PURPOSE: Over 175,000 Americans underwent bariatric surgery in 2013 alone, and the number of patients with massive weight loss is growing at an astonishing rate. As obesity is a known risk factor for breast cancer, and there are an increasing amount of post-bariatric surgery patients being diagnosed with malignancy, plastic surgeons are now being challenged to reconstruct the breasts of massive weight loss patients after oncologic resection. The goal of this study is to assess the outcomes of autologous breast reconstruction in post-bariatric surgery patients at a single institution. METHODS: Patients who underwent autologous breast reconstruction with a history of bariatric surgery were identified and compared to patients who underwent autologous reconstruction without a history of bariatric surgery. Analysis included age, ethnicity, BMI, comorbidities, flap type, operative complications, and reoperation rates. Propensity matched analysis was also conducted to control for preoperative differences. RESULTS: Fourteen women underwent breast reconstruction following bariatric surgery, compared against 1,012 controls. Table 1 demonstrates demographic comparisons. Outcomes analysis revealed significant differences in breast revisions (p=0.0055), implant placements (p=0.0003), and total OR visits (p=0.0007). Of note, there was no significant difference noted in delayed healing of the breast (p=0.087) or at the donor site (p=1). Table 2 compiles complete outcomes analysis.Table 1: Preoperative demographics identify our patient cohorts and highlight comorbidities.Table 2: Outcomes analysis demonstrates the significant differences in rates of revision, implant/expander placement, and total OR visits.CONCLUSIONS: As the rise in bariatric surgery mirrors that of obesity, an increasing amount of massive weight loss patients undergo treatment for breast cancer. We present the largest review of postoperative outcomes in autologous breast reconstruction in the post-bariatric patient. Our findings highlight profound differences in this patient population, particularly the amount of operative revisions required. This large difference in revisions is not completely accounted for by differences in complication rates, and remains significant despite propensity matching for preoperative differences. This could indicate a major difference in post-reconstruction rates of satisfaction resulting in a higher likelihood to return to the operating room, or a true difference in healing that is not captured by deficiencies noted preoperatively.
AMERICAN SOCIETY OF PLASTIC SURGEONS PLASTIC & RECONSTRUCTIVE SURGERY PRS GLOBAL OPEN ASPS EDUCATION NETWORK AMERICAN SOCIETY OF PLASTIC SURGEONS PLASTIC & RECONSTRUCTIVE SURGERY PRS GLOBAL OPEN ASPS EDUCATION NETWORK
AMERICAN SOCIETY OF PLASTIC SURGEONS PLASTIC & RECONSTRUCTIVE SURGERY PRS GLOBAL OPEN ASPS EDUCATION NETWORK AMERICAN SOCIETY OF PLASTIC SURGEONS PLASTIC & RECONSTRUCTIVE SURGERY PRS GLOBAL OPEN ASPS EDUCATION NETWORK
BACKGROUND: Facial reanimation provides patients with facial palsy the ability to generate facial movement and therefore communicate emotions; however, results are often criticized as incomplete or unnatural. There is little reliable objective data for outcomes analysis of facial reanimation. This is largely secondary to a lack of means of objectively and quantitatively evaluating the dynamic face. This pilot study introduces Digital Image Correlation (DIC) and speckle tracking as a novel technology for precisely quantifying the re-animated face during dynamic activity. METHODS: A prospective pilot study of children aged 4-20 years with and without facial motion pathology was conducted at a tertiary referral children’s hospital. After complete facial coverage with speckle make-up, patients were asked to make an “open-mouthed” smile for 5 seconds. Average major (vertical) and minor (horizontal) strain was calculated for each side of the face using DIC. Each hemiface was then compared with the contralateral side and a precise percentage of facial asymmetry between sides was determined. RESULTS: A total of 10 patients were recruited into the pilot phase of this study, 6 cases and 4 controls. In the affected group there was a 45.9% minor (horizontal) strain asymmetry and 45.94% major (vertical) strain asymmetry. In control patients there was an 8.78 % minor (horizontal) strain asymmetry and 8.56 % (vertical) asymmetry. The difference between affected group and controls were strongly statistically significant between the minor strain (p <0.01) and the major strain (p<0.01) during smiling. CONCLUSIONS: We present DIC with speckle tracking as a novel mechanism of objectively and precisely quantifying facial motion of the animated face. As our surgical and medical approaches towards facial palsy expand, it is essential we have a means to compare results and improve patient outcomes.
