Search Results (27)

Background: Breast augmentation is traditionally performed under general anesthesia, but tumescent local anesthesia (TLA) offers advantages in terms of rapid recovery and reduced risks. This study presents the largest European series on the use of TLA for breast augmentation, analyzing the cumulative results of 16 years of experience. Methods: A multicenter retrospective analysis was conducted on 1644 consecutive patients (982 subglandular and 662 subpectoral) between 2008 and 2024. All procedures were performed under TLA with conscious sedation without the use of general anesthesia. The tumescent solution consisted of 25 mL of 2% lidocaine, 8 mEq of sodium bicarbonate, and 1 mL of epinephrine (1 mg/1 mL) in 1000 mL of 0.9% saline solution. Infiltration protocols differed between groups: the subglandular approach utilized a single-plane technique (mean 589 mL per breast), whereas the subpectoral approach required a two-stage process (pre-fascial and retromuscular) with a higher mean volume (770 mL per breast). Intraoperative parameters, complication rates, and patient-reported outcomes (BREAST-Q) were analyzed. Statistical comparisons between the two surgical planes were performed using Independent Samples T-tests. Results: The procedure was successfully completed under TLA in 100% of cases, with no conversions to GA. The subpectoral approach was associated with significantly higher mean operating times (141 ± 11.2 min vs. 90.3 ± 11 min; p < 0.001) and TLA solution volumes (770 ± 16.1 mL vs. 589 ± 53.6 mL; p < 0.001). The overall major complication rate was 4.74%, with a significantly higher incidence of hematoma in the subpectoral group compared to the subglandular group (3.51% vs. 1.83%; p = 0.015). Regarding severe capsular contracture (Baker III–IV), although a slightly higher incidence was observed in the subpectoral cohort compared to the subglandular group (2.11% vs. 1.22%), this difference was not statistically significant (p = 0.155). Patient satisfaction via Breast-Q was high, with dissatisfaction exclusively linked to implant dislocation. Conclusions: This 16-year cumulative analysis validates TLA as a safe, effective, and reproducible alternative to general anesthesia for both subglandular and subpectoral breast augmentation. While the subpectoral plane entails longer surgical times and a slightly higher risk of minor complications, the TLA protocol ensures excellent pharmacological safety and rapid functional recovery, supporting its use in modern outpatient surgical settings. Full article

Although occult breast carcinomas and lesions with uncertain malignant potential are rare, their incidental discovery during symmetrizing mammoplasty can significantly alter the treatment approaches and cancer staging. In the context of oncoplastic surgery, the systematic evaluation of the contralateral breast is a clinical priority that has been underexplored in Eastern Europe. Background/Objectives: This study aimed to assess the incidence and histological characteristics of incidental carcinomas and B 3 lesions detected during contralateral symmetry mammoplasty in patients with breast cancer. Methods: This retrospective study was conducted at the Plastic and Reconstructive Surgery Clinic of the “Pius Brînzeu” County Emergency Clinical Hospital in Timisoara, Romania, over six years (2018–2024), and included 180 of 256 patients who underwent contralateral breast symmetrization. Results: Among the 180 patients, 21 (11.66%) had incidental findings: eight (4.44%) had contralateral carcinomas, and 13 (7.22%) had B3 lesions. The histopathological types identified were invasive ductal carcinoma NST (one case), ductal carcinoma in situ (one case), invasive lobular carcinoma (five cases), and mucinous/papillary carcinoma (one case). Compared to the reported international range of 2–10%, our observed incidence of 11.66% reflects the unique aspects of our patient cohort and the thoroughness of our histological analyses. Conclusions: Detection of contralateral carcinomas and B3 lesions during symmetry mammoplasties underscores the importance of a multidisciplinary approach, comprehensive bilateral screening, and detailed histopathological examination of specimens. Full article

