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Background Reduction mammaplasty is a common procedure associated with a very high patient satisfaction rate. It has been shown to alleviate symptoms related to macromastia, such as back, neck, and shoulder pain, poor posture, bra strap grooving, paresthesia, and rashes. Despite the manifold benefits of reduction mammaplasty, some insurance companies require minimum resection weights of at least 500 g per breast in order to distinguish between a reconstructive and aesthetic procedure. Objectives The aim of this study was to assess the origins of the 500-g rule used in reduction mammaplasty. Methods A comprehensive literature search of the MEDLINE, PubMed, Google Scholar, EMBASE, the Cochrane Central Register of Controlled Trials databases was conducted for studies published through July 2020 with multiple search terms related to resection weight criteria for breast reduction. Data on criteria, outcomes, and patient satisfaction were collected. Results A total of 14 articles were selected from the 27 articles that were identified. The 500-g rule appears to be arbitrary, and not based on any available hard evidence. However, numerous studies show that patients who have less than 500 g of tissue removed from each breast still experience significant symptomatic relief from reduction mammaplasty with a marked improvement in their quality of life. Conclusions The 500-g rule should be re-evaluated as an insurance company criterion for authorizing reduction mammaplasty. The rule may influence surgeons to choose between form and function. Many additional patients might then benefit from this important procedure.

Background Many patients with keloids experience symptoms, such as pain and pruritus, and may present with significant psychosocial burdens. However, no single therapeutic regimen has been firmly established for treatment of keloids. Objectives The aim of this study was to assess patients’ perspectives on their keloids after treatment by comparing preoperative and postoperative surveys. Methods All patients seen at the keloid clinic, both preoperatively and postoperatively, were contacted by telephone call. Information about demographics, keloid characteristics, and levels of pain and pruritus were recorded. Participants also completed all 3 parts (appearance, symptoms, and psychosocial impact) of the SCAR-Q, a validated patient-reported outcome measure questionnaire. Statistical analysis was performed with SPSS version 23 (IBM Corp., Armonk, NY). Results Of the 60 patients who participated in the study, 35 preoperative and 34 postoperative surveys were completed. Patients experienced significant reductions in mean [standard deviation] pain levels (from 5.6 [4.0] to 0.1 [0.4], P Conclusions Patients with keloids experience significant improvement in their symptomatic and psychosocial burden after treatment. Although management modalities are not well established, it is essential that plastic surgeons do not overlook the therapeutic benefits for their patients’ well-being.

Senescent cells accumulate in the adipose tissue (AT) of individuals with obesity and secrete multiple factors that constitute the senescence-associated secretory phenotype (SASP). This paper aimed at the identification of B cells with a SASP phenotype in the AT, as compared to the peripheral blood, of individuals with obesity. Our results show increased expression of SASP markers in AT versus blood B cells, a phenotype associated with a hyper-metabolic profile necessary to support the increased immune activation of AT-derived B cells as compared to blood-derived B cells. This hyper-metabolic profile is needed for the secretion of the pro-inflammatory mediators (cytokines, chemokines, micro-RNAs) that fuel local and systemic inflammation.

Perforin-2 (P-2) is an antimicrobial protein with unique properties to kill intracellular bacteria. Gamma delta (GD) T cells, as the major T cell population in epithelial tissues, play a central role in protective and pathogenic immune responses in the skin. However, the tissue-specific mechanisms that control the innate immune response and the effector functions of GD T cells, especially the cross-talk with commensal organisms, are not very well understood. We hypothesized that the most prevalent skin commensal microorganism, Staphylococcus epidermidis, may play a role in regulating GD T cell-mediated cutaneous responses. We analyzed antimicrobial protein P-2 expression in human skin at a single cell resolution using an amplified fluorescence in situ hybridization approach to detect P-2 mRNA in combination with immunophenotyping. We show that S. epidermidis activates GD T cells and upregulates P-2 in human skin ex vivo in a cell-specific manner. Furthermore, P-2 upregulation following S. epidermidis stimulation correlates with increased ability of skin cells to kill intracellular Staphylococcus aureus. Our findings are the first to reveal that skin commensal bacteria induce P-2 expression, which may be utilized beneficially to modulate host innate immune responses and protect from skin infections.

