Scientific Abstract Presentations: Resident Only Aesthetic & Breast Abstracts Session 1 Friday, October 10 Fri, Oct 10 8:00-9:30 a.m. CDT

PURPOSE: The FACE-Q Aesthetics is a validated tool for assessing patient-reported outcomes related to surgical and non-surgical facial aesthetic treatments. Recognizing patient-specific variables that may influence FACE-Q scores is essential to control for potential confounders in research. This study aimed to identify factors that predict FACE-Q Aesthetic scale scores.

METHODS: A cross-sectional survey was conducted among an international cohort of participants recruited through the Prolific platform. Participants aged 20 years or older who had undergone non-invasive facial aesthetic procedures within the past year were included. Demographic and clinical information was collected, and univariable and multivariable linear regression analyses were employed to assess predictors of FACE-Q Face Overall, Psychological, and Social scale scores.

RESULTS: A total of 1,259 participants were analyzed, with an average age of 42.6 years (±11.9). The mean scores were 52.4 (±18.3) for the Face Overall scale, 56.5 (±23.7) for the Psychological scale, and 62.7 (±24.0) for the Social scale. Several factors were significantly associated (p < 0.05) with higher scores, including lower body mass index (BMI), African American ethnicity, male gender, Fitzpatrick skin type V, residence in the United States, financial stability, and residual effects of prior aesthetic treatments. Younger participants were more likely to report higher Face Overall scores (p<0.05).

CONCLUSIONS: This study identified several patient characteristics that predict Face Overall, Psychological, and Social scale scores. These findings offer valuable insights into how patient-specific factors influence outcomes following facial aesthetic procedures and underscore the need to account for these variables in future research using the FACE-Q Aesthetics tool.

Introduction: Medical tourism, the practice of traveling to another country for medical care, has experienced a significant rise in popularity over the past decade. This trend is especially evident in elective aesthetic plastic surgery, where out-of-pocket costs in the United States drive many patients to seek less expensive options abroad. While medical tourism can offer cost savings, it also carries inherent risks, particularly in regards to postoperative care and limited ability to carefully evaluate and choose a provider. When complications occur, patients often seek care at home institutions rather than returning to their original surgeon. Local providers are increasingly treating sequelae from these procedures, which can range in severity from minor wound dehiscence to life-threatening necrotizing infection. While complications from aesthetic surgery performed abroad have been reported in the literature, there is a paucity of information regarding domestic medical tourism. Although domestic locations offer standardized surgical facilities and board-vetted surgeons, medical tourists inherently experience limited follow-up; we hypothesize that this truncated postoperative care contributes to similar complications and interventions among all medical tourists regardless of operative location. In this paper, we compare patients presenting to our institution for management of complications after either domestic or international medical tourism.

Methods: A retrospective review was conducted to identify patients who presented between January 2015 and March 2025 with complications related to elective aesthetic surgery performed at outside institutions. Patients were classified as international medical tourists if their surgery occurred in a foreign country, and domestic medical tourists if they traveled at least 100 miles within the United States. Data collected included demographics, surgical details, location and duration of stay, time to presentation at our institution, nature of complications, and treatment measures.

Results: Thirty-eight patients met inclusion criteria: 20 (53%) underwent procedures domestically, while 18 (47%) underwent procedures abroad. Miami was the most common domestic location (80% of cohort), and the Dominican Republic the most common international location (71% of cohort). Domestic patients returned home sooner after surgery than their international counterparts (6.3 vs 12.2 days, p < 0.05), and presented earlier with complications (22.8 vs. 65.4 days post-op, p < 0.05). No significant differences were found in the type of procedures, complication rates, or the necessity for surgical intervention between the two groups. The patients were then analyzed based on length of time spent at operative destination, regardless of whether they were domestic or international. Patients who spent 1 week or less at their operative destination before returning home were more likely to require inpatient admission when compared to patients who stayed longer than 1 week (82% vs 25%, p < 0.05). Length of time at operative destination was not correlated with antibiotic treatment or need for surgical intervention.

Conclusion: Our findings suggest that length of postoperative stay after medical tourism is more predictive of complications requiring inpatient admission than the surgical destination itself. Domestic medical tourism, though perceived as safer by many patients, may pose similar risks to international procedures if follow-up care is insufficient.

Background Alloplastic chin augmentation is the most common aesthetic surgical treatment to reshape the chin. However, factory-made chin implants are typically standardized rather than custom-made and have potential to cause complications. Although the fabrication of custom-made implants by using computer-assisted planning and 3D printing technology has become widespread, the process has several disadvantages, including long preoperative prosthesis preparation times, high costs, and unsuitability for patients with asymmetric chins or those who undergo combined mandibuloplasty before implant placement. The present study developed an innovative chin augmentation technique involving stacked expanded polytetrafluoroethylene (e-PTFE) sheets that is suitable for most patients and has minimal side effects.