Background: Microsurgical breast reconstruction is advancing rapidly with the integration of innovative technologies that enhance surgical precision, safety, and outcomes. This narrative review highlights recent developments across four key phases: flap planning, flap harvest, microvascular anastomosis, and flap monitoring. Methods: To identify the most updated and relevant data, all content on «Aesthetic and Reconstructive Breast Surgery Network» (ARBS Network, Copyright 2025 Mark Allen Group, United Kingdom) was screened regarding new technology. The contributions were grouped into one of four key phases. More references related to the content viewed were then searched on the electronic database MEDLINE (Bethesda, MD: U.S. National Library of Medicine). Results: 24 contributions regarding new technology were identified on ARBS Network. Of these, 17 were relevant for this paper. Preoperative tools such as CT angiography and AI-based perforator mapping optimize surgical planning and execution. Robotic-assisted or endoscopic techniques for deep inferior epigastric perforator (DIEP) flap harvest enable minimally invasive dissection with reduced donor-site morbidity and improved muscle preservation. Robotic microsurgery, particularly with the MUSA and Symani^® Surgical System, allows for precise, tremor-free suturing of submillimeter vessels. Indocyanine green (ICG) angiography remains the gold standard for intraoperative perfusion evaluation. Postoperative flap surveillance is crucial for detecting vascular compromise early. Devices such as the Cook-Swartz Doppler probe and flow couplers offer continuous monitoring. Wireless oximetry systems like ViOptix^® provide non-invasive, real-time perfusion data and support remote monitoring. Conclusions: Collectively, these innovations are transforming microsurgical breast reconstruction by increasing efficiency, consistency, and outcomes. Full article

Background and Objectives: The term “oncoplastic breast surgery” (OBS) incorporates plastic and oncologic concepts. Through the application of diverse mammoplasty approaches, the remaining breast tissue can be reconstructed, thereby enabling more extensive resections to be achieved with oncologically safe, margin-free outcomes. This study aims to assess the efficacy of the single incision lateral mammoplasty (SILM) technique as an oncoplastic approach for managing breast cancer located in the outer quadrant, in comparison with the matrix rotation flap (MRF) technique. Materials and Methods: This prospective randomized controlled study comprised 68 patients, who were randomized into two groups scheduled to undergo breast surgery: Group A constitutes the matrix rotation flap MRF group and Group B represents the single incision lateral sulcus mammoplasty (SLIM) group. A follow-up was planned for postoperative complications and esthetic outcomes. Results: The mean age of patients in Group A was 51.4 ± 9.4 years, compared with 52.6 ± 8.1 years in Group B. A total of 14.7% and 11.8% of patients in Group A reported a hematoma or seroma, respectively, which were higher than what was reported in Group B, where a hematoma and seroma were reported in 5.9% of patients. Additionally, 32.4% and 50% of patients in Groups A and B, respectively, reported excellent satisfaction. The evaluation with the Vancouver Scar Scale (VSS) revealed that esthetic outcomes were significantly better in Group B. Conclusions: Compared to the MRF procedure, the SLIM results in a much lower rate of postoperative hematoma, minor seroma, minimum blood loss, reduced areolar deviation, and improved breast symmetry. Both the MRF and SLIM techniques yield acceptable cosmetic outcomes. However, a longer-term follow-up is necessary to establish the definitive oncological equivalence between techniques. Full article

