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Karol A Gutowski - One of the best experts on this subject based on the ideXlab platform.
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benchmarking outcomes in plastic surgery national complication rates for abdominoplasty and Breast Augmentation
Plastic and Reconstructive Surgery, 2011Co-Authors: Amy K Alderman, Dale E Collins, Rachel Streu, James C Grotting, Amy L Sulkin, Peter C Neligan, Phillip C Haeck, Karol A GutowskiAbstract:Background: The authors evaluated the use of national databases to track surgical complications among abdominoplasty and Breast Augmentation patients. Methods: Their study population included all patients with abdominoplasty or Breast Augmentation in the Tracking Operations and Outcomes for Plastic Surgeons (TOPS) and CosmetAssure databases from 2003 to 2007. They evaluated the incidence of hematoma, infection, and/or deep venous thrombosis/pulmonary embolism. Chi-square and t tests were used for the analyses. Results: The TOPS and CosmetAssure databases included 7310 and 3350 patients with abdominoplasty and 30,831 and 14,227 patients with Breast Augmentation, respectively. In the TOPS and CosmetAssure populations, the complication rates for abdominoplasty were 0.9 percent and 0.5 percent with hematoma (p = 0.29), 3.5 percent and 0.7 percent with infection (p < 0.001 ) , and 0.3 percent and 0.1 percent with deep venous thrombosis/pulmonary embolism (p = 0.05), respectively. The complication rates for Breast Augmentation in TOPS and CosmetAssure were 0.6 percent and 0.7 percent with hematoma (p = 0.21), 0.3 percent and 0.1 percent with infection (p < 0.001), and 0.02 percent and less than 0.01 percent with deep venous thrombosis/pulmonary embolism (p = 0.31), respectively. Conclusions: Complication rates for abdominoplasty and Breast Augmentation were similar in TOPS and CosmetAssure, providing a measure of cross-validation. The low complication rates support the safety of these procedures when they are performed by plastic surgeons. These data should be used by individual practitioners for outcomes benchmarking.
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benchmarking outcomes in plastic surgery national complication rates for abdominoplasty and Breast Augmentation outcomes article
Plastic and Reconstructive Surgery, 2009Co-Authors: Amy K Alderman, Dale E Collins, Rachel Streu, James C Grotting, Amy L Sulkin, Peter C Neligan, Phillip C Haeck, Karol A GutowskiAbstract:Background:The authors evaluated the use of national databases to track surgical complications among abdominoplasty and Breast Augmentation patients.Methods:Their study population included all patients with abdominoplasty or Breast Augmentation in the Tracking Operations and Outcomes for Plastic Sur
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benchmarking outcomes in plastic surgery national complication rates for abdominoplasty and Breast Augmentation
Plastic and Reconstructive Surgery, 2009Co-Authors: Amy K Alderman, Dale E Collins, Rachel Streu, James C Grotting, Amy L Sulkin, Peter C Neligan, Phillip C Haeck, Karol A GutowskiAbstract:Background:The authors evaluated the use of national databases to track surgical complications among abdominoplasty and Breast Augmentation patients.Methods:Their study population included all patients with abdominoplasty or Breast Augmentation in the Tracking Operations and Outcomes for Plastic Sur
Amy K Alderman - One of the best experts on this subject based on the ideXlab platform.
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benchmarking outcomes in plastic surgery national complication rates for abdominoplasty and Breast Augmentation
Plastic and Reconstructive Surgery, 2011Co-Authors: Amy K Alderman, Dale E Collins, Rachel Streu, James C Grotting, Amy L Sulkin, Peter C Neligan, Phillip C Haeck, Karol A GutowskiAbstract:Background: The authors evaluated the use of national databases to track surgical complications among abdominoplasty and Breast Augmentation patients. Methods: Their study population included all patients with abdominoplasty or Breast Augmentation in the Tracking Operations and Outcomes for Plastic Surgeons (TOPS) and CosmetAssure databases from 2003 to 2007. They evaluated the incidence of hematoma, infection, and/or deep venous thrombosis/pulmonary embolism. Chi-square and t tests were used for the analyses. Results: The TOPS and CosmetAssure databases included 7310 and 3350 patients with abdominoplasty and 30,831 and 14,227 patients with Breast Augmentation, respectively. In the TOPS and CosmetAssure populations, the complication rates for abdominoplasty were 0.9 percent and 0.5 percent with hematoma (p = 0.29), 3.5 percent and 0.7 percent with infection (p < 0.001 ) , and 0.3 percent and 0.1 percent with deep venous thrombosis/pulmonary embolism (p = 0.05), respectively. The complication rates for Breast Augmentation in TOPS and CosmetAssure were 0.6 percent and 0.7 percent with hematoma (p = 0.21), 0.3 percent and 0.1 percent with infection (p < 0.001), and 0.02 percent and less than 0.01 percent with deep venous thrombosis/pulmonary embolism (p = 0.31), respectively. Conclusions: Complication rates for abdominoplasty and Breast Augmentation were similar in TOPS and CosmetAssure, providing a measure of cross-validation. The low complication rates support the safety of these procedures when they are performed by plastic surgeons. These data should be used by individual practitioners for outcomes benchmarking.
