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Gynecomastia Has Psychological Impact on Adolescent Boys, Reports Plastic and Reconstructive Surgery

Brenda.Busick — Wed, 03 Apr 2013 01:50:40 +0000

Effects on Self-Esteem and Social Functioning Support ‘Early Intervention and Treatment’

Philadelphia, Pa. (April 2, 2013) – Persistent breast enlargement (gynecomastia) negatively affects self-esteem and other areas of mental and emotional health in adolescent males, reports the April issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

Even mild gynecomastia can have adverse psychological effects in boys, according to the study by ASPS Member Surgeon Dr. Brian I. Labow and colleagues of Boston Children’s Hospital. They believe their findings have important implications for early intervention and treatment, including male breast reduction in appropriate cases.

Study Shows Psychological Impact of Gynecomastia in Boys

The researchers administered a series of psychological tests to 47 healthy boys, average age 16.5 years, being evaluated for gynecomastia. The results were compared to those of a group of boys without breast enlargement.

Sixty-two percent of the gynecomastia patients had mild to moderate breast enlargement. As in previous studies, many of the boys with gynecomastia were overweight or obese: 64 percent, compared to 41 percent of the comparison group.

Patients with gynecomastia had lower scores on a standard quality of life assessment, indicating problems in several areas. Even after adjustment for weight and body mass index (BMI), the patients had lower scores for general health, social functioning and mental health. They also had lower scores for physical health, but this was attributed to being overweight.

Breast enlargement was also associated with lower scores for self-esteem. This, along with impairment in emotional areas of quality of life, appeared directly related to gynecomastia, rather than being overweight.

Boys with gynecomastia also scored higher on a test of attitudes toward food and eating. However, there was no difference in the rate of clinical eating disorders between groups.

Psychosocial Effects Independent of Gynecomastia Severity

The negative psychological effects of gynecomastia were similar for boys at different levels of severity. “Merely having gynecomastia was sufficient to cause significant deficits in general health, social functioning, mental health, self-esteem, and eating behaviors and attitudes compared with controls,” Dr. Labow and coauthors write.

Gynecomastia is benign enlargement of male glandular tissue that is very common in adolescent boys. Although breast enlargement usually resolves over time, the problem persists in about eight percent of boys. Typically, boys with gynecomastia who are overweight or obese may simply be advised to lose weight.

However, losing weight won’t correct the problem in patients who have true glandular enlargement, or in those with a large amount of excess skin in the breast area. As shown by the new study, patients with gynecomastia may experience emotional and self-esteem issues regardless of body weight or the severity of breast enlargement.

“As a result, early intervention and treatment for gynecomastia may be necessary to improve the negative physical and emotional symptoms,” Dr. Labow and coauthors state. They note that male breast reduction, performed by a qualified plastic surgeon, is typically a simple and safe procedure.

It may seem self-evident that breast enlargement could have a psychological and emotional impact on teenage boys. However, adolescent gynecomastia has historically been regarded as a “cosmetic” procedure, not reimbursed by most insurance plans. The researchers note that only 35 percent of adolescent boys undergoing surgery for gynecomastia at their hospital were covered by insurance, compared to 85 percent of girls undergoing breast reduction.

“Our results indicate that careful and regular evaluation for gynecomastia may benefit adolescents regardless of BMI status or severity of gynecomastia,” Dr. Labow and colleagues conclude. They call for further studies to evaluate the effects of male breast reduction, including its impact on physical and psychological symptoms.

Plastic and Reconstructive Surgery® is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.

About Plastic and Reconstructive Surgery

For more than 60 years, Plastic and Reconstructive Surgery® (http://journals.lww.com/plasreconsurg/) has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. The official journal of the American Society of Plastic Surgeons, Plastic and Reconstructive Surgery® brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair, and cosmetic surgery, as well as news on medico-legal issues.

About ASPS

The American Society of Plastic Surgeons (ASPS) is the world’s largest organization of board-certified plastic surgeons. Representing more than 7,000 Member Surgeons, the Society is recognized as a leading authority and information source on aesthetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada. ASPS advances quality care to plastic surgery patients by encouraging high standards of training, ethics, physician practice and research in plastic surgery. You can learn more and visit the American Society of Plastic Surgeons at www.plasticsurgery.org or www.facebook.com/PlasticSurgeryASPS and www.twitter.com/ASPS_news.

About Lippincott Williams & WilkinsLippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes.

LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2012 annual revenues of €3.6 billion ($4.6 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

‘Sharps’ Injuries Have Major Health and Cost Impact for Surgeons

Brenda.Busick — Wed, 03 Apr 2013 01:45:58 +0000

Need for Increased Awareness, Reporting and Prevention, Says Review in Plastic and Reconstructive Surgery

Philadelphia, Pa. (April 2, 2013) – Injuries caused by needles and other sharp instruments are a major occupational hazard for surgeons—with high costs related to the risk of contracting serious infectious diseases, according to a special article in the April issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

ASPS Member Surgeon Dr. Kevin C. Chung and colleagues at The University of Michigan Health System, Ann Arbor, review the risks, health impact and costs of “sharps” injuries for surgeons and other operating room personnel. They write, “Increased attention to the health, economic, personal and social implications of these injuries is essential for appropriate management and future prevention.”

High Rate of Sharps Injuries in OR—Surgeons at Highest Risk

Nearly 400,000 sharps injuries occur each year in the United States. About 25 percent of injured workers are surgeons—for whom the risk is highest in the operating room. “Despite healthcare policies designed to protect healthcare workers, injuries remain common,” Dr. Chung and colleagues write. Nearly all surgeons will sustain a sharps injury sometime during their career. Medical students and residents are also at high risk; fatigue and inexperience are important risk factors.

The main health concern of sharps injuries is the risk of acquiring a communicable disease from a patient. While HIV is the most-feared result, the risk of infection with hepatitis B virus is actually much higher. Sharps injuries can also have a major psychological impact on the injured person and his or her family—particularly during the time needed to confirm that the injured worker is free of infection, which may take several weeks or months.

Once an injury occurs, there are standardized guidelines for post-exposure prevention, depending on whether the patient has any known transmissible infections. Recommendations include antiviral medications for healthcare workers exposed to HIV and hepatitis B or C virus—ideally starting within hours after the injury.

As a result of the need for testing and treatment, sharps injuries have a major economic impact. Average costs for testing, follow-up and preventive treatment range from $375 for needlestick exposure from a patient with no known blood-borne illness, up to nearly $2,500 for injuries from a patient with known HIV.

Need for Increased Emphasis on Reporting and Prevention

Post-exposure prevention can only be executed if the injury is reported. One study found that 70 percent of surgeons “never or rarely” report sharps injuries. They may feel they “don’t have time” to report, or may misunderstand the risks involved.

“Fortunately, the majority of sharps injuries are preventable,” Dr. Chung and colleagues write. Engineered safety devices can prevent many injuries—especially if surgeons and other workers are involved in choosing to use them. Other options include the use of “non-sharp” alternatives, creating safe procedures for passing sharp instruments and wearing double gloves to reduce the risk of infection.

Over the years, regulations have been introduced to ensure that proper prevention and reporting strategies are in place. Introduction of the Needlestick Safety and Prevention Act of 2000 led to an overall 38 percent reduction in injuries in all care settings. However, one study reported that the rate of sharps injuries in the operating room actually increased. “Although preventive strategies exist, their success ultimately relies on clinician compliance,” Dr. Chung and coauthors write.

The authors hope their review will help to increase awareness of the risks and potential harms of sharps injuries among surgeons and operating room personnel, and to increase awareness of efforts to reduce the risk. They conclude, “Targeting educational initiatives during medical school and training may improve knowledge among surgeons of the safest ways to practice in the operating room, and ensuring compliance among all surgeons in practice can reduce the economic and psychosocial burden of these highly prevalent injuries.”

Plastic and Reconstructive Surgery® is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.

About Plastic and Reconstructive Surgery

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Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Round or ‘Shaped,’ Implants Yield Good Results in Breast Reconstruction, Reports Plastic and Reconstructive Surgery

Brenda.Busick — Fri, 01 Mar 2013 15:05:09 +0000

Study Provides Data on ‘Patient-Reported Outcomes’ for Different Types of Silicone Implants

Philadelphia, Pa. (February 28, 2013) –For women undergoing breast reconstruction using implants, most patient-reported outcomes are similar with two different shapes of silicone gel-filled implants, reports a study in the March issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

Assessment of key areas of quality of life after breast reconstruction shows few significant differences with conventional round implants versus newer “shaped” implants, according to the new research, led by Dr. Sheina A. Macadam of University of British Columbia, Vancouver.

Does Implant Shape Affect Breast Reconstruction Outcomes?

The researchers evaluated patient-reported outcomes in women who underwent breast reconstruction with implants after mastectomy for breast cancer. Reconstructions were done using two different types of silicone gel-filled implants: conventional round implants and anatomical “shaped” implants. The study included 65 women receiving round implants and 63 receiving shaped implants; the round implants all had a smooth surface, while the shaped implants had a textured surface

The patients completed the BREAST-Q© questionnaire, which evaluated changes in several areas of health-related quality of life, including satisfaction with breasts and with overall outcome, psychosocial, sexual, and physical well-being, and satisfaction with care. Quality of life is increasingly regarded as an important factor in evaluating the benefits of various types of medical or surgical treatments.

