INTRODUCTION: Ischaemic stroke is a severe complication of dermal filler injections that remains poorly described and understood. This study aims to characterise the clinical features and outcomes of patients who experience strokes following facial dermal filler injections. METHOD: A systematic review and retrospective analysis of ischaemic strokes caused by dermal filler injections and reported over the past 3 decades, were conducted. Cases involving autologous fat were also compared against those that did not. RESULTS: Fifty-five cases from 45 studies were analysed. Their median age was 32 years (18-61), and most were women (49/55, 89%). Injections frequently occurred at the glabella (17/53, 32%) and temples (12/53, 23%), and autologous fat was most often used (33/55, 60%). Half (29/55, 53%) had ocular symptoms at presentation. Hemiparesis/hemiplegia (30/55, 55%) and confusion/ reduced consciousness/alertness (26/55, 47%) were the predominant stroke symptoms. Most infarcts were unilateral (45/54, 83%) and large (32/48, 67%). Treatment primarily involved corticosteroids (12/41, 29%) and antiplatelet agents (11/41, 27%), while hyaluronidase injections (3/41, 7%) and hyperbaric oxygen therapy (2/41, 5%) were rarely used. Less than half (22/55, 40%) experienced good functional recovery. Those injected with autologous fat were likelier to be symptomatic from their strokes (100% versus [vs] 68%, P=0.0012), develop larger strokes (93% vs 24%, P<0.0001) and experience non-ambulatory outcomes (44% vs 73%, =0.0381). CONCLUSION Strokes are rare complications of dermal fillers. Injections using autologous fat risk larger strokes and worse ambulatory outcomes. An hour of post-procedural observation appears reasonable, and those with ocular complications should undergo brain imaging even in the absence of stroke symptoms.
Humans ; Dermal Fillers/administration & dosage* ; Female ; Ischemic Stroke/chemically induced* ; Adult ; Cosmetic Techniques/adverse effects* ; Retrospective Studies ; Middle Aged ; Male ; Face ; Adolescent ; Young Adult

OBJECTIVE: To review the latest research advancements in surgical techniques for the treatment of limb lymphedema. METHODS: The relevant literature at home and abroad in recent years was extensively reviewed, and the research on the treatment of limb lymphedema by surgical techniques were summarized and analyzed. RESULTS: Lymphovenous anastomosis has demonstrated good effectiveness for early to mid-stage limb lymphedema, however its long-term effectiveness and applicability for late-stage limb lymphedema still require further validation. Autologous lymphatic/venous grafting has shown clinical feasibility in the treatment of secondary limb lymphedema. Research on tissue-engineered lymphatic scaffolds remains insufficient, primarily due to the complexity of lymphatic anatomical structures and the technical challenges involved. Nevertheless, its potential application is promising. Vascularized lymph node flap transplantation has shown significant effectiveness in treating limb lymphedema, particularly yielding good outcomes in upper limb cases. However, it can not guarantee a complete cure for the condition. Charles' operation is the most effective treatment option for patients with late-stage limb lymphedema, but its extensive incision and severe postoperative complications limit its application. Liposuction has the advantages such as minimal invasiveness, high safety, and repeatability. It is suitable for patients with late-stage limb lymphedema who have failed conservative treatment or developed adiposity. However, its effectiveness is limited in patients with significant limb fibrosis. CONCLUSION Current treatments for limb lymphedema require further improvement, and there is considerable debate regarding treatment strategies for different stages of the condition. Future high-quality, multi-system combined treatment approaches are anticipated to guide clinical practice.
Humans ; Lymphedema/surgery* ; Surgical Flaps/blood supply* ; Lymphatic Vessels/surgery* ; Anastomosis, Surgical/methods* ; Lymph Nodes/transplantation* ; Lipectomy/methods* ; Extremities/surgery* ; Treatment Outcome ; Tissue Engineering ; Tissue Scaffolds ; Veins/transplantation*

