Aesthetic restoration of axillary contour deformity after lymph node dissection

Revision Abdominoplasty with Truncal Liposculpting: A 10-Year Experience

INTRODUCTION

Abdominoplasty is one of the most popular body-contouring procedures. Despite its popularity, classic abdominoplasty is still associated with a significant rate of complaints from patients such as: fullness of flanks and epigastric areas, lack of a posterior lumbar curve, hanging skin over the incision line, and visible scars over the flanks and beyond underwear or swimming suit coverage. This study reviews the authors' experience in redo abdominoplasty when the patient is not or partially satisfied with the primary procedure.

PATIENTS AND METHODS

A total of 115 female and 32 male patients underwent revision abdominoplasty with truncal liposculpting between 2007 and 2016. The age distribution of patients ranged from 33 to 73 years, with a mean of 43.1 years. All the patients included in the study had undergone classic abdominoplasty in a different institution. Overall satisfaction with the body appearance after the combined procedure was rated on a scale of 1-5, where 1 is 'poor,' 2 is 'fair,' 3 is 'good,' 4 is 'very good,' and 5 is 'excellent.' The evaluation was made 12 months after the composite body-contouring procedure.

RESULTS

Four hundred to 1500 ml of fat were obtained with liposuction (mean 840 ml). The amount of clean, adipose tissue transplanted to the buttocks varied from 95 to 425 (mean 286 ml) and to the lower limbs from 75 to 270 ml (mean 195 ml). The stromal-enriched lipograft technique was used in all the cases to enrich the fat transplantation. There was no hematoma, infection or deep vein thrombosis. Seventy-five percent reported that their appearance after composite body contouring was 'very good' to 'excellent' (30% 'excellent' and 45% 'very good') and 20% responded that their appearance was 'good.' Only 5% of patients thought their appearance was less than good ('fair'). The average follow-up time for this group of patients has been 6.3 years (range 1-10 years).

CONCLUSION

Truncal liposculpting with modified abdominoplasty accomplishes very good aesthetic results in a single surgical procedure with a low rate of complications and high patient satisfaction in cases of revision abdominoplasties.

LEVEL OF EVIDENCE V

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 Table of Contents or the online Instructions to Authors www.springer.com/00266 .

An engineered muscle flap for reconstruction of large soft tissue defects

Large soft tissue defects involve significant tissue loss, requiring surgical reconstruction. Autologous flaps are occasionally scant, demand prolonged transfer surgery, and induce donor site morbidity. The present work set out to fabricate an engineered muscle flap bearing its own functional vascular pedicle for repair of a large soft tissue defect in mice. Full-thickness abdominal wall defect was reconstructed using this engineered vascular muscle flap. A 3D engineered tissue constructed of a porous, biodegradable polymer scaffold embedded with endothelial cells, fibroblasts, and/or myoblasts was cultured in vitro and then implanted around the femoral artery and veins before being transferred, as an axial flap, with its vascular pedicle to reconstruct a full-thickness abdominal wall defect in the same mouse. Within 1 wk of implantation, scaffolds showed extensive functional vascular density and perfusion and anastomosis with host vessels. At 1 wk posttransfer, the engineered muscle flaps were highly vascularized, were well-integrated within the surrounding tissue, and featured sufficient mechanical strength to support the abdominal viscera. Thus, the described engineered muscle flap, equipped with an autologous vascular pedicle, constitutes an effective tool for reconstruction of large defects, thereby circumventing the need for both harvesting autologous flaps and postoperative scarification.

Bilateral calf augmentation for aesthetic purposes

BACKGROUND

The shape of the calf is determined by the development of the soleus and gastrocnemius muscles, the length and orientation of the crural bones, and the distribution of subcutaneous fat. Some people have a naturally thin or underdeveloped calf that remains small despite exercise. Calf augmentation is indicated for cosmetic reasons or for reconstruction of a shrunken lower leg resulting from injury, illness, or congenital disability.

METHODS

A total of 53 consecutive patients (40 women and 13 men) had surgery for calf augmentation between January 2004 and January 2007. The patients ranged in age from 25 to 51 years (mean, 29.5 years). All the patients included in the study requested calf augmentation for aesthetic purposes. Asymmetric-base silicone elastomer smooth-surface implants were used. Overall satisfaction after silicone calf augmentation was rated on a scale of 1 (poor), 2 (fair), 3 (good), 4 (very good), and 5 (excellent). All the patients had surgery by the same team of surgeons (L.H.P., A.S., B.N.). The evaluation was made at follow-up office consultations after 1 year. The total mean follow-up time was 4.4 years.