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benchmarking outcomes in plastic surgery national complication rates for abdominoplasty and Breast Augmentation outcomes article
Plastic and Reconstructive Surgery, 2009Co-Authors: Amy K Alderman, Dale E Collins, Rachel Streu, James C Grotting, Amy L Sulkin, Peter C Neligan, Phillip C Haeck, Karol A GutowskiAbstract:Background:The authors evaluated the use of national databases to track surgical complications among abdominoplasty and Breast Augmentation patients.Methods:Their study population included all patients with abdominoplasty or Breast Augmentation in the Tracking Operations and Outcomes for Plastic Sur
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benchmarking outcomes in plastic surgery national complication rates for abdominoplasty and Breast Augmentation
Plastic and Reconstructive Surgery, 2009Co-Authors: Amy K Alderman, Dale E Collins, Rachel Streu, James C Grotting, Amy L Sulkin, Peter C Neligan, Phillip C Haeck, Karol A GutowskiAbstract:Background:The authors evaluated the use of national databases to track surgical complications among abdominoplasty and Breast Augmentation patients.Methods:Their study population included all patients with abdominoplasty or Breast Augmentation in the Tracking Operations and Outcomes for Plastic Sur
David A Hidalgo - One of the best experts on this subject based on the ideXlab platform.
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current trends in Breast Augmentation an international analysis
Aesthetic Surgery Journal, 2018Co-Authors: Paul I Heidekrueger, David A Hidalgo, Sammy Sinno, Martin Colombo, Niclas P BroerAbstract:Background Breast Augmentation surgery remains the most frequently performed aesthetic surgical procedure worldwide. However, many variations exist regarding preoperative planning, surgical management, and postoperative care. Objectives The goal was to evaluate current trends and practices in Breast Augmentation, with a focus on international variability. Methods A questionnaire was sent to over 5000 active Breast surgeons in 44 countries worldwide. The survey inquired about current controversies, new technologies, common practices, secondary procedures, and surgeon demographics. The findings and variations were evaluated and correlated to evidence-based literature. Results There were a total 628 respondents equaling a response rate of approximately 18%. While certain approaches and common practices prevail also on an international basis, there exist several geographic controversies. For example, while almost fifty percent of surgeons in the United States and Latin America never use anatomically shaped implants, in Europe and Oceania most surgeons use them. Similarly, in Latin America, Europe, Asia, and Oceania, over 80% of surgeons use silicone implants only, whereas in the United States only 20% use them - meanwhile US surgeons use the largest implants (78% > 300 cc). Internationally dominant practice preferences include preoperative sizing with silicone implants, as well as the use of inframammary incisions and partial submuscular pockets. Conclusions Significant differences exist when comparing most common surgical Breast Augmentation approaches on an international basis. While certain techniques seem to be universal standards, there still remain several controversies. Further standardizing this most common aesthetic surgical procedure according to evidence-based guidelines will help to improve outcomes.
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intraoperative comparison of anatomical versus round implants in Breast Augmentation a randomized controlled trial
Plastic and Reconstructive Surgery, 2017Co-Authors: David A Hidalgo, Andrew L WeinsteinAbstract:Background: The purpose of this randomized controlled trial was to determine whether anatomical implants are aesthetically superior to round implants in Breast Augmentation. Methods: Seventy-five patients undergoing primary Breast Augmentation had a round silicone implant of optimal volume, projection, and diameter placed in one Breast and an anatomical silicone device of similar volume and optimal shape placed in the other. After intraoperative photographs were taken, the anatomical device was replaced by a round implant to complete the procedure. A survey designed to measure Breast aesthetics was administered to 10 plastic surgeon and 10 lay reviewers for blind evaluation of the 75 cases. Results: No observable difference in Breast aesthetics between anatomical and round implants was reported by plastic surgeons in 43.6 percent or by lay individuals in 29.2 percent of cases. When a difference was perceived, neither plastic surgeons nor lay individuals preferred the anatomical side more often than the round side. Plastic surgeons judged the anatomical side superior in 51.1 percent of cases and the round side superior in 48.9 percent of cases (p = 0.496). Lay individuals judged the anatomical side superior in 46.7 percent of cases and the round side superior in 53.3 percent (p = 0.140). Plastic surgeons identified implant shape correctly in only 26.5 percent of cases. Conclusions: This study provides high-level evidence supporting no aesthetic superiority of anatomical over round implants. Given that anatomical implants have important and unique disadvantages, a lack of proven aesthetic superiority argues against their continued use in Breast Augmentation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.