Materials and Methods A retrospective review of a single surgeon's experience was performed over a 2-year period for patients who underwent a procedure involving piled up e-PTFE sheets for alloplastic chin augmentation. This study analyzed the outcomes, complications (temporary nerve numbness, wound infection, hematoma formation, and implant displacement), and patient satisfaction during follow-up.

Results Between January 2018 and December 2020, 38 patients underwent the procedure involving piled up e-PTFE sheets for alloplastic chin augmentation. Six patients (15.8%) experienced nerve-related temporary numbness, and one (2.6%) experienced wound infection. None had developed major complications such as implant displacement or wound infection at follow-up. Moreover, the patients demonstrated a high level of satisfaction with the surgical results.

Conclusion Piled up e-PTFE sheets can be used to produce custom fit porous polyethylene chin implants that result in minimal complications and a very high satisfaction rate.

Purpose: Abdominoplasty and liposuction are among the most common plastic surgery procedures performed annually. However, despite reliable results, concerns remain regarding their combined use, as for the ideal abdominal contour continue to rise. First described by Dr. Villegas, the TULUA technique (transverse plication, undermining limited to umbilicus, liposuction [unrestricted], umbilicoplasty, and abdominoplasty with low transverse scar), was designed to optimize liposuction while reducing the risk of vascular compromise and correct abdominal wall laxity, with a minimal-tension closure (1). Despite advantageous initial outcomes, additional improvements in waist-to-hip ratios were needed. In this study, we present the extended TULUA (E-TULUA) abdominoplasty technique, with additional plication of the external oblique muscles and aim to assess the safety and efficacy of this technique through an assessment of clinical outcomes.

Methods: A retrospective review was conducted of all consecutive E-TULUA abdominoplasty procedures by a single surgeon from January 2022 to May 2024. E-TULUA technique was standardized for all patients, which involves liposuction, skin resection, horizontal plication of the rectus abdominis, plication of the oblique muscles, no undermining above the umbilicus, and umbilicoplasty (novel four-flap technique). Inclusion criteria included a minimum follow-up of 6 months and patients > 18 years old. Demographics and clinical outcomes, including surgical site occurrences (SSO), such as seroma and infection, and cosmetic complications, such as delayed healing, and umbilical necrosis, were assessed. Pre- and post-operative waist-to-hip ratios were also collected and analyzed.

Results: A total of 87 patients were included, with a mean follow-up of 6 months (range 6 to 24 months). Mean age of our cohort was 36.5 years (28–45 years), and the mean BMI was 25.9 kg/m² (range: 24–29 kg/m²). The majority of patients were female (97%), and none with a history of smoking. Average operative time was 155 minutes. The overall complication rate was 5.7% (n=5), with a re-operation rate of 2.2% (n=2). Seroma occurred in 2.2% of patients (n=2), and umbilical lower flap necrosis, managed conservatively with wound care, was observed in 3.4% (n=3). Notably, there were no cases of surgical site infection, pulmonary embolism, deep vein thrombosis, or significant flap necrosis (>4 cm in diameter). At 6 months postoperatively, the average waist-to-hip ratio improvement ranged from 6 to 8 cm, with a mean ratio reduction of 9%, reflecting high levels of patient satisfaction and benefits with additional plication.

Conclusion The extended-TULUA abdominoplasty can be performed safely and effectively with an acceptable complication and re-operation rate. The value of the E-TULUA technique can be defined by its improved waist-to-hip ratios and high patient satisfaction, while maintaining low complication rates. Overall, an individualized, patient-centric approach should be employed for ideal results, were patient selection is critical. Through these results, the authors hope to highlight the value of this surgical technique to safely optimize outcomes and add to the existing literature assessing this modernized approach to lipoabdominoplasty.

References: 1. Villegas-Alzate FJ, Blugerman G, Vera-Cucchiaro J, et al. TULUA Lipoabdominoplasty: Transversal Aponeurotic Plication, No Undermining, and Unrestricted Liposuction. Plastic and reconstructive surgery. Dec 1 2021;148(6):1248-1261. doi:10.1097/PRS.0000000000008577