RESULTS

In this study, 53 bilateral calf augmentations were performed, for a total of 106 procedures. The 125-ml implant was used in 37 bilateral cases, the 70-ml implant in 10 cases; and the 175-ml implant in 6 cases. In three cases, unilateral seroma formation needed to be drained by a partial skin incision opening. There were no cases of infection or hematoma. Hypertrophic scar was observed in four patients bilaterally. One patient requested removal of the implants, and the procedure was performed on an outpatient basis. There were no cases of compartment syndrome or deep vein thrombosis, and no pulmonary embolisms occurred. There were no cases of rotation or displacement of the implant. At 12 months, 73% of the patients rated their appearance after calf augmentation as "very good" to "excellent," and 19% responded that their appearance was "good." Only 8% of the patients thought their appearance was less than good. At this writing, the average follow-up time for this group of patients has been 3.4 years.

CONCLUSION

Calf augmentation by silicone-filled implants for cosmetic purposes appears to be effective, safe, and aesthetically pleasing, with minor side effects.

Autologous fat transplantation versus adipose-derived stem cell-enriched lipografts: a study

BACKGROUND

Several techniques for lipoinjection have been described in the literature. Recently, the role of adult stem cells in adipose tissue has gained interest.

OBJECTIVES

The authors compare autologous fat transplantation to adipose-derived stem cell-enriched lipografts.

METHODS

A group of 20 patients with congenital or acquired facial tissue defects were included in this study and randomly divided into two groups. Ten patients were treated with autologous fat transplantation (Group A; 12-165 mL per session), and the remaining ten were treated with adipose-derived stem cell-enriched lipografts (Group B; 8-155 mL per session). Overall patient satisfaction after both treatments was evaluated at six, 12, and 18 months after the initial surgical procedure.

RESULTS

In Group A, three patients achieved aesthetically-acceptable results after the first treatment; the remaining seven patients required additional sessions. In Group B, all patients required only one treatment. Analysis of patient satisfaction in the first six months clearly demonstrated better results in Group B. However, by the 18-month evaluation, there was no statistical difference between the two groups in terms of patient satisfaction.

CONCLUSIONS

Adipose-derived stem cell-enriched lipografts produced aesthetically-acceptable results without the need for repeat treatment sessions, which are necessary with autologous fat transplantation. Further long-term studies are necessary to confirm the favorable results seen in this study.

Treatment of iatrogenic abdominal contour irregularities

In many countries, liposuction is the most frequently performed aesthetic procedure. The procedure is promoted as a safe, easy-to-learn, outpatient procedure. The increasing number of liposuction procedures, often performed by inadequately trained physicians, has led to a growing number of iatrogenic postliposuction contour deformities and skin irregularities. This report describes a treatment protocol for iatrogenic abdominal contouring deformities. For patients who present with contour deformities but no skin flaccidity, the type 1 treatment plan (syringe-assisted lipectomy and lipografting) is the suggested approach. In cases of contour deformities and infraumbilical skin flaccidity, the type 2 treatment plan (mini-lipoabdominoplasty and lipografting procedures) is used. Finally, in the case of contour deformities as well as supra- and infraumbilical flaccidity, the type 3 treatment plan (lipoabdominoplasty and lipografting procedures) is indicated.

Autologous fat transplantation and delayed silicone implant insertion in a case of Mycobacterium avium breast infection

BACKGROUND

Infection after breast augmentation is uncommon, occurring in 1-3% of cases. They are typically caused by bacterial skin flora, specifically Staphylococcus aureus and the coagulase-negative staphylococci. There have been infrequent reports of breast implant infection caused by the atypical mycobacteria.

METHODS

This report summarizes the case of a female patient who was infected by Mycobacterium avium after undergoing augmentation mammoplasty. This is the second case reported in the literature. Conservative recommendations include antibiotic therapy and removal of the implant until resolution of the infection or until healing of the wound. Salvage methods include one or more of the following: antibiotic therapy, debridement, curettage, pulse lavage, capsulectomy, device exchange, primary closure, and/or flap coverage.

RESULTS

After removal of the implant and antibiotic therapy, autologous fat transplantation for correction of breast tissue depressions caused by the mycobacterium infection was done. Delayed bilateral breast augmentation by inserting polyurethane-covered silicone implants in subpectoral position and round block mastopexy to resect the periareolar scars were performed.

