Striae distensae of augmented breasts after oral contraceptive therapy

Efficacy of Microneedling Versus Fractional Non-ablative Laser to Treat Striae Alba: A Randomized Study

BACKGROUND

Striae distensae (SD), an unsightly cutaneous condition characterized by epidermal atrophy, can affect the quality of life of women.

OBJECTIVES

The aim of our study was to compare the efficacy of a neodymium:yttrium-aluminum-perovskite 1340 nm non-ablative fractional laser (NAFL) and the microneedling (MN) technique to treat striae alba (SA).

MATERIALS AND METHODS

NAFL and MN were used to treat striae on the longitudinally divided abdominal surface of 20 women classified as Fitzpatrick skin type III or IV (five sessions at monthly intervals). Photographs and skin biopsies were obtained during pretreatment and after the third and fifth treatment sessions for all patients. Patients and two independent evaluators assessed the clinical response using the Global Aesthetic Improvement Scale.

RESULTS

Patient-reported evaluation showed improvement of striae using both modalities, with no statistically significant difference between the groups. Collagen and elastic fibers were significantly increased (p < 0.01) after the third and fifth treatment sessions, with no significant difference between the modalities. In addition, Dermatology Life Quality Index scores showed significant improvement (p < 0.001) after the third and fifth treatment sessions compared with pretreatment values, with average values of 8.4 (standard error [SE] ± 1.21), 3.17 (SE ± 0.55), and 2.64 (SE ± 0.60), respectively. The mean pain score using the Visual Analog Scale in the MN group versus the NAFL group was 5.23 (SE ± 0.31) versus 2.39 (SE ± 0.22) [p < 0.001], and the mean duration of adverse events in the NAFL group versus the MN group was 4.03 days (SE ± 0.45) versus 3 days (SE ± 0.37) [p = 0.02].

CONCLUSION

NAFL and MN are safe for treating SD, particularly in individuals classified as phototype III or IV. MN is a useful non-technology-dependent, low-cost alternative therapy for SA.

CLINICAL TRIAL REGISTRATION NUMBER

NCT03390439.

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.

Intense pulsed light in the treatment of telangiectasias: case report of Behçet's disease with superficial vascular involvement

Behçet's disease (BD) is a chronic systemic inflammatory disorder of unknown etiology with variable clinical manifestations. HLA-B51 allele is the most strongly associated known genetic factor. The mucocutaneous lesions (oral aphthae, genital aphthae, skin lesions such as pseudofolliculitis) constitute the hallmark of the disease, but also gastrointestinal, vascular, central nervous systems, and others may be involved. We report a case of a young man affected with Behçet's disease who presented facial telangiectasias and striae rubra in the inner region of his arms and at the level of his hips, as uncommon minor superficial vascular manifestations of BD. To manage them we have subjected the patient to a cycle of Intense Pulsed Light (IPL) therapy. Our findings showed that the use of IPL is a safe and effective treatment for telangiectasias and striae rubra, also in the complex clinical condition of Behçet's disease. In fact, the treatments were well tolerated, no sign of scarring or hyper/hypopigmentation was reported and we obtained a significant improvement of the lesions in terms of color and size of them.

Striae distensae after breast augmentation

BACKGROUND

One known but not fully understood complication after breast augmentation is the new onset of stretch marks (striae distensae) on the surgically treated breast. To date, all publications on this subject have been case reports. No report has fully described the actual incidence, risk factors, or management of striae distensae after breast surgery.

METHODS

This study prospectively followed patients who underwent primary breast augmentation using silicone implants in a single group practice from 2007 to 2011. New-onset striae distensae were actively investigated. Time from surgery to the moment of striae onset, patient age, nulliparity, use of oral contraceptives, overweight, personal history of stretch marks, and other variables were evaluated.

RESULTS

A total of 409 patients were included in the study. In 19 cases (4.6%), new-onset striae distensae after breast augmentation were observed. The population with striae distensae was significantly younger than the total population (29.56 vs 20.91 years; p=0.012). Striae distensae also were more common in nulliparous than in multiparous women (8.29 vs 0.52%; p=0.006), overweight women (17.77 vs 3.02%; p=0.016), women using oral contraceptives (7.89 vs 0.55%; p=0.008), and women with a personal history of stretch marks (8.97 vs 3.36%; p=0.031). No relation was shown regarding implant pocket type, size, or profile.

CONCLUSION

Striae distensae may be a common but underreported complication after breast augmentation. In this series, striae distensae developed in 4.6% of the patients within 1 year after breast augmentation. Severity may vary from inconspicuous small marks (classifications 1 and 2) to wide red and active striae rubra (classifications 3 and 4). Nulliparity, use of oral contraceptives, overweight, personal history of stretch marks, and younger age were related to a higher incidence of striae distensae. The increased rates in these groups may be associated with their exposure to higher estrogen levels and the important role of this hormone in facilitating the formation of striae distensae. Further studies are needed to show whether changes in these risk factors (i.e., weight loss, contraceptive withdrawal) may help to decrease striae distensae rates is these populations.

LEVEL OF EVIDENCE IV

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Transaxillary subpectoral augmentation mammaplasty: a single surgeon's 20-year experience

BACKGROUND

Transaxillary subpectoral augmentation mammaplasty (TASPA) is not widely accepted due to perceived limitations in pocket access, visualization, control, and subsequent risk for postoperative complications. Current published data do little to substantiate or refute those claims.

OBJECTIVE

A retrospective chart review of a single surgeon's 20-year experience with the TASPA technique was undertaken to assess the incidence of total secondary procedures, implant-related revisions, and reoperations unrelated to the implant.

METHODS

The senior author (DCM) performed 1776 primary TASPA procedures from January 1989 through December 2008. Of those, 94 patients did not meet inclusion criteria, leaving a total of 1682 records for analysis. Data reviewed included age, date of surgery, race, implant size and type, manufacturer, and reasons for reoperation.

RESULTS

Average age was 32.7 ± 8.1 years (range, 16-62). Average implant size was 438.5 ± 51.5 cc (range, 270-630). Implants from Allergan/Inamed/McGhan (Irvine, CA), Dow-Corning (Midland, MI), Mentor (Santa Barbara, CA), and Surgitek (Racine, PA) were inserted (n = 2094 saline, n = 1270 silicone). Mean follow-up time was 37.9 ± 45.4 months (range, one month to 19.8 years). Excluding staged mastopexies and treatment for breast cancer, total secondary procedures were required in 225 patients (13.4%). Implant-related revisions included malposition (2.97%), size change (2.5%), and capsular contracture (1.9%). Perioperatively, no infections occurred, and two patients (0.12%) experienced hematoma. Most reoperations (62.8%) were performed through the axilla. Comparison to published data showed an equal or lower rate of capsular contracture, hematoma, and infection with the TASPA approach.

CONCLUSIONS

Given its advantages of an inconspicuous scar, decreased infection, and decreased capsular contracture, TASPA can be safely offered to patients as an option in breast augmentation.

Striae distensae after subfascial breast augmentation

Striae distensae or stretch marks after breast augmentation are a rare complication. To date, 10 cases have been published. In seven of these cases, the implant was placed in a subglandular position and in the other three cases, placement was submuscular. Two cases of stretch marks in two young nulliparous women who underwent subfacial breast augmentation are presented. To the best of the authors' knowledge, this is the first report of striae distensae after subfascial breast augmentation.