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Management of the nipple in TOP surgery

Management of the nipple in the double incision surgery has incorrectly assumed that a free nipple graft is the only option.  In fact, almost every patient can have a "pedicle" procedure which leaves the nipple attached to a portion of the breast tissue to preserve its blood supply.  The result is a normal appearing nipple with preservation of sensation in almost every case.  In people with dark pigmentation, normal color is retained as well.  The added benefit of a pedicle is fulness  under the nipple which is normally present in a male chest and easier postoperative care and recovery.

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Transgender Care

My interest in transgender individuals began more than 20 years ago when I was asked to join a multidisciplinary working group on gender.  Over the years, my participation has educated me about all aspects of transgenderism.  My personal clinical experience has been most gratifying in providing gender defining surgery.

The intent of this blog is to dispense information to interested individuals, both patients and colleagues and invite their comments and questions.

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Chin Surgery Skyrockets Among Women and Men in All Age Groups

New ASPS statistics show “chinplants” are fastest growing procedure

New statistics released by the American Society of Plastic Surgeons (ASPS) show that chin augmentation is the fastest growing plastic surgery trend among all major demographics -- a phenomenon which appears, in part, to be sparked by increased usage of video chat technology, an aging baby boomer population and a desire for success in the workplace.

Chin augmentation grew more than breast augmentation, Botox® and liposuction combined in 2011. The procedure skyrocketed in both women and men, as well as in all patients over the age of 20, with the largest increase seen in patients age 40 or older.

Chin Augmentation By The Numbers:

Category # of Procedures in 2011 % Change 2011 vs. 2010
Overall 20,680 71% increase
Women 10,087 66% increase
Men 10,593 76% increase
20-29 years 2,750 68% increase
30-39 years 2,587 69% increase
40-54 years 5,075 77% increase
55 and over 8,459 70% increase

"The chin and jawline are among the first areas to show signs of aging. People are considering chin augmentation as a way to restore their youthful look just like a facelift or eyelid surgery," said ASPS President Malcolm Z. Roth, MD. "We also know that as more people see themselves on video chat technology, they may notice that their jawline is not as sharp as they want it to be. Chin implants can make a dramatic difference."

As a manager for a major software company, Lizette Stephens often finds herself face-to-face with people all over the world. And while she loves how technology keeps her in touch, she didn't always like how it made her look.

"I do a lot of video chats and I'm in a lot of photos and noticed that my double chin was very pronounced. It really, really bothered me. I wanted to do something about it to get a more profound profile and more definition in my chin area," said Stephens.

Stephens received a chin implant from Darrick Antell, MD, an ASPS Member Surgeon based in New York City. Dr. Antell, who has studied the profiles of many CEOs, said, "We know that CEOs tend to be tall, attractive, good-looking people. We now know that these people also tend to have a stronger chin. As a result, people subconsciously associate a stronger chin with more authority, self-confidence and trustworthiness."

Factors like wanting a competitive advantage in the workforce may lead people to consider a variety of cosmetic facial procedures. The following are additional cosmetic procedures that saw an increase in popularity in 2011:

  • Lip augmentation: 49% increase
  • Cheek implant: 47% increase
  • Laser skin resurfacing: 9% increase
  • Soft tissue fillers: 7% increase
  • Facelift: 5% increase

For more statistics released today on trends in plastic surgery including gender, age, regional, national average fees and other breakouts, view the ASPS 2011 National Clearinghouse of Plastic Surgery Procedural Statistics report.

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13.8 Million Cosmetic Plastic Surgery Procedures Performed in 2011

5 Percent Increase Leads to Second Consecutive Yearly Gain

The plastic surgery market continues to show significant growth - two years in a row. According to statistics released today by the American Society of Plastic Surgeons (ASPS), 13.8 million cosmetic plastic surgery procedures (both surgical and minimally-invasive) were performed in the United States in 2011, up 5 percent since 2010. In addition, 5.5 million reconstructive plastic surgery procedures were performed last year, up 5 percent.

"While the rate of economic recovery in the U.S. is still uncertain, 2011 proved to be a good year for plastic surgery," said ASPS President Malcolm Z. Roth, MD. "Consumer confidence was up, auto sales rose 10 percent, so it is not surprising that we would also see increased demand for plastic surgery procedures."

Top Procedures

Cosmetic surgical procedures increased 2 percent, with nearly 1.6 million procedures in 2011. The top five surgical procedures were:

• Breast augmentation (307,000 procedures, up 4 percent)
• Nose reshaping (244,000 procedures, down 3 percent)
• Liposuction (205,000 procedures, up 1 percent)
• Eyelid surgery (196,000 procedures, down 6 percent)
• Facelift (119,000 procedures, up 5 percent)

Facelifts are among the top five cosmetic surgical procedures for the first time since 2004, replacing tummy tucks. Interestingly, a procedure popular with men, chin augmentation, nearly doubled in 2011, with 21,000 procedures performed, up 71 percent. Lip augmentation also rose significantly - up 49 percent, with more than 25,000 procedures performed.