CONCLUSION

Although this kind of complication has significantly compromised the aimed result and has caused frustration to both the patient and the physicians involved, we believe that the combination of autologous fat transplantation and delayed silicone implant insertion can be a safe strategy and can produce an acceptable aesthetic result.

Tissue engineering with adipose-derived stem cells (ADSCs): current and future applications

Soft-tissue loss presents an ongoing challenge in plastic and reconstructive surgery. Standard approaches to soft-tissue reconstruction include autologous tissue flaps, autologous fat transplantation and alloplastic implants. All of these approaches have disadvantages, including donor-site morbidity, implant migration and absorption and foreign body reaction. Stem cell application has recently been suggested as a possible novel therapy. Adipose-derived stem cells (ADSCs) are an abundant, readily available population of multipotent progenitor cells that reside in adipose tissue, which is an easily accessible and abundant source of putative stem cells for translational clinical research. Their therapeutic use in pre-clinical studies and experimental clinical trials has been well documented. We present the current strategies of tissue engineering with ADSC and we discuss the possible future applications of this new method in the field of plastic and reconstructive surgery. Complete understanding of the mechanisms of interactions among adipose stem cells, growth factors and biomaterials in tissue engineering is still lacking. Adipose tissue stem cell-based regenerative strategies hold tremendous promise, although this potential must be balanced against stringent standards of scientific and clinical investigation, before developing 'off-the-shelf' tissue engineering products.

Composite body contouring

BACKGROUND

Aesthetic surgery of the thoracoabdominal region is one of the most frequently performed surgical procedures in plastic surgery. The combination of circumferential liposuction, autologous fat grafting of the buttocks and/or lower limbs, and the modified transverse abdominoplasty as an adjuvant procedure all done in a single surgical procedure is not very common. The authors present a prospective study of the surgical technique of composite body contouring, emphasizing the low rate of complications and the high overall patient satisfaction.

METHODS

A total of 64 consecutive female patients were operated on between January 2004 and January 2007. All the patients who were included in the study were candidates for a classical abdominoplasty. Posterior and lateral syringe-assisted liposuction combined with fat insertion into the buttocks and/or lower limbs was performed. Autologous fat grafting was done in the gluteal area for buttocks enhancement and in the lower limbs to correct contour deformities. Anterolateral liposuction with modified transverse abdominoplasty was done as an adjuvant procedure. Overall satisfaction with body appearance after composite body contouring was rated on a scale of 1-5.

RESULTS

From 1,500 to 4,600 ml of fat was obtained with liposuction (mean = 2,478 ml). Forty-five patients had fat grafting only to the buttocks area. Six patients had fat insertion into the lower limbs and 13 had fat injection into the buttocks and lower limbs. The amount of fat transplanted to the buttocks varied from 165 to 625 ml (mean = 346 ml) and to the lower limbs it varied from 75 to 270 ml (mean = 195 ml). Three patients (5%) suffered from early complications, including infection (3%) and hematoma formation (2%). Nine patients (14%) had late complications, including hypertophic scars (7.5%), dog ears (4.5%), and localized fat excess (2%). Nine patients (14%) underwent revision surgery. Sixty-three percent reported that their appearance after composite body contouring was "very good" (42%) or "excellent" (21%) and 27% responded that their appearance was "good." Only 10% thought their appearance was less than good, (7% "fair" and 3% "poor").The average follow-up time has been 3.2 years (range = 2-5 years).

CONCLUSION

Composite body contouring combines circumferential liposuction, fat grafting of the buttocks and lower limbs, and modified transverse abdominoplasty to accomplish very good aesthetic results in a single surgical procedure with a low rate of complications and high patient satisfaction.

Correction for the iatrogenic form of banana fold and sensuous triangle deformity

The "banana fold," or the infragluteal fold, is a fat deposit on the posterior thigh near the gluteal crease and parallel to it. The "sensuous triangle" is found at the junction of the lateral buttocks, the lateral thigh, and the posterior thigh. The iatrogenic forms of banana fold and sensuous triangle deformity are produced by excessive liposuction. The authors' experience using autologous fat transplantation to treat tissue defects led them to use this technique for correcting iatrogenic forms of banana fold and sensuous triangle deformity. The simplicity of the procedure, the low incidence of complications, and the high satisfaction rate makes autologous fat transplantation an attractive option for correcting iatrogenic complications of liposuction.