Indiana Plastic Surgery Blog

A study published recently in the American Journal of Surgery confirmed the common perception that breast surgery can be more efficiently performed outside of hospitals in dedicated outpatient ambulatory surgery centers (ASC).

According to study results, performing breast surgery in an ASC rather than a hospital saved 69 minutes on average, and most of the time savings was attributable to decreased preoperative time, or time spent preparing for surgery.

Key time-saving advantages of the ASC include:

• Avoidance of unscheduled surgeries, such as add-on cases and emergency cases common in hospitals
• Better case flow as a result of having a surgeon assigned to a single room in the ASC
• Smaller, more consistent ASC staffing
• Smaller physical ASC facility that makes it easier to move patients and equipment

The study also concluded that while the type of anesthesia used during surgery can also affect recovery time immediately following surgery, this did not significantly affect overall surgical time from the preparation stage to the patient discharge stage.

Hospital vs. ASC study details

In 2005, the study authors’ ASC facility was closed, which forced all outpatient breast surgeries to be performed alternatively in a hospital setting.

Study authors Drs. Terrence Trentman, Jeff Mueller, Richard Gray, Barbara Pockaj and Daniel Simula compared the surgical records of 92 patients who had breast surgery in an ASC facility between January 2004 and December 2005 with the surgical records of 92 patients who had breast surgery in a hospital facility starting January 2006.

All study subjects were female patients of similar age, with similar recovery room times, and each breast surgery procedure was performed by the same two salaried surgeons who did not receive additional bonus pay for productivity.

ASC pre-op vs. post-op

In addition to concluding that ASC facilities offer significant preoperative time-savings, the results of the study also suggest that breast surgery patients spend an almost identical amount of time in an ASC as in a hospital once they reach the operating room.

The Anteis Injection System, an automated soft-tissue filler injection pen, was released in 2010 and is now being used for cosmetic injections by physicians in Europe.  The device was developed by Anteis S.A., a Swiss-based company that also manufactures and distributes the Injection System.

According to Anteis, the injection pen allows physicians to achieve more precise and consistent results with gel-based dermal filler injections because it electronically controls and regulates the volume of the filler as it is injected, as well as the injection speed as the filler is introduced into the dermis.  As a result, the Anteis Injection System also decreases physician muscle fatigue, making it physically easier to use than standard syringes.

In addition, the device is said to offer physicians improved handling, greater freedom of movement and increased opportunity to focus on ideal product placement rather than injection technique.

Physicians who use the Injection System have also reported improved patient outcomes marked by less pain during treatment, decreased social downtime and fewer and less severe side effects, such as bruising, swelling and redness after treatment.

According to Anteis, the Injection System is effective for all types of cosmetic injectable treatments, including:

• Wrinkle treatments
• Facial volume restoration and augmentation
• Treatment of skin depressions, such as cellulite

Although the Anteis Injection System is a promising innovation in cosmetic dermatology, it has not been appropriately tested or approved by the FDA and is not yet available in the U.S.

Additionally, the injection device was designed to work with Anteis-brand injectable fillers made of hyaluronic acid gel that are also not available in the U.S.  The Injection System has not been tested with other brands of hyaluronic acid fillers, such as Juvederm and Restylane, nor has it been tested with wrinkle-relaxing injectables, such as Botox.

If you’re considering non-surgical facial rejuvenation with injectable fillers, seek a skilled injector with superior injection technique and experience using a wide variety of injectable fillers.

After an inquiry by the French Society of Plastic, Reconstructive and Aesthetic Plastic Surgeons (SOFCPRE) uncovered safety issues with Poly Implant Prostheses (PIP) breast implants, the British Association of Aesthetic Plastic Surgeons issued a guidance advising the estimated 50,000 British women who have the implants to seek corrective surgery if their implants are ruptured.  

According to the results of the SOFCPRE inquiry, PIP breast implants were found to contain an untested, unapproved silicone gel that has not undergone safety tests and also lacked an essential protective barrier, making them especially prone to rupture.

