its occurrence in association with age, breast implant volume, history of SD, history of pregnancies and breastfeeding, body mass index (BMI), changes in postoperative weight, smoking habits, and use of oral contraceptives.

Methods

A cohort study was conducted and the patient data from a specific social group that underwent augmentation mammaplasty with silicone breast implants in a private clinic was analyzed.

Results

563 patients entered the cohort, while 538 completed the study. The SD incidence was 7.06%. The risk was almost the double at 22–28 years of age and triple in women of 21 years of age or less. The women who did not use oral contraceptives were 2.59 times more likely of developing SD. A higher incidence of SD was observed among those with normal or low BMI values, smokers, and in those who had implants larger than 300 ml.

Conclusions

Young age, larger implant volumes, smoking, and normal or low BMI values were the risk factors responsible for the development of SD; while using oral contraceptives was found to be a protective factor.

Physiological striae atrophicae of adolescence with involvement of the upper back

We report a 13-year-old boy with multiple purplish, atrophic, horizontal linear striae in the thoracic area. He reported a growth spurt in the preceding 12 months. His past health was unremarkable, and he took no medications. To our knowledge, physiological striae atrophicae of adolescence where idiopathic striae were restricted to the upper back have rarely been reported. Physiological striae atrophicae of adolescence may, on occasions, be mistaken for child abuse. It is important that child care professionals recognize this condition so that false accusations of child abuse will not be made.