Despite increasing interest in the reversal of age-related processes, there is a paucity of data regarding the effects of post-menopausal-associated estrogen loss on cellular function. We studied human adipose-derived mesenchymal stem cells (hASCs) isolated from women younger than 45 years old (pre-menopause, pre-hASC) or older than 55 years old (post-menopause, post-hASC). In this study, we provide proof of concept that the age-related ineffective functionality of ASCs can be reversed to improve their ability in promoting tissue repair. We found reduced estrogen receptor expression, decreased estrogen receptor activation, and reduced sensitivity to 17β-estradiol in post-hASCs. This correlated with decreased antioxidants (catalase and superoxide dismutase [SOD] expression) and increased oxidative stress compared with pre-hASCs. Increasing catalase expression in post-hASCs restored estrogen receptor (ER) expression and their functional capacity to promote tissue repair as shown in human skin ex vivo wound healing and in vivo mouse model of lung injury. Our results suggest that the consequences of 17β-estradiol decline on the function of hASCs may be reversible by changing the oxidative stress/antioxidant composition.

Many inflammation-associated diseases, including cancers, increase in women after menopause and with obesity. In contrast to anti-inflammatory actions of 17β-estradiol, we find estrone, which dominates after menopause, is pro-inflammatory. In human mammary adipocytes, cytokine expression increases with obesity, menopause, and cancer. Adipocyte:cancer cell interaction stimulates estrone- and NFκB-dependent pro-inflammatory cytokine upregulation. Estrone- and 17β-estradiol-driven transcriptomes differ. Estrone:ERα stimulates NFκB-mediated cytokine gene induction; 17β-estradiol opposes this. In obese mice, estrone increases and 17β-estradiol relieves inflammation. Estrone drives more rapid ER+ breast cancer growth in vivo. HSD17B14, which converts 17β-estradiol to estrone, associates with poor ER+ breast cancer outcome. Estrone and HSD17B14 upregulate inflammation, ALDH1 activity, and tumorspheres, while 17β-estradiol and HSD17B14 knockdown oppose these. Finally, a high intratumor estrone:17β-estradiol ratio increases tumor-initiating stem cells and ER+ cancer growth in vivo. These findings help explain why postmenopausal ER+ breast cancer increases with obesity, and offer new strategies for prevention and therapy., This project has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 845104

The subset of pro-inflammatory B cells, called late memory, tissue-like or double negative (DN), accumulates in the blood of elderly individuals. Here we show that DN B cells do not proliferate and do not make antibodies to influenza antigens, but they secrete antibodies with autoimmune reactivity, in agreement with their membrane phenotype (CD95+CD21-CD11c+) and their spontaneous expression of the transcription factor T-bet. These cells also increase in the blood of individuals with obesity and autoimmune diseases, but causative mechanisms and signaling pathways involved are known only in part. In the present paper we compare frequencies and metabolic requirements of these cells in the blood of healthy individuals of different ages and in the blood and the subcutaneous adipose tissue (SAT) of individuals with obesity. Results show that DN B cells from young individuals have minimal metabolic requirements, DN B cells from elderly and obese individuals utilize higher amounts of glucose to perform autoimmune antibody production and enroll in aerobic glycolysis to support their function. DN B cells from the SAT have the highest metabolic requirements as they activate oxidative phosphorylation, aerobic glycolysis and fatty acid oxidation. DN B cells from the SAT also show the highest levels of ROS and the highest levels of phosphorylated AMPK (5’-AMP activated kinase) and Sestrin 1, both able to mitigate stress and cell death. This metabolic advantage drives DN B cell survival and function (secretion of autoimmune antibodies).