Breast implant ruptures are uncommon in the safe, FDA-approved breast implants used in the U.S., but breast augmentation patients should know how to detect a breast implant rupture, as well as the corrective surgery options that exist should implant malfunction or breast implant trauma occur.

In saline breast implants, ruptures are usually easy to detect because the implants deflate and noticeably lose volume.  In silicone breast implants, ruptures are not as obvious and require an MRI for detection.  When ruptured breast implants do not cause problems with breast appearance or health, occasionally women will choose to forego revision surgery, however most pursue corrective surgery. 

Options for corrective breast surgery include:

• Breast implant exchange (breast augmentation revision)
• Breast implant removal (breast explant surgery)
• Breast lift with implants or without implants

Many women who experience a rupture in one or both breast implants choose to exchange their implants for new ones via breast augmentation revision surgery, while other women choose to simply undergo breast explant surgery, or implant removal, and do not have their implants replaced.  

A breast lift with implants may also be performed to remove skin that has sagged with age since the initial breast augmentation, while a breast lift without implants may be performed to remove skin stretched by the breast implants if a patient decides not to have the implants replaced.

If you experience a rupture in your breast implants, remember there’s no need to panic, as ruptures in FDA-approved breast implants pose no immediate health risk.  Consult a board-certified plastic surgeon with considerable experience performing breast surgery for reassurance and help deciding which corrective surgery option is best for you.

Ptosis (pronounced “toe-sis”) is a condition characterized by breast droop and loose, stretched skin on the breasts.  The skin on a woman’s breasts is primarily responsible for maintaining their position.  When the skin becomes stretched or loose or less elastic, the breasts will droop.

What causes breast ptosis?

Breast ptosis is caused by a combination of factors including large breast size, aging, and gravity.  Large breasts may be gradually pulled down by gravity and the skin becomes thinner and less elastic with age.

A recent study sheds light on the lifestyle factors that contribute to breast ptosis.  Plastic surgeons at the University of Kentucky found that age, significant weight loss, higher BMI, larger bra cup size, number of pregnancies, and smoking were found to be significant risk factors for breast ptosis, while “breast-feeding, weight gain during pregnancy, and lack of participation in regular upper body exercise were not found to be significant risk factors.”

Evaluating Breast Ptosis

Plastic surgeons often measure breast ptosis using the Regnault classification, which is as follows in simplified form:

1. Pseudoptosis – the nipple falls above the fold, but the breast is hypoplastic and hangs below the breast crease.

2. Glandular Ptosis – the nipple is above the fold, but the breast hangs below the crease.

3. Minor Ptosis – the nipple is level with the breast crease.

4. Moderate Ptosis – the nipple is below the breast crease, but above the lower breast contour.

5. Severe Ptosis: the nipple is below the breast crease and below the lower breast contour.

Correcting Breast Ptosis

Using the classification system above, a surgeon can recommend the right procedure to correct breast ptosis.  Surgery to correct minor ptosis may be quite different from the procedure to correct a severe case of ptosis.  The usual procedure of choice is breast lift surgery / mastopexy.

A new study published in Plastic and Reconstructive Surgery analyzes the factors that motivate women to undergo breast augmentation, rhinoplasty, liposuction, and abdominoplasty.

According to survey analysis, specific factors –both physical and psychological –can predict an interest in cosmetic procedures.   1862 women in northern Norway responded to a questionnaire regarding their interest in cosmetic surgery.  All participants were under the age of 35.

Women interested in rhinoplasty, breast augmentation, and liposuction were motivated by “complex psychological factors.”   Researchers found correlations with lifestyle factors such as divorce, history of teasing, education, self-image, body dysmorphic disorder, and the so-called Big-Five personality traits.

Questions about abdominoplasty (the tummy tuck) presented some unique findings.  Most participants who were interested in the procedure were interested in it exclusively. Having children and the “desire to repair the bodily changes occurring after childbirth” was a consistent predictor of interest for a tummy tuck.

