Background: Cosmetic tourism for breast augmentation has increased globally, yet the downstream burden of complications and revision surgery in returning patients remains poorly quantified. This study compares the characteristics and complication profiles of breast implant revision procedures among Australian residents whose devices were inserted overseas with those inserted domestically. Methods: A retrospective registry-based study was conducted using Australian Breast Device Registry data (2012–2023). Australian residents who underwent breast implant explantation or replacement between 2016 and 2023, with documented implant insertion location, were included. Primary outcomes were the incidence of breast implant revision and types of complications, stratified by overseas versus domestic insertion. Secondary outcomes included public versus private hospital management, explant-only versus replacement procedures, concurrent mastopexy or reduction, and geographic and temporal trends. Results: Among 30,579 breast implant revision procedures, 3577 (11.7%) involved overseas-inserted devices, with both the number and proportion increasing over time. Patients with overseas-inserted implants were younger at revision (median 41 versus 44 y, P < 0.001). A greater proportion of overseas-related complications were treated in public hospitals (2.7% versus 1.5%, P < 0.001). Revisions due to complications were more common in the overseas group (73.0% versus 69.8%, P < 0.001). Device rupture (27.0% versus 24.5%), malposition (24.9% versus 20.5%), and skin scarring concerns (4.4% versus 2.2%) were more frequent among overseas-inserted implants (all P < 0.001). Conclusions: Revision of overseas-inserted breast implants is increasing in Australia and is associated with a higher burden of specific complications and greater public hospital utilization, highlighting the need for improved counseling, surveillance, and health policy responses.
Background: Sarcomas are rare but aggressive cancers, and their treatment can have profound effects on quality of life. We sought to develop and establish the content validity of the LIMB-Q ONC, a novel patient-reported outcome measure (PROM) for adults with lower extremity malignancies, designed to reliably capture the impact of these cancers on patients. Methods: Following international guidelines for the development of PROMs, we created a preliminary LIMB-Q ONC by adapting the LIMB-Q scales and incorporating 2 cancer-specific scales from the BREAST-Q. Content validity was evaluated through cognitive debriefing interviews with patients and feedback from subject experts. Comments were used to refine a final instrument. Results: We conducted 16 cognitive debriefing interviews with patients with soft-tissue sarcomas (n = 12), bone sarcomas (n = 3), and late effects of nonsarcoma cancer treatment (n = 1). Treatments included chemotherapy (75%), radiation therapy (69%), amputation (63%), and/or flap (50%) surgery. Revisions included replacing “injured lower limb” with “affected lower limb” and “uninjured lower limb” with “lower limb unaffected by cancer.” Minor wording changes improved clarity, whereas no scales were added or removed. Content experts confirmed the instrument’s comprehensiveness and relevance. Conclusions: Content validity of the LIMB-Q ONC was established through qualitative patient interviews and expert review. The LIMB-Q ONC offers a valid tool for measuring the outcomes important to patients with primary lower extremity malignancies. This article demonstrates the content validity of the LIMB-Q ONC in this patient population and allows for future field testing of the PROM.
Summary: Long-term outcomes of flap surgery for hidradenitis suppurativa (HS) of the buttocks have not been reported. We encountered a case of severe HS in which multiple new lesions appeared during a 27-year follow-up period. This article reports useful information regarding reconstruction using a free flap from the back. The patient was a 62-year-old Japanese man. At the age of 35 years, he developed HS in the bilateral groin and sacral regions. Reconstructive surgery was performed for the left groin using a left pedicled rectus abdominis flap, for the right groin using a left free scapular flap, and for the sacral region using a mesh skin graft. During the follow-up period, new lesions appeared in the axilla, face, buttocks, and lower extremities and were primarily treated with deroofing and skin grafting. Subsequently, no recurrent lesions were observed in the sacrum, left buttock, or axilla, and only mild recurrence was observed in the scapular flap transplanted to the right groin. In such severely affected patients, initially harvesting a flap from a distal area rather than an adjacent area may reduce the burden of any subsequent surgery. In particular, the incidence of HS has been reported to be low in the back, and HS did not occur in this patient. This report describes the challenges of buttock reconstruction for progressive severe HS, the advantages of using a free flap from the back during the initial surgery, and the favorable long-term results achieved.
Background: Craniosynostosis is a congenital disorder resulting in the early fusion of several bones in the skull, causing a deformity of the head and facial structures. The 2 most commonly performed surgical procedures to treat craniosynostosis include the monobloc and Le Fort III procedures. This literature review compares the functional and anatomical outcomes and complications between the monobloc and Le Fort III procedures for treating craniosynostosis. Methods: A PubMed search was conducted to identify studies assessing the outcomes following monobloc and Le Fort procedures. Data on anatomical changes, ophthalmic, airway, and neurological sequelae, as well as miscellaneous infectious or aesthetic complications were extracted from each study. Results: A total of 63 articles were included for analysis. The average length of midface advancement across distraction and nondistraction procedures was significantly higher in the monobloc cases (14.28 mm; 98.8% of patients with distraction) compared with Le Fort III cases (12.26 mm; 63% of patients with distraction) ( P = 0.002). Both procedures exhibited similar rates of obstructive sleep apnea improvement. Cerebrospinal fluid leakage (69 of 373 monobloc patients; 15 of 448 Le Fort III patients) ( P ≤ 0.001), seizures (8 of 373 monobloc surgery patients), and meningitis (9 of 373 and 2 of 448, monobloc and Le Fort III patients respectively) ( P = 0.01) were observed. Conclusions: In summary, this review demonstrates that both the monobloc and Le Fort III procedures are effective in producing maxillofacial advancement and correcting craniosynostosis, with the monobloc procedure demonstrating significantly greater average advancement. Future research should investigate the comparison of aesthetic and obstructive sleep apnea outcomes further.
Background: Traditional brachioplasty for moderate to severe arm laxity typically requires longitudinal incisions extending from the axilla to the elbow, often resulting in visible scarring and patient dissatisfaction. To address this limitation, we developed subdermal axillar brachioplasty (SAB), a minimally invasive technique combining liposuction, gas-assisted subdermal radiofrequency, and limited axillary skin excision. Methods: A retrospective observational cohort study was conducted including 67 female patients who underwent SAB between January 2023 and November 2025. Patients with Iglesias grade IV laxity and active smokers were excluded. Arm laxity was objectively measured using a standardized metric protocol preoperatively and at 12-month follow-up according to the Iglesias classification. Outcomes included postoperative laxity grade, surgical parameters, complications, and patient satisfaction assessed using the BODY-Q scale. Results: Preoperatively, 73.13% of patients presented with grade III laxity and 26.86% with grade II. At 12 months, 89.55% achieved grade I laxity and 10.44%, grade II. The mean lipoaspirate volume was 245 ± 62 mL per arm, reflecting conservative contouring. Mean axillary incision length was 5.4 ± 0.4 cm. Complications included 2 hematomas (2.98%), 1 seroma (1.49%), and 1 infection (1.49%). BODY-Q scores significantly improved from 31.9 ± 2.98 preoperatively to 94.2 ± 3.45 postoperatively ( P < 0.001). Conclusions: SAB is a safe and effective technique for patients with moderate arm laxity, achieving significant contour improvement and high patient satisfaction with minimal visible scarring. This approach offers a viable alternative to traditional longitudinal brachioplasty in appropriately selected patients.