OBJECTIVE: To compare the effectiveness of single-stage vascularized lymph node transfer (VLNT) combined with lymphaticovenular anastomosis (LVA) and liposuction (LS) (3L) versus LVA combined with LS (2L) for the treatment of moderate-to-late stage upper limb lymphedema following breast cancer surgery. METHODS: A retrospective analysis was conducted on the clinical data of 16 patients with moderate-to-late stage upper limb lymphedema after breast cancer surgery, treated between June 2022 and June 2024, who met the selection criteria. Patients were divided into 3L group (n=7) and 2L group (n=9) based on the surgical approach. There was no significant difference (P>0.05) in baseline data between the groups, including age, body mass index, duration of edema, volume of liposuction, International Society of Lymphology (ISL) stage, preoperative affected limb volume, preoperative circumferences of the affected limb at 12 levels (from 4 cm distal to the wrist to 42 cm proximal to the wrist), preoperative Lymphoedema Quality of Life (LYMQoL) score, and frequency of cellulitis episodes. The 2L group underwent LS on the upper arm and proximal forearm and LVA on the middle and distal forearm. The 3L group received additional VLNT in the axilla, with the groin serving as the donor site. Outcomes were assessed included the change in affected limb volume at 12 months postoperatively, and comparisons of limb circumferences, LYMQoL score, and frequency of cellulitis episodes between preoperative and 12-month postoperative. Ultrasound evaluation was performed at 12 months in the 3L group to assess lymph node viability. RESULTS: Both groups were followed up 12-20 months, with an average of 15.13 months. There was no significant difference in the follow-up time between the groups (t=-1.115, P=0.284). All surgical incisions healed by first intention. No adverse events, such as flap infection or necrosis, occurred in the 3L group. At 12 months after operation, ultrasound confirmed good viability of the transferred lymph nodes in the 3L group. Palpation revealed significant improvement in skin fibrosis and improved skin softness in both groups. Affected limb volume significantly decreased in both groups postoperatively (P<0.05). The reduction in limb volume significantly greater in the 3L group compared to the 2L group (P<0.05). Circumferences at all 12 measured levels significantly decreased in both groups compared to preoperative values (P<0.05). The reduction in circumference at all 12 levels was better in the 3L group than in the 2L group, with significant differences observed at 7 levels (8, 12, 16, 30, 34, 38, and 42 cm) proximal to the wrist (P<0.05). Both groups showed significant improvement in the frequency of cellulitis episodes and LYMQoL scores postoperatively (P<0.05). While the improvement in LYMQoL scores at 12 months did not differ significantly between groups (P>0.05), the reduction in cellulitis episodes was significantly greater in the 3L group compared to the 2L group (P<0.05). CONCLUSION The combination of VLNT+LVA+LS provides more durable and comprehensive outcomes for moderate-to-late stage upper limb lymphedema after breast cancer surgery compared to LVA+LS, offering an improved therapeutic solution for patients.
Humans ; Female ; Lipectomy/methods* ; Retrospective Studies ; Anastomosis, Surgical/methods* ; Lymphedema/etiology* ; Middle Aged ; Upper Extremity/surgery* ; Breast Neoplasms/surgery* ; Lymph Nodes/blood supply* ; Adult ; Lymphatic Vessels/surgery* ; Iliac Artery/surgery* ; Postoperative Complications/surgery* ; Perforator Flap/blood supply* ; Treatment Outcome ; Mastectomy/adverse effects* ; Quality of Life ; Aged

