Cosmetic and reconstructive breast surgery in blacks

Black women have not embraced cosmetic and reconstructive surgery of the breast with the same enthusiasm as their Caucasian counterparts because of fear of hypertrophic scars. The authors offer suggestions on how to minimize the scarring associated with breast surgery in black women. They feel that intraareolar incisions should be used whenever circumareolar incisions are indicated in augmentation mammaplasty, because the areola, being a favored area, is less likely to produce hypertrophic scars. The Marchac technique of reduction mammaplasty is recommended because it produces a short horizontal scar of 5 to 8 cm confined to the breast without medial and lateral extension, which may hypertrophy in black women. In the reduction of large breasts, secondary excision of dogears 6 or more weeks after mammaplasty reduces the medial and lateral extents of the scar. The use of liposuction as an adjunct to reduction mammaplasty may also accomplish the same thing. Amputation and free nipple-areola grafting should be used with caution in black patients because of the tendency of the grafted areola to hypopigment. In postmastectomy reconstruction, the authors suggest that the techniques described by Ryan and Radovan should be considered first before the techniques of reconstruction utilizing myocutaneous flaps. In these procedures, no new scars which may hypertrophy are created away from the site of reconstruction. Staples should not be used in skin closure in blacks because they cause cross-hatching of the wound even when removed early.     

Type of breast reconstructive surgery among breast cancer patients: a population-based study

The type of breast reconstructive surgery (implant versus flap) was examined among all Connecticut-resident breast cancer patients diagnosed between 1994 and 1997 and identified from a population-based cancer registry. Type of reconstruction was obtained primarily from questionnaires sent to hospitals, but physicians were contacted about selected patients. Among 526 patients who underwent reconstruction, reconstruction with a flap (with or without an implant; 367 patients, or 69.8 percent) was more frequent than reconstruction with an implant alone (111 patients, or 21.1 percent); the type of reconstruction was unknown for 48 patients (9.1 percent). Some disagreement was found between reports from physicians and hospitals in a subsample of patients diagnosed in 1997. This study describes the baseline data and methods for examining trends in type of reconstruction among breast cancer patients in a defined population.     

Use of stacked polyurethane-covered mammary implants in aesthetic and reconstructive breast surgery

The use of stacked polyurethane-covered mammary implants has proven useful in improving results in the correction of deficiencies of mammary form and projection that can occur in certain cases of congenital and acquired breast deformity. The method has been used in 57 patients (102 breasts). The rate of significant complications, including seroma, rash, infection, hematoma, and capsular contracture, has been low (1 to 6 percent). Polyurethane-covered implants will maintain their position when used in a stacked system because of their unique biophysical characteristics, which include tissue bonding and a high friction coefficient between the implant surfaces.     

De novo adipogenesis for reconstructive surgery

Autografting of lost soft tissue is an important subject of the plastic and reconstructive surgery and autograft of fat pads has been only technique for this goal. However, the results are disappointing because of absorption of the grafts with time. Adipoblasts or adipocyte precursor cells distribute widely in connective tissues and they can proliferate and mature into adipocytes even in the adult body. In experiments using mice, we found that de novo adipogenesis of endogenous precursor cells can be induced by injecting reconstituted basement membrane, Matrigel, supplemented with more than 1 ng/ml of bFGF. This adipogenesis was reproducibly induced by subcutaneous injection over the chest, lateral abdomen or head. Adipogenesis was induced even in ear cartilage or in muscle. To evaluate the possibility of future application of this de novo adipogenesis to plastic and reconstructive surgery, we have reviewed updated knowledge of the adipogenesis. This revised version was published online in August 2006 with corrections to the Cover Date.     

Prophylactic antibiotics in plastic and reconstructive surgery.

There is no consensus in the literature on the use of prophylactic antibiotics to prevent postoperative infection. This study was performed to investigate whether the use of prophylactic antibiotics has an effect on postoperative infection rates. A total of 1400 patients were classified into four groups based on their diagnosis. During the induction of anesthesia, half of each group received 2 g of a sulbactam-ampicillin combination and the other half received a placebo (saline solution) intravenously. Wound infection rates were observed in the postoperative period. Age, sex, and operative site of the patients with the same diagnosis were comparable in each group. The white blood cell count and the body temperature reading of each patient were recorded postoperatively. Wounds were observed daily in the postoperative period and graded according to a predetermined scale. Bacteriologic specimens were obtained from patients who had wound infections. According to our clinical experience, antibiotic prophylaxis is not necessary in plastic surgery. At the end of our 6-year study, a significant difference could not be found between the antibiotic prophylaxis and placebo groups.