BACKGROUND: FACE-Q Aesthetics scales assess patient-important outcomes following both surgical/nonsurgical facial cosmetic interventions (1). While the FACE-Q Aesthetics module has been found to be reliable and responsive to change, establishing the validity of this patient-reported outcome measure remains an iterative process (2). Convergent validity is the degree to which the scores of one measurement relate to another measuring a similar construct and is established through hypothesis testing, where investigators make a priori predictions about the strength of the correlation between two related measures (3). OBJECTIVE: This study aims to establish the convergent validity of 11 FACE-Q Aesthetics appearance scales using the MERZ Aesthetics scales (4). METHODS: Data were collected from an online international sample of participants aged ≥20 years, who presented to a dermatologist or plastic surgeon within the last 12 months for a minimally invasive facial aesthetic treatment. Participants provided demographic and clinical data and completed 11 FACE-Q Aesthetics scales and 12 MERZ Aesthetics scales. Hypotheses regarding the strength of correlations between scales were adapted from the COSMIN methodology for systematic reviews of Patient-Reported Outcome Measures user manual (5). Spearman's rank correlation coefficient (ρ) was used to calculate correlation. Adequate convergent validity was based on percentage of correct hypotheses (>75%) and/or correlation ≥0.50 with an instrument measuring a similar construct. Given that FACE-Q Aesthetics Scales include items which evaluate participant perceptions of their appearance and the MERZ scales use standardized photographs for participants to match their appearance, it was hypothesized that these scales likely measure related, but dissimilar constructs. RESULTS: 1259 participants were included in this survey. Participants were on average 42.6 (±11.9) years old, and mostly female (72.5%), Caucasian (76.9%), and living in the United States (49.9%) or the United Kingdom (42.9%). FACE-Q Lines Overall, Lower Face and Jawline, Appraisal of Lines – Forehead/Between Eyebrows/Crow's Feet/Lips/Nasolabial Folds/Marionette, and Lips scales demonstrated adequate convergent validity with patient reported MERZ Aesthetics scales. The FACE-Q Face Overall and Cheeks scales did not show adequate convergent validity. CONCLUSION: This study demonstrates evidence of adequate convergent validity of 9 FACE-Q Aesthetics scales (Lines Overall, Lower Face and Jaw, Appraisal of Lines – Forehead/Between Eyebrows/Crow's Feet/Nasolabial Folds/Marionette/Lips, and Lips). Establishing validity of these scales remains an iterative process and further studies comparing the FACE-Q to other related measurement tools are required to strengthen this evidence.

References: 1. Klassen AF, Cano SJ, Scott A, Snell L, Pusic AL. Measuring patient-reported outcomes in facial aesthetic patients: development of the FACE-Q. Facial Plastic Surgery. 2010;26(04):303-309. doi:10.1055/s-0030-1262313

2. Gallo L, Rae C, Kim PJ, et al. ESTABLISHING TEST-RETEST RELIABILITY AND SMALLEST DETECTABLE CHANGE OF FACE-Q AESTHETIC MODULE SCALES. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2024;doi:10.1016/j.bjps.2024.06.002

3. Abma IL, Rovers M, van der Wees PJ. Appraising convergent validity of patient-reported outcome measures in systematic reviews: constructing hypotheses and interpreting outcomes. BMC research notes. 2016;9(1):1-5. doi:10.1186/s13104-016-2034-2

4. Merz Aesthetics Scales Patient Marketing Booklet. Merz Pharma Canada; 2022.

5. COSMIN methodology for systematic reviews of Patient-Reported Outcome Measures user manual. COnsensus‐based Standards for the selection of health Measurement INstruments; 2018.

Purpose: Abdominal compartment syndrome is a rare complication of abdominoplasty, and the risks among post-bariatric surgery patients are not well known. The purpose of this study is to review the existing literature on abdominal compartment syndrome after abdominoplasty and report a unique case of patient with a history of Roux-en-Y gastric bypass who presented with abdominal compartment syndrome secondary to gastric perforation after abdominoplasty.

Methods: First, we present an original case report. Second, we provide a review of the existing literature on the incidence of abdominal compartment syndrome after abdominoplasty.

Results: A 37 year old woman with a history of Roux-en-Y gastric bypass three years prior presented four days after an abdominoplasty and bilateral breast reduction to the emergency room after cardiac arrest at home. She had been complaining of increasing abdominal pain, nausea/emesis, and difficulty urinating since the procedure. On arrival, she was intubated and noted to have elevated peak pressures, hypotension requiring multiple pressors, and a tense abdomen. Cross-sectional imaging revealed significant free fluid with biliopancreatic limb dilation. She was taken emergently to the operating room for exploratory laparotomy. The rectus plication was released and midline fascia transected with immediate improvement in peak airway pressures. Large volume bilious ascites and duskiness of the proximal remnant stomach with adherent fibrinous tissue were noted, concerning for a sealed perforation. A temporary abdominal closure was placed; on return to the operating room 12 hours later, a significant portion of necrotic abdominoplasty skin flap was resected, and the remnant stomach, which was noted to be frankly necrotic and adherent to the gastric pouch, was also resected. She ultimately underwent a staged fascial closure with interposition Vicryl mesh, and later split-thickness skin grafting.

