Background Female cosmetic genital surgery is rapidly growing. However, controversy reports raised around these procedures question their indications, motives, and safety. Warning against performing this surgery might unjustly restrict surgical alleviation of symptoms. Objectives Through anonymous research, the authors explored patient characteristics and motivation, when women started to think about surgery, and effects of surgery on psychosocial and cosmetic aspects. Methods Of 125 patients who underwent female cosmetic genital surgery at Oslo Plastic Surgery Clinic between 2010 and 2016, 69 patients were reachable by email. A questionnaire with 40 questions was completed anonymously. Answers were processed by a third, independent party via QuestBack return mail system. Results The response rate was 77%. Mean follow-up time was 31.4 months. Mean patient age was 30.8 years. Motivations for surgery were cosmetic (69.8%), physical/practical (62.3%), emotional (54.7%), and intimate (49.1%). When emotional reasons were involved, media (39.7%), pornography (31.5%), and negative comments (28.8%) influenced the decision to undergo surgery. Genital concerns had negative effects on self-esteem (63.2%) and sexual attractiveness (57.9%) among others; 90.5% thought about surgery for more than 1 year. The overall cosmetic result was satisfactory for 69.8%, and the operation as a whole was satisfactory for 75.5%. Conclusions Age, level of education, and gross income of patients who underwent this surgery seem high compared with those of breast implant patients. Genital dissatisfaction arose early in life and affected various psychosexual aspects. Most patients are satisfied with the outcome of surgery and would recommend this surgery to others. Additional anonymous multicenter studies are recommended. Level of Evidence: 4
Background Inverted nipples are prevalent in 3% to 10% of women and can often cause functional, psychological, and aesthetic problems. Objectives The authors sought to treat inverted nipples and restore the aesthetic appearance of the nipple while minimizing ductal disruption, preserving the ability to breast-feed, and reducing recurrence rates. Methods A retrospective review was performed on a total of 161 inverted nipples in 86 consecutive patients who underwent correction of inverted nipples at Oslo Plastic Surgery Clinic. Mean age at operation was 28.7 years and mean follow-up period was 14 months. A novel technique with central tunnelization of the retracted fibers/ducts was employed in 39 patients (45%); partial incision of the center of the inversion through a tunnel in 31 patients (36%); and total cut of the lactiferous ducts in 16 patients (19%). Fat grafting was utilized as support in 14 patients (26 nipples). Postoperatively, nipples were suspended for 4 weeks with a manually constructed device. Results Most patients had moderate (grade 2, 40 patients) or severe (grade 3, 52 patients) nipple inversion. Infection occurred in 4 patients and 2 patients had local irritation. Recurrence was seen in 32 patients (55 nipples) after the first operation, in 6 patients (6 nipples) after the second operation, and in 1 patient (1 nipple) after the third operation. Conclusions The authors propose a treatment algorithm that addresses important therapeutic goals when treating inverted nipples. Clinical examination is crucial to determine the method to be employed. The new central tunnel method and fat grafting to support the nipple are promising, although additional follow-up is necessary. Level of Evidence: 4
Gluteal augmentation with fat is one of the most popular procedures, with an internationally high mortality rate. Patient safety is a priority, and preventive measures should improve safety because appropriate patient selection, avoiding muscular and submuscular grafting, avoiding infragluteal incision, moderate grafted volume, and direct postoperative mobilization are essential.
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