Background/Objectives: The breast implant exchange/explantation rate has been increasing in recent years due to various types of long-term complications or adverse effects, such as implant migration, rippling, or capsular contracture. To reduce complications such as migration and/or implant–pocket mismatch, surgical meshes may provide implant support. Here, we present a case series about the use of a non-absorbable synthetic bra-shaped mesh in revision surgery of the breast, using implants that do not adhere to the surrounding tissues. Methods: In this retrospective case series, eight patients underwent breast revision surgery between 2021 and 2024 due to implant-related long-term complications following aesthetic surgery. Surgical revision included implant exchange, total or partial capsulectomy, creation of a pre-pectoral implant pocket for the new implant, and positioning of the non-absorbable synthetic mesh, acting as an internal support for the implants. BREAST-Qs were collected from all patients. Results: Of the eight patients included, the following symptoms were observed: symptomatic capsular contracture (n = 3), implant migration (n = 4), and breast animation deformity (n = 2). After revision surgery, during the follow-up period of 6–42 months, neither infection nor seroma occurred. No implant-related complications were registered. The BREAST-Q analysis revealed the highest patient satisfaction in the domain “satisfaction with the implants” (median score 87.5%). Conclusions: In revision surgery after breast augmentation, the synthetic, non-absorbable and titanized pocket-like mesh may provide implant support and avoid recurrence of complications related to implant position. However, due to the small and heterogeneous patient group, larger studies are needed to validate these preliminary findings. Full article

Background: Variability and low volume yield in breast aesthetic outcomes utilizing fat grafting promoted a search for surgical technique improvement. Aim: Using evidence-based information to optimize a surgical technique for aesthetic breast augmentation using stem cell-enriched fat grafting. Methods: Retrospective study of consecutive women (n = 118) from 2008 to 2025 requesting breast fat grafting using centrifugation–filtration fat processing combined with platelet-rich plasma and autologous adipose-derived stem cell-enriched fat. Results: Most surgical indications were for primary breast augmentation (65.8%), followed by fat grafting after implant removal (13.6%), during or after mammoplasty (13.6%), or simultaneously with implant exchange (12.7%). The mean volume per breast of purified, enriched fat grafted was 192 to 206 cc. Each patient had fat grafted into the subcutaneous plane with some patients having additional fat placed submuscularly in those without a dual plane or submuscularly placed implant, or where an implant capsule was absent. Most patients were either very satisfied or satisfied (95.8%), with 4.2% dissatisfied. Those dissatisfied were mainly those with insufficient breast volume and one with a suspected atypical mycobacteria infection. There was a 11.9% complication rate, with seroma formation at the harvested site the most common at 5.1% (n = 6). Palpable fibrotic areas were second in frequency at 3.4% (n = 4), but with no instances of breast oil cyst formation. The average number of fat grafting sessions per indication was only one, with 6.8% requesting a second staged fat grafting procedure. The revision procedures were only in patients with a sole augmentation indication, except for one mastopexy patient with severe breast size asymmetry. An estimated 75–85% grafted volume take was confirmed by a previous diagnostic ultrasound measurement study. Conclusions: Breast fat grafting incorporating learned knowledge of optimal harvesting, processing, storing, enrichment, and administration techniques yielded superior consistent breast enhancement aesthetic outcomes with a high patient and surgeon satisfaction rate through increased adipocyte survival, while minimizing complications including a low incidence of fibrotic areas and no oil cyst formation. Full article

Background: Superomedial pedicle breast reduction is a widely performed procedure in plastic surgery. However, in cases of massive ptosis and excessively large breasts, achieving adequate pedicle reduction can be challenging. Direct excision of the tissue bulk may compromise blood supply while insufficient reduction can hinder proper pedicle positioning or result in strangulation when forcefully placed in the keyhole area. This study investigates the application of power-assisted liposuction (PAL) to the superomedial pedicle, aiming to achieve volume reduction while preserving its vascular integrity. Methods: Patients who underwent reduction mammaplasty with concomitant PAL were retrospectively reviewed. Parenchymal resection was performed first, followed by PAL, which was selectively applied to the pedicle. Eligibility for liposuction was made intraoperatively based on breast morphology and the ease of pedicle insetting. Results: The mean lipoaspirate per breast was 243.0 mL (SD 131.3) following a mean resection weight of 1261.7 g (SD 356.9). In 76.7% of cases, more than 150 mL was aspirated. The smallest volume per breast was 50 mL, while the highest reached 500 mL. A strong correlation was observed between the aspirated volume and resection weight. The overall complication rate was 3.3%, with one patient requiring hematoma evacuation. No cases of NAC necrosis occurred. All patients reported satisfactory breast shape and size. Conclusions: Power-assisted liposuction of the superomedial pedicle is a reliable and efficient technique for reshaping and reducing the pedicle while maintaining a low risk of complications. Full article