Fibrosis can develop in nearly any tissue leading to a wide range of chronic fibrotic diseases. However, current treatment options are limited. In this study, we utilized an established aged mouse model of bleomycin-induced lung fibrosis (BLM) to test our hypothesis that fibrosis may develop simultaneously in multiple organs by evaluating skin fibrosis and wound healing. Fibrosis was induced in lung in aged (18-22-month-old) C57BL/6 male mice by intratracheal BLM administration. Allogeneic adipose-derived mesenchymal stromal cells (ASCs) or saline were injected intravenously 24 hr after BLM administration. Full thickness 8-mm punch wounds were performed 7 days later to study potential systemic anti-fibrotic and wound healing effects of intravenously delivered ASCs. Mice developed lung and skin fibrosis as well as delayed wound closure. Moreover, we observed similar changes in the expression of known pro-fibrotic factors in both lung and skin wound tissue, including miR-199 and protein expression of its corresponding target, caveolin-1, as well as phosphorylation of protein kinase B. Importantly, ASC-treated mice exhibited attenuation of BLM-induced lung and skin fibrosis and accelerated wound healing, suggesting that ASCs may prime injured tissues and prevent end-organ fibrosis.

Surgical patients are frequently discharged with surgical drains to assist in wound closure that could be disrupted by postoperative hematomas, lymphoceles, or seromas. In clinical practice, duration of drain use is typically dependent on daily output.The aim of this paper was to examine the origins and justifications of drain removal criteria. The authors considered factors that may influence recommendations such as duration, area of surgical site, and risk of infection.A literature review was performed regarding the indications for drain removal in patients undergoing reconstructive and breast surgeries. PubMed was queried for publications up to May 2015 with the following search terms: drain removal, hematomas, lymphoceles, seroma, volume, reconstruction, and mastectomy. Clinical trials, retrospective reviews, meta-analyses, and literature reviews were included.Most plastic surgeons remove drains based on volume criteria; however, some evidence supports early, fixed-duration drain removal. Patients who produce large volumes of fluid from the surgical site are more likely to continue to do so after drain removal and may require increased duration of drain use. Surgical site surface area may also be a factor to consider when pulling a drain.Though drain-associated infection rates are low and appear unaffected by duration, poor outcomes such as implant loss and need for reoperation may be mitigated by antisepsis strategies.

Capsular contracture is a common sequelae of implant-based breast augmentation. Despite its prevalence, the etiology of capsular contracture remains controversial. Numerous studies have identified microbial biofilms on various implantable materials, including breast implants. Furthermore, biofilms have been implicated in subclinical infections associated with other surgical implants. In this review, we discuss microbial biofilms as a potential etiology of capsular contracture. The review also outlines the key diagnostic modalities available to identify the possible infectious agents found in biofilm, as well as available preventative and treatment measures.

The adipose tissue (AT) contributes to systemic and B cell intrinsic inflammation, reduced B cell responses and secretion of autoimmune antibodies. In this study we show that adipocytes in the human obese subcutaneous AT (SAT) secrete several pro-inflammatory cytokines and chemokines, which contribute to the establishment and maintenance of local and systemic inflammation, and consequent suboptimal immune responses in obese individuals, as we have previously shown. We also show that pro-inflammatory chemokines recruit immune cells expressing the corresponding receptors to the SAT, where they also contribute to local and systemic inflammation, secreting additional pro-inflammatory mediators. Moreover, we show that the SAT generates autoimmune antibodies. During the development of obesity, reduced oxygen and consequent hypoxia and cell death lead to further release of pro-inflammatory cytokines, "self" protein antigens, cell-free DNA and lipids. All these stimulate class switch and the production of autoimmune IgG antibodies which have been described to be pathogenic. In addition to hypoxia, we have measured cell cytotoxicity and DNA damage mechanisms, which may also contribute to the release of "self" antigens in the SAT. All these processes are significantly elevated in the SAT as compared to the blood. We definitively found that fat-specific IgG antibodies are secreted by B cells in the SAT and that B cells express mRNA for the transcription factor T-bet and the membrane marker CD11c, both involved in the production of autoimmune IgG antibodies. Finally, the SAT also expresses RNA for cytokines known to promote Germinal Center formation, isotype class switch, and plasma cell differentiation. Our results show novel mechanisms for the generation of autoimmune antibody responses in the human SAT and allow the identification of new pathways to possibly manipulate in order to reduce systemic inflammation and autoantibody production in obese individuals.

