Michele A Shermak’s research while affiliated with Johns Hopkins Medicine and other places

Gluteal lift is performed when there is significant skin laxity and/or redundancy of the lower back skin, typically stemming from massive weight loss, and resulting in sagging and possible deflation of the buttock region. Gluteal lift comprises a portion of lower body lift surgery often pursued by massive weight loss patients, with abdominoplasty and thigh lift performed in addition to gluteal lift. Augmentation of a deflated buttock may be performed at the time of gluteal lift, and is provided with flaps, fat grafting, or implants. Patients pursuing gluteal lift need to be screened preoperatively for medical issues, including nutritional deficiencies, which may limit the surgery that can be safely performed. Physical examination is necessary in determining the most optimal body contouring procedures and whether staging might be necessary to optimize aesthetic outcome and reduce surgical risks. Markings drawn prior to surgery serve as a guide intraoperatively, and excision may need to be adjusted to assure optimal scar, tension of closure, and postoperative healing. Safety measures must be observed during surgery including safe positioning, warming, efficient surgery, and VTE prophylaxis to reduce risk of complications. Postoperatively patients are followed up to assure optimal scarring and surveillance of healing. Gluteal lift provides beautiful results and rejuvenation for individuals who undergo the procedure.

Abdominoplasty is the fifth most common cosmetic plastic surgery procedure performed in the United States and combining it with other procedures has become more the norm than the outlier. Liposuction is the most common adjunctive procedure, followed by breast surgery, lower back lift, and thigh lift, in addition to hernia repair and gynecologic procedures. The goal of these combination procedures includes creating more global aesthetic improvement while protecting patients from complications, based on consideration of confounding medical variables and increased risks presented by surgery of prolonged duration and exposure.

“Incidence and Risk Factors of Major Complications in Brachioplasty: Analysis of 2294 Patients” is an outcomes analysis that describes the greatest number of patients undergoing brachioplasty studied in the literature.1 Patients who underwent brachioplasty and were covered by CosmetAssure health insurance comprised the database. The study investigates risk factors for major complications as well as the major complications that occur in patients undergoing brachioplasty as a stand-alone or as part of a combined cosmetic surgical procedure. The investigators found that patients undergoing brachioplasty were more likely to be older than 50 years and typically have a body mass index (BMI) >30 kg/m2. With regard to complicated outcomes, 77 patients (3.4%) developed at least one major complication, the most common being infection (1.7%), followed by hematoma (1.1%), venous thromboembolism (VTE) evaluation (0.4%), hypotension (0.1%), and cardiac complications (0.04%). Male gender led to an increased risk in overall complications, and specifically hematoma rates. BMI ≥ 30 was similarly found to be a risk factor for overall complications and infection. Brachioplasty was most frequently combined with liposuction or abdominoplasty, and there was an increase in hematoma rates and overall complications in combined procedures. The study assists plastic surgeons in forming a risk stratification scheme for patients pursuing brachioplasty, with a greater understanding of the factors that incite a higher risk for a major complication. The literature investigating body contouring outcomes (and brachioplasty outcomes more specifically) is generally young and relatively thin. The majority of papers are retrospective and emanate from a single surgeon experience. The benefit of this source of data is that the investigator knows the study population and has followed the patients, so the reader knows …