Background/Objectives: Immediate implant-based breast reconstruction is an established option for selected patients undergoing mastectomy. However, patients with large and ptotic breasts present specific reconstructive challenges, often requiring tailored approaches to minimize complications and optimize aesthetics. This pilot study aimed to evaluate the clinical feasibility and effectiveness of a mobile application developed to support intraoperative decision-making based on an institutional algorithm for breast reconstruction. It is also important to underline that this pilot study was exploratory in nature and primarily aimed at assessing feasibility and adherence to an app-based decision pathway, rather than comparative efficacy. Methods: We conducted a prospective observational study from October 2023 to December 2024 at the University Hospital of Sassari. Female patients with large and ptotic breasts undergoing immediate implant-based reconstruction were included. A mobile app, developed using MIT App Inventor 2, implemented our institution’s algorithm and guided surgeons through both preoperative and intraoperative decision-making. Surgical options included subpectoral, prepectoral with autologous fascial flaps, or prepectoral with acellular dermal matrix (ADM) reconstruction, depending on flap thickness and fascia integrity. Results: Sixteen patients (21 reconstructed breasts) were included. Surgical planning and execution followed app-generated recommendations in all cases, with no intraoperative deviations. Subpectoral reconstruction was performed in six patients, prepectoral with ADM in eight, and prepectoral with fascial flaps in two. The app was rated positively by all surgeons and facilitated consistent decision-making. Conclusions: The proposed mobile application, described in this pilot study, proved to be a feasible and effective decision-support tool for implant-based breast reconstruction in patients with challenging anatomy. It standardized surgical choices, supported training, and has the potential to enhance reproducibility and safety in complex reconstructive procedures. Full article

Background and Objectives: The incorporation of oncoplastic surgery techniques into the management of breast cancer has become more popular and offers both oncological safety and good cosmetic results. However, it is challenging for surgeons to obtain good oncological control and acceptable cosmetic results. This study aims to evaluate racquet mammoplasty in patients managing lateral quadrant breast tumors. Materials and Methods: In total, 59 female patients with lesions in their lateral breast quadrants were operated upon using the racquet mammoplasty technique. Their intraoperative data and postoperative outcomes were assessed and analyzed. Follow-up was planned for at least 1 year later. Results: In the current study, 59 females were enrolled, with a mean age of 38.6 ± 4.3 years. Tumors were located in the lateral upper quadrant in most of the patients (74.4%). The mean size of the tumors was 2.7 ± 1.8. The surgical margins were free of malignancy in all cases. A total of 5.1% of cases reported a wound infection. A single patient developed loco-regional recurrence. Concerning the cosmetic outcomes, 89.8% of patients reported excellent outcomes and none reported poor or bad results. Conclusions: The racquet mammoplasty technique, when used as an oncoplastic technique, provides oncological safety as well as good cosmetic results for tumors in the lateral breast quadrants. Full article

