Last month, I traveled to Chicago to attend the Annual Scientific Meeting of the American Society of Plastic Surgeons. The educational offerings include basic science papers, panel discussions, structured courses, and vendor displays. I thought I would present a brief update on what I found interesting or new.
Breast
One of the courses I took was on breast reconstruction using the latissimus flap, a large muscle which covers most of the back. While the latissimus adds strength to arm movements, transferring it to the chest front results in relatively impact on activities of daily living. I use this muscle in breast reconstruction on patients who have had radiation treatment, have particularly thin skin coverage, or who have other problems requiring the addition of health tissue. The course instructor confirmed much about how I like to do the procedure and gave me some technical tips to make the operation go more smoothly. He also convinced me that in the appropriate setting, immediate breast reconstruction using the latissimus is a good idea. I otherwise usually avoid immediate breast reconstruction, but more on this next month.
Fat grafting for breast reconstruction is being used more often to soften contours around an implant and to improve the condition of overlying skin.
Body
Lipoabdominoplasty is a technique advanced by South American surgeons and becoming more practiced here in the United States. It differs from traditional procedures by more extensively liposuctioning the central abdomen with less undermining (raising the whole sheet of tissue). I have used this technique with mini abdominoplasty and have been happy with the results.
There were a number of laser assisted liposuction companies (e.g. SmartLipo), but not a lot of interest from Plastic Surgeons. I believe that the technology may be used best in areas which need only a small improvement and have overlying poor skin elasticity (stretch). I have chosen not to offer this procedure as I almost none of my patient population would benefit and the cost is excessive. Beware of non Plastic Surgeons offering this procedure who may not have the appropriate training to safely perform it.
Plastic Surgery after large weight loss procedures continues to thrive. As this is a young and rapidly evolving area of the specialty, surgeons presented safer and more effective ways to help these patients.
Face
There were several panels on temporary filler placement (i.e. Juvederm and Restylane). These minimally invasive procedures may be very effective, but emphasis was on ways to avoid complications and ensure patient satisfaction.
Surgeons specializing in Facelift surgery presented their long term results. They emphasized that the exact technique is not as important as the care taken to perform it. They also found that short scar / mini facelift techniques had been over performed resulting in deformities and dissatisfied patients. These limited techniques may still give good results in patients with early signs of aging only, but this is not the typical Boise patient. A good facelift surgeon should be able to offer a broad range of operations and select one which will best help the patient.
