Henry C. Hsia

Differences in breast shape preferences between plastic surgeons and patients seeking breast augmentation.

There has been little discussion in the published literature regarding breast shape preferences. This study was conducted to ascertain previously undocumented differences in breast shape preferences between plastic surgeons and patients seeking breast augmentation, with respect to upper-pole contour. Sixty-six respondents, grouped into three cohort categories (plastic surgeons, breast augmentation patients, and lay people), were asked to evaluate a series of 12 nonptotic breast profiles representing a range of upper-pole contours. Five profiles exhibited convex upper-pole contours, five exhibited concave contours, and two exhibited upper poles with flat slopes. A five-point Likert-type scale was used to rate attractiveness, naturalness, how close the shape was to each respondent’s personal ideal, and how close the shape was to what the respondent believed was our society’s ideal. Statistical comparisons were made among the three cohorts. The plastic surgeon cohort (n = 11) rated concave upper-pole contours significantly higher than did the patient cohort (n = 13) for attractiveness, naturalness, and personal ideal (p < 0.01). For convex contours, the plastic surgeon cohort gave significantly lower scores than did the patient cohort (p < 0.01). The lay category (n = 42) demonstrated preferences intermediate between those of the other groups. There are no known studies in the literature documenting the breast shape preferences of plastic surgeons and their patients. This study suggests that plastic surgeons and patients seeking breast augmentation may have drastically different images in mind regarding what constitutes an attractive, natural, and ideal breast shape. These findings have potential implications for patient treatment and satisfaction.

Reversible Modulation of Myofibroblast Differentiation in Adipose-Derived Mesenchymal Stem Cells

Unregulated activity of myofibroblasts, highly contractile cells that deposit abundant extracellular matrix (ECM), leads to fibrosis. To study the modulation of myofibroblast activity, we used human adipose-derived mesenchymal stem cells (ADSCs), which have much potential in regenerative medicine. We found that ADSCs treated with TGF-β developed a myofibroblastic phenotype with increases in α-smooth muscle actin (α-SMA), a myofibroblast marker, and ECM proteins type I collagen and fibronectin. In contrast, treatment with bFGF had the opposite effect. bFGF-differentiated ADSCs showed marked down-regulation of α-SMA expression, collagen I, and fibronectin, and loss of focal adhesions and stress fibers. Functionally, bFGF-differentiated ADSCs were significantly more migratory, which correlated with up-regulation of tenascin-C, an anti-adhesive ECM protein, and vimentin, a pro-migratory cytoskeletal protein. On the other hand, TGF-β-differentiated ADSCs were significantly more contractile than bFGF-differentiated cells. Interestingly, cells completely reversed their morphologies, marker expression, signaling pathways, and contractility versus migratory profiles when switched from culture with one growth factor to the other, demonstrating that the myofibroblast differentiation process is not terminal. Cell differentiation was associated with activation of Smad2 downstream of TGF-β and of ERK/MAP kinase downstream of bFGF. Reversibility of the TGF-β-induced myofibroblastic phenotype depends, in part, on bFGF-induced ERK/MAP kinase signaling. These findings show that ADSC differentiation into myofibroblasts and re-differentiation into fibroblast-like cells can be manipulated with growth factors, which may have implications in the development of novel therapeutic strategies to reduce the risk of fibrosis.

The Fiber Diameter of Synthetic Bioresorbable Extracellular Matrix Influences Human Fibroblast Morphology and Fibronectin Matrix Assembly

Background: The ideal scaffold material should provide immediate capacity to bear mechanical loads and also permit eventual resorption and replacement with native tissue of similar mechanical integrity. Scaffold characteristics such as fiber diameter provide environmental cues that can influence cell function and differentiation. In this study, the impact of fiber diameter of scaffolds constructed from a tyrosine-based bioresorbable polymer on cellular response was investigated. Methods: Electrospun bioresorbable poly(desamino tyrosyl-tyrosine ethyl ester carbonate) scaffolds composed of microfibers or nanofibers were constructed and seeded with human dermal fibroblasts. The impact of fiber diameter on actin cytoskeletal morphology, focal adhesion size, fibronectin matrix assembly, and cell proliferation was evaluated using immunofluorescent microscopy and computer-assisted image analysis. Results: Actin stress fibers were more easily observed in cells on microfiber scaffolds compared with those on nanofiber scaffolds. Cells on nanofiber scaffolds developed smaller focal adhesion complexes compared with those on microfiber scaffolds (p < 0.0001). The temporal patterns of fibronectin matrix assembly were affected by scaffold fiber diameter, with cells on microfiber scaffolds showing a delayed response in dense fibril formation compared with nanofiber scaffolds. Cells on nanofiber scaffolds showed higher proliferation compared with microfiber scaffolds at time points under 1 week (p < 0.01), but by 2 weeks significantly higher cell proliferation was observed on microfiber scaffolds (p < 0.01). Conclusions: The fiber diameter of bioresorbable scaffolds can significantly influence cell response and suggests that the ability of scaffolds to elicit consistent biological responses depends on factors beyond scaffold composition. Such findings have important implications for the design of clinically useful engineered constructs.

