Breast augmentation surgery using an inframammary fold incision in Southeast Asian women: Patient-reported outcomes

Randquist, Charles,Por, Yong Chen,Yeow, Vincent,Maglambayan, Joy,Simonyi, Susan Korean Society of Plastic and Reconstructive Surge 2018 Archives of Plastic Surgery Vol.45 No.4

Background This analysis presents patient-reported outcomes of breast augmentation procedures performed in Singapore using an inframammary fold incision and the "5 Ps" best practice principles for breast augmentation. These data are the first of their kind in Southeast Asian patients. Methods Through a retrospective chart review, patients who underwent primary breast augmentation with anatomical form-stable silicone gel breast implants using an inframammary fold incision were followed for ${\geq}6$ months postoperatively. The BREAST-Q Augmentation Module (scores standardized to 0 [worst] - 100 [best]) and Patient and Observer Scar Assessment Scale (POSAS; 1 [normal skin] to 10 [worst scar imaginable]) were administered. Responses were summarized using descriptive statistics. Patient-reported events were collected. Results Twenty-two Southeast Asian patients (mean age, 35.1 years) completed ${\geq}1$ postoperative BREAST-Q and POSAS assessment and were assessed 11 months to 5.5 years postoperatively. The mean postoperative BREAST-Q satisfaction with breasts and psychosocial well-being scores were 69.2 and 84.0, respectively. The mean POSAS score for their overall opinion of the scar was 4.2; the mean scores for all scar characteristics ranged from 1.2 to 4.2. Over 90% of patients (20/22) said that they would recommend the procedure. Patient complaints following surgery included anisomastia (possibly pre-existing; n=2), sensory loss at the nipple (n=2) or around the nipple (n=3), scarring (n=4), and slight capsular contracture (n=1). No patients required reoperation. Conclusions Southeast Asian patients reported high long-term satisfaction scores on the BREAST-Q scale and with their scar characteristics following breast augmentation using an inframammary fold incision, and nearly all said they would recommend this procedure. No reoperations were necessary in patients assessed for up to 5.5 years postoperatively.

Distally Based Sural Artery Adipofascial Flap based on a Single Sural Nerve Branch: Anatomy and Clinical Applications

Wan Loong James Mok,Yong Chen Por,Bien-Keem Tan 대한성형외과학회 2014 Archives of Plastic Surgery Vol.41 No.6

Background: The distally based sural artery flap is a reliable, local reconstructive option forsmall soft tissue defects of the distal third of the leg. The purpose of this study is to describean adipofascial flap based on a single sural nerve branch without sacrificing the entire suralnerve, thereby preserving sensibility of the lateral foot. Methods: The posterior aspect of the lower limb was dissected in 15 cadaveric limbs. Fourpatients with soft tissue defects over the tendo-achilles and ankle underwent reconstructionusing the adipofascial flap, which incorporated the distal peroneal perforator, shortsaphenous vein, and a single branch of the sural nerve. Results: From the anatomical study, the distal peroneal perforator was situated at an averageof 6.2 cm (2.5-12 cm) from the distal tip of the lateral malleolus. The medial and lateral suralnerve branches ran subfascially and pierced the muscle fascia 16 cm (14-19 cm) proximal tothe lateral malleolus to enter the subcutaneous plane. They merged 1–2 cm distal to thesubcutaneous entry point to form the common sural nerve at a mean distance of 14.5 cm(11.5–18 cm) proximal to the lateral malleolus. This merging point determined the pivot pointof the flap. In the clinical cases, all patients reported near complete recovery of sensationover the lateral foot six months after surgery. All donor sites healed well with a full range ofmotion over the foot and ankle. Conclusions: The distally based sural artery adipofascial flap allowed for minimal sensory loss,a good range of motion, an aesthetically acceptable outcome and can be performed by asingle surgeon in under 2 hours.