Read the abstract of this study online on Plastic and Reconstructive Surgery

First quarter earnings for Allergan, maker of Botox, are way up. Second quarter forecasts, according to the Wall Street Journal, are way ahead of expectations.

Given the statistics just released by the ASPS, their success shouldn’t be all that surprising. According to the society, minimally invasive procedures have increased an incredible 99 percent since 2000.  Topping the list are wrinkle fillers and botulinum toxin injections, two treatments in which plastic surgeons will likely reach for an Allergan product.

Image courtesy of the ASPS

For Allergan, being on the cutting-edge of aesthetic medicine also doesn’t hurt. New products like Juvederm Ultra XC and Latisse are getting plenty of attention right now, which should only increase consumer demand for these cosmetic procedures.

A recent study of 581 breast cancer patients has revealed inequalities correlated with race and health insurance coverage.

According to the research, black women have to wait longer for breast cancer treatment and diagnosis, regardless of their health insurance coverage.  White women with no insurance coverage also waited significantly longer.

The findings come from George Washington University Cancer Institute.  Patients were treated at 7 hospitals and clinics between 1997 and 2009.

Highlights

• To get a definitive diagnosis, insured black patients and uninsured white patients had to wait over twice as long as insured white patients.
• Contrary to the researcher’s expectations, insurance coverage did not even the field between racial groups. Having health insurance coverage did not mean a quicker diagnosis in black women.
• After diagnosis, black patients had to wait twice as long as white patients to begin breast cancer treatment.

Read more about this study on womenshealth.gov
Information on breast reconstruction in Indiana

This story from CNN documents the increasing number of cosmetic procedures being performed in Iraq. As violence in the region subsides, Iraqi women have begun to seek cosmetic enhancement with greater frequency.

“It does seem that cosmetic surgery is on the rise” says reporter Mahammed Jamjoom, who stands by while rhinoplasty is performed on 26-year old Noor Aziz.

Read “Buying Beauty in Baghdad” and see more videos on CNN.com

FDA warnings were issued to several med-spas last week (including one here in Indiana) regarding claims made about the safety and effectiveness of lipodissolve.

With an injection of certain chemicals (phosphatidylcholine, deoxycholate, and others) lipodissolve is said to remove areas of persistent fat.  The procedure, which is also known as injection lipolysis, lacks scientific evidence supporting its use as a fat removal treatment.

The medispas involved were apparently claiming that Lipodissolve was “superior to other fat removal procedures, including liposuction” and making misleading claims about the safety record and effectiveness of lipodissolve.

Given the lack of supporting evidence for lipodissolve and the side effects reported by consumers, officials in the FDA felt it was necessary to crack down on these misleading claims and warn consumers about them.  The medical spas are being instructed to “correct these violations and prevent similar violations in the future.”

You can find more information on the FDA website

As you age, the underlying bone structure of your face may begin to change and negatively affect your outward appearance. According to studies published in Plastic and Reconstructive Surgery Journal, the facial bones of your chin and jaw may actually recede as you get older, affecting the proportions of your face.

For these studies, a group of 60 men and 60 women were analyzed with CT scans. The authors noticed that older individuals actually showed changes in bone structure, especially in the chin and jaw area.

Other areas of concern include the middle of the face, in the cheekbones and eye-sockets.

The authors, Dr. Howard Langstein and Dr. Robert Shaw Jr., suggest that during future cosmetic surgeries, a patient’s skeletal structures may require more attention. Aside from traditional facelift surgeries that reduce sagging tissues in the middle and lower part of the face, surgeons may need to focus more on chin implants and procedures that augment your bone structure.

Restoring facial volume has already become commonplace in facial plastic surgery. Non-surgical procedures such as Juvederm and Restylane are used to temporarily augment multiple areas of the face, while facial implants provide long-term solution for inadequate chin or cheek projection.