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current trends and controversies in Breast Augmentation
Plastic and Reconstructive Surgery, 2016Co-Authors: David A Hidalgo, Sammy SinnoAbstract:BACKGROUND A survey was conducted to study current attitudes and common practices in Breast Augmentation. METHODS A 35-item electronic questionnaire was sent to the entire active American Society of Plastic Surgeons membership. It was divided into current controversies, new technologies, common practices, secondary procedures, and member demographics. RESULTS There were 1067 respondents. Fifty percent of surgeons never use anatomically shaped implants and another 42 percent do so less than half the time. Autologous fat is used infrequently as a primary technique but more often as a supplemental technique. Approximately 7 percent report a case of anaplastic large cell lymphoma. Eighty-five percent do not use preoperative three-dimensional imaging. More than half of surgeons use acellular dermal matrix in secondary procedures. Approximately half do not use insertion funnels. Preoperative sizing with silicone implants, inframammary incisions, partial submuscular pockets, and smooth silicone implants larger than 300 cc are dominant practice preferences. Postoperative massage is still popular with over half of respondents. Just over half do not use pharmacologic agents for capsular contracture. Capsular contracture and size change were the most frequent reasons for reoperation. Capsular contracture is typically treated with anterior capsulectomy the first time, and either total capsulectomy or anterior capsulectomy with acellular dermal matrix use when recurrent. Almost half of respondents perform fewer than 50 Breast Augmentations yearly. CONCLUSIONS There is an established most common approach to Breast Augmentation among respondents. Most surgeons are slow to embrace controversial practices and to adopt new technologies, although acellular dermal matrix use is becoming more popular. The 7 percent incidence of anaplastic large cell lymphoma was noteworthy.
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preoperative sizing in Breast Augmentation
Plastic and Reconstructive Surgery, 2010Co-Authors: David A Hidalgo, Jason A SpectorAbstract:BACKGROUND Implant size selection in Breast Augmentation patients is one of many variables to be determined before surgery. Few methods exist today that allow the patient to participate in this process and accurately determine optimal size. The authors describe a simple method of preoperative sizing using silicone implant samples. METHODS A total of 567 patients underwent Breast Augmentation: 297 had surgery before implementation of preoperative sizing and 270 patients were sized preoperatively. Sizing consisted of fitting the patients with various size silicone implants in a larger bra at least twice before surgery to determine desired size. Surveys were sent to both groups to inquire about overall satisfaction, how many preferred a different size postoperatively, and how many ultimately underwent size change surgery. RESULTS One hundred two responses (34.3 percent) were obtained from the control group and 142 (52.6 percent) were obtained from the sized group. Sized patients received smaller implants (average, 276.6 cc nonsized versus 246.4 cc sized; p < 0.001). Four patients (1.4 percent) in the control group underwent a size change procedure compared with none in the sized group. In the sized cohort, 69 percent believe they are the size that the process predicted, 21 percent are smaller, 9 percent are larger, and 1 percent did not answer the question. CONCLUSIONS Sized patients were more satisfied than controls and fewer were interested in having a different size implant postoperatively. Sized patients indicated that preoperative sizing was both helpful and reasonably accurate in predicting final Breast size.
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the role of methocarbamol and intercostal nerve blocks for pain management in Breast Augmentation
Aesthetic Surgery Journal, 2005Co-Authors: David A Hidalgo, Andrea L PusicAbstract:Background Breast Augmentation is one of the most common plastic surgery procedures performed in the United States. The optimal approach to postoperative pain management has yet to be determined. Objective The objective of this study was to investigate the efficacy of intercostal nerve blocks and oral methocarbamol for postoperative pain control. Method One hundred primary Breast Augmentation patients were randomized to 1 of 4 treatment groups: (1) methocarbamol given with intercostal blocks, (2) methocarbamol given without intercostal blocks, (3) no methocarbamol given with intercostal blocks, and (4) no methocarbamol or intercostal blocks given. The patients and recovery room nurses were strictly blinded to treatment group assignment. Results All patients underwent primary Augmentation with no other procedures performed. Patients who received intercostal nerve blocks required the same amounts of postoperative narcotics as those who did not receive blocks. Their mean visual analog scale (VAS) pain scores also did not differ significantly from those who received blocks. Patients who received preoperative methocarbamol had significantly lower VAS pain scores in the first hours after surgery than did those who did not receive the drug ( P = 0.03). Conclusions This study suggests that intercostal nerve blocks do not significantly decrease postoperative pain following Breast Augmentation. Preoperative use of methocarbamol may be of benefit to help diminish early perioperative pain. In this outpatient cosmetic surgery population, expeditious pain management with minimization of nausea and sedation is critical. A preoperative dose of methocarbamol may be of benefit and merits further investigation.
