Search PubMed⌕ Search

Biomedical subjects

Scott L Spear

Publications and source records attributed to Scott L Spear.

At least 19 recordsLinked to original sources
PubMed2006

Breast augmentation.

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Understand the different variables that are inherent to breast augmentation. 2. Identify certain breast shape characteristics that make one approach more advantageous than others. 3. Take into account certain patient characteristics to develop a logical surgical plan for breast augmentation. SUMMARY: The optimal technique for breast augmentation has always been debated, and numerous variables fit the needs of the variously shaped patients in our population. The purpose of this article is to present the advantages and disadvantages of the various techniques available in breast augmentation so that, in conjunction with the patient's physical examination, a sound surgical plan can be developed for aesthetic augmentation of the breast.

Journal Article↗
PubMed2006

Synmastia after breast augmentation.

BACKGROUND: Synmastia after breast augmentation is a condition of aberrant communication of the breasts caused by violation of the chest midline by medial migration of one or both implants. This condition, though rare, has been seen with increasing frequency in the authors' practice. METHODS: The records of 20 women with synmastia were reviewed. Data collection for these women included their preoperative repair history, implant sizes, and breast to chest wall proportions. RESULTS: All of the previous augmentations were subpectoral. Ten of the patients had undergone multiple augmentation operations. Twelve patients had implants that appeared excessively wide for their chest. CONCLUSIONS: Synmastia is a difficult surgical complication to address. Patients with multiple breast operations, excessively large implants, and overaggressive medial dissection are susceptible to developing synmastia. Understanding these potential risk factors leading to synmastia should help prevent its occurrence.

Adult↗
PubMed2006

Augmentation/mastopexy: a 3-year review of a single surgeon's practice.

BACKGROUND: Augmentation/mastopexy is of considerable interest to plastic surgeons who perform breast surgery because of its complexity as well as its high rate of legal claims. METHODS: This single-surgeon, 3-year study evaluated complications, outcomes, and reoperation rates among 166 patients who underwent 171 procedures for primary and secondary augmentation and primary and secondary augmentation/mastopexy. Aspects of the treatment plan were reviewed, including classification of ptosis, procedure selection, surgical planning, and operative technique. There were 57 primary breast augmentations, 60 secondary breast augmentations, 17 primary mastopexies, eight secondary mastopexies, 23 primary augmentation/mastopexies, and 30 secondary augmentation/mastopexies. RESULTS: The 23 primary and 30 secondary augmentation/mastopexy patients had 17 percent and 23 percent complication rates, respectively. The revision rate for augmentation mastopexy was 8.7 percent for the primary group and 16.6 percent for the secondary group. For reference, primary augmentation and secondary augmentation had complication rates of 1.7 percent and 21.6 percent, respectively. Primary augmentation had a 1.7 percent revision rate compared with 18.7 percent for secondary augmentation. The authors reviewed the most common problems leading to a revision, which were capsular contracture and asymmetry correction. Other complications included size change and rupture. CONCLUSIONS: Primary augmentation/mastopexy is a commonly performed procedure and has a significantly higher complication rate than primary augmentation. Secondary augmentation/mastopexy is also common and has higher revision and complication rates.

Adult↗
PubMed2005

Prophylactic mastectomy: indications, options, and reconstructive alternatives.

Prophylactic mastectomy continues to be a controversial procedure as a preventive tool against breast cancer. Recent research and other scientific advances, however, have refocused attention on better risk estimation, evidence of efficacy, and improvements in reconstruction. The recently discovered genetic markers BRCA1 and BRCA2 have become increasingly important in determining risk; a BRCA1-positive patient's risk of developing breast cancer by the age of 65 is estimated at 50 percent to 80 percent. BRCA1- and BRCA2-positive breast cancers also tend to be higher grade and occur in younger women (making mammography less effective). Genetically linked breast cancers are usually estrogen receptor negative, making them less susceptible to chemoprevention. Various predictive models and recommendations by experts in the field are also available for today's clinicians to ascertain who should be genetically tested. The benefit of bilateral prophylactic mastectomy, although difficult to estimate, can be evaluated by looking at the incidence of breast cancer in studies of patients who have previously undergone prophylactic mastectomy. The estimated risk reduction from these studies is 80 percent to 95 percent. Similarly, life expectancy is believed to be increased from 2.9 to 5.3 years. The psychological benefits include a 70 percent rate of satisfaction and a decrease in emotional concern over developing breast cancer by 74 percent of women who underwent prophylactic mastectomy. Although reconstruction results may vary, most patients have been very satisfied and some may achieve cosmetic results that are better than their preoperative situation. Patient selection for specific types of reconstruction after prophylactic mastectomy and the decision to proceed should be based on surgical risk and the likelihood of a good outcome. The choice of mastectomy incision should consider the size of the breast, preexisting scars, patient risk factors, and the planned method and goal of reconstruction. The authors propose certain guidelines based on degree of ptosis and cup size when planning prophylactic mastectomies with reconstruction. In certain cases, a nipple-sparing mastectomy may provide cosmetic advantages that could outweigh the additional oncologic risk.

