Suction-Assisted Lipectomy for Lipodystrophy Syndromes Attributed to HIV-Protease Inhibitor Use

Case Report:Reduction Mammoplasty in an HIV-Positive Woman

“…5 Liposuction in HIV patients with lipodystrophic complications from protease inhibitors and antiretroviral medications has also been described. 6,7 Although controversial, HIVassociated lipodystrophies have been associated more with D4T therapy than protease inhibitors. 8,9 Facial plastic surgery and chemical peels have been performed for cosmetic purposes in HIV-positive patients.…”

Maintenance of Breast Size Reduction After Mastoplasty and Switch to a Protease Inhibitor-Sparing Regimen in an HIV-Positive Woman with Highly Active Antiretroviral Therapy-Associated Massive Breast Enlargement

“…41 Some reports have described success with surgical removal or with liposuction for fat accumulation in the dorsal-cervical region. [37][38][39][40] According to the outcome for our patient, breast reduction may be evaluated in patients with symptomatic macromastia. In the case presented, in which this approach was chosen in order to treat the marked functional impairment and the depressive status more than for simple esthetic reasons, and before obtaining possible amelioration with drug switching and because of the great discomfort and the decision of the patient; plastic surgery was effective in substantially improving both functions and psychological conditions without postintervention complications.…”

“…[15][16][17][18][19][20] Treatment strategies developed to manage these alterations include modifications of antiretroviral regimens, [21][22][23][24][25][26][27] lifestyle changes, 28,29 drug and hormonal therapies, [30][31][32][33][34][35][36] and surgery. [37][38][39][40] However, none has yet emerged as most effective in managing fat distribution disorders. Here we report the case of a human immunodeficiency virus (HIV)-positive woman who developed massive breast hypertrophy and who was successfully treated using reductive mastoplasty.…”

Surgical Algorithm for Management of HIV Lipodystrophy

“…Wolfort et al 30 first described the use of tumescent liposuction in three HIV-positive men. The patients were receiving highly active antiviral therapy to treat hypertrophied dorsocervical fat pads and in areas of excess fat deposition in the submental, submandibular, and lateral cheek regions and the abdomen.…”

“…Wolfort et al 30 recommend postponement of surgery (1) during increased viral activity, (2) when preoperative laboratory results reveal an inversion of the normal 2:1 CD4-to-CD8 ratio, or (3) when patients report increased fatigue or weight loss. In their study, antibiotic prophylaxis was achieved by administering cefazolin preoperatively followed by cephalexin orally twice daily.…”