OBJECTIVE: To optimize the perioperative management experiences for breast cancer patients undergoing direct-to-implant-based breast reconstruction, and provide reference for clinical practice. METHODS: A comprehensive review of recent domestic and international literature was conducted to systematically summarize the key points of perioperative management for direct-to-implant-based breast reconstruction, including preoperative health education, intraoperative strategies, and postoperative management measures, along with an introduction to the clinical experiences of West China Hospital of Sichuan University. RESULTS: Standardized perioperative management can effectively reduce the incidence of complications and achieve excellent cosmetic outcomes and quality of life after operation. Preoperative management includes proactive health education to alleviate patients' anxiety and improve treatment compliance, as well as comprehensive assessment by surgeons of the patient's physical condition and reconstructive expectations to select the most appropriate implant. Intraoperative management consists of strict aseptic technique, minimizing implant exposure, preserving blood supply to the nipple-areola complex (e.g., by using minimally invasive techniques or indocyanine green angiography, etc), and meticulous hemostasis. Postoperative management encompasses multimodal analgesia, individualized drain management (such as early removal or retaining a small amount of fluid to optimize contour), infection prevention and control (including topical and systemic antibiotics, ultrasound-guided minimally invasive drainage), guidance on rehabilitation exercises (early activity restriction followed by gradual recovery), and regular follow-up to evaluate aesthetic results and monitor for complications. CONCLUSION Establishing a standardized, multidisciplinary perioperative management framework markedly enhances surgical safety and patient satisfaction, thereby providing a replicable benchmark for direct-to-implant-based breast reconstruction across diverse clinical settings.
Humans ; Female ; Breast Neoplasms/surgery* ; China ; Perioperative Care/methods* ; Breast Implants ; Mammaplasty/methods* ; Breast Implantation/methods* ; Postoperative Complications/prevention & control* ; Quality of Life ; Mastectomy

Various techniques have been described for reconstructing the skin of the penile shaft; however, no universally accepted standard exists for correcting buried penis in adults. We aimed to describe a new technique for correcting an adult-acquired buried penis through a diamond-shaped incision at the penopubic junction. We retrospectively analyzed data from patients treated with our technique between March 2019 and June 2023 in the Department of Andrology, Nanjing Drum Tower Hospital (Nanjing, China). Forty-two adult males with buried penises, with a mean (±standard deviation [s.d.]) age of 26.6 (±6.6) years, underwent surgery. All patients were obese, with an average (±s.d.) body mass index of 35.56 (±3.23) kg m -2 . In addition to phalloplasty, 32 patients concurrently underwent circumcision, and 28 underwent suprapubic liposuction. The mean (±s.d.) duration of the operation was 98.02 (±13.28) min. The mean (±s.d.) duration of follow-up was 6.71 (±3.43) months. The length in the flaccid unstretched state postoperatively was significantly greater than that preoperatively (mean ± s.d: 5.55±1.19 cm vs 1.94±0.59 cm, P < 0.01). Only minor complications, such as wound disruption (7.1%) and infection (4.8%), were observed. The mean (±s.d.) score of patient satisfaction was 4.02 (±0.84) on a scale of 5. This technique provides excellent cosmetic and functional outcomes with a minimal risk of complications. However, additional clinical studies are needed to evaluate the long-term effects of this procedure.
Humans ; Male ; Patient Satisfaction ; Adult ; Lipectomy/methods* ; Penis/surgery* ; Retrospective Studies ; Treatment Outcome ; Plastic Surgery Procedures/methods* ; Young Adult ; Penile Diseases/surgery* ; Urologic Surgical Procedures, Male/methods*