This study uses Nationwide Inpatient Sample data to investigate the effects of abdominoplasty procedures on patients with autoimmune connective tissue diseases

Skull-based osteomyelitis, which is a true bony infection, originates from a chronic, inadequately treated infection. Because of the complex craniofacial skeletal anatomy and associated aesthetic concerns, osteomyelitis of the craniofacial skeleton must be uniquely managed and is more difficult to treat than osteomyelitis of other bones of the body. It is thought that osteomyelitis is decreasing in prevalence due to broad-spectrum antibiotic treatment; however, it still remains a challenging clinical entity in developing countries and lower socioeconomic areas.

Background: Although it is becoming more common for abdominoplasty to be performed in combination with other procedures, it has been suggested that such combined procedures may raise the risk of postoperative complications. Objective: The purpose of this study was to determine whether abdominoplasty performed in conjunction with adjunct procedures would result in an increased morbidity. Methods: A total of 102 patients who underwent abdominoplasty, either alone or combined with additional surgery, between March 2003 and March 2005 were included. A retrospective chart review following institutional review board guidelines was conducted. Combined surgeries included breast reduction, mastopexy, hysterectomy, colostomy revisions, and ventral hernia repairs. Complication rates were also correlated with body mass index (BMI). Twenty-seven patients underwent abdominoplasty alone, and 47 patients were in the abdominoplasty combined group. Complication rates of 18.5% vs. 17%, respectively, were analyzed with a t test ( P = .44) and were further stratified in relation to BMI. Results: We found a direct correlation between elevated BMI and increased complication rate. Comparison of BMI 30 (obese) revealed complication rates of 9% vs. 36%, respectively ( P < .02). Obesity in our study was a significant predictor of postoperative complications. Conclusions: It would appear that combining abdominoplasty with additional surgical procedures does not lead to increased complication rates and is safe with carefully selected patients and appropriate deep vein thrombosis prophylaxis.

After studying this article, the reader will be able to: (1) review the incidence and etiology of mandibular angle fractures; (2) gain an understanding of patient evaluation and general management principles; and (3) discuss indications and available techniques for management of mandibular angle fractures. Angle fractures represent the highest percentage of mandibular fractures. Two of the most common causes of mandibular angle fractures are motor vehicle accidents and assaults or altercations. With any patient who has sustained facial trauma, a thorough history and comprehensive physical examination centering on the head and neck region as well as proper radiological assessment are essential. These elements are fundamental in establishing a diagnosis and developing an appropriate treatment plan for any mandibular fracture.

The gold standard of peripheral nerve repair is nerve autograft when tensionless repair is not possible. Use of nerve autograft has several shortcomings, however. These include limited availability of donor tissue, sacrifice of a functional nerve, and possible neuroma formation. In order to address these deficiencies, researchers have developed a variety of biomaterials available for repair of peripheral nerve gaps. We review the clinical studies published in the English literature detailing outcomes and reconstructive options. Regardless of the material used or the type of nerve repaired, outcomes are generally similar to nerve autograft in gaps less than 3 cm. New biomaterials currently under preclinical evaluation may provide improvements in outcomes.

Laryngeal tuberculosis is usually a complication of pulmonary tuberculosis and the clinical patterns have changed in recent decades. To evaluate the changing patterns, we reviewed 15 patients seen at the Massachusetts Eye and Ear Infirmary over a 20-year period and diagnosed as having laryngeal tuberculosis. The results showed a mean age of 56 years; a male predominance by a 2:1 ratio; minimal pulmonary lesions on radiographic studies in nine patients and one normal radiograph; clinical simulation by the tuberculous lesion of laryngeal cancer; excellent response to antituberculosis therapy; and low infectivity. Laryngeal lesions and concurrent pulmonary lesions should alert the otolaryngologist to consider systemic disease processes and the most frequent granulomatous lesion of the larynx, tuberculosis.