There are five published cases of abdominal compartment syndrome after abdominoplasty. One patient developed acute bowel ischemia in the setting of internal hernia from prior Roux-en-Y gastric bypass(1); another developed acute respiratory failure requiring intubation(2); and three developed symptoms of compressive feelings of the chest and abdomen, high urinary frequency, and anxiety(3). Four of these patients required surgery.

Conclusion: Abdominal compartment syndrome is a rare complication of abdominoplasty, but it requires prompt surgical evaluation. Since abdominoplasty is one of the most common cosmetic procedures performed among plastic surgeons, it is critical to recognize and address this potentially lethal problem early. This unique case report highlights the importance of identifying patients at high risk for such complications – particularly those with prior bariatric surgery – and underscores signs and symptoms of abdominal compartment syndrome that warrant urgent surgical evaluation.

References

1. Izadpanah A, Izadpanah A, Karunanayake M, Petropolis C, Deckelbaum DL, Luc M. Abdominal compartment syndrome following abdominoplasty: A case report and review. Indian Journal of Plastic Surgery. 2014;47(2):263-266.
2. Rylova A V., Kapil R, Parekh J, Mays L, Kwon J. A case of severe acute respiratory failure after elective abdominoplasty. Respir Med Case Rep. 2022;38.
3. Shen GX, Gu B, Xie F, et al. Three case reports of abdominal compartment syndrome after full abdominoplasty. Chinese Journal of Plastic Surgery. 2007;23(3):226-228.

Purpose: To describe the clinical presentation, management strategies, and outcomes of rare iatrogenic sialocele complications following facelift surgery.

Methods: This case series includes three female patients (aged 42–56) who developed sialocele 10–14 days after SMAS plication facelifts. Initial management involved aspiration and compression. Persistent cases were treated with botulinum toxin type A or surgical drainage with parotid duct ligation. Patient outcomes were assessed for resolution and recurrence.

Results: Conservative management led to resolution in one case. The second patient responded to botulinum toxin injection, achieving symptom resolution within two weeks. The third case required surgical intervention, resulting in complete resolution. All patients reported satisfactory aesthetic and functional outcomes without recurrence during follow-up.

Conclusions: Sialocele post-facelift can often be managed conservatively; however, refractory cases benefit from botulinum toxin or surgical intervention. Early diagnosis and a stepwise, individualized treatment approach are critical to achieving optimal outcomes.

Purpose: Masculinizing top surgery is the most prevalent gender-affirming procedure offered to transgender and gender diverse individuals, most commonly with gender-affirming mastectomy and free nipple grafting. (Ammari et al. 2018) Our institution presents a novel technique for gender-affirming mammoplasty, adapted from the Modified Robertson technique for reduction mammoplasty. (Chalekson et al. 2001) Our approach maintains nipple attachment using an inferiorly-based bell curve pedicle obviating free nipple grafting. It produces overall similar aesthetic results, while achieving reactive as opposed to flaccid nipples as with free nipple grafting.

Methods and Materials: We conducted a retrospective chart review including all patients who underwent the Lahey Modification technique of gender-affirming mammoplasty by a single surgeon at an academic hospital in Massachusetts from October 2017 to November 2024. Patient characteristics, intraoperative data, and clinical outcomes were analyzed utilizing descriptive statistics and univariate logistic regression. Outcomes were stratified by resection weight greater or less than the mean (x̄ = 571.5g) to inform optimal patient selection for this procedure.

Results: Seventy-two nipples were included in this study. Average age was 27.26 (± 6.55) years, 86.8% of patients identified as non-Hispanic White, average BMI was 32.19 ± 10.11 kg/m^2. On average, length of follow-up was 8.66 ± 12.5 months. In total, there was partial necrosis of seven nipples (9.72%), decreased sensation in seven nipples (9.72%), and one patient with complete loss of nipple sensation (1.38%). None of the patients experienced complete nipple loss that required reoperation. There was no significant risk for postoperative complications, including hematoma, seroma, or skin flap necrosis. Outcomes were similar between patients with both small and large resection weights. Furthermore, there was an overall high rate of subjective patient satisfaction.

Conclusions: This study demonstrates that the Lahey Modification is a safe, efficient, and easily reproducible technique for gender-affirming mammoplasty for young transgender patients with a wide range of breast sizes. Our results show that these patients retained a certain level of nipple sensation and satisfactory aesthetic outcome.