SDF‐1 liposomes promote sustained cell proliferation in mouse diabetic wounds

Chronic skin wounds are a common complication of diabetes. When standard wound care fails to heal such wounds, a promising approach consists of using decellularized matrices and other porous scaffold materials to promote the restoration of skin. Proper revascularization is critical for the efficacy of such materials in regenerative medicine. Stromal cell‐derived factor‐1 (SDF‐1) is a chemokine known to play a key role for angiogenesis in ischemic tissues. Herein we developed nanosized SDF‐1 liposomes, which were then incorporated into decellularized dermis scaffolds used for skin wound healing applications. SDF‐1 peptide associated with liposomes with an efficiency of 80%, and liposomes were easily dispersed throughout the acellular dermis. Acellular dermis spiked with SDF‐1 liposomes exhibited more persistent cell proliferation in the dermis, especially in CD31+ areas, compared to acellular dermis spiked with free SDF‐1, which resulted in increased improved wound closure at day 21, and increased granulation tissue thickness at day 28. SDF‐1 liposomes may increase the performance of a variety of decellularized matrices used in tissue engineering.

Local anesthetic use in tumescent liposuction: an American Society of Plastic Surgeons survey.

BackgroundCurrent guidelines favor the use of lidocaine in liposuction wetting solutions. The use of bupivacaine as an alternative remains controversial despite reports of its use with safe and favorable outcomes suggesting faster postoperative recovery time secondary to improved pain control. The goals of this study were to determine the prevalence of bupivacaine use, examine liposuction practices of bupivacaine users, and elucidate opinions regarding bupivacaine use. MethodsAn online survey was distributed to 2500 randomly selected members of the American Society of Plastic Surgeons. Data were collected and analyzed with special attention toward the practice and opinions of bupivacaine use. ResultsThe response rate of the survey met the average American Society of Plastic Surgeons online survey response rate at 12.8% (n = 320). Respondents (7.2%; n = 22) reported using bupivacaine in their wetting solutions (bupivacaine group) and provided a dosage range of 62.5 to 150 mg. Respondents (83.5%; n =254) reported using either lidocaine or prilocaine (no-bupivacaine group). There were no reports of bupivacaine toxicity in 2011. The demographic profile and liposuction practices of both groups were comparable. Although 36% of the no-bupivacaine group did not know or had no opinion on when it is appropriate to use bupivacaine in liposuction wetting solutions, 85% of this group has used bupivacaine for other clinical purposes. ConclusionsA review of 320 plastic surgeons’ experiences revealed that 7% of respondents are using bupivacaine in their tumescent solutions with no reported cases of toxicity. Bupivacaine users differed dramatically only in their opinion regarding the safety of bupivacaine in tumescent liposuction. The recent studies suggesting better postoperative pain control with bupivacaine along with the proportion of respondents reporting bupivacaine use call for distinct guidelines on bupivacaine use in liposuction. Further studies, including a rigorous clinical trial documenting the safety and efficacy of bupivacaine when compared with lidocaine, would be warranted.

Fibroblast growth factor receptor is a mechanistic link between visceral adiposity and cancer

Epidemiological evidence implicates excess adipose tissue in increasing cancer risk. Despite a steeply rising global prevalence of obesity, how adiposity contributes to transformation (stage a non-tumorigenic cell undergoes to become malignant) is unknown. To determine the factors in adipose tissue that stimulate transformation, we used a novel ex vivo system of visceral adipose tissue (VAT)-condition medium-stimulated epithelial cell growth in soft agar. To extend this system in vivo, we used a murine lipectomy model of ultraviolet light B-induced, VAT-promoted skin tumor formation. We found that VAT from mice and obese human donors stimulated growth in soft agar of non-tumorigenic epithelial cells. The difference in VAT activity was associated with fibroblast growth factor-2 (FGF2) levels. Moreover, human and mouse VAT failed to stimulate growth in soft of agar in cells deficient in FGFR-1 (FGF2 receptor). We also demonstrated that circulating levels of FGF2 were associated with non-melanoma tumor formation in vivo. These data implicate FGF2 as a major factor VAT releases to transform epithelial cells—a novel, potential pathway of VAT-enhanced tumorigenesis. Strategies designed to deplete VAT stores of FGF2 or inhibit FGFR-1 in abdominally obese individuals may be important cancer prevention strategies as well as adjuvant therapies for improving outcomes.