Breast Implants↗
PubMed2005

A review of the biomechanical and functional changes in the shoulder following transfer of the latissimus dorsi muscles.

The latissimus dorsi muscle is among the most commonly used muscle flaps because it has broad versatility and is generally believed to result in minimal donor-site morbidity. However, the normal physiology of the shoulder girdle depends on the function of this muscle. Therefore, we have undertaken this review of the literature to examine the issue of biomechanical and functional changes of the shoulder that occur with transfer of the latissimus dorsi muscle and to determine whether these changes result in deficits in normal function. A review of the literature pertaining to all aspects of the latissimus muscle and shoulder function following muscle transfer was conducted. The latissimus muscle functions in extension, adduction, and internal and external rotation. After the transfer of the muscle there are deficits in extension and adduction. These deficits result in a faster rate of fatigue during activities in which the arms are extended over the head, such as ladder climbing and swimming. In addition, there is no decrease in range of shoulder motion.

Biomechanical Phenomena↗
PubMed2005

Fat injection to correct contour deformities in the reconstructed breast.

BACKGROUND: A ten-year, single-surgeon study of 37 patients from 1993 to 2003 who underwent fat injections to improve contour deformities in their reconstructed breasts was reviewed. METHODS: Fat was harvested from elsewhere in the body using a low-pressure syringe lipoaspiration system, washed gently with saline, and injected into depressions along the margins of reconstructed breasts. Blinded physician observers judged preoperative and postoperative photographs of breasts injected with fat and categorized the degree of contour improvement as substantial, minimal to moderate, or none. Complications of fat injections were noted. A total of 43 breasts in 37 patients were injected with autologous fat during 47 discrete events; some patients had the procedure repeated and some were treated bilaterally. Of the 43 treated breasts, 25 (58 percent) were reconstructed with implants, 17 (40 percent) were reconstructed with a TRAM (transverse rectus abdominis muscle) flap, and one (2 percent) was reconstructed with a TRAM and an implant. RESULTS: There were four complications (8.5 percent) in 47 treated breasts: one breast with cellulitis that resolved with antibiotics and three breasts with small, superficial lumps--two of which were biopsied and found to be liponecrotic cysts. Patient follow-up averaged 49 weeks, ranging from 3 weeks to 6 years. There was a substantial contour improvement in ten breasts (21 percent), minimal to moderate improvement in 30 breasts (64 percent), and no improvement in 7 breasts (15 percent). CONCLUSIONS: Although fat injection in and around the reconstructed breast has limitations, such as fat necrosis and need for repeated injections, our experience indicates that overall it is a very safe technique that can improve or correct significant contour deformities that otherwise would require more complicated, riskier procedures to improve.

Adipose Tissue↗
PubMed2005

The effect of smoking on flap and donor-site complications in pedicled TRAM breast reconstruction.

BACKGROUND: The detrimental effects of smoking on pedicled and free flap reconstruction are well documented. The purpose of this study was to examine the effect of smoking on flap, donor-site, and other individual and multiple complications in pedicled transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction. METHODS: A retrospective review was carried out of 224 pedicled TRAM flaps in 200 patients over a 10-year period. Three subgroups of patients were identified: active smokers, former smokers (defined as patients who stopped smoking at least 4 weeks before reconstruction), and nonsmokers (patients with no history of smoking). Active smokers made up 15.5 percent of the study population, while former smokers and nonsmokers made up 17.5 percent and 67 percent, respectively. There were no statistically significant differences in age, weight, radiation/chemotherapy history, distribution of flap pedicle types, timing of reconstruction, or percentage of delay procedures performed among the smoking subgroups. Logistic regression analysis was used to identify significant risk factors and determine their odds ratios. RESULTS: Compared with nonsmokers, both active and former smokers had a higher incidence of multiple flap complications (p = 0.0023 and 0.0018, respectively; odds ratios, 5.1 and 4.9). Active smokers also had a statistically significant higher rate of TRAM infection compared with nonsmokers (p = 0.0243; odds ratio, 4.7). Finally, former smokers were found to have a higher rate of TRAM delayed wound healing compared with nonsmokers (p = 0.0165; odds ratio, 4.7). CONCLUSIONS: Logistic regression identified active smoking as a statistically significant risk factor for developing multiple flap complications and TRAM infection, while former smoking was a risk factor for multiple flap complications and TRAM delayed wound healing. Thus, active and former smoking should similarly be considered contraindications for pedicled TRAM flap breast reconstruction, unless the patient has stopped smoking for more than 4 weeks before surgery.

