S. Garson

Fat Injection to the Breast: Technique, Results, and Indications Based on 880 Procedures Over 10 Years

BACKGROUND Fat injection to the breast is not a new idea, but it has always been controversial. In particular, it has been feared that breast augmentation with autologous fat could lead to the formation of calcifications and cysts that might hinder mammagraphic examinations for detection of possible breast cancer. OBJECTIVE The authors report their experience with fat transplantation in the breast (lipomodeling) covering 880 procedures performed over the past 10 years. They review their technique and results, and describe the various indications for which they have found lipomodeling to be appropriate. METHODS Lipomodeling was generally performed under general anesthesia. Fat was harvested from the abdomen or in some cases from the inner thighs, depending on the patients natural fat deposits. The harvested fat was centrifuged to obtain purified fat, which was transferred to 10-mL syringes for injection directly into the breast. Fat was injected in small quantities under light pressure, utilizing a honeycomb of microtunnels and halting when the recipient tissues were saturated to avoid creation of fatty pools that could lead to fat necrosis. To compensate for fat resorption, 140 mL of fat was injected for a desired final volume of 100 mL. RESULTS Clinical follow-up shows that the morphologic results of lipomodeling with regard to the volume obtained are stable three to four months postoperatively if the patients weight remains constant. The postoperative radiologic appearance is usually that of normal breasts, sometimes showing images of fat necrosis that will not confuse the differential diagnosis of cancer for radiologists experienced in breast imaging. Oncologic follow-up at 10 years postoperatively (for the first patients) showed no increased risk of local recurrence of cancer or development of a new cancer. Results were highly satisfactory for both patients and surgeons. Complications included one case of infection at the harvest site, six cases of infection at the injection site, and one case of intraoperative pneumothorax that was successfully treated in the recovery room with no later consequences. The incidence of fat necrosis was 3%, with most cases occurring early in the surgeons experience. CONCLUSIONS Lipomodeling, because of a low complication rate and positive results, presents a new option for plastic, reconstructive, and aesthetic surgery of the breast. Pre- and postoperative examination by a radiologist specialized in breast imaging is necessary to limit the risk that a cancer may occur coincidentally with lipomodeling.

Reconstruction mammaire bilatérale par lambeau myocutanéograisseux de grand dorsal (31 cas consécutifs)

PURPOSE OF THE STUDY The purpose of this study was to analyse the advantages, disadvantages and results of bilateral breast reconstruction by autologous latissimus dorsi flap. MATERIAL AND METHOD Thirty-one two-stage consecutive bilateral breast reconstructions were performed by the same operator between 1993 and 2001. All the reconstructions, in immediate or delayed manner, were indicated after radical or skin sparing mastectomy for breast cancer. We used the autologous latissimus dorsi flap for all cases. The reconstruction of the second breast was always delayed of a few months to avoid backs complications. We reviewed the charts of these patients retrospectively. Preoperative data, postoperative complications, dorsal seroma occurrence, morphological results and patients satisfaction were evaluated. Median follow-up was 22 months. RESULTS The results confirm the procedures reliability. Comparative rates of postoperative complications are not significantly different between first and contralateral breast reconstruction. Functional after-effects of bilateral latissimus dorsi harvesting are moderate. The aesthetics results have been judged as very good in 84% of cases and good in 16%. The satisfaction rate of the patients is high: 90,3% are pleased, 6,5% are satisfied and 3,2% are moderately satisfied. CONCLUSION The autologous latissimus dorsi flap allows a two-stage bilateral breast reconstruction. This procedure is not indicated for simultaneous bilateral breast reconstruction; it is the main drawback of this technique. So we believe that this procedure is an excellent alternative in all the indications of sequential bilateral breast reconstructions.

Article originalReconstruction mammaire bilatérale par lambeau myocutanéograisseux de grand dorsal (31 cas consécutifs)Bilateral breast reconstruction with the autologous latissimus dorsi flap (a retrospective study of 31 consecutive cases)

PURPOSE OF THE STUDY The purpose of this study was to analyse the advantages, disadvantages and results of bilateral breast reconstruction by autologous latissimus dorsi flap. MATERIAL AND METHOD Thirty-one two-stage consecutive bilateral breast reconstructions were performed by the same operator between 1993 and 2001. All the reconstructions, in immediate or delayed manner, were indicated after radical or skin sparing mastectomy for breast cancer. We used the autologous latissimus dorsi flap for all cases. The reconstruction of the second breast was always delayed of a few months to avoid backs complications. We reviewed the charts of these patients retrospectively. Preoperative data, postoperative complications, dorsal seroma occurrence, morphological results and patients satisfaction were evaluated. Median follow-up was 22 months. RESULTS The results confirm the procedures reliability. Comparative rates of postoperative complications are not significantly different between first and contralateral breast reconstruction. Functional after-effects of bilateral latissimus dorsi harvesting are moderate. The aesthetics results have been judged as very good in 84% of cases and good in 16%. The satisfaction rate of the patients is high: 90,3% are pleased, 6,5% are satisfied and 3,2% are moderately satisfied. CONCLUSION The autologous latissimus dorsi flap allows a two-stage bilateral breast reconstruction. This procedure is not indicated for simultaneous bilateral breast reconstruction; it is the main drawback of this technique. So we believe that this procedure is an excellent alternative in all the indications of sequential bilateral breast reconstructions.

Bases anatomiques du tégument facial appliquées à la chirurgie du rajeunissement facial

The understanding of the face anatomy is mandatory before to be able to appreciate the different surgical techniques of face lifting. Despite numerous controversies and anatomical variations, we can find in the literature several keystone works that allows us to understand that the soft tissues of the face are not only a superposition of layers but also a tridimensionnal structure with a fibrous system that links the different layers. This structures creates a mix loose spaces, fat and retaining ligament that can be describe in a quite systematic manner. This systematisation can help the surgeon during the surgical procedure to search and find the area where there is no danger and alert him around the retaining for example, which is where we can often find a vessel or a branch of the facial nerve that we want to avoid. This article summarizes these anatomical knowledge.

Chirurgiens plasticiens français: état des lieux en 2007

French medical demography is a true public health issue. The medicine doctors scarcity announced by many will not appear for the plastic surgeons. In this speciality, problems are an excess staff and irregular sharing out. The aim of the study was to make a very sharp update of the speciality thanks to an actual demographic descriptive and analytic study compared with the one realised in 1998 including a French plastic surgeons activity study. In 2007, there were 889 plastic surgeons in France, so 235 surgeons more than in 1998 and an average of 26 new plastic surgeons a year. The plastic surgeons density was 1 for 71,174 people, much more important than the recommended value. The distribution of these surgeons is still unequal and the excess staff is getting worse. The plastic surgeons activity study based on the Information System Medicalisation Program (ISMP) between 2004 and 2006, including 13 classic plastic surgerys procedures, showed an important decrease of the activity especially for the private sector. The analytic study put together the data concerning the demography and the activity considering the economic side of esthetic surgery. Thanks to these data, plastic surgeons will now be able to choose their working area not only based on geographic reasons but also depending on the activity they want and on the importance of the competition. This work stands for a help for plastic surgeons, in the hope of a fair sharing out of these practioners.