Dennis Hurwitz. Comprehensive Body Contouring: Theory and Practice . New York, NY: Springer, 2015. ISBN-13: 978-3662469750, ISBN-10: 3662469758. $109.00. ![Graphic][1] Dr Dennis Hurwitz has written a surgical text entitled Comprehensive Body Contouring: Theory and Practice . This is a small, condensed hardback. It is divided into sections encompassing aesthetics, conceptual and surgical principles, surgery for women, surgery for men, and facelifting in the body contouring patient. Unlike many texts on body contouring that are divided into treatment of specific body regions, the author structured his text to be more gender-focused, including comprehensive management of body contouring for men and women from head to toe. Notably, there is a whole section of the book devoted to facelift principles this author endorses for individuals who sustained significant weight loss. Included in this text are mommy makeovers, post-bariatric body contouring procedures, and facelift for post-bariatric patients; essentially, the book is a presentation of current surgical techniques Dr Hurwitz endorses, not just a body contouring text as the title leads the reader to anticipate. On first thumb-through, this book, packed with photos, figures, and text between the covers, communicates the energy and enthusiasm the author feels about this subject. Anyone who is familiar with Dr Hurwitz and his presentations will not be confused by this publication as the book personifies … Corresponding Author: Dr Michele A. Shermak, 1304 Bellona Avenue, Lutherville, MD 21093, USA. E-mail: shermakmd{at}gmail.com [1]: /embed/inline-graphic-1.gif

Breast reduction alleviates macromastia symptoms and facilitates symmetrical breast reconstruction after cancer treatment. We investigated a large series of consecutive breast reductions to study important factors that impact outcomes. An institutional review board-approved, retrospective review of all breast reductions from 1999 to 2009 in a single institution was performed using the medical record for demographics, medical history, physical examination, intraoperative data, and postoperative complications. Multivariate statistical analysis was performed using Stata 1.0. P ≤ 0.05 defined significance. Seventeen surgeons performed 2152 consecutive breast reductions on 1148 patients using inferior pedicle/Wise pattern (56.4%), medial pedicle/Wise pattern (16.8%), superior pedicle/nipple graft/Wise pattern (15.1%), superior pedicle/vertical pattern (11.6%), and liposuction (0.1%) techniques. Complications included discernible scars (14.5%), nonsurgical wounds (13.5%), fat necrosis (8.2%), infection (7.3%), wounds requiring negative pressure wound therapy or reoperation (1.4%), and seroma (1.2%). Reoperation rates were 6.7% for scars, 1.4% for fat necrosis, and 1% for wounds.Body mass index greater than or equal to 35 kg/m increased risk of infections [odds ratio (OR), 2.3, P = 0.000], seromas (OR, 2.9, P = 0.03), fat necrosis (OR, 2.0, P = 0.002), and minor wounds (OR, 1.7, P = 0.001). Cardiac disease increased reoperation for scar (OR, 3.0, P = 0.04) and fat necrosis (OR, 5.3, P = 0.03). Tobacco use increased infection rate (OR, 2.1, P = 0.008). Secondary surgery increased seromas (OR, 12.0, P = 0.001). Previous hysterectomy/oophorectomy increased risk of wound reoperations (OR, 3.4, P = 0.02), and exogenous hormone supplementation trended toward decreasing infections (OR, 0.5, P = 0.08). χ analysis revealed 7.8% infection risk without exogenous hormone versus 3.8% risk with hormone supplementation (P = 0.02). Morbid obesity, tobacco, cardiac history, and secondary surgery negatively impacted breast reduction outcomes. Hormonal status impacted reoperations and infections.

Background: The literature has witnessed an evolution in brachioplasty technique since the procedure was introduced by Thorek in 1930. Aesthetic refinements in brachioplasty have been increasingly described in the literature, and this has paralleled the rise in the massive weight loss population. The aim of this review is to share the plastic surgery experience with this challenging body region and present different approaches to achieve the best results for a broad spectrum of patients. Methods: A literature review studying brachioplasty was performed through PubMed. Throughout the literature there has been debate about scar placement, scar length, application of liposuction, drain placement, and optimization of outcomes, and differences of opinion have been compared. Results: There is no definitive best method of brachioplasty, as evidenced by multiple classification systems which present algorithms for management depending on presentation. Not only does approach differ depending on degree of presentation, but there are also different approaches depending on author for similar manifestations. Approaches vary through incision length, incision placement, and use of liposuction. Outcomes studies similarly reveal lack of consensus. Conclusion: This literature review has elucidated multiple approaches to brachioplasty, and the pearls and pitfalls described may all be incorporated to produce excellent outcomes and patient satisfaction in an individualized approach.