Faculty Bibliography

BACKGROUND:Patient reported outcome studies are extremely valuable. We hypothesize that breast reduction surgery has a high satisfaction rate, and that body mass index (BMI), and the amount of breast tissue removed would not alter this outcome. The purpose of this study was to determine if there is an improvement in the quality of life in patients undergoing breast reduction surgery, and whether breast volume or patient size influences this outcome. METHODS:A retrospective chart review was performed on 600 consecutive patients at a single institution from 2000 to 2010. Patients were mailed The Breast Q questionnaire to complete. Demographic, surgical, and clinical data were collected and entered into a database. Descriptive statistical analyses were conducted using SAS Software version 9.1.3 with statistical significance determined at P<0.05. RESULTS:A total of 178 surveys were returned and included in our study (a response rate of 29.6%). Patient data included a mean BMI of 28.3 (4.6) kg/m, and mean total amount of breast tissue removed of 1220.9 (665.4) g. The primary indications for patients having breast surgery were for symptomatic macromastia (85%), asymmetry (5.6%), and for cosmesis (2.5%). The Breast Q questionnaire demonstrated patients overwhelmingly agreed that they were satisfied with their breast surgery. The mean response was 2.8 with a standard deviation (SD) of 0.47 (where 1, disagree; 2, somewhat agree; and 3, definitely agree). Patient BMI and total amount of breast tissue removed had a statistically significant positive correlation (0.479; P<0.0001). There was no statistically significant difference between the amount of total breast tissue removed and patient response (P=0.57). CONCLUSIONS:The study supports a positive outcome after breast reduction surgery. Over 95% of the patients surveyed were satisfied and would do it again. It demonstrates the improvement of the patient's quality of life regardless of the amount of breast tissue removed. Furthermore, it suggests that the size and weight of the patient has no impact on this outcome. As we face new government and insurance restrictions for surgeries that have both cosmetic and reconstructive value, patient reported outcome studies may have an influence on future third-party payer.

BACKGROUND:In light of the scarce literature published regarding seroma formation following abdominoplasty when performed with or without liposuction, the objective of this study was to determine whether abdominoplasty performed in conjunction with flank liposuction confers an increased risk for seroma formation compared with abdominoplasty alone. METHODS:This was a retrospective cohort study of 200 patients who underwent abdominoplasty with or without liposuction from 2004 to 2007. Medical records were reviewed to collect data regarding patient demographics, length of drain use, operative technique, seroma formation, and other complications. Seroma formation was determined by physical examination 1 week after closed-suction drain removal. Logistic regression analysis was used to determine independent predictors of seroma formation. Results were considered significant for values of p < 0.05. RESULTS:One hundred twenty-five patients underwent abdominoplasty with flank liposuction and 75 patients underwent abdominoplasty alone. The incidence of seroma formation was 16.0 percent in the abdominoplasty-alone group and 31.2 percent in the abdominoplasty with liposuction group (p < 0.05). The mean age was 43.1 ± 10.2 years and the mean body mass index was 27.3 ± 5.4 kg/m2. Increasing body mass index (odds ratio, 1.1; 95 percent confidence interval, 1.02 to 1.17) and liposuction of the flanks (odds ratio, 3.3; 95 percent confidence interval, 1.37 to 7.97) were independent and significant predictors of seroma formation in abdominoplasty patients. CONCLUSIONS:Patients should be counseled regarding an increased risk of seroma formation following abdominoplasty when combined with liposuction of the flanks. In addition, patients who are overweight are at increased risk for developing a postoperative seroma compared with patients with normal body mass indices.

Endometriosis is described as the presence of functioning endometrial tissue outside the uterine cavity. Scar endometriosis is a rare disease, and is difficult to diagnose. The symptoms are nonspecific, typically involving abdominal wall pain at the incision site at the time of menstruation. It commonly follows obstetrical and gynecological surgeries. The diagnosis is frequently made only after excision of the diseased tissue. A case report of a patient with a troublesome scar after a caesarian section is presented. Surgical excision led to the diagnosis of scar endometriosis. The pathogenesis, diagnosis and treatment of this somewhat rare condition are discussed.

Neurothekeoma is a rare and benign tumour that occurs most frequently on the head and neck. It is classified as a nerve sheath tumour and epidemiologically occurs in young adults. It is rare to find these tumours occurring in children. The following report describes a case of neurothekeoma in a young girl, its treatment and a review of the literature. Specific histological analysis may reveal atypical and aggressive features, which, in turn, affect resection and reconstructive options.