Body Mass Index↗
PubMed2005

Safety and risk factors for breast reconstruction with pedicled transverse rectus abdominis musculocutaneous flaps: a 10-year analysis.

BACKGROUND: The purpose of this study is to examine the effect of various risk factors on complications in patients undergoing pedicled transverse rectus abdominis musculocutaneous (TRAM) flap breast reconstruction. METHODS: A retrospective review of 224 pedicled TRAMs in 200 patients over a 10-year period was carried out. Patients were divided into subgroups based on smoking history, weight, radiation status, and pedicle type. Complication rates were calculated and logistic regression analysis was used to identify risk factors. RESULTS: Logistic regression identified active smoking as a statistically significant risk factor for developing multiple (2 or more) flap complications (P = 0.0061) and TRAM infection (P = 0.0255), while former smoking was a risk factor for multiple flap complications (P = 0.01) and TRAM-delayed wound healing (P = 0.0433). Obesity (body mass index > or =30) was found to be a statistically significant risk factor for overall (1 or more) donor-site complications (P = 0.0281), overall flap complications (P = 0.0375), multiple flap complications (P = 0.0002), TRAM-delayed wound healing (P = 0.0334), and minor flap necrosis (P = 0.0075). CONCLUSIONS: This study identified that active or former smoking and obesity contribute to a significant complication rate, while overweight body habitus, use of double-pedicled flaps, and pre-TRAM radiation do not. This second decade "look-back" on pedicled TRAM flap breast reconstruction emphasizes the need for appropriate patient selection to achieve successful results with pedicled TRAM breast reconstruction.

Female↗
PubMed2005

The effect of radiation on pedicled TRAM flap breast reconstruction: outcomes and implications.

The purpose of this study was to examine the effect of postreconstruction radiation therapy on patients undergoing pedicled TRAM flap breast reconstruction. Post-TRAM radiation patients were compared with patients who received pre-TRAM radiation and a control TRAM-only group who received no radiation. Overall aesthetic appearance, evidence of symmetry, flap contracture, and hyperpigmentation were assessed by blinded reviewers. A total of 171 pedicled TRAM reconstructions were performed in 150 patients. Total flap complications were seen in 49.5 percent of the control patients, 57.1 percent of pre-TRAM radiation patients, and 50 percent of post-TRAM radiation patients but were not statistically different. The complete flap necrosis rate was 0.6 percent and the partial flap necrosis rate was 7.6 percent, again with no statistical differences among the groups. Donor-site complications occurred in approximately one third of patients in each of the groups. Deep venous thrombosis and pulmonary embolus each occurred once and only in the post-TRAM radiation group. In terms of overall aesthetic outcome, symmetry, and contracture, the control group consistently rated better than the pre-TRAM (p = 0.021, p = 0.03, p = 0.03, respectively) and the post-TRAM (p = 0.0001, p = 0.0001, and p =0.0001, respectively) radiation groups. The control group also had clinically and statistically significant less hyperpigmentation than the post-TRAM radiation group (p = 0.0002). In contrast, irradiated postreconstruction patients had scores, including aesthetic outcome, symmetry, and contracture, worse than those of irradiated prereconstruction patients. When these two groups were compared with each other, except for contracture, no statistical significance, because of a small patient sample, was found. Neither preoperative nor postoperative radiation increased the risk for flap or donor-site complications. In contrast, radiation of any type did affect aesthetic appearance, symmetry, contracture, and hyperpigmentation. The authors recommend that TRAM flap breast reconstruction be postponed in those patients known or expected to receive postmastectomy radiation.