References: 1. Ammari T, Sluiter EC, Gast K, Kuzon WM, Jr. Female-to-Male Gender-Affirming Chest Reconstruction Surgery. Aesthet Surg J. Jan 17 2019;39(2):150-163. doi:10.1093/asj/sjy098 2. Chalekson CP, Neumeister MW, Zook EG, Russell RC. Outcome analysis of reduction mammaplasty using the modified Robertson technique. Plast Reconstr Surg. 2002;110(1):71-81. doi:10.1097/00006534-200207000-00013

Background: Breast implantation induces a fibrous capsule formation as a natural foreign body response. While capsule-related complications, such as contracture, are known, the need for capsulectomy during implant removal in asymptomatic patients remains unclear. This study examines the capsule's degradation process over time and identifies key cytokines involved in its remodeling. Methods: 12 7-week-old Sprague-Dawley rats received custom 2.25 cm silicone cohesive gel implants subcutaneously on both dorsal sides. Capsule tissues were collected at immediate (0M), 3-month (3M), and 6-month (6M) intervals following implant removal without capsulectomy. Tissues were fixed, embedded, and analyzed histologically using hematoxylin and eosin and Masson's trichrome staining. Immunohistochemical staining for MMP-9, CD31, αSMA, COL1, and CD68 was quantified for comparative analysis. Results: The immediate group (0M) showed robust capsule formation with dense collagen and myofibroblasts. Over time, capsules thinned (315 µm at 0M, 194.8 µm at 3M, 136.8 µm at 6M; p < 0.01), became structurally disrupted, and merged with surrounding adipose tissue. Notably, MMP-9 and CD31 levels increased significantly, indicating enhanced matrix turnover and vascularization. αSMA and COL1 declined initially before partially rebounding at 6M, while CD68 exhibited trends consistent with ongoing remodeling. Conclusions: The findings illustrate the natural degradation and remodeling of implant-induced capsules, driven by specific cytokines and matrix markers. These insights may inform future guidelines on the necessity of capsulectomy during implant removal.

Background:
Prepectoral implant-based breast reconstruction was popularized over the past decade due to its ability to address the animation deformity and implant malposition associated with subpectoral implants. However, prepectoral implants present their own drawbacks, including risk of implant exposure and rippling. The split-muscle style support (SMS) technique, originally described for breast augmentation, provides muscular implant coverage while avoiding animation deformity and flattening (1). The implant relies on autologous support instead of mesh, as all origins and insertions of the pectoralis muscle are maintained, and only a small segment of acellular dermal matrix is interposed between the split ends of the muscle. Owing to strong autologous support fixating the implant against the chest wall, much of the tension on the skin envelope seen in prepectoral or dual plane implant placement is avoided.

Methods:
A retrospective review of a single-surgeon experience in direct-to-implant reconstruction with SMS technique was performed. Smooth cohesive gel silicone implants were used. The pectoralis muscle is divided at the middle to lower third junction of the sternum and continued 2 cm lateral to the breast meridian. The implant is placed behind the split and elevated pectoralis muscle while maintaining the inframammary and medial attachments of the muscle (SMS type 3) (2). Acellular dermal matrix is shaped to the size of the interval between the split edges of the muscle and secured as an interposition matrix. The skin envelope is draped over the implant, and excess skin is excised. The inframammary fold can be repositioned to the level of the inferior attachments of the pectoralis, which have been left intact and serve as the inferior support for the implant. Drains and incisional wound vac are placed.

Results:
A total of 19 patients underwent SMS implant-based reconstruction between March 2024 and February 2025. Of these, 7 were unilateral, and 12 were bilateral. Mean implant volume was 470cc. Mean age and BMI were 55.9 years and 29.9 kg/m². Eleven breasts were radiated. Mean follow-up time was 6.8 months. Major complications included infected seroma leading to implant loss (n=1, 3.2%) and cellulitis requiring implant exchange (n=1, 3.2%). Other complications included mastectomy flap necrosis (n=1, 3.2%) and capsular contracture (n=1, 3.2%).

Conclusion:
We present a novel split-muscle support pocket for implant-based breast reconstruction which may address the shortcomings of both prepectoral and subpectoral implant-based reconstruction. This technique provides muscular coverage at the most crucial superomedial and lateral aspects of the pocket and autologous inframammary support, while avoiding the animation deformity caused by subpectoral implants. Complication rates are acceptable (3). Future comparative studies with established methods of implant reconstruction are needed.

References: 1. Khan UD. Muscle-splitting breast augmentation: a new pocket in a different plane. Aesthetic Plast Surg. 2007;31(5):553-558. doi:10.1007/s00266-006-0242-1 2. Rigo MH, Piccinini PS, Sartori LDP, de Carvalho LAR, Uebel CO. SMS-Split Muscle Support: A Reproducible Approach for Breast Implant Stabilization. Aesthetic Plast Surg. 2020;44(3):698-705. doi:10.1007/s00266-019-01565-5 3. Vingan PS, Kim M, Boe LA, et al. One-Year Outcomes in Prepectoral versus Subpectoral Alloplastic Breast Reconstruction. Plast Reconstr Surg. Published online February 11, 2025. doi:10.1097/PRS.0000000000012033

Background: Reduction mammoplasties are a common elective procedure in the U.S. with over 75,000 performed in 2023. A common complication after a breast reduction is postoperative hematoma. These can result in further complications with reoperations and poor aesthetic outcome. One technique that is believed to reduce the risk of bleeding and improve aesthetic outcomes is tumescence(Uslu et al). However, the risk of bleeding or hematoma must be balanced with the risk for venous thromboembolism (VTE) in high-risk patients(Lapid et al). Reduction mammoplasties are frequently performed with other procedures, including abdominoplasty and liposuction. This may contribute to increased risk of complications and reoperations(Pouramin et al). In this study, we aimed to assess whether tumescence use, VTE prophylaxis, and concomitant operations contributed to increased risk of hematoma and reoperation. Methods: Multi-institutional retrospective review of 2500 reduction mammaplasties from 2010-2019 was performed to determine the proportion of patients using tumescence during surgery or receiving postoperative VTE prophylaxis with subsequent impact on hematoma and reoperation rates. We also examined associations between adjunct liposuction, concomitant operations, and reoperation rates. Results: 1317(52.7%) breast reductions were performed with tumescence. Tumescence was not associated with an increased risk of hematoma (OR 1.37,p=0.264) or fluid collection (OR1.24,p=0.325). Tumescence was associated with greater resection weights (β=98.6,p<0.001) and a decreased likelihood of reoperation (OR0.73,p=0.029). 54(2.16%) patients received outpatient VTE prophylaxis, which did not increase risk of hematoma (OR1.6,p=0.522). Use of VTE prophylaxis was significantly associated with greater BMI (p=0.038) and greater resection weights (β=158.7,p=0.003). 131(5.24%) patients had adjunct liposuction which had a significant risk for seroma development (OR4.12,p=0.012) and was associated with lower resection weights(β=-117,p=0.006). 189(7.56%) reductions were performed with a concomitant operation, which was associated with increased risk of reoperation (OR1.67,p=0.048). Conclusions: This study found that tumescent technique was associated with a decreased likelihood of reoperation but had no significant association with postoperative hematoma. Similarly, postoperative VTE prophylaxis was not significantly associated with postoperative hematomas, suggesting that both tumescent and VTE prophylaxis are safe in patients undergoing reduction mammoplasties. Adjunct liposuction was associated with increased likelihood of seroma, while concomitant procedures were associated with increased likelihood of reoperation. Patients who are candidates for concomitant procedures, including adjunct liposuction, should be carefully counseled on the increased risks for postoperative complications, including seroma and reoperation.

References: 1. Uslu AB. Effect of Tumescent Lidocaine and Epinephrine Infiltration on Blood Loss in Inferior Pedicle Wise-Pattern Breast Reduction: A Prospective Randomized Study. Aesthetic Plast Surg. 2021 Apr;45(2):442-450. doi: 10.1007/s00266-020-01859-z. Epub 2020 Jul 15. PMID: 32671449. 2. Lapid, O., Pietersen, L., & van der Horst, C. M. (2012). Reoperation for Haematoma after breast reduction with preoperative administration of low-molecular-weight heparin: Experience in 720 patients. Journal of Plastic, Reconstructive & Aesthetic Surgery, 65(11), 1513–1517. doi:10.1016/j.bjps.2012.05.027 3. Pouramin P, Dow T, Williams J. Exploring Complication Rates: A Comparative Study of Breast Reduction and Combined Breast Reduction with Abdominoplasty. Aesthetic Plast Surg. 2024 Nov;48(22):4660-4666. doi: 10.1007/s00266-024-04040-y. Epub 2024 Apr 29. PMID: 38684537.

PURPOSE: Fat necrosis (FN) is a common complication following Deep Inferior Epigastric Artery Perforator (DIEP) flap breast reconstruction, occurring in up to 25.0% of cases (1). FN not only compromises aesthetic outcomes but may also falsely raise concerns regarding cancer recurrence. The purpose of this study is to identify factors associated with the development of postoperative FN in DIEP flap breast reconstruction.

METHODS: This study was conducted in accordance with PRISMA 2020 guidelines. MEDLINE, EMBASE, CINAHL, and CENTRAL databases were systematically searched up to December 4, 2024. Studies reporting the incidence of FN following DIEP flap breast reconstruction were independently screened and extracted by two reviewers. Meta-analyses were performed on variables assessed in at least four comparative studies. Both fixed-effects and random-effects models were utilized to calculate pooled risk ratios (RRs) with corresponding 95% confidence intervals (95% CIs). Heterogeneity was assessed using the I² statistic, with a threshold of 50% being considered significant.

RESULTS: The systematic review identified 100 studies and highlighted 28 independent variables, each supported by at least three studies, as potential factors associated with postoperative FN. Of these 100 studies, 42 were eligible for inclusion in the meta-analysis (MA), representing a total of 9,704 DIEP flaps.

The MA demonstrated significantly reduced FN risk with intra-operative indocyanine green fluorescence (ICG) use (RR=0.64, 95% CI 0.49–0.83, P=0.0008), flaps based solely on lateral row perforators compared to flaps with perforators from both the medial and lateral rows (RR=0.59, 95% CI 0.43–0.82, P=0.001), flaps harvested with ≥2 perforators versus a single perforator (RR=0.68, 95% CI 0.48–0.96, P=0.03), and flaps augmented by an additional Superficial Inferior Epigastric Vein (SIEV) anastomosis (RR=0.48, 95% CI 0.28–0.84, P=0.010). Conversely, FN risk was significantly increased in unilateral compared to bilateral reconstructions (RR=1.53, 95% CI 1.13–2.06, P=0.006) and among patients with a BMI ≥25 (RR=1.60, 95% CI 1.05–2.43, P=0.03).

Factors not significantly associated with FN included prior abdominal surgery or scarring (RR=1.04, 95% CI 0.73–1.49, P=0.81), preoperative CT angiography (RR=0.60, 95% CI 0.33–1.11, P=0.10), and venous outflow augmentation involving any two-vein anastomoses compared to a single DIEP vein anastomosis (RR=0.95, 95% CI 0.71–1.27, P=0.71). Additionally, DIEP flaps based exclusively on medial row perforators compared to lateral row perforators (RR=0.67, 95% CI 0.29–1.53, P=0.34) or combined medial and lateral row perforators (RR=1.23, 95% CI 0.69–2.21, P=0.49) were not significantly associated with post-operative FN.

CONCLUSION: To minimize the risk of postoperative FN, surgeons should carefully select the optimal location and number of perforators, consider intra-operative perfusion mapping with ICG fluorescence, and augment venous outflow through an additional SIEV anastomosis. Patients with a BMI ≥25 or those undergoing unilateral reconstruction should be counselled regarding their increased FN risk.

REFERENCES: 1. Baumann DP, Lin HY & Chevray PM. Perforator number predicts fat necrosis in a prospective analysis of breast reconstruction with free TRAM, DIEP, and SIEA flaps. Plast Reconstr Surg 2010;125(5): 1335–1341. doi: 10.1097/PRS.0b013e3181d4fb4a.

Purpose: Prepectoral direct-to-implant (DTI) breast reconstruction is becoming more commonplace in patients undergoing post-mastectomy breast reconstruction. Increasingly, surgeons are utilizing soft tissue support constructs to optimize post-operative outcomes (1). While acellular dermal matrix (ADM) is a well-established adjunct, newer materials like resorbable poly-4-hydroxybutyrate mesh (GalaFLEX) offer potential advantages in strength and durability (2, 3). Despite growing use, comparative outcome data remains limited amongst these materials. Therefore, we sought to compare outcomes of our two most recent soft tissue support strategies: ADM alone for anterior implant coverage versus ADM and GalaFLEX for complete implant coverage in patients undergoing prepectoral DTI breast reconstruction.

Methods: A retrospective cohort analysis was performed on patients undergoing prepectoral DTI breast reconstruction with either ADM alone or ADM and GalaFLEX between April 2019 and July 2024. In the ADM cohort, the anterior surface of breast implants alone was covered with ADM. For the ADM and GalaFLEX construct, ADM was placed on the anterior/superior surface and GalaFLEX was placed on the remaining anterior/inferior and posterior surface of the implant. All patients received smooth, round, silicone implants. The primary clinical outcome of interest was implant malposition. Secondary outcomes including reconstructive failure, infection, seroma, hematoma, capsular contracture, revision surgeries, and operative costs were also collected. Outcomes at 6 months postoperatively were analyzed.

Results: A total of 170 breasts underwent DTI breast reconstruction with ADM alone and 168 breasts with ADM and GalaFLEX. Patients in the ADM and GalaFLEX cohort were older in age, had higher body mass indices, and had higher rates of hypertension and autoimmune disorders. Patients with ADM and GalaFLEX had significantly lower rates of implant malposition (1.7% vs 17%, p<0.001) and seroma (0% vs 3.5%, p=0.03). On multivariate regression analysis, odds of malposition with ADM and GalaFLEX were significantly lower than with ADM alone (OR=0.088, CI 0.026-0.296, p<0.001). Despite these findings, frequency of revision surgeries was no different between groups. When comparing ADM and GalaFLEX to ADM alone, index operating room costs ($16,053 vs $17,565, p=0.001) were significantly lower.

Conclusions: In prepectoral DTI breast reconstruction, combining ADM with GalaFLEX for implant coverage significantly reduced post-operative rates of implant malposition. Although revision rates were similar, this combination approach aided in reducing index operating room costs. These findings support the use of ADM and GalaFLEX for full breast implant coverage as a safe strategy that improves short term outcomes in prepectoral direct-to-implant breast reconstruction.

References 1. Salibian AA, Bekisz JM, Kussie HC, et al. Do We Need Support in Prepectoral Breast Reconstruction? Comparing Outcomes with and without ADM. Plastic and Reconstructive Surgery – Global Open. 2021;9(8):e3745. doi:10.1097/GOX.0000000000003745 2. Keane AM, Chiang SN, Tao Y, et al. Cortiva versus AlloDerm in Prepectoral and Partial Submuscular Implant-Based Breast Reconstruction: A Randomized Clinical Trial. Plast Reconstr Surg. 2024;154(4S):13S-26S. doi:10.1097/PRS.0000000000011244 3. Karp N, Sorenson TJ, Boyd CJ, et al. The GalaFLEX "Empanada" for Direct-to-Implant Prepectoral Breast Reconstruction. Plastic and Reconstructive Surgery. 2025;155(3):488e. doi:10.1097/PRS.0000000000011592

Introduction: Peri-implant infection is one of the most common complications of implant-based breast reconstruction. Treatment options for periprosthetic infection include intravenous (IV) antibiotics, surgical washout, removal and replacement of prosthesis, percutaneous drainage of fluid collections, and complete removal of the prosthesis. Percutaneous drainage of tissue expander infection has a previously published high failure rate, with 45% of patients requiring subsequent removal of the prosthesis[1]. Surgical washout and replacement with new implants had a failure rate of 11%, while the use of IV antibiotics alone had a failure rate of 24%[1]. Complete prosthesis removal is the most effective method for infection control, but this can lead to scarring, capsular contraction, distortion, poor aesthetic outcomes, and reconstruction abandonment making early salvage attempts critical.

Methodology: Ethical approval from the IRB was obtained prior to initiation of this study. A list of all patients that received a percutaneous drain during the period of 8/1/2015 – 8/24/2024 was compiled, then refined by a keyword search for "breast" in the procedure description, then further reduced to 132 patients after removing duplicate entries. Patients eligible for inclusion were those with infectious symptoms (fever, chills, erythema, warmth, swelling, and pain) and a fluid collection associated with a breast implant who had a percutaneous drain placed. A total of 34 patients met inclusion criteria. Data gleaned through retrospective chart review was entered into a RedCap database[2]. Microsoft Excel was used to analyze descriptive statistics.

Results: There were 34 participants enrolled in this study. 21 participants failed implant salvage and required subsequent operative intervention, while 13 participants had successful implant salvage. Those who required further operative intervention included 3 participants who underwent washout only, 18 with complete removal of the implant, and 0 participants with removal and replacement of implants. 5 participants who failed implant salvage required additional surgical intervention for infection control. Of patients who failed implant salvage, 10 participants (47.6%) abandoned reconstruction or were lost to follow up. Discussion: Our observed failure rate of 61.76% underscores the critical need for careful patient selection and consideration of more aggressive initial management strategies in the presence of periprosthetic infection. Consistent with earlier research, surgical washout combined with implant exchange or complete removal has shown higher success rates compared to percutaneous drainage alone with implant replacement has been documented to have significantly lower failure rates with an over al rate of about 19%[3]. 47.6% of the patients who experienced implant salvage failure ultimately abandoned reconstruction or were lost to follow-up in our study limiting our finding and posing the need for adequate counseling regarding patient expectations.

Conclusions: Among 34 participants, the implant salvage rate was 38.24%, with a failure rate of 61.76%. These findings suggest the limited efficacy of percutaneous drainage for implant salvage and highlight the high likelihood of needing operative management for periprosthetic infections. Nearly half of participants in the failure group abandoned reconstruction or were lost to follow-up, emphasizing patient dissatisfaction with outcomes following failed initial management of periprosthetic infections.

References 1. Nelson, J.A., et al., Management of the Infected Tissue Expander. Plast Reconstr Surg, 2024. 2. Harris, P.A., et al., Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform, 2009. 42(2): p. 377-81. 3. Kanapathy, M., et al., Management of periprosthetic breast infection: a systematic review and meta-analysis. J Plast Reconstr Aesthet Surg, 2021. 74(11): p. 2831-2845.