Distally Based Sural Artery Adipofascial Flap based on a Single Sural Nerve Branch: Anatomy and Clinical Applications

Mok, Wan Loong James,Por, Yong Chen,Tan, Bien Keem Korean Society of Plastic and Reconstructive Surge 2014 Archives of Plastic Surgery Vol.41 No.6

Background The distally based sural artery flap is a reliable, local reconstructive option for small soft tissue defects of the distal third of the leg. The purpose of this study is to describe an adipofascial flap based on a single sural nerve branch without sacrificing the entire sural nerve, thereby preserving sensibility of the lateral foot. Methods The posterior aspect of the lower limb was dissected in 15 cadaveric limbs. Four patients with soft tissue defects over the tendo-achilles and ankle underwent reconstruction using the adipofascial flap, which incorporated the distal peroneal perforator, short saphenous vein, and a single branch of the sural nerve. Results From the anatomical study, the distal peroneal perforator was situated at an average of 6.2 cm (2.5-12 cm) from the distal tip of the lateral malleolus. The medial and lateral sural nerve branches ran subfascially and pierced the muscle fascia 16 cm (14-19 cm) proximal to the lateral malleolus to enter the subcutaneous plane. They merged 1-2 cm distal to the subcutaneous entry point to form the common sural nerve at a mean distance of 14.5 cm (11.5-18 cm) proximal to the lateral malleolus. This merging point determined the pivot point of the flap. In the clinical cases, all patients reported near complete recovery of sensation over the lateral foot six months after surgery. All donor sites healed well with a full range of motion over the foot and ankle. Conclusions The distally based sural artery adipofascial flap allowed for minimal sensory loss, a good range of motion, an aesthetically acceptable outcome and can be performed by a single surgeon in under 2 hours.

Subunit Principle of Vulvar Reconstruction: Algorithm and Outcomes

Tan, Bien-Keem,Kang, Gavin Chun-Wui,Tay, Eng Hseon,Por, Yong Chen Korean Society of Plastic and Reconstructive Surge 2014 Archives of Plastic Surgery Vol.41 No.4

Background Vulvar defects result chiefly from oncologic resection of vulvar tumors. Reconstruction of vulvar defects restores form and function for the purpose of coitus, micturition, and defecation. Many surgical options exist for vulvar reconstruction. The purpose of this article is to present our experience with vulvar reconstruction. Methods From 2007 to 2013, 43 women presented to us with vulvar defects for reconstruction. Their mean age at the time of reconstruction was 61.1 years. The most common cause of vulvar defect was from resection of vulvar carcinoma and extramammary Paget's disease of the vulva. Method s of reconstruction ranged from primary closure to skin grafting to the use of pedicled flaps. Results The main complications were that of long term hypertrophic and/or unaesthetic scarring of the donor site in 4 patients. Twenty-two patients (51%) were able to resume sexual intercourse. There were no complications of flap loss, wound dehiscence, and urethral stenosis. Conclusions We present a subunit algorithmic approach to vulvar reconstruction based on defect location within the vulva, dimension of the defect, and patient age and comorbidity. The gracilis and gluteal fold flaps are particularly versatile and aesthetically suited for reconstruction of a variety of vulvar defects. From an aesthetic viewpoint the gluteal fold flap was superior because of the well-concealed donor scar. We advocate the routine use of these 2 flaps for vulvar reconstruction.

Subunit Principle of Vulvar Reconstruction: Algorithm and Outcomes

Bien-Keem Tan,Gavin Chun-Wui Kang,Eng Hseon Tay,Yong Chen Por 대한성형외과학회 2014 Archives of Plastic Surgery Vol.41 No.4

Background: Vulvar defects result chiefly from oncologic resection of vulvar tumors. Reconstructionof vulvar defects restores form and function for the purpose of coitus, micturition,and defecation. Many surgical options exist for vulvar reconstruction. The purpose of thisarticle is to present our experience with vulvar reconstruction. Methods: From 2007 to 2013, 43 women presented to us with vulvar defects for reconstruction. Their mean age at the time of reconstruction was 61.1 years. The most commoncause of vulvar defect was from resection of vulvar carcinoma and extramammary Paget’sdisease of the vulva. Method s of reconstruction ranged from primary closure to skin graftingto the use of pedicled flaps. Results: The main complications were that of long term hypertrophic and/or unaestheticscarring of the donor site in 4 patients. Twenty-two patients (51%) were able to resume sexualintercourse. There were no complications of flap loss, wound dehiscence, and urethral stenosis. Conclusions: We present a subunit algorithmic approach to vulvar reconstruction based ondefect location within the vulva, dimension of the defect, and patient age and comorbidity. The gracilis and gluteal fold flaps are particularly versatile and aesthetically suited for reconstructionof a variety of vulvar defects. From an aesthetic viewpoint the gluteal fold flap wassuperior because of the well-concealed donor scar. We advocate the routine use of these 2flaps for vulvar reconstruction.