The fate of internalized α5 integrin is regulated by matrix-capable fibronectin

BACKGROUND Assembly of fibronectin matrices is associated with integrin receptor turnover and is an important determinant of tissue remodeling. Although it is well established that fibronectin is the primary ligand for α5β1 receptor, the relationship between fibronectin matrix assembly and the fate of internalized α5 integrin remains poorly characterized. MATERIALS AND METHODS To evaluate the effect of fibronectin matrix on the fate of internalized α5 integrin, fibronectin-null Chinese hamster ovary and mouse embryo fibroblast cells were used to track the fate of α5 after exposure to exogenous fibronectin. RESULTS In the absence of matrix-capable fibronectin dimer, levels of internalized α5 decreased rapidly over time. This correlated with a decline in total cellular α5 and was associated with the ubiquitination of α5 integrin. In contrast, internalized and total cellular α5 protein levels were maintained when matrix-capable fibronectin was present in the extracellular space. Further, we show that ubiquitination and degradation of internalized α5 integrin in the absence of fibronectin require the presence of two specific lysine residues in the α5 cytoplasmic tail. CONCLUSIONS Our data demonstrate that α5 integrin turnover is dependent on fibronectin matrix assembly, where the absence of matrix-capable fibronectin in the extracellular space targets the internalized receptor for rapid degradation. These findings have important implications for understanding tissue-remodeling processes found in wound repair and tumor invasion.

Stem Cells and Engineered Scaffolds for Regenerative Wound Healing

The normal wound healing process involves a well-organized cascade of biological pathways and any failure in this process leads to wounds becoming chronic. Non-healing wounds are a burden on healthcare systems and set to increase with aging population and growing incidences of obesity and diabetes. Stem cell-based therapies have the potential to heal chronic wounds but have so far seen little success in the clinic. Current research has been focused on using polymeric biomaterial systems that can act as a niche for these stem cells to improve their survival and paracrine activity that would eventually promote wound healing. Furthermore, different modification strategies have been developed to improve stem cell survival and differentiation, ultimately promoting regenerative wound healing. This review focuses on advanced polymeric scaffolds that have been used to deliver stem cells and have been tested for their efficiency in preclinical animal models of wounds.

On Beyond Lidocaine: Reconsidering Local Anesthetics in Tumescent Liposuction-A Critical Review.

AbstractThe use of tumescent solution in liposuction is now considered standard of care; however, much debate still exists regarding its ideal components, especially surrounding the inclusion of local anesthetics. This article reviews the discussion regarding the use of local anesthetics in tumescent liposuction and how it may evolve in the future. The need for local anesthetic additives in tumescent liposuction has been questioned, and the use of longer-acting agents discouraged; however, increasing number of reports in recent years have described the increasingly widespread use of tumescent anesthesia where a wetting solution is infiltrated to achieve anesthesia in an operative field for procedures other than liposuction. More high-level evidence, such as randomized controlled clinical trials, will be required; however, it should be possible to develop a useful standardized algorithm that can guide surgeons to optimize patient safety as well as patient experience.

Abstract 64: Deterioration of Sensory Perception or Friction & Shear in Low Risk Braden Scores is Associated with Accelerated Development of Hospital Acquired Pressure Ulcers

PURPOSE: The Braden Scale is a risk stratification tool currently used by nurses to identify patients at risk of developing hospital acquired pressure ulcers (HAPUs). The tool operates on a 23-point system comprised of 6 components (Sensory Perception, Moisture, Activity, Mobility, Nutrition, Friction & Shear) where a threshold value of 18 distinguishes those with “low risk” (19–23 points) from those considered “high risk” (≤18 points). A Braden score is calculated on day of admission and updated throughout the hospital stay. Only patients deemed “high risk” are placed under special nursing protocols aimed at preventing pressure ulcer formation. Using linear regressions analysis, this study sought to better understand factors affecting the timing of HAPU development between high and low risk patients.