BACKGROUND: Aesthetic breast surgeries, including breast reduction, are commonly performed surgical procedures associated with postoperative pain. Pain control is essential to patient comfort, satisfaction, and early recovery. This systematic review is the first to conduct both qualitative and quantitative analysis to evaluate the efficacy and safety of local anesthetic infiltration in reducing pain after breast reduction surgeries.
METHODS: This systematic review is registered in PROSPERO, assessed for bias using the RoB2 tool, and follows the PRISMA guidelines. A full electronic search was performed in different databases for all clinical papers on adult female patients undergoing cosmetic breast reduction surgery who were given local anesthetic infiltration for postoperative pain relief.
RESULTS: A systematic review of five randomized clinical trials with a total of 191 patients found that local anesthetic infiltration significantly reduces postoperative pain in breast reduction surgery, reduces opioid consumption, and improves patient outcomes. A meta-analysis of two trials reported the mean VAS score for postoperative pain in the local anesthetic and placebo groups.
CONCLUSIONS: A systematic review and a meta-analysis show a significant reduction in postoperative pain following local anesthetic infiltration, but further research is needed to understand its effectiveness and potential adverse effects.
METHODS: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

UNASSIGNED: Persistent lactation, or galactorrhoea, is a common problem which is infrequently seen in the setting of aesthetic surgery. Increasing frequency of aesthetic breast surgery such as breast augmentation suggests a need for improved understanding of the effect of galactorrhoea on surgical outcomes.
UNASSIGNED: A 34-year-old patient underwent day-case bilateral breast reduction/mastopexy combined with sub-muscular implant augmentation, abdominoplasty and bilateral liposuction to the flanks. She reported to have stopped breastfeeding more than 6 months prior. Intraoperatively, the breast tissue was noted to be lactating. The procedure was completed as planned and a routine postoperative plan was followed including oral antibiotics, analgesia and compression garments. The patient was discharged, however reattended on postoperative day 10 with breast pain and fevers. She was treated for right breast surgical site infection and required washout and implant removal. She was referred to Endocrinology for treatment of galactorrhoea with Bromocriptine and Cabergoline. She subsequently underwent revision implant augmentation with good outcomes.
UNASSIGNED: This case highlights the increased likelihood of post-operative infection in galactorrhoea associated with breast implant augmentation. It is important to exclude lactation preoperatively and avoid a prosthesis in this situation, to minimise this risk and optimise surgical outcomes.
UNASSIGNED: Aesthetic breast surgeons must be aware of the incidence of galactorrhoea, and its possible effects on risks of postoperative complications and poor aesthetic outcomes. The authors suggest deferring implant augmentation until complete resolution of lactation where possible.

BACKGROUND: This pioneering study evaluates the safety, efficacy, and Aesthetic outcomes of Ergonomix2 Motiva Ergonomic Implants in breast augmentation. It aims to assess their capability to offer more natural touch and dynamics, delineate the learning curve for surgical techniques, and examine their safety profile compared to Ergonomix1 implants.
METHODS: A prospective cohort study was conducted, comparing 31 patients who received Ergonomix2 implants with a control group of 51 patients with Ergonomix1 implants. Eligible patients were those seeking Aesthetic breast augmentation without prior surgeries or chronic illnesses. Detailed documentation of surgical techniques, implant characteristics, and patient demographics was performed. The study assessed surgical learning curve, implant positioning accuracy, and short-term and early complications. Aesthetic outcomes were evaluated using the BreastQ questionnaire and quantitative elastography.
RESULTS: Patients with Ergonomix2 implants showed significant improvements in Aesthetic outcomes, including breast contour symmetry and natural feel. The learning curve demonstrated a decrease in surgical time and higher implant positioning accuracy. The safety profile was favorable, with a low complication rate and high patient satisfaction levels. Ergonomix2 implants exhibited enhanced softness and pliability, closely mimicking natural breast tissue, as confirmed by elastographic analyzes.
CONCLUSIONS: Ergonomix2 implants represent a significant advancement in Aesthetic breast surgery, offering natural-feeling and dynamically adaptable outcomes. Despite the promising results, the need for specialized surgical techniques and further research on long-term safety and efficacy is emphasized. This study contributes foundational knowledge to the field of ergonomic breast implants and their application in modern plastic surgery.
METHODS: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Aesthetic breast surgery is the most common body surgery at Bagatin Polyclinic. During 2020 and 2021, altogether 274 cosmetic surgeries were performed on the breasts. This included breast augmentation, breast augmentation and lifting operations, in a ratio of 2 to 1.According to statistics from the American Association of Plastic Surgeons (ASPS), in 2020 breast augmentation with implants was ranked fifth of all cosmetic surgeries performedand the second largest body surgery immediately after liposuction, with 193,073 procedures done. In addition to these procedures, breast augmentation (87,051) and breast reduction (33,574) procedures were also popular. Due to the increased interestin these procedures and their high daily percentage of operating programs, adequate analgesia and recovery of patients, who undergo these cosmetic breast corrections, areimportant. Today, it is no longer enough for an operation to go well and the patients to have good results. It is also important that the procedure itself, from induction of anesthesia to early and late recovery, allows for a quick return to daily activities and work.

The popularity of aesthetic breast surgery in China results in greater demand for assessing risk factors for complications and mortality.
To determine the incidence and independent risk factors for postoperative complications following aesthetic breast surgery in China.
A retrospective cohort study on 4973 patients who had aesthetic breast surgery between 2012 and 2021 was performed. Postoperative complications include minor complications (incision healing impaired, hematoma, or fat liquefaction) and surgical site infection (SSI), which were recorded within 30 days after surgery. The follow-up time was expanded to 1 year only after prosthesis implantation procedures. Potential risk factors including age, weight, length of hospital stay, operation time, volