Breast augmentation is consistently one of the most commonly performed aesthetic operations every year. Unfortunately, revision rates following primary augmentation remain as high as 36%. There are several causes for revision breast augmentation; however, the most common and challenging of these include capsular contracture, implant malposition, and ptosis of the aging breast following augmentation. Successful management of these problems requires knowledge on how to best treat the implant and capsule with the corresponding soft tissue simultaneously. While surgical management is important, understanding the pathological causes of these entities during the primary operation can reduce the need for revision. This article utilizes the most up-to-date literature to review the appropriate clinical evaluation and surgical management of these complex cases.

Adipose fat grafting (AFG) is a popular technique used to add volume in the face, breasts, and other tissue deficient areas of the body. In terms of scar release, not only has fat provided additional soft tissue coverage but also the relief of pain in scars in those patients suffering from disease processes, such as complex regional pain syndrome with steroid-induced atrophy, burn scars, morphea, and lupus. The purpose of this article is to demonstrate the senior author's technique and outcomes of using AFG in the face and body for treating volume deficiency, atrophic scarring, and deformities. A retrospective chart review of 127 AFG procedures of the face and body from September 2006 to September 2019 was performed. Of these, 14 patients had scar releases performed with fat grafting of areas of scar contracture. Fat was harvested from the abdomen, thighs, and flanks using Toomey syringes or an enclosed power-assisted system with 3.7- or 3.0-mm cannulas. Grafting in small areas, such as the face, was performed with the 0.9-mm blunt cannula. The majority of AFG was completed in the face (45%), followed by breasts (22%), and scar contracture (16%). The mean volume of fat grafted in procedures involving the breasts, buttocks, and face was 102, 182, and 21 mL, respectively. For scar contracture, the mean volume was 38 mL and for deformations, 27 mL. Sixteen percent of the cohort required at least 1 additional AFG procedure to achieve satisfactory results. There were no major complications, such as skin loss, vascular injury, embolization, or blindness. Minor complications, such as erythema, edema, and hematoma at the fat harvest or graft site, did occur and were managed with local measures. Autologous fat grafting has consistently resulted in volume correction. In addition, in patients with autoimmune disorders, burn scars, and retracted scars, not only has there been volume correction but also decreased pain in the area of treatment. In our series of patients, we described our technique of AFG for the face, body, and scar contracture. Our results demonstrate that AFG remains an inexpensive, safe, and effective treatment option to achieve volume.

Introduction: Immediate breast reconstruction after mastectomy has increased in recent years when compared with delayed reconstruction. Despite this encouraging trend, racial and socioeconomic disparities in the receipt of postmastectomy breast reconstruction have been well documented. We sought to assess the effect of race, socioeconomic status, and patient comorbidities on muscle sparing transverse rectus abdominis myocutaneous outcomes at our safety net hospital institution in the southeast. Methods: The database of a tertiary referral center was queried for patients who received free transverse rectus abdominis myocutaneous flaps for immediate reconstruction after mastectomy meeting inclusion criteria from 2006 to 2020. Patient demographics and outcomes were compared based on socioeconomic status. The primary outcome (reconstructive success) was defined as breast reconstruction without flap loss. Statistical analysis included analysis of variance and χ 2 tests were appropriate using Rstudio. Results: Three-hundred fourteen patients were included in the study, with 76% White, 16% Black, and 8% other. Overall complication rate at our institution was 17% and reconstructive success was 94%. Non-White race, older age at time of breast cancer diagnosis, higher body mass index, and presence of comorbid conditions including current smoking and hypertension were all associated with low socioeconomic status. Despite this, surgical complication rates were not predicted by non-White race, older age, or presence of diabetes mellitus. When analyzing major and minor complications based on radiation received or reconstructive success, there was no significant difference regardless of radiation treatment with the group overall achieving a 94% success rate (P = 0.229).Conclusions: This study aimed to characterize the impact of socioeconomic status and race/ethnic status of patients on breast reconstruction outcomes at an institution in the South. We found that despite the greater morbidity in low income and ethnic/minority patients that when treated by a comprehensive safety net institution, they had excellent reconstructive outcomes due to low complications and minimal reoperations.

Background: Provision of enteral nutrition (EN) support is historically inadequate in the critically ill population. An interdisciplinary approach utilizing various strategies has been shown to improve initiation of timely EN support. The purpose of this study was to examine whether the implementation of a series of interventions led by an interdisciplinary team was associated with changes in the initiation of nutrition support in a level 1 trauma center. Methods: Patients admitted between 2009 and 2013 with isolated closed head trauma injuries were identified through the hospital’s trauma center database. The initial population consisted of 159 patients; after exclusion criteria, 141 patients were included in the statistical analyses. Two statistical analyses were conducted. The first calculated the average days to the initiation of nutrition start by admission year. The second estimated the association between admission year and time to nutrition initiation with a generalized linear model. Results: Time to initiate nutrition therapy was estimated to decrease by 1.46 days (47.31%) from 2009 to 2013. The time to initiate nutrition in 2013 was 1.63 days. A significant association was found between the time to initiate nutrition and the 2012 and 2013 binary variables while controlling for confounding variables. The time frame was estimated to be 1.09 (P = .008) and 1.75 (P = .000) days shorter in 2012 and 2013 relative to 2009. Conclusions: An interdisciplinary effort utilizing multiple strategies identified and addressed barriers, resulting in a reduction of variability and a proactive approach to early EN.