Background/Objectives: This study was designed to evaluate skin-sparing mastectomy with implant reconstruction complication rates in patients operated on due to high penetrant gene profile. All patients went to skin-sparing mastectomy with implant reconstruction and risk-reducing salpingo-oophorectomy. The effect of radiotherapy and chemotherapy on wound healing is a frequently discussed topic in the literature. However, studies on the effect of these on patients undergoing implant-based reconstruction are rare. In our clinic, two surgeries are performed under the same anesthesia and it is aimed to investigate the effect of this situation on complications in this rare patient group. In this retrospective study, we report our clinical experience regarding complication rates due to these factors among the high penetrant gene group. Methods: Between June 2022 and June 2024, 61 patients were grouped according to demographic data. Post-operative complications were defined as any of the following: major complications which were active bleeding or wound dehiscence; minor complications which were hematoma, seroma, surgical-site infection, <20% skin or nipple necrosis, and reoperation due to wound dehiscence or any other complication. Patients were compared in terms of complications according to whether they received previous radiotherapy (RT), neoadjuvant chemotherapy (CT), or underwent skin-reducing mammoplasty. Results: Patients receiving neoadjuvant chemotherapy, patients receiving preoperative RT, and patients undergoing skin-reducing mastectomy were compared in terms of major and minor complications. While neoadjuvant CT and preoperative RT only increased the risk of seroma, it was found that skin-reducing mastectomy had no significant effect on complication rates. Conclusions: Skin-sparing mastectomy with implant reconstruction and risk-reducing salphingo-oophorectomy is a comprehensive operation method in this patient group. Complication control can be achieved by performing two surgeries in a single anesthesia period, using the spy immunofluorescence device for vascularization control, and performing all surgeries with the same experienced team. Full article

Background: Negative Pressure Wound Therapy (NPWT) has proven to be an effective intervention in preventing postoperative complications across a range of surgical specialties, including orthopedics, vascular, and abdominal surgery. This study aimed to assess the prophylactic use of NPWT dressing compared to the Standard of Care (SOC) in high-risk patients undergoing oncoplastic and reconstructive breast surgery. Materials and Methods: This preliminary case-control study included 23 high-risk patients, enrolled between September 2023 and February 2024, at San Martino Polyclinic Hospital, Genoa. High-risk patients were defined as those with one or more of the following risk factors: obesity, prior radiotherapy, neoadjuvant chemotherapy, smoking history, diabetes, or corticosteroid use. The surgical procedures evaluated in this study included mastectomy with immediate implant-based breast reconstruction, reduction mammoplasty, and oncoplastic breast surgery following local excision or quadrantectomy. NPWT dressing was applied immediately after skin closure in the operating room, replaced after 2–3 days, and removed 7 days post-procedure. Surgical outcomes assessed included skin flap necrosis, wound dehiscence, infection, implant loss, and delays in adjuvant therapy. Results: A total of 23 patients, aged 45 to 57 years, were enrolled. Eleven patients received NPWT dressing, while twelve were treated with SOC. No complications occurred in the NPWT dressing group, whereas four complications were observed in the SOC group. Of the control group, three patients developed infections, which were treated with oral antibiotics for two, while one required implant replacement surgery. The remaining patient in the control group experienced wound dehiscence, which was successfully managed conservatively on an outpatient basis. Discussion and Conclusions: Our findings suggest that prophylactic NPWT dressing in oncoplastic and reconstructive breast surgery results in a significantly lower rate of wound-related complications. Although this is a preliminary study, it provides a foundation for further research in a larger cohort. These results also prompt a discussion of the cost-effectiveness of NPWT dressing relative to the SOC, given its higher cost. Full article

Objective: to study the effectiveness of type II pectoral nerve block (PEC II) for breast augmentation with submuscular implants by assessing opioid consumption and pain scale in the immediate postoperative period, from the post-anesthesia care unit (PACU) to 24 h postoperatively. Methods: A prospective, controlled, randomized, and double-blind study. Thirty-four patients were analyzed during the perioperative period and in the PACU, with one group receiving bilateral PEC II combined with general anesthesia and the control group receiving only general anesthesia. Results: There was no difference between the groups regarding demographic data, surgical and anesthetic times, or intraoperative opioid use. Opioid consumption in the control group was consistently higher at all the time intervals studied, with an average morphine consumption 38.7% greater. The largest variation in morphine consumption occurred at the fourth and sixth hours postoperatively. The greatest difference in postoperative pain was 36% higher in the control group compared to the intervention group. Conclusions: patients who underwent general anesthesia combined with PEC II had lower opioid consumption and a lower postoperative pain score without associated complications, confirming the effectiveness of the procedure. Full article

