Steven G. Wallach

Reevaluating the need for routine drainage in reduction mammaplasty.

&NA; The incidence of complications after reduction mammaplasty without drains was reviewed by analysis of 50 bilateral reduction mammaplasty procedures. Patients ranged in age from 14 to 65 years; the average combined volume removed was 953 g. Eighty‐four percent of the patients underwent a Pitanguy technique, and the remaining patients underwent an inferior pedicle or amputative technique with free nipple grafts. Three patients had six complications; one of these patients had three of the complications. Complications included two cases of fat necrosis and one case of wound disruption. One patient had a hematoma with wound disruption and partial nipple loss. There were no cases of infection. The purpose of this study was to determine the rate of complications in reduction mammaplasty performed without drains. Incidentally, statistical analysis using the chi‐squared test revealed that this series without drains compared favorably with previously published data for reduction mammaplasty using drains. It is concluded that routine closed suction drainage after reduction mammaplasty is unnecessary and should be reconsidered. (Plast. Reconstr. Surg. 102: 1917, 1998.)

Reconstruction with irradiated homograft costal cartilage.

The authors present their experience with 51 patients who underwent 55 reconstructive and cosmetic operative procedures with irradiated homograft costal cartilage, who were studied between August of 1988 and June of 2001. The procedures included 52 rhinoplasties and three penile implantations among a total of 130 grafts. Follow-up ranged from 7 months to 12 years. There were two immediate graft exposure complications. Late complications included displacement of the graft in two patients, fracture of the graft in one patient, and partial resorption in one patient at 6 months postoperatively. The experience is described and the literature is reviewed.

Abdominal Contour Surgery: Treating All Aesthetic Units, Including the Mons Pubis

BACKGROUND Many patients who seek [ldquo ]abdominal[rdquo ] contour surgery also desire improvement of areas of the torso adjacent to the abdomen, such as the flanks and back rolls. OBJECTIVE We propose a classification of the abdomen into distinct aesthetic units and report on a series of cases in which this classification was used, with special emphasis on one such unit, the mons pubis. METHODS A series of 400 consecutive patients were evaluated according the proposed designation of aesthetic units. Lipoplasty was performed as described in previous studies. A subset of 6 patients who specifically desired improvement of the mons pubis were treated by lipoplasty and/or horizontal or vertical wedge incision. RESULTS Most patients who received treatment according to aesthetic unit were satisfied with their outcomes. Two of the patients who sought improvement of the mons pubis specifically requested additional procedures. CONCLUSIONS An approach to abdominal contour surgery that includes consideration of all related aesthetic units can achieve more proportional, harmonious results and increase patient satisfaction.

Secondary abdominal contour surgery: a review of early and late reoperative surgery.

A retrospective chart review of 400 abdominal contour operations produced a series of 24 patients who underwent both their primary and then their secondary abdominal contour surgeries with the senior author (Matarasso). The majority of patients were classified and treated according to the abdominoplasty classification system previously described; however, a subgroup could not be categorized according to this system. In this study, the authors identified the secondary abdominal contour surgical experience of one surgeon. A comparison was made between two groups of patients treated for both primary and secondary operations: group I, considered early, less than 18 months after the previous operation; and group II, considered late, 18 or more months after the previous operation. There was a significant difference between groups I and II (&khgr;2 = 4.12, p = 0.05); most patients had their surgical procedures before 18 months. For patients who underwent either a miniabdominoplasty or a full primary abdominoplasty, there was a statistically significant difference between the number of patients treated in group I and the number in group II (Fisher’s exact test, D = 0, p = 0.05). Next, the nature of the secondary procedure was determined to be either a revisional procedure or a completely new reoperative procedure. The majority of patients underwent revision or “touch-ups,” accomplished with either liposuction alone or in combination with scar revision. There was no significant difference between types of primary and secondary procedures performed in group I or group II. Secondary abdominal contour surgery accounted for 6 percent (24 of 400) of all abdominal contour procedures performed by one surgeon. Complete secondary surgery, performing an additional open procedure, occurred in 21 percent of cases (five of 24). Revision surgery (scar revision or removal of dog-ears) was performed in 29 percent of all cases (seven of 24). There was a 4 percent (one of 24) complication rate requiring operative intervention. This rate is consistent with that reported in the literature for primary abdominal contour surgery. With the overall acceptance of aesthetic surgery increasing, the number of patients undergoing abdominoplasty increasing, an aging population, and the safety of secondary abdominal contour surgery suggested from this review, it is likely that plastic surgeons will see more patients requesting secondary abdominal contour surgery in the future.

Maximizing the use of the abdominoplasty incision.