Adult↗
PubMed2004

One-stage augmentation combined with mastopexy: aesthetic results and patient satisfaction.

Since the original descriptions by Gonzales-Ulloa in 1960 and Regnault in 1966, breast augmentation in combination with mastopexy has remained a difficult, and often polarizing, topic in plastic surgery, not only because of its results but also because of its litany of potential complications. Over the past few years, there has been an increase in the discussion of one-stage augmentation combined with mastopexy throughout the literature. However, a critical analysis of the aesthetic results, as well as patient satisfaction with the procedure, continues to be absent. Because there have not been any reported studies on the aesthetic results or patient satisfaction with augmentation and mastopexy, we undertook this retrospective review in an attempt answer a fundamental question: is one-stage breast augmentation combined with mastopexy aesthetically and functionally worthwhile for both the physician and patient? All 34 patients reviewed for this retrospective study underwent bilateral, one-stage breast augmentation and mastopexy between April 1996 and December 2002. Patient charts were reviewed for a number of parameters including previous breast surgery, degree of preoperative ptosis, type of mastopexy used, size and type of implants placed, implant position, postoperative complications, and any revision surgeries performed. Patient photographs were evaluated by observers blinded to the study, and patients were asked to complete a satisfaction questionnaire. Ptosis was graded according to the Regnault classification. As a result, 14 women had grade 1 ptosis (41%), fourteen had grade 2 ptosis (41%), one had grade 3 ptosis (3%), two had pseudoptosis (6%), and two had tuberous breasts (6%). The grade of ptosis in one patient was not defined. The patient complication rate was 8.8% (3 patients). For the aesthetic rating scale, preoperative and postoperative photographs taken after more than 1 year were evaluated. On the scale of 1 (poor) to 4 (excellent), overall ptosis correction was rated as 3.4, asymmetry correction as 3.4, postoperative breast symmetry as 3.2, scar quality as 3.3, breast shape as 3.1, nipple/areola size as 2.9, and overall result as 3. Only 13 of the 34 patients were available for completion of the satisfaction survey. Evaluation of the 13 patient satisfaction surveys showed that, on the average, the patients were satisfied with the various aspects of their surgery. The average overall result and surgical goals both were 3.1. However, 54% of the patients (n = 7) desired revision surgery for various reasons, the most common being a desire for more breast lift. A review of the patients and results, brought a number of issues to light. First, aesthetic results for augmentation and mastopexy truly depend on a number of different factors that must work in harmony to yield an excellent result. Second, what is aesthetically pleasing to the surgeon may not be pleasing to the patient, and vice versa. Third, although the patient aesthetic results were good, they were not consistently rated as excellent, nor were the patients totally satisfied with their outcomes. This perhaps reflects the more complex nature of both the patient's problems and the surgical procedure itself. Finally, although the overall results of one-stage breast augmentation and mastopexy are good, and the patients generally are satisfied, this study raises the question whether staging the surgery by performing the mastopexy first may not yield significantly better results than the combined simultaneous procedure.

Adult↗
PubMed2004

Prevention of venous thromboembolism in the plastic surgery patient.

The term venous thromboembolism refers to a spectrum of disease that includes deep venous thrombosis and pulmonary embolism. Both deep venous thrombosis and pulmonary embolism are often clinically silent and thus difficult to diagnose, which leads to a substantial delay in treatment that results in high rates of morbidity and mortality. The purposes of this article are to help physicians determine the proper venous thromboembolism prophylaxis and to simplify the complex problem of treating venous thromboembolism. The tools provided in this article will help expedite and clarify the decision-making process.

Adult↗
PubMed2004

Anterior thoracic hypoplasia: a separate entity from Poland syndrome.

