The Double Capsule Phenomenon in a Case Series and its Relationship with the Macro-Textured Breast Implant.

Background: Silicone breast augmentation remains one of the most common aesthetic surgery procedures, and 2022 marks the 60th anniversary of the first case. Recent studies suggest a link between double capsule (DC) formation and macro-textured devices.

Methods: Between 2010 and 2015, 268 aesthetic patients underwent bilateral mammary prosthesis exchange for indications including PIP exchange, adverse capsular contracture and ultrasonographic evidence of rupture.

Fibrin tissue adhesive for face- and necklift.

Introduction: Although available for decades, fibrin-based tissue adhesives (FTAs) have enjoyed only variable popularity in aesthetic surgery since their introduction in the 1980s. Whilst benefits in facelift surgery have been reported for a range of measures, including expanding haematoma, oedema and ecchymosis, irrefutable evidence has not yet been forthcoming. We instigated a prospective study to test the hypothesis that an underappreciated property of FTA, namely its ability to distribute tension, would reduce complications and revision due to early relapse.

PIP implant biodurability: a post-publicity update.

Introduction: in the year since Poly Implant Prothèse (PIP) found itself the epicentre of intense, global media attention initial studies have started to evaluate the abnormally high premature device failure rate suspected for their mammary prostheses. A cohort free from most of the usual confounding variables affords opportunities to improve upon previous estimates of rupture prevalence, assess the media effect and evaluate contemporary ultrasound scan (USS) accuracy.

Patients & Methods: 460 patients who underwent cosmetic breast augmentation (BA) with PIP silicone prostheses (January 2000-August 2005) have now been followed since their withdrawal in 2010.

Short-stay hospitalisation for benign thyroid surgery: a prospective study.

We report our prospective experience of short-stay hospitalisation for benign thyroid surgery. Post-operative outcome, complication rate and duration of hospitalisation were evaluated for 200 similar patients with bilateral multi-nodular goitres treated surgically by total thyroidectomy. All subjects gave written informed consent.

Botulinum neurotoxin A: a review.

Despite its ubiquity in cosmetic circles and broad general awareness, a literature search of botulinum neurotoxin in JPRAS and BJPS yielded a mere 4 articles germane to cosmesis. A pair each detailing its application in masseteric hypertrophy(1,2) and the use of cryoanalgesia.(3,4) Given that botulinum neurotoxin A is the most commonly used cosmetic treatment, with American figures being most accurate,(5) a review of the background, development and scientific evidence would be perhaps useful, if not overdue, as Plastic Surgeons increasingly incorporate non-surgical interventions into their practices as part of a comprehensive facial rejuvenation strategy.

The PIP mammary prosthesis: a product recall study.

Introduction: Concerns about the durability of silicone breast implants manufactured by Poly Implant Prothèse (PIP) have been expressed for several years prior to their formal withdrawal from the market in March 2010. Although precise details of what elements were at fault remain unclear, concerns have been raised about both the elastomer and the filler gel. Media speculation has focussed on device safety, longevity and, recently, a possible association with lymphoma, specifically anaplastic large cell lymphoma (ALCL).

Arterial injuries at the elbow carry a high risk of muscle necrosis and warrant urgent revascularisation.

Introduction: Revascularisation following axial arterial system injury is effective in upper limb salvage but necrosis of muscle, the tissue most sensitive to ischaemia, may still occur. We examined the frequency of necrosis, its related factors and its functional significance.

Methods: The clinical findings and operative management of 13 patients with injuries at the elbow referred to 2 plastic surgical hand surgery units over a 30-month period were reviewed.

Female-to-male transgender chest reconstruction: a large consecutive, single-surgeon experience.

Introduction: Chest reconstruction in the female-to-male transgender individual is not a common procedure due to the low prevalence of intractable gender dysphoria. It means that few surgeons acquire sufficient expertise and many UK patients find themselves travelling abroad to centres such as Singapore, Amsterdam and the United States.

Patients And Methods: This study retrospectively evaluated 100 consecutive patients of a single surgeon over a 3-year period with prime outcome measures including surgical technique, complications, surgical revision and patient-reported satisfaction, using a simple, 1-5 linear analogue scoring system.

Management of exposed, infected implant-based breast reconstruction and strategies for salvage.

Introduction: Complications of implant-based breast reconstruction are rare but mastectomy flap necrosis and peri-implant infection are the most frequent and remain an important cause of early implant failure. This study aimed to compare the results of three different management strategies employed to deal with these complications at our institution.

Patients And Methods: A consecutive series of 71 infected/exposed prostheses in 68 patients over a 20-year period were analysed.

Breast augmentation: Part III--preoperative considerations and planning.

The past four decades since the introduction of silicone mammary prostheses have seen significant improvements in their quality and durability. Advances in our understanding of the aetiopathology and prevention of adverse capsular contracture (ACC) have occurred such that surgical technique itself has now probably become the single most important determinant of both immediate and long-term outcome. Considered a simple, and in some quarters mindless, procedure it has evolved such that high-quality short- and stable long-term results are now expected.

Aggressive management of tibial osteomyelitis shows good functional outcomes.

Background: Severe open tibial fractures can be successfully treated acutely with a combined orthopedic and plastic surgery approach, but a proportion will go on to develop chronic osteomyelitis. For the past 6 years, an aggressive approach of bone and soft tissue debridement followed by skeletal reconstruction and vascularized tissue transfer has been pursued by the orthopedic and plastic surgery teams at Liverpool Hospital. We present the results of our patient series.

Liposuction: a review of principles and techniques.

For one of the most commonly performed aesthetic procedures, liposuction has a somewhat mixed reputation. This may result from suboptimal technical comprehension and/or poor patient selection. It has also attracted strong commercial pressure from manufacturers of new, sometimes less assiduously-evaluated, technologies.

Umbilical reconstruction: a review of techniques.

Whilst of minimal functional importance, the umbilicus is a key aesthetic landmark of the anterior abdominal wall and its absence or distortion a frequent cause for concern and patient complaint. For such an anatomically simple structure, the plethora of techniques described indicates either an unappreciated complexity or the lack of a universally appropriate procedure. In order to rationalise decision-making and assist with the surgical management of umbilical reconstruction, we present a summary of the literature and propose a classification system based on reconstructive technique.