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BACKGROUND: The superomedial pedicle reduction mammaplasty has been noted in the literature to provide superior aesthetic results and longevity as well as shorter operative times. However, the inferior pedicle continues to be the most commonly utilized technique in the United States. There is a lack of large-volume outcome studies examining how the superomedial pedicle technique compares against more established reduction methods. METHODS: A retrospective review of 938 reduction mammaplasties was performed at a single institution over a 10-year period. A literature review of superomedial and inferior pedicle complication rates were performed. Study variables were compared against overall mean complication rates for the two techniques. Logistic regression, paired student T-Tests, and Chi-square analyses were used to calculate adjusted odds ratios and to compare continuous and categorical variables. RESULTS: Mean reduction weight was 730 g per breast, ranging from 100 to 4700 g. Overall complication rate was 16%, of which 10% were minor complications related to delayed wound healing. No cases of skin flap necrosis occurred. Increased complications were highly correlated with a BMI > 30, breast reduction weights > 831 g, and sternal notch to nipple distances > 35.5 cm. CONCLUSIONS: The superomedial pedicle reduction mammaplasty technique is safe and reliable with a complication rate lower than the inferior pedicle technique. Based on our findings we propose that residents should be exposed to this method of reduction mammaplasty as part of a compilation of techniques learned in residency and that practicing surgeons would benefit from becoming familiar with its applications.

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BACKGROUND: The desire for efficient and safe office-based facial plastic surgery procedures has continued to rise. Oral sedation is a safe and effective method to provide anesthesia for facial aesthetic surgery. OBJECTIVES: This study reviewed private practice anesthesia-related outcomes using oral sedation combined with local anesthesia for office-based facial aesthetic surgery procedures. METHODS: A retrospective chart review was performed on all patients who underwent office-based facial plastic surgery procedures from July 2008 to July 2014. Patient demographic data including age, gender, body mass index (BMI), past medical history, social history, surgical history, allergies, and medications were collected. Anesthesia-related data were also collected including: American Society of Anesthesia (ASA) class, type of procedure, medications administered, and major complications related to sedation were assessed. RESULTS: There were 199 patients (23 males and 176 females) who underwent 283 facial aesthetic surgical procedures. Mean age was 49.8 years (range, 29 to 80 years). There were 195 patients in ASA class I and 4 patients were in ASA class II. Patients underwent 44 upper blepharoplasty procedures, 35 lower blepharoplasty procedures, 5 browlifts, 43 upper blepharoplasty-browpexy, 46 facelifts, 38 neck lifts/lower facelifts, 54 fat grafting, 3 tip rhinoplasties, and 15 minor revision cases. During the study period, there were no major complications and no sedation issues. CONCLUSIONS: Facial aesthetic surgical procedures can be performed safely and comfortably in the office-based setting under oral sedation in appropriately selected patients. LEVEL OF EVIDENCE 4: Therapeutic.

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BACKGROUND: Traditional latissimus dorsi myocutaneous flap breast reconstruction results in a large wound on the back, difficult inset of flap, and skin color disparity. An anterior approach to harvesting the latissimus dorsi muscle flap reduces morbidity, and with skin-sparing mastectomy, immediate single-stage reconstruction with a permanent implant is provided. METHODS: A retrospective review was performed of patients who underwent skin-sparing mastectomies and immediate reconstruction with the anterior approach latissimus dorsi muscle flap and permanent implant with 6- to 12-month follow-up. All procedures were performed by a single surgeon at three facilities from January of 2008 through December of 2008. Data included the patient's age; body mass index; history of axillary dissection, chemotherapy, or irradiation; occurrence of seroma, flap necrosis, infection, or cellulitis; and the need for further surgery. RESULTS: Fifty-eight reconstructions were performed in 36 patients (bilateral, 22 patients). Major complications included pulmonary embolism in one patient, removal of both implants in one patient because of infection, and removal of one implant because of hematoma. Minor complications included seroma in 40 of 58 procedures (68.9 percent), flap necrosis in seven (12 percent), cellulitis in four (6.8 percent), and a secondary procedure for cosmesis in four (6.8 percent). Seroma formation was more frequent in patients with a body mass index greater than 25 kg/m², patients aged older than 50 years, and after axillary dissection (p > 0.05). CONCLUSIONS: The anterior approach latissimus dorsi muscle flap with permanent implants provides a single-stage reconstructive option after skin-sparing mastectomy. Postoperative morbidity is comparable to that of the traditional latissimus dorsi muscle flap. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

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