SUMMARY: Women presenting with anterior thoracic depression, breast hypoplasia, and subsequent asymmetry are often diagnosed with Poland syndrome regardless of pectoralis involvement, or are placed in the generic category of breast asymmetry or skeletal dysplasias. Recently, though, the term "sunken chest" has been used to describe forms of chest wall depression that previously may have fallen under generic skeletal dysplasias. The authors believe that, combined with hypoplasia of the ipsilateral breast, superior location of the nipple-areola complex compared with the contralateral side, and normal pectoralis muscles, this represents a previously undefined and real condition called anterior thoracic hypoplasia. During the past 4 years, the authors have treated eight women who have presented with a diagnosis of Poland syndrome or pectus excavatum, all of whom share the same characteristics-unilateral sunken anterior chest wall, hypoplasia of the breast, superiorly placed nipple-areola complex, normal pectoralis muscle, and normal sternal position. All of the patients underwent correction of breast asymmetry and unilateral anterior thoracic hypoplasia with augmentation mammaplasty, a method that when tailored for each side yields good aesthetic results. The average age of the patients was 31 years and the average chest size was 34. Cup size, as measured by the patient's standard bra, was a B on the nonaffected side in all patients and an A on the affected side in all patients except one. Of the eight patients, seven had the right anterior chest and breast involved, whereas one patient had involvement on the left. For all of the patients, the nipple and areola of the hypoplastic side were smaller and in a more superior position compared with the contralateral side on visual inspection. In the eight patients, a total of 19 augmentations (15 primary augmentations and four revisions) and one mastopexy were performed. Ten inframammary-fold approaches and nine periareolar approaches were used, and all of the implants were placed in a partial submuscular position, except for two implants placed in a subglandular position that were converted to partial submuscular positions in a secondary setting. In all the women, the sternal head of the pectoralis muscle was present and the pectoralis muscle appeared to be equal in size compared to the contralateral side. Nine different types of implants were used. Average implant fill volume measured 412 cc on the hypoplastic side and 257 cc on the contralateral side. In follow-up, all of the patients were satisfied with their operation and rated their aesthetic outcome as very good to excellent. The authors believe that anterior thoracic hypoplasia is a real, previously misdiagnosed and undescribed condition, and that both chest wall and breast deformities can be corrected safely and with excellent results using proper augmentation planning and implant selection.

Adult↗
PubMed2004

The infected or exposed breast implant: management and treatment strategies.

Among the potential complications associated with the use of breast implants are the risks of periprosthetic infection and device extrusion. There is little published information about the effective management of these situations. Conservative recommendations include antibiotic therapy and removal of the implant until resolution of the infection or until the wound has healed. A retrospective review identified patients with periprosthetic infection or threatened or actual device exposure treated by the senior author. Twenty-four patients encompassing 26 affected prostheses were available for review and were classified into seven groups based on initial presentation as follows: group 1, mild infection (n = 8); group 2, severe infection (n = 4); group 3, threatened exposure without infection (n = 3); group 4, threatened exposure with mild infection (n = 3); group 5, threatened exposure with severe infection (n = 1); group 6, actual exposure without clinical infection (n = 5); and group 7, actual exposure with infection (n = 2). To salvage the prosthesis in these patients, various treatment strategies were utilized. All patients with a suspected infection or device exposure were started immediately on appropriate antibiotic therapy (oral antibiotics for mild infections and parenteral antibiotics for severe infections). Salvage methods included one or more of the following: antibiotic therapy, débridement, curettage, pulse lavage, capsulectomy, device exchange, primary closure, and/or flap coverage. Twenty (76.9 percent) of 26 threatened implants with infection or threatened or actual prosthesis exposure were salvaged after aggressive intervention. The presence of severe infection adversely affected the salvage rate in this series. A statistically significant difference exists among those patients without infection or with mild infection only (groups 1, 3, 4, and 6); successful salvage was achieved in 18 (94.7 percent) of 19 patients, whereas only two of seven of those implants with severe infection (groups 2, 5, and 7) were salvaged (p = 0.0017). Ten (90.9 percent) of 11 devices with threatened or actual exposure, not complicated by severe infection (groups 3, 4, and 6), were salvaged. Several treatment strategies were developed for periprosthetic infection and for threatened or actual implant exposure. Patients with infection were placed on oral or intravenous antibiotics; those who responded completely required no further treatment. For persistent mild infection or threatened or actual exposure, operative intervention was required, including some or all of the following steps: implant removal, pocket curettage, partial or total capsulectomy, débridement, site change, placement of a new implant, and/or flap coverage; the menu of options varied with the precise circumstances. No immediate salvage was attempted in five cases, due to either severe infection, nonresponding infection with gross purulence, marginal tissues, or lack of options for healthy tissue coverage. Based on the authors' experience, salvage attempts for periprosthetic infection and prosthesis exposure may be successful, except in cases of overwhelming infection or deficient soft-tissue coverage. Although an attempt at implant salvage may be offered to a patient, device removal and delayed reinsertion will always remain a more conservative and predictable option.

Adolescent↗