Kerstin Sandelin - One of the best experts on this subject based on the ideXlab platform.
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polyacrylamide gel injections for Breast Augmentation management of complications in 106 patients a multicenter study
World Journal of Surgery, 2012Co-Authors: Dmytro Unukovych, V V Khrapach, Marie Wickman, Annelie Liljegren, V G Mishalov, Gennadiy Patlazhan, Kerstin SandelinAbstract:Background Polyacrylamide gel (PAAG) was first manufactured in Ukraine in the late 1980s and introduced as a biomaterial for “Breast Augmentation without surgery.” Since it is prohibited in most countries, PAAG injections are rare nowadays, but their consequences and long-term complications can be crucial.
Phillip C Haeck - One of the best experts on this subject based on the ideXlab platform.
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benchmarking outcomes in plastic surgery national complication rates for abdominoplasty and Breast Augmentation
Plastic and Reconstructive Surgery, 2011Co-Authors: Amy K Alderman, Dale E Collins, Rachel Streu, James C Grotting, Amy L Sulkin, Peter C Neligan, Phillip C Haeck, Karol A GutowskiAbstract:Background: The authors evaluated the use of national databases to track surgical complications among abdominoplasty and Breast Augmentation patients. Methods: Their study population included all patients with abdominoplasty or Breast Augmentation in the Tracking Operations and Outcomes for Plastic Surgeons (TOPS) and CosmetAssure databases from 2003 to 2007. They evaluated the incidence of hematoma, infection, and/or deep venous thrombosis/pulmonary embolism. Chi-square and t tests were used for the analyses. Results: The TOPS and CosmetAssure databases included 7310 and 3350 patients with abdominoplasty and 30,831 and 14,227 patients with Breast Augmentation, respectively. In the TOPS and CosmetAssure populations, the complication rates for abdominoplasty were 0.9 percent and 0.5 percent with hematoma (p = 0.29), 3.5 percent and 0.7 percent with infection (p < 0.001 ) , and 0.3 percent and 0.1 percent with deep venous thrombosis/pulmonary embolism (p = 0.05), respectively. The complication rates for Breast Augmentation in TOPS and CosmetAssure were 0.6 percent and 0.7 percent with hematoma (p = 0.21), 0.3 percent and 0.1 percent with infection (p < 0.001), and 0.02 percent and less than 0.01 percent with deep venous thrombosis/pulmonary embolism (p = 0.31), respectively. Conclusions: Complication rates for abdominoplasty and Breast Augmentation were similar in TOPS and CosmetAssure, providing a measure of cross-validation. The low complication rates support the safety of these procedures when they are performed by plastic surgeons. These data should be used by individual practitioners for outcomes benchmarking.
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benchmarking outcomes in plastic surgery national complication rates for abdominoplasty and Breast Augmentation outcomes article
Plastic and Reconstructive Surgery, 2009Co-Authors: Amy K Alderman, Dale E Collins, Rachel Streu, James C Grotting, Amy L Sulkin, Peter C Neligan, Phillip C Haeck, Karol A GutowskiAbstract:Background:The authors evaluated the use of national databases to track surgical complications among abdominoplasty and Breast Augmentation patients.Methods:Their study population included all patients with abdominoplasty or Breast Augmentation in the Tracking Operations and Outcomes for Plastic Sur
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benchmarking outcomes in plastic surgery national complication rates for abdominoplasty and Breast Augmentation
Plastic and Reconstructive Surgery, 2009Co-Authors: Amy K Alderman, Dale E Collins, Rachel Streu, James C Grotting, Amy L Sulkin, Peter C Neligan, Phillip C Haeck, Karol A GutowskiAbstract:Background:The authors evaluated the use of national databases to track surgical complications among abdominoplasty and Breast Augmentation patients.Methods:Their study population included all patients with abdominoplasty or Breast Augmentation in the Tracking Operations and Outcomes for Plastic Sur