Data on patient-reported outcomes was collected one to four years after breast reconstruction. About 80 percent of women in both groups had reconstruction immediately after mastectomy.

The BREAST-Q data showed good overall outcomes with both types of implants. Average scores for satisfaction with the overall reconstruction (on a 100-point scale) were approximately 77 for women receiving shaped implants and 75 for those with round implants. Scores for satisfaction with the breasts were about 64 in both groups.

Scores in other areas—including psychological and sexual well-being—were also similar for the two groups. Just one area differed significantly between groups: women with shaped implants rated their breasts as firmer than women with round implants.

Findings May Help to Guide Women’s Choice of Implants

In a finding important to plastic surgeons, there was no difference in implant “rippling” between groups. Rippling, or wrinkling, had been a drawback of the first generation of shaped implants. Newer shaped silicone implants are not yet approved in the United States; clinical trials are underway.

New implants are introduced to the breast reconstruction market with limited data on the outcomes important to patients—especially in terms of how the reconstruction affects key areas of quality of life. “Patient-reported outcomes data is required to provide guidance based on previous patients’ experience and satisfaction profiles,” Dr. Macadam and colleagues write.

The new study finds few differences in patient-reported outcomes after breast reconstruction with round versus shaped implants. “[T]hese two types of silicone implants are equivalent in terms of satisfaction with outcome,” according to the authors.

Dr. Macadam and colleagues point out the increased firmness of shaped implants as “the one notable difference” between the two types. They believe their findings will help surgeons inform patients about the expected outcomes of reconstruction using round versus shaped implants, and may help to guide introduction of the shaped implants for widespread use.

Plastic and Reconstructive Surgery® is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.

About Plastic and Reconstructive Surgery

About ASPS

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Secondary Facelift Achieves Good Results, Reports Plastic and Reconstructive Surgery

Brenda.Busick — Fri, 01 Mar 2013 15:01:43 +0000

Most Patients Found to Have a Second Facelift Ten Years After the First

Philadelphia, Pa. (February 28, 2013) – Performed an average of a decade after initial facelift surgery, a “secondary” facelift can achieve similarly lasting results with a low complication rate, according to a paper in the March issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

Dr. Rod J. Rohrich and colleagues of University of Southwestern Medical Center, Dallas, report their 20-year experience with secondary facelift surgery, or “rhytidectomy.” The researchers conclude that, with attention to some key surgical principles, “Secondary rhytidectomy is a safe and effective procedure for continued surgical facial rejuvenation in the aging patient.”

Experience Shows Good Results with Secondary Facelift Surgery

From 1990 through 2010, Dr. Rohrich performed more than 800 facelift operations. Sixty of those were secondary facelifts—repeat procedures to treat recurrent signs of facial aging. The new study reviewed this experience to gain insights into the technique, outcomes and longevity of the results of secondary facelifts. (The analysis excluded patients undergoing minor “revisions” after facelift surgery.)

The experience included 57 women and three men undergoing secondary rhytidectomy. The patients averaged 51 years of age at the time of their initial facelift and 60 years at their secondary facelift. Thus for these patients, the results of the initial facelift lasted an average of nine years.

Of the 60 patients undergoing a second facelift, 10 later underwent a third facelift procedure. The time between the second and third procedures was 7.5 years—suggesting that the results of the secondary facelift lasted about as long as those of the initial procedure.

The complication rate after secondary rhytidectomy was about five percent. Consistent with previous studies, the risk of complications was about the same after secondary versus primary facelift surgery. In contrast to some reports, there was no increase in the rate of facial nerve injury after secondary facelift.

Study Highlights Importance of the ‘Five R’s’

An increasing number of patients have undergone second or even third facelifts in recent years. “With an ever-growing middle-aged population and an overall interest in facial rejuvenation at an earlier age, there has been a substantial increase in patients undergoing secondary rhytidectomy,” according to Dr. Rohrich and colleagues.

While their experience suggests good results, researchers emphasize that secondary facelift procedures may require some unique surgical techniques. Dr. Rohrich and colleagues outline some important principles for plastic surgeons to follow in planning and carrying out secondary facelifts. They write, “Adherence to the five R’s of secondary rhytidectomy (resect, release, reshape, refill and redrape) will enable the plastic surgeon to safely restore youth and correct stigmata of primary facelift.”

The article includes brief descriptions of individual cases illustrating the authors’ approach to some of the unique challenges of secondary rhytidectomy—reflecting not only the effects of continued aging, but also some “stigmata” of the initial facelift. Dr. Rohrich and colleagues conclude, “Use of five ‘R’s’ described in this article…will help patients return to a natural and youthful look of beauty, even a second time.”