Purpose: To determine whether intraocular pressure (IOP) in the early postoperative period after trabeculectomy or combined phacoemulsification-trabeculectomy, augmented with antimetabolite, correlates with IOP at one year in surgeries considered to be successful at that time point. Design: Retrospective case series. Methods: A chart review of antimetabolite-augmented surgical procedures done by DJG and JBS between January 1994 and November 2000 identified 82 primary or secondary trabeculectomies and 53 combined phacoemulsification-trabeculectomies with at least one year of follow-up. The success rate for each surgical subgroup was calculated and IOP on postoperative days (POD ± SD) 1, 7 (±2), 30 (±5), 90 (±10), and 180 (±20) was correlated with IOP at one year (POY 1, between month 12 and 15) using linear regression. IOP at each time point was compared among eyes that achieved success at one year with and without the use of IOP-lowering agents. Results: Of the 82 eyes having undergone antimetabolite-augmented trabeculectomies and the 53 eyes having undergone combined surgeries with at least one year of follow-up, the surgical success rates at POY 1 were 87.8% (72 of 82 eyes) and 92.5% (49 of 53 eyes). Of these, 42 eyes (58.3%) from 39 patients in the trabeculectomy group and 27 eyes (55.1%) from 24 patients in the combined surgery group did not require glaucoma medications at one year postsurgically, and were considered complete surgical successes. Mean preoperative IOP mm Hg ± SD was 26.0 ± 8.5 for the trabeculectomy group and 18.2 ± 4.5 for the phaco-trabeculectomy group. Postoperative IOP at POD 1, POD 7, POD 30, POD 90, POD 180, and POY 1 respectively for the eyes undergoing trabeculectomy were 13.9 ± 10.4, 9.5 ± 6.2, 12.0 ± 5.5, 12.0 ± 5.2, 12.8 ± 5.9, and 12.1 ± 4.3, and for the combined surgery group were 20.8 ± 12.5, 9.7 ± 5.7, 12.2 ± 5.4, 11.1 ± 3.4, 11.6 ± 4.6, and 10.3 ± 4.3. Intraocular pressure on postoperative day one correlated poorly with intraocular pressure at POY 1 for the trabeculectomy group (R2 = 0.0788), and not at all for the combined procedures group (R2 = 0.018). The correlation was slightly better for intraocular pressure at postoperative day 90 for the trabeculectomy group (R2 = 0.546), and at postoperative day 180 for the combined group (R2 = 0.37), but still rather low. Eyes requiring glaucoma medication use at POY 1 in the trabeculectomy group had higher (P < 0.009) intraocular pressure at POD 30 and at all subsequent visits than eyes not requiring these medications. Eyes requiring glaucoma medication use at POY 1 in the phaco-trabeculectomy group had higher (P < 0.0025) intraocular pressure at POD 30, POD 180, and POY 1 than eyes not requiring these medications. Conclusion: Intraocular pressure in the early postoperative period correlates very poorly with intraocular pressure one year after successful antimetabolite-augmented trabeculectomy or combined cataract extraction and trabeculectomy. Starting one month after glaucoma surgery, intraocular pressure is substantially lower in eyes that will ultimately not require the use of ocular hypotensive agents to achieve clinical success one year postoperatively.
AMERICAN SOCIETY OF PLASTIC SURGEONS PLASTIC & RECONSTRUCTIVE SURGERY PRS GLOBAL OPEN ASPS EDUCATION NETWORK AMERICAN SOCIETY OF PLASTIC SURGEONS PLASTIC & RECONSTRUCTIVE SURGERY PRS GLOBAL OPEN ASPS EDUCATION NETWORK
After reading this article and watching the accompanying videos, the participant should be able to: 1. Assess patients seeking facial volumization and correlate volume deficiencies anatomically. 2. Identify appropriate fillers based on rheologic properties and anatomical needs. 3. Recognize poor candidates for facial volumization. 4. Recognize and treat filler-related side effects and complications.Facial volumization is widely applied for minimally invasive facial rejuvenation both as a solitary means and in conjunction with surgical correction. Appropriate facial volumization is dependent on patient characteristics, consistent longitudinal anatomical changes, and qualities of fillers available. In this article, anatomical changes seen with aging are illustrated, appropriate techniques for facial volumization are described in the setting of correct filler selection, and potential complications are addressed.
AMERICAN SOCIETY OF PLASTIC SURGEONS PLASTIC & RECONSTRUCTIVE SURGERY PRS GLOBAL OPEN ASPS EDUCATION NETWORK AMERICAN SOCIETY OF PLASTIC SURGEONS PLASTIC & RECONSTRUCTIVE SURGERY PRS GLOBAL OPEN ASPS EDUCATION NETWORK
AMERICAN SOCIETY OF PLASTIC SURGEONS PLASTIC & RECONSTRUCTIVE SURGERY PRS GLOBAL OPEN ASPS EDUCATION NETWORK AMERICAN SOCIETY OF PLASTIC SURGEONS PLASTIC & RECONSTRUCTIVE SURGERY PRS GLOBAL OPEN ASPS EDUCATION NETWORK
AMERICAN SOCIETY OF PLASTIC SURGEONS PLASTIC & RECONSTRUCTIVE SURGERY PRS GLOBAL OPEN ASPS EDUCATION NETWORK AMERICAN SOCIETY OF PLASTIC SURGEONS PLASTIC & RECONSTRUCTIVE SURGERY PRS GLOBAL OPEN ASPS EDUCATION NETWORK