Candidates for abdominoplasty often request multiple procedures at the time of consultation. Some of these patients have the potential opportunity to have ancillary procedures performed through the abdominoplasty incision, such as breast augmentation or suction-assisted lipectomy. Access via the abdominoplasty incision can also limit the need for distant donor sites, for instance, when autologous fillers or rib graft are necessary. The techniques described are straightforward and are based on standard principles that should be considered when ancillary procedures are performed in conjunction with abdominal contouring procedures. In a review of 70 consecutive patients undergoing abdominoplasty, 91 ancillary procedures were performed in conjunction with the abdominoplasty. Of the total number of patients undergoing abdominoplasty, 29 patients underwent 30 procedures facilitated through their abdominoplasty incision, including 23 suction-assisted lipectomies of the flanks, six breast augmentations, and one rib cartilage harvesting for rhinoplasty. A review of the author’s experience and discussion for potential options afforded by this exposure are presented.

Age-based Comparisons of Patients Undergoing Secondary Rhytidectomy

BACKGROUND Statistics published by The American Society for Aesthetic Plastic Surgery report a 48% increase in cosmetic procedures for 2000-2001 and a 14% increase for rhytidectomies alone. Patients aged 35 to 50 account for 30.2% of all rhytidectomies performed. Many of these patients undergo secondary rhytidectomy. OBJECTIVE We investigated differences between patients undergoing secondary rhytidectomy and those undergoing a primary rhytidectomy, and between older (more than 60 years) and younger (60 years or less) patients undergoing secondary rhytidectomy. METHODS A retrospective descriptive research design with the computer cross-filing system of the senior author (A.M.) was reviewed for patients undergoing secondary or more (ie, tertiary, quaternary, etc) rhytidectomy. A total of 113 consecutive patients were identified; charts from 98 female patients and 3 male patients, were available for review. Ages at the time of surgery ranged from 40 to 81 years, with an average of 60. RESULTS Among patients older than 60 undergoing secondary face lift, 41 of 53 patients (77%) had combined procedures with their most recent face lift; 39 of 53 (74%) of these patients had at least one comorbid medical condition. Among patients aged 60 or younger undergoing secondary face lift, 37 of 48 patients (77%) underwent multiple procedures along with their most recent face lift, and 16 of 48 patients (33%) had at least one comorbid medical condition. The overall complication rate was 2/101 (2%). CONCLUSIONS There is a statistically significant increase in the number of comorbid medical conditions in older patients. The overall complication rate in patients undergoing secondary rhytidectomy compares favorably to that traditionally quoted for patients undergoing primary rhytidectomy, who on average are younger at the time of surgery. This suggests that in properly screened patients, even in older patients with combined ancillary procedures, secondary face lifting is both common and safe. (Aesthetic Surg J 2002;22:526-530.).

Glioma of the tongue.

A case of glioma of the tongue that was treated successfully by simple excision and repair is presented. It may represent neural tissue that remains in the occipital somites that differentiate into the tongue muscles. Histologically, it consists of sheets of glial tissue. The literature is reviewed, and the case is discussed.

Treating the Abdominotorso Region of the Massive Weight Loss Patient : An Algorithmic Approach

There has been tremendous growth in the number of patients seeking body contouring procedures after massive weight loss. Most patients desire improvement of the abdominotorso region first. After massive weight loss, there is enormous variability of body proportions, and therefore there have been many surgical options proposed based on the quality of the skin, subcutaneous fat component, and location of the lax tissue. Each area needs to be assessed to see whether there is a significant lower abdominal component, an upper midline abdominal component, or contributions from the buttocks and flanks. An algorithm for treatment is presented to simplify the decision-making process. Patient examples are also shown to demonstrate the usefulness of the algorithm.

Transabdominoplasty Breast Augmentation

The author recommends transabdominal breast augmentation as a safe, straightforward procedure for patients who have completed childbearing, have minimal breast ptosis, and desire a full abdominoplasty. The use of this procedure helps avoid scars on or near the breast, maximizes the use of the abdominoplasty incision, and does not add significant surgery time.

Book Review: Plastic Surgery Emergencies: Principles and Techniques

Jamal M. Bullocks, Patrick W. Hsu, Shayan A. Izaddoost, Larry H. Hollier, Samuel Stal. Plastic Surgery Emergencies: Principles and Techniques. New York: Thieme; 2008. ISBN-10: 1588906701 Friedrich Nietzsche once said, “It is my ambition to say in ten sentences what others say in a whole book.” As a resident on call, I too valued that type of brevity. I wanted a manual that was portable, easily accessible, and a fairly quick read—something I could carry in my white lab coat or in my briefcase without it being too cumbersome. The reference manual I used in those days, although it was a great book, was a 500-page spiral notebook that too often was left at home or in the call room because it was too heavy to carry. When I think of the perfect-sized manual, I believe that Plastic Surgery Emergencies fits the bill in every way. The group from the Division of …