Plastic and Reconstructive Surgery® is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.

About Plastic and Reconstructive Surgery

About ASPS

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Inhaled Betadine Leads to Rare Complication

Brenda.Busick — Thu, 21 Feb 2013 21:48:16 +0000

Craniofacial Surgeons Recommend Steps to Lower Risk of Pneumonitis from Povidone-Iodine

Philadelphia, Pa. (February 21, 2013) – A routine step in preparing for cleft palate surgery in a child led to an unusual—but not unprecedented—case of lung inflammation (pneumonitis), according to a report in the The Journal of Craniofacial Surgery. The journal, edited by Mutaz B. Habal, MD, FRCSC, is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The complication resulted from accidental inhalation of povidone-iodine (PI), or Betadine—an antiseptic widely used before surgery. The rare complication led to new surgical “prep” steps to reduce the chances of inhaling PI during head and neck surgery, write Drs. Kyle J. Chepla and Arun K. Gosain of University Hospitals–Case Medical Center, Cleveland.

Betadine Inhlation Leads to Chemical Pneumonitis

Drs. Chepla and Gosain describe their experience with Betadine-induced pneumonitis in a seven-year-old girl undergoing surgery for a persistent cleft palate deformity. After a breathing tube was placed and anesthesia was induced, the patient underwent routine surgical prep—including scrubbing and rinsing the nose and mouth with Betadine.

Betadine is the familiar antiseptic, orange or yellow in color, used before many types of medical and surgical procedures. In the case report, Dr. Kepla writes that he has routinely used Betadine for prep before craniofacial surgery for more than 20 years with no complications.

But in this case, shortly after rinsing the inside of the nose, the surgeons noted Betadine in the patient’s breathing tube. She rapidly developed difficulty breathing, with a drop in blood oxygen levels.

The procedure was stopped and the patient was rushed to the ICU for treatment. Although the child eventually recovered completely, she required seven days of mechanical ventilation.

This patient’s condition was diagnosed as chemical pneumonitis—inflammation of the lungs caused by inhalation of some type of irritant. Pneumonitis most commonly results from inhalation (aspiration) of the stomach contents.

Because it is effective against a wide range of bacteria, viruses, and other pathogens, Betadine is one of the most commonly used disinfectants. It is useful in preparing for surgical procedures of the head and neck, because it does not irritate the mucosal lining. However, studies in animals have shown that Betadine can cause inflammatory damage to the lungs, if inhaled.

Prompted by their experience, Drs. Chepla and Gosain performed a comprehensive review of the medical literature to look for similar cases. The review identified three previous cases of chemical pneumonitis caused by Betadine after disinfection of the mouth. All patients recovered after a period of mechanical ventilation.

Although Betadine-induced pneumonitis appears very rare, Drs. Chepla and Gosain have modified their routines to reduce the risk of this complication. They write, “We conclude that PI is safe to use as a disinfectant before head and neck surgery, but surgeons need to be aware of the risk for PI aspiration and take the appropriate steps to prevent its passage into the tracheobronchial tree.”

About The Journal of Craniofacial Surgery

The Journal of Craniofacial Surgery serves as a forum of communication for all those involved in craniofacial and maxillofacial surgery. Coverage ranges from practical aspects of craniofacial surgery to the basic science that underlies surgical practice. Affiliates include 14 major specialty societies around the world, including the American Association of Pediatric Plastic Surgeons, the American Academy of Pediatrics Section of Pediatric Plastic Surgery, the American Society of Craniofacial Surgeons, the American Society of Maxillofacial Surgeons, the Argentine Society of Plastic Surgery Section of Pediatric Plastic Surgery, the Asian Pacific Craniofacial Association, the Association of Military Plastic Surgeons of the U.S., the Brazilian Society of Craniofacial Surgeons, the European Society of Craniofacial Surgery, the International Society of Craniofacial Surgery, the Japanese Society of Craniofacial Surgery, the Korean Society of Craniofacial Surgery, the Thai Cleft and Craniofacial Association, and the World Craniofacial Foundation.

LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

The Journal of Craniofacial Surgery Honors Dr. Joseph E. Murray

Brenda.Busick — Tue, 12 Feb 2013 18:25:07 +0000

Tribute to Nobel Prize Winner and ‘Master of Plastic Surgery’ Leads off January Issue

Philadelphia, Pa. (February 12, 2013) – The field of surgery lost a giant last year with the death of Joseph E. Murray, MD, Nobel laureate in medicine and biology and a pioneer in both transplantation and craniofacial surgery. A special tribute to Dr. Murray appears in the January issue of The Journal of Craniofacial Surgery, published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Mutaz Habal, MD, Editor-in-Chief of The Journal of Craniofacial Surgery, shares an editorial celebrating the career and contributions of Dr. Murray as a mentor, colleague, and friend. Dr. Habal’s is one of several tributes included in the special January issue, which also features updates on new research developments and clinical problems of interest to plastic, reconstructive, and craniofacial surgeons.

Memories of Dr. Murray by a Colleague and Friend

Dr. Murray died last November at age 93. His place in history is assured as the surgeon who performed the first successful human kidney transplant, between a pair of identical twins, in 1954. Dr. Murray went on to perform groundbreaking research in transplantation biology and tissue and organ rejection.

Dr. Murray was also instrumental in developing immunosuppressive drugs that led to the development of modern organ transplantation. In 1990, he shared the shared the Nobel Prize in Physiology or Medicine with Dr. E. Donnall Thomas “for their discoveries concerning organ and cell transplantation in the treatment of human disease.” (Dr. Thomas, a pioneer in bone marrow transplantation, also died last year.)

At a time when transplantation surgery is a specialty in its own right, it may be surprising to learn that Dr Murray’s specialty was plastic surgery. His interest in transplantation developed from his experience with skin grafting as a military surgeon treating seriously burned patients.

In his editorial, Dr. Habal recalls his first encounter Dr. Murray during a lecture question-and-answer period more than four decades ago. Dr. Habal went on to train with Dr. Murray in the Department of Plastic Surgery at Harvard University and Brigham and Women’s Hospital. It was a time of groundbreaking contributions to craniofacial surgery—including the first mid-face advancement surgery, and the correction of hypertelorism. Dr. Murray inspired all the young surgeons who became the spear head of the development of the field of craniofacial surgery with his work on composite transplantation with Dr. John Woods, which was the grounds for the development of face transplant at the same medical institution. This was well discussed as the new frontier in plastic surgery.

“This special issue of the journal should serve as an inspiration to the young and newcomers of the specialty as a model for the advancement of their careers,” Dr. Habal writes. “Dr. Murray taught us all that the patient comes first, and self-promotion is out of the formula of patient care.”

New Research on Wound Healing, and Two Unusual Injuries

The special issue includes a number of other tributes to Dr. Murray—including one by Elof Eriksson, MD, PhD, who succeeded Dr. Murray as Chief of Plastic Surgery at Brigham and Women’s Hospital. Along with his colleagues Johan P.E. Junker, PhD, and E.-J. Caterson, MD, PhD, Dr. Eriksson is coauthor of an update on the microenvironment of wound healing. They report on recent research showing that a “wet, incubator-like environment provides the fastest healing with fewest aberrations and least scar formation.”

The researchers have created a “wound chamber” that creates a wet environment, promoting survival and proliferation of transplanted cells and tissues. Dr. Eriksson and colleagues conclude, “With the addition of various active molecules and cells, it also provides a platform technology for regeneration in vivo.”

The special issue also present brief reports on unusual wounds of special interest to plastic, reconstructive, and craniofacial surgeons. One report describes “conductive contact burns” as a serious injury caused by overexposure to Korean-style hot dry saunas. Another suggests that titanium miniplates used in reconstructive surgery may be a risk factor for osteonecrosis in elderly patients taking bisphosphonate drugs for osteoporosis.

Dr. Habal comments, “We believe the tributes to Dr. Murray, along with the cutting-edge research and practical clinical information presented in our special issue, are a fitting memorial to a surgeon-scientist who contributed so much to the fields of plastic, transplantation, and craniofacial surgery—thus affecting the lives of countless patients, now and in the future.”

About The Journal of Craniofacial Surgery

The Journal of Craniofacial Surgery, under the guidance of Editor-in-Chief Mutaz B. Habal, MD, serves as a forum of communication for all those involved in craniofacial and maxillofacial surgery. Coverage ranges from practical aspects of craniofacial surgery to the basic science that underlies surgical practice. Affiliates include 14 major specialty societies around the world, including the American Association of Pediatric Plastic Surgeons, the American Academy of Pediatrics Section of Pediatric Plastic Surgery, the American Society of Craniofacial Surgeons, the American Society of Maxillofacial Surgeons, the Argentine Society of Plastic Surgery Section of Pediatric Plastic Surgery, the Asian Pacific Craniofacial Association, the Association of Military Plastic Surgeons of the U.S., the Brazilian Society of Craniofacial Surgeons, the European Society of Craniofacial Surgery, the International Society of Craniofacial Surgery, the Japanese Society of Craniofacial Surgery, the Korean Society of Craniofacial Surgery, the Thai Cleft and Craniofacial Association, and the World Craniofacial Foundation.

LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Face Transplantation Calls for ‘Reverse Craniofacial Planning’

Brenda.Busick — Tue, 11 Dec 2012 03:31:56 +0000

Principles of Craniofacial Surgery Can Inform the Surgical Plan, Says Report in The Journal of Craniofacial Surgery

Philadelphia, Pa. (December 10, 2012) – As surgical teams gain experience with facial transplantation, a careful approach to planning based on the principles of craniofacial surgery can help to maximize patient outcomes in terms of facial form and function, according to an article in The Journal of Craniofacial Surgery. The journal, under the editorship of Mutaz B. Habal, MD, is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

In patients with extensive facial defects including loss of the normal bone and soft tissue landmarks, a “reverse craniofacial planning” approach can restore normal facial relationships, the report suggests. The lead author was Dr. Edward J. Caterson, a member of the facial transplant team at Brigham and Women’s Hospital/Harvard Medical School, Boston.

Craniofacial Principles Applied to Facial Transplantation

Dr. Caterson and colleagues apply some basic principles of craniofacial surgery to the planning and performance of facial transplants. Although still a rare and relatively new procedure, facial transplantation now offers a reconstructive option for patients with severe facial deficits. Most patients who are candidates for facial transplant have loss of soft tissues only (such as skin, muscle, blood vessels, and nerves).

However, some patients also have defects of the underlying facial bones. In these cases, the challenge for the facial transplant team is nothing less than “the complete restoration of the structural anatomy of the craniofacial skeleton,” the authors write.

Through their experience with reconstructive surgery in patients with severe congenital deformities, craniofacial surgeons have developed an understanding of the “intimate functional relationship” between the facial soft tissue and supporting bone. In the traditional craniofacial procedure, the surgeon carefully plans and designs “bone movements that will translate into a desired change of the attached soft tissues.”

But in facial transplantation, the situation is essentially reversed: the degree of injury and the subsequent transplantation of facial soft tissues dictate the “osteosynthesis” of the craniofacial skeleton. Dr. Caterson and colleagues describe a simple but practical technique for surgical planning to promote proper positioning of the facial transplant. The technique applies “normative” data on facial landmarks and relationships and then transposes them onto the recipient.

Understanding the relationships of facial structure allows surgeons to compensate for missing bony or soft tissue landmarks. The authors provide a straightforward approach to establishing a plane of reference, allowing the facial transplant to be positioned in a proper relationship with the skull base and occlusal plane (teeth and lower face).

Optimal positioning of the facial transplant is essential not only to achieve the most normal-appearing result, but also to maximize function—particularly in eating and breathing. Dr. Caterson and colleagues emphasize that “proper positioning of the hard tissues of the allograft is the fundamental starting point for functional and aesthetic restoration.” As long as the bony structure is right, any cosmetic soft tissue problems that remain after surgery are relatively easy to correct.

The authors believe that such craniofacial principles are likely to become an increasingly important consideration—”especially with the trend toward full face transplantation.” In early experience, donor selection for face transplantation has focused mainly on immunological factors—similar to those used in organ transplantation.

In the future, transplant teams may become more sophisticated in donor selection—including assessment of the degree of “craniofacial match” between donors and recipients. In the meantime, Dr. Caterson and coauthors conclude, “[C]areful attention to the soft tissue relationships with the skeletal anatomy requires that face transplantation include ‘reverse craniofacial planning’ to optimize the form and function of the recipient’s new face.”

About The Journal of Craniofacial Surgery

LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Implant-Based Breast Reconstruction Following Radiation Has High Patient Satisfaction Rate

Brenda.Busick — Tue, 02 Oct 2012 19:22:30 +0000

Autologous Tissue-Based Reconstruction Has Lower Incidence of Major Corrective Surgery, Reports Plastic and Reconstructive Surgery

Philadelphia, Pa. (October 2, 2012) – Breast cancer patients who have received radiation therapy after mastectomy have more problems related to the use of implants for breast reconstruction, according to a review in the October issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

Although women should be aware of these increased risks, implant-based breast reconstruction after radiation therapy is still successful in most cases, according to the paper by Dr. Steven J. Kronowitz of The University of Texas MD Anderson Cancer Center, Houston.

Breast Implants after Radiation Carry Increased Risks

Dr. Kronowitz reviews and synthesizes recent research on breast reconstruction using implants for patients receiving radiation therapy. To reduce the risk of recurrent breast cancer, increasing numbers of women are being treated with radiation therapy after mastectomy (postmastectomy radiation therapy, or PMRT). Radiation has toxic effects on tissues that can cause problems with healing.

