Defining Spatial and Temporal Resolution of Edema Following Rhinoplasty: A Three-Dimensional Topographical Analysis

Abstract

The published (albeit limited) experience with breast implant capsule-associated squamous cell carcinoma suggests that this is a much more aggressive pathology than BIA-ALCL, with more aggressive surgical management, as well as adjuvant therapy, necessary for disease management. 3,4,6 Our patient had transaxillary, periareolar, and inframammary incisions used in her previous augmentation and subsequent revisions, putting her at risk for ductal transection, implant colonization with biofilmproducing organisms, and subsequent chronic inflammation, which may have led to squamous metaplasia and subsequent dysplasia. There is no mention of incision type in the other case reports, but this information would be useful to document. Our patient's most recent revision surgery was in 2016, at which time there was periprosthetic fluid and a mass on her capsule at the same site where her SCC ultimately developed. This was reported as benign on biopsy but no pathology report was available for our review. A unique factor in our patient's case was her concurrent pregnancy. To our knowledge, this is the first report of a gravid woman with BICA-SCC. Given the paucity of data surrounding this pathology, we are unable to draw any conclusions regarding whether our patient's pregnancy contributed to her disease development in any way.Breast implant capsule-associated squamous cell carcinoma is a rare but aggressive disease whose etiology remains unclear. Further study of this disease is needed to better classify risks, treatment, and outcomes. Plastic surgeons should remain vigilant in the follow-up of patients who have undergone placement of breast implants. A differential diagnosis of breast implant capsule-associated squamous cell carcinoma in patients presenting with late-onset breast edema, particularly with a history of previous capsular contracture or revision surgery, should be maintained. A similar approach to diagnosing BIA-ALCL should also be applied to diagnosing this disease: aspiration of any periprosthetic fluid collection for cytologic analysis and biopsy of any mass present. 9 The surgeon should include the possibility of breast implant capsule-associated squamous cell carcinoma when discussing the possible risks of breast implant placement with patients before surgery.

Comparing Postoperative Taping vs Customized 3D Splints for Managing Nasal Edema after Rhinoplasty

“…This has an important clinical implication, as swelling in the nasal tip may be more noticeable due to the complexity of the surface anatomy. 5 This underscores the positive effect of 3D-printed splints compared with nasal taping on nasal tip postoperative edema, as the taping group did not demonstrate significant volume reduction after the 6 week time point.…”

“…4 Previously our group reported on postoperative edema resolution, and its effect on the nasal contour, and demonstrated the total amount of postoperative edema to be relatively greater in the dorsum versus the nasal tip. 5 Additionally, our prior study revealed that although dorsal edema is greater than that of the nasal tip, the dorsal volume exhibited faster resolution of edema. The results of this study support this notion by demonstrating postoperative edema resolving more quickly in the dorsum when compared with the nasal tip in the 3D-printed splint group.…”

“…Unfortunately, this can be a significant contributor to patient dissatisfaction due to the delayed visualization of the final aesthetic result. [1][2][3][4] Despite the clinical significance of postoperative edema, there is currently no standard management of this phenomenon in rhinoplasty. Methods that have been used include pharmacologic approaches (such as corticosteroids, NSAIDs, and herbal supplements) or manual techniques (such as head elevation, nasal packing, use of drainage tubes, and nasal taping).…”

“…Methods that have been used include pharmacologic approaches (such as corticosteroids, NSAIDs, and herbal supplements) or manual techniques (such as head elevation, nasal packing, use of drainage tubes, and nasal taping). 5–8…”

“…Methods that have been used include pharmacologic approaches (such as corticosteroids, NSAIDs, and herbal supplements) or manual techniques (such as head elevation, nasal packing, use of drainage tubes, and nasal taping). [5][6][7][8] customized splints to positively impact swelling. A randomized controlled study was conducted comparing traditional nasal taping methods and 3D-printed splints on long-term postoperative edema.…”