Background: The incidence of reduction mammoplasty has been steadily increasing over recent decades. Surgical site infections (SSIs) represent a common yet preventable complication across surgical disciplines. Studies across various surgical specialties have indicated a seasonal influence on SSIs, primarily correlated with higher temperatures and humidity. However, there remains a scarcity of clear data regarding the seasonal effects on complications specifically in breast surgery. Methods: We conducted a retrospective review encompassing all patients who underwent primary bilateral reduction mammoplasties at our institution between 1 June 2016, and 1 September 2019. The data collected included patient demographics, surgical details, and postoperative complications. The rates of SSIs and wound healing disturbances (WHDs) were correlated with local meteorological data at the time of surgery. Results: A total of 808 patients (1616 breasts) met the inclusion criteria. The mean age was 41 ± 14.8 years, with a mean BMI of 28.9 ± 5.2 kg/m² and a mean follow-up duration of 8.9 ± 9.8 months. Nineteen cases (2.35%) of surgical site infections and 77 cases (9.52%) of wound healing disturbances were reported. No statistically significant increase in the risk of SSIs (p = 0.928) or WHDs (p = 0.078) was observed during the warmer months of the year. Although no specific risk factors were identified for surgical site infections, both resection weight (p < 0.001) and diabetes mellitus (p = 0.001) demonstrated increased risks for wound healing disturbances. Conclusions: While seasonal temperature variations have been shown to impact SSIs and WHDs in body contouring procedures, our findings suggest that breast reduction surgery may not be similarly affected. Full article

In the past, polyacrylamide hydrogel was a popular choice for breast augmentation filler, and many women underwent mammoplasty with this gel. However, due to frequent complications, the use of polyacrylamide hydrogel in mammoplasty has been banned. Despite this ban, patients experiencing complications still seek medical treatment. The aim of this study was to investigate the fate of the polymer over a defined implantation period. Biopsies of breast implants were obtained from patients with 23 and 27 years of post-mammoplasty. These biopsies were meticulously purified from biological impurities and subjected to analysis using IR spectrometry, liquid chromatography—mass spectrometry, gas chromatography, and differential scanning calorimetry. The findings revealed the presence of polyacrylamide hydrogel residues, along with degradation products, within the infected material. Notably, the low-molecular-weight degradation products revealed via gas chromatography are aggressive and toxic substances capable of inducing chronic inflammation. This study sheds light on the long-term consequences of polyacrylamide hydrogel implantation, highlighting the persistence of harmful degradation products and their role in exacerbating patient complications. Full article

Background: The medicinal leech has been used in plastic surgery to resolve venous congestion that can threaten the viability of tissue transfer. Within the context of breast surgery, venous congestion is a pertinent consideration for reconstructive and non-reconstructive breast surgery such as mammoplasty and mastopexy. However, leeching is closely associated with complications such as infection, pain, and anaemia. This is the first systematic review that examines the methodology, efficacy, and post therapeutic outcome data across all existing studies on medicinal leeching in breast surgery. Methods: A systematic search of PubMed and Embase databases from their inception to November 2023 was conducted. Inclusion criteria included studies reporting on the use of leeches to resolve venous congestion in any breast surgery. The JBI Critical Appraisal Checklist for Case Series tool was used for bias analysis. Descriptive statistics were undertaken in Microsoft Excel. Results: A total of 18 studies with a combined sample size of 28 were examined, including 4 case series and 14 case reports. Patients mostly underwent reconstructive breast surgery (75%). The median number of leeches used was two, with a median number of three leeching sessions per day and 3 days of leeching. Medicinal leeching successfully prevented the loss of 75% of all tissue transfers. The complication rate was high at 81.14% and mainly included infection and anaemia. Conclusions: Medicinal leeching is an effective method to relieve venous congestion in breast surgery but must be judiciously used within the clinical context of the patient to maximise efficacy and mitigate harm from complications. Full article