"We are seeing notable increases in surgical procedures, such as facelifts, that reflect the demands of an aging boomer population," said Dr. Roth. "However, the overall growth in cosmetic procedures is being primarily driven by a substantial rise in minimally-invasive procedures."

Cosmetic minimally-invasive procedures increased 6 percent, with nearly 12.2 million procedures in 2011. The top five minimally-invasive procedures were:

• Botulinum toxin type A (5.7 million procedures, up 5 percent)
• Soft tissue fillers (1.9 million procedures, up 7 percent)
• Chemical peel (1.1 million procedures, down 3 percent)
• Laser hair removal (1.1 million procedures, up 15 percent)
• Microdermabrasion (900,000 procedures, up 9 percent)

Soft tissue fillers like hyaluronic acid (Restylane®, Juvederm Ultra®, etc.), calcium hydroxylapatite (Radiesse®), and fat injections experienced some of the largest growth in the minimally-invasive market during 2011. More than 1.3 million hylauronic acid procedures were performed in 2011, up 9 percent; 286,000 calcium hydroxylapatite procedures, up 36 percent; and 68,000 fat injections, up 19 percent.

Reconstructive plastic surgery, which improves function and appearance to abnormal structures, increased 5 percent in 2011. The top five reconstructive procedures were:

• Tumor removal (4.2 million, up 3 percent)
• Laceration repair (303,000, down 15 percent)
• Maxillofacial surgery (195,000, up 125 percent)
• Scar revision (175,000, up 9 percent)
• Hand surgery (120,000, up 13 percent)

Breast reconstruction rates continue to rise, with more than 96,000 procedures performed last year, up 3 percent since 2010.

"While insurance coverage for breast reconstruction is mandated by law, continued strides to provide coverage for other reconstructive procedures has contributed, in part, to the sizable gain that we are seeing with these procedures," said Dr. Roth. "Reconstructive surgery is a critical pillar of the specialty, and it is encouraging to see that increasing numbers of patients entrust board-certified plastic surgeons to reconstruct their bodies after disease or trauma."

ASPS members can report procedural information through the first online national database for plastic surgery procedures, Tracking Operations and Outcome for Plastic Surgeons (TOPS). This data, combined with the annual survey sent to American Board of Medical Specialties certified physicians most likely to perform these procedures, results in the most comprehensive census on plastic surgery.

To view the 2011 National Clearinghouse of Plastic Surgery Statistics report, visit www.plasticsurgery.org/2011-statistics. Visitors can also find information about procedures and referrals to ASPS Member Surgeons.

Liposuction and Tummy Tuck Improve Quality of Life, Reports Plastic and Reconstructive Surgery

Study is first of its kind to assess patient-reported outcomes of procedures to reduce abdominal fat

Patients undergoing cosmetic liposuction and/or abdominoplasty ("tummy tuck") procedures report significant improvements in self-esteem and quality of life, according to a study in the April issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

Outcomes are especially good with liposuction plus "tummy tuck," although they include somewhat higher pain scores and longer recovery times, reports the new study by ASPS Member Surgeon Dr. Eric Swanson, MD, a plastic surgeon in private practice in Leawood, Kan.

Study Shows Improved Quality of Life and Other Benefits

Dr. Swanson formally evaluated quality of life and other outcomes in 360 patients undergoing liposuction and/or abdominoplasty to remove excess abdominal fat. About 60 percent of patients underwent liposuction alone, while 35 percent underwent a combination of liposuction and abdominoplasty. The rest underwent abdominoplasty alone.

The patients' average age was 42 years; 85 percent were women. Thirty percent of patients underwent other cosmetic plastic surgery procedures (such as face lift or breast augmentation) at the same time. Outcomes were assessed an average of four months after surgery.

Patients undergoing liposuction alone had shorter recovery times: average time off work was about six days, compared to 16 days with abdominoplasty (with or without liposuction). The liposuction-only patients also had less discomfort: average pain score 6 out of 10, compared to 7.5 for those undergoing abdominoplasty.

Combined Procedure Yields Best Results

Patients undergoing abdominoplasty rated their cosmetic outcomes higher than others: average score 9 out of 10, compared to 8 out of 10 with liposuction only. Liposuction plus abdominoplasty produced the highest patient satisfaction rate-over 99 percent-with no increase in pain compared to abdominoplasty alone.

Ninety-eight percent of patients undergoing liposuction plus abdominoplasty said they would undergo the procedure again and 99 percent that they would recommend it to others.

Overall, 86 percent of patients reported an improved sense of self-esteem after surgery. About 70 percent reported improved quality of life, more commonly after liposuction plus abdominoplasty.

Quality of life is an increasingly important focus measure of effectiveness for all types of medical and surgical treatments. Even though liposuction and abdominoplasty are among the most frequently performed cosmetic surgery procedures, few studies have formally evaluated their impact on quality of life and other patient-reported outcomes.

"Liposuction and abdominoplasty, individually and in combination, produce high rates of patient satisfaction and reliably improve self-esteem," Dr. Swanson writes. By formally assessing these important outcomes in a large number of patients, he hopes his study will provide a clearer picture of the expected results and recovery times associated with these widely performed cosmetic surgery procedures.


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