Purpose. To review and identify the most accurate ways of diagnosing and treating adventitial cystic disease (ACD) of the venous system. Methods. Cases of ACD were collected through three popular medical databases, including PubMed, Cochrane, OVID, and MEDLINE. After reviewing the literature, the sites of occurrence of 323 cases of adventitial cystic disease were documented, and all cases of arterial ACD were excluded. The clinical features, treatment, and subsequent course of 45 cases of venous ACD are included in this paper. Results. After reviewing all 45 cases of venous ACD , we have confirmed that the most common vessel affected is the common femoral vein, which reproduces the most common symptom of venous ACD: asymmetric lower extremity swelling worsening over time. Conclusion. Venous ACD most commonly affects the common femoral vein. When unilateral leg swelling occurs with or without a noticeable mass, ACD should be considered. It is best confirmed with CT venography and the treatment of choice is transluminal cyst evacuation and excision.
Goals/Purpose
Breast implant illness (BII) is a poorly understood heterogeneous disorder treated with implant removal; however, patient-reported symptoms and outcomes following treatment remain unclear.
Methods/Technique
A retrospective review of patients undergoing bilateral breast implant removal related to BII by two surgeons between 2018-2022 was performed. Patients were surveyed with the BREAST-Q augmentation model with the American Society of Plastic Surgeons (ASPS) BII survey extension. Outcomes were analyzed using a multivariable logistic regression adjusting for patient-associated factors.
Results/Complications
Forty-seven patients were surveyed with a response rate of 51% (n=24). Of the 20 patients completing the survey, the majority were Caucasian (85%), with 45% (n=9) having a documented history of psychiatric illness. Six (30%) had capsular contracture and four (20%) had documented implant rupture. The majority of implant removals (n=12, 60%) were not covered by insurance. Fourteen (70%) had a net improvement in their symptoms after implant removal—most commonly improving chest discomfort, muscle pain, fever, and headaches. Self-pay was predictive of increased breast satisfaction scores (p=0.009), but had no impact on symptomatic improvement. Reduced time to implant removal was predictive of fewer residual symptoms (p=0.032). Capsular contracture was predictive of reduced psychosocial, sexual, and breast satisfaction scores (p=0.015). Psychiatric illness had no significant impact on outcomes.
Conclusion
In the setting of suspected or diagnosed BII, reduced time to implant removal may decrease the risk of residual symptoms and improve overall patient satisfaction. In patients with capsular contracture, preoperative counseling should emphasize the fact that implant removal may improve physical symptoms only.
BACKGROUND: Demand for lip filler injection continues to increase. Despite the current literature's acknowledgement of the role both venous and arterial vasculature play in minor and major side effects, research addressing the venous vasculature of the lower one-third of the face is scarce. The purpose of our study was to create a venous map demonstrating areas of venous pooling that one should avoid when injecting, thus improving the safety and overall aesthetic appearance of the lips postaugmentation.
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