OBJECTIVE: To explore the application value of dual chamber round tissue expander in immediate breast reconstruction. METHODS: Sixteen patients, who had been provided immediate tissue expander/implant two-stage breast reconstruction using dual chamber round tissue expander in our hospital from March 2022 to October 2023, were involved in this study, and the relevant information was analyzed retrospectively. The overall design of the expander is a round shape, consisting of two equally divided semi-circular chambers. The two expansion chambers are connected by a silicone pad below and are respectively connected to their own water injection tubes. Both chambers are designed to expand unidirectionally towards the surface. The expansion principle, insertion process, and type of expander selection were investigated. The expansion effect and incidence of complications were summarized. The aesthetic effect of reconstructed breasts was evaluated from three aspects after stage Ⅱ surgery: the position of infra mammary fold, the breast protrusion, and the breast volume. RESULTS: Among sixteen patients in this study, three patients were selected with the type of 400 mL expander and thirteen patients were given the type of 600 mL expander. The median time of tissue expansion was 4.0 (2.0, 5.0) months, with an average volume of expansion of (538.8±111.7) mL. The average expansion ratio of upper/lower chamber was 45.4%±8.4%. The position of the infra mammary fold needed not to be adjusted during the prosthesis exchange process. All the patients were applied anatomical prostheses, and the median volume of the prosthesis was 395 (345, 410) mL. One patient developed seroma during expansion period, who got improved after local aspiration. The average follow-up time was (9.0±3.6) months. 81.3% (13/16) of the patients achieved an aesthetic evaluation of "Good" in breast reconstruction, and 75.0% (12/16) of the patients got a grade Ⅰ or grade Ⅱ capsule contracture of the prosthesis. CONCLUSION The application of dual chamber round tissue expander could effectively dilate the lower pole of the breast, personalize the expansion ratio of the upper and lower poles of the breast, and avoid the displacement of the expander during the expansion period. Therefore, it could provide a good foundation for subsequent prosthesis exchange.
Humans ; Tissue Expansion Devices ; Female ; Mammaplasty/instrumentation* ; Tissue Expansion/instrumentation* ; Retrospective Studies ; Adult ; Middle Aged ; Breast Neoplasms/surgery* ; Breast Implants ; Mastectomy

INTRODUCTION: Localised swelling at sites of filler injections has been reported in the Moderna mRNA-1273 coronavirus disease 2019 (COVID-19) vaccine trial. METHODS: We conducted a review of the existing data and literature on the potential pathophysiology for this adverse event and its potential management. RESULTS: Data from the Moderna and Pfizer COVID-19 vaccine Phase 3 trial and one case series were available. Three out of 30,400 subjects developed possible filler reaction in the Moderna trial. Two other cases were reported after emergency use authorisation. Reactions occurred at a mean of 1.4 days post-vaccination. Fillers were injected at a mean of 14.1 months before vaccination. Areas involved included lips, infraorbital areas and tear troughs. Treatment included observation, corticosteroids, antihistamine, hyaluronidase and 5-fluorouracil. CONCLUSION Rare, self-limiting adverse reactions to dermal fillers have been reported following COVID-19 vaccination. Clinicians should be aware of this clinical phenomenon and its management, as vaccination is carried out globally.
Humans ; 2019-nCoV Vaccine mRNA-1273/adverse effects* ; Cosmetic Techniques/adverse effects* ; COVID-19/prevention & control* ; COVID-19 Vaccines/administration & dosage* ; Dermal Fillers/administration & dosage* ; Edema/chemically induced* ; Injection Site Reaction/etiology*

Objective: To investigate the oncologic and surgical safety of the fused fascia method for immediate breast reconstruction with implants. Methods: The clinical data of 343 patients with immediate breast reconstruction with implants in Tianjin Medical University Cancer Hospital from 2014-2017 were retrospectively analyzed to compare the 5-year local recurrence-free survival, 5-year disease-free survival and 5-year overall survival of patients with breast reconstruction by fusion fascia and other methods, and to analyze the complication incidences of implant removal between different implant groups. Results: Of the 343 patients with breast reconstruction, 95 were in the fused fascia group (fascia group) and 248 were in the non-fascia group (25 in the bovine pericardial patch group and 223 in the muscle flap group). At a median follow-up of 49 months, the differences in 5-year local recurrence-free survival (90.1% and 94.9%, respectively), 5-year disease-free survival (89.2% and 87.6%, respectively), and 5-year overall survival (95.2% and 95.1%, respectively) between patients in the fascial and non-fascial groups were not statistically significant (P>0.05). The complication incidence of implant removal was 24.0% (6/25) in the patch group and 2.1% (2/95) and 2.2% (5/223) in the fascia and muscle flap groups, respectively. Conclusion: Immediate breast reconstruction with fused fascial combined with implant is safe and feasible, less invasive than muscle flaps, more economical and with fewer complications than patches.
Humans ; Animals ; Cattle ; Female ; Mastectomy/methods* ; Retrospective Studies ; Breast Implants/adverse effects* ; Feasibility Studies ; Mammaplasty/methods* ; Breast Neoplasms/complications* ; Treatment Outcome ; Postoperative Complications/surgery*

The Breast Cancer Surgery Operative Standards Consensus Conference aimed to establish industry technical standards and improve breast cancer surgery practices by addressing controversial and operative breast cancer surgery-related issues in clinical practice.The conference was led by the Breast Oncoplastic and Reconstruction Branch of Guangdong Medical Industry Association (GMIA) and involved 85 breast surgeons with expertise in breast cancer conserving, oncoplastic, and reconstructive surgery.Consensus was reached through 3 meetings.The first meeting brought up the topics of interest, and evidence summaries were presented for debate during the second meeting; the third meeting was held to reach consensus recommendation for selected topics.Pre-defined consensus criteria required that the consensus was reached only when more than 70% of the panelists agreed on the topic.Out of the 57 questions set for voting, 11 operative standards were recommended as Preferred, and one was recommended as Considered.Preferred operative standards included surgical details in breast conserving surgery, mastectomy, reconstructive surgery, surgical treatment of phyllodes tumor.Selected topics that did not reach consensus among the panelists were also discussed.These Preferred operative standards could help guide clinical surgical practice in routine patient care.
Humans ; Female ; Mastectomy ; Breast Neoplasms ; Mastectomy, Segmental ; Mammaplasty ; Breast

Background: The introduction of new therapeutic options and advances in the field of breast surgery has put the importance of patient satisfaction and quality of life at par with long-term survival. These essential parameters help physicians and patients decide on the appropriate approach when managing both malignant and benign breast conditions. They have also been used to measure the outcome and success of breast surgery, whether cosmetic or reconstructive, using patients’ perspectives. To date, there is no available questionnaire that is translated, culturally adapted, and validated among Filipino patients to specifically assess their quality of life (QOL) and satisfaction after breast reconstructive surgery. Objective: This study aims to translate a previously validated, internationally accepted, patient-reported outcome (PRO) instrument, the Breast-Q Reconstruction Module, and validate its use among Filipino patients. Methods: This is a tool validation study of a Filipino translation of the Breast-Q Reconstruction Module for the preoperative and postoperative settings. Forward and backward translations were done for the two questionnaires and were finalized after assessment of accuracy and feasibility by language professionals and bilingual patients. We recruited patients referred to the Division of Plastic Surgery of a tertiary government hospital for breast reconstruction to answer the final questionnaires, with 15 re-taking each questionnaire after two weeks. Psychometric properties of the questionnaires, including internal consistency, construct validity, test-retest reliability, and acceptability, were then evaluated. Results: We included 30 patients in this validation study. The internal consistencies of the translated Preoperative and Postoperative Breast-Q Reconstruction Module had high Cronbach’s α coefficients (range: 0.92–0.98 and 0.97–1.00, respectively). Internal consistency was also supported by high mean item-total correlations in all dimensions. The two questionnaires had good test-retest reliability as supported by high intraclass correlation (range for Preoperative: 0.995–1.000 and for Postoperative: 0.95–1.00). Construct validity was supported by inter-scale correlations with low to moderate Spearman’s coefficients (range for Preoperative: 0.22–0.34 and for Postoperative: 0.11–0.27). The sexual well-being dimension had the lowest inter-scale Spearman’s coefficient in both questionnaires and is the only dimension with low acceptability. Conclusion The translated Preoperative and Postoperative Breast-Q Reconstruction Module has high internal consistency, test-retest reliability, acceptability, and low to moderate construct validity among Filipino patients after breast reconstruction surgery. However, the “Satisfaction with the Nipple Reconstruction” subscale is pending since there were no qualified respondents in the sample population. In considering how their relatively conservative culture influences the way Filipino patients tend to view the importance of sexual satisfaction as it relates to their medical management, the sexual well-being domain is suggested to be interpreted separately when assessing the patient’s overall satisfaction with breast reconstruction procedure.
Mammaplasty ; Quality of Life