Reconstructive surgeons agree that breast reconstruction results after radiation therapy tend to be better when the patient’s own (autologous) tissue is used. However, in some situations implants may be the preferred option for reconstruction, or the only choice. The goal of the review was to analyze the best available evidence on the use of breast implants after radiation therapy.

Dr. Kronowitz identified 19 studies, of varying quality, evaluating the results of implant-based reconstruction in patients receiving PMRT. He writes, “In general, radiation increases the risk of complications and poor aesthetic outcomes of implant-based reconstruction.”

In one of the largest studies performed to date, the risk of major complications was about 45 percent for women receiving implants with radiation therapy, compared to 24 percent in patients not exposed to radiation. Complications were more common when radiation was given before versus after implant-based reconstruction: 64 versus 58 percent.

The highest-quality study found that, among women undergoing implant reconstruction, patient satisfaction scores were lower for those receiving radiation therapy. Another study reported that women receiving implants after radiation therapy were more likely to need major corrective surgery.

Newer Techniques May Lead to Improved Results

One paper suggested that radiation-related skin damage predicted higher complication rates and poorer aesthetic outcomes after implant-based reconstruction. Some recent research indicated that the results of implant reconstruction after PMRT could be improved by the addition of autologous fat transfer—using the patient’s own fat tissue to enhance the results.

“Despite advances in reconstructive devices and materials, PMRT still appears to have an adverse impact on outcomes of implant-based breast reconstruction,” Dr. Kronowitz writes. “However,” he adds,” the majority of patients who undergo implant-based reconstruction and PMRT ultimately keep the implant-based reconstruction.” Outcomes appear better with two-stage reconstruction, where the implant is placed after PMRT, rather than immediately after mastectomy.

Autologous fat grafting and other new approaches hold promise for improving the results of implant-based reconstruction after radiation therapy for breast cancer, Dr. Kronowitz believes. “In the meantime, patients who will receive or have received radiation should be advised of the risks of implant-based breast reconstruction.” In an upcoming article, Dr. Kronowitz will review recent data on the results of autologous tissue-based breast reconstruction after radiation therapy.

Plastic and Reconstructive Surgery® is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.

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Obesity Epidemic Means Bariatric Surgery Rates Continue to Rise, Reports Plastic and Reconstructive Surgery

Brenda.Busick — Tue, 02 Oct 2012 19:02:52 +0000

Plastic Surgeons Play Key Role in Body Contouring after Massive Weight Loss

Philadelphia, Pa. (October 2, 2012) – With rising rates of morbid obesity, the number of bariatric surgery procedures is likely to increase as well, reports a paper in the October issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

Because of their role in dealing with aesthetic problems after massive weight loss, plastic surgeons must understand the principles and expected benefits of bariatric surgery procedures—as well as the characteristics and potential medical risks of patients undergoing these procedures, according to the new review by Drs. Bruce Wolfe and Erin Gilbert of Oregon Health and Science University, Portland.

Rising Rates of Obesity Lead to Increases in Bariatric Surgery…

The authors reviewed and summarized the latest data on the use and outcomes of bariatric surgery for the management of morbid obesity. The rise of bariatric surgery parallels the rising rates of obesity in the United States. Drs. Wolfe and Gilbert point out, “In 1990, not one state had a prevalence of obesity greater than 15 percent, whereas in 2009, only Colorado and the District of Columbia had prevalence less than 20 percent.”

Obesity increases the risk of a wide range of chronic health problems—highlighted by the recent surge in diabetes among overweight and obese children and adolescents. ”Not only is obesity a significant risk factor for many [diseases], but it also is associated with an overall increase in mortality and a reduction in life span of 10 years,” the authors write. Currently, bariatric surgery is considered for patients who are unable to achieve a five percent decrease in weight with diet and lifestyle modifications.

Drs. Wolfe and Gilbert review the three main options for bariatric surgery: adjustable gastric banding, sleeve gastrectomy, and “Roux-en-Y” gastric bypass. The expected percentage of excess weight loss is about 48 percent after adjustable gastric banding and 61 percent after sleeve gastrectomy and gastric bypass.

Gastric bypass is the most popular procedure because it results in greater weight loss and less weight regain. It also performs best in terms of resolving obesity-related diseases, such as diabetes, high cholesterol and high blood pressure. However, gastric banding is a reversible procedure that causes fewer long-term metabolic problems.

…And Rising Demand for Body Contouring

It’s especially important for plastic surgeons to understand the concepts and outcomes of bariatric surgery procedures, as there is a fast-growing population of patients seeking body contouring surgery. Body contouring refers to several different types of plastic surgery procedures done to remove excess fat and skin in patients after massive weight loss. ASPS statistics show sharp increases in the demand for body-contouring procedures—such as lower body lift, upper arm lift, and abdominoplasty (“tummy tuck”) over the past decade.

In general, body contouring should be delayed until weight has stabilized for at least three months—which may take a year or longer after surgery, according to Drs. Wolfe and Gilbert. They emphasize the need to carefully screen patients for ongoing medical issues such as diabetes, heart disease or obstructive sleep apnea. Nutritional deficiencies are also common after bariatric surgery, including protein malnutrition and deficient levels of nutrients such as vitamin B12, vitamin D, iron, calcium and folate. All of these conditions should be identified and corrected before body contouring is performed.

“Given the increasing incidence of morbid obesity and the effectiveness of bariatric surgery in treating this disease, it will likely continue to increase in popularity,” Drs. Wolfe and Gilbert conclude. They believe that the growth of bariatric surgery may increase even further as the overall safety profile continues to improve. In addition, the number of adolescent patients undergoing surgical treatment for obesity is likely to increase as future studies verify the safety of bariatric surgery in this age group.

Plastic and Reconstructive Surgery® is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.

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Motivation for Revision Rhinoplasty Similar to that of Reconstructive Patients

Brenda.Busick — Wed, 29 Aug 2012 15:19:55 +0000

Ninety-Seven Percent of Patients Satisfied With Revision, Reports Paper in Plastic and Reconstructive Surgery

Philadelphia, Pa. (August 29, 2012) – Most patients who seek repeated (secondary) cosmetic nose surgeries do so because of new or uncorrected deformities—similar to the reasons for patients undergoing primary rhinoplasty, suggests a report in the September issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

Based on his experience of 150 secondary procedures, Dr. Mark Constantian of St. Joseph Hospital and Southern NH Medical Center, Nashua, NH, concludes, “[T]he motivations of secondary rhinoplasty patients resemble those of most other aesthetic and reconstructive patients.” His experience questions the perception that patients seeking repeated rhinoplasty are “demanding” or “difficult.”

In Most Cases, Secondary Rhinoplasty Is Appropriate

Dr. Constantian performed the secondary procedures over a 16-month period in 2007-08. He analyzed the patients’ reasons for surgery, any management issues, the surgeon’s and patient’s satisfaction with the results, and other issues. The patients were 121 women and 29 men, median age 42 years. They had undergone one to eight previous surgeries, with an average of 3.6 per patient.

For 41 percent of patients, the reason for repeat rhinoplasty was the development of a new deformity—for example, a previously straight nose that had become crooked. In 33 percent, the first rhinoplasty failed to correct the original deformity.

Another 15 percent of patients perceived the loss of desired “personal, familial, or ethnic characteristics.” One percent had new or continued problems with airflow obstruction. “Thus the majority (90 percent) sought surgery to correct residual or new deformities, to restore personal characteristics than had been lost, or to correct functional complaints,” writes Dr. Constantian.

Only 10 percent of patients were seeking further improvement in an “already acceptable result,” as judged by Dr. Constantian. He rated this group of patients as having an average score of about 1 on a 5-point deformity scale, compared to 3 or higher in the other groups.

Dr. Constantian had previously operated on 16 of the patients; in 12 cases, he agreed that the repeat surgery was appropriate. Overall, 14 percent of patients were considered “demanding” by the surgeon and staff, while 27 percent had possible depression. Overall, 97 percent of patients were happy with their outcomes.

Few Patients Have Body Dysmorphic Disorder

Just three patients met criteria for body dysmorphic disorder (BDD)—a psychiatric disorder in which patients have excessive concerns about their physical appearance that interferes with daily life. Previous reports have suggested high rates of BDD among patients undergoing multiple plastic surgery procedures.

Patients seeking second (or more) rhinoplasties are often considered problematic by plastic surgeons. Such patients may be seen as “excessively demanding, often depressed, and impossible to please.”

But Dr. Constantian questions those perceptions—his experience suggests that 90 percent of patients have appropriate cosmetic or functional reasons for repeat rhinoplasty. He points out that nearly three-fourths of patients in his study had deformities that either developed after or weren’t corrected by the original surgery. “To these patients, the first operation had either been wasted or had done harm.”

Dr. Constantian believes that a careful selection process—including evaluation of the patient’s expectations and ability to handle possible complications—may have led to a lower rate of “severely unhappy patients” in his practice. Noting the spectrum of body dysmorphic symptoms, he plans a more in-depth analysis of patients who undergo multiple plastic surgeries but fall short of meeting criteria for BDD.

Plastic and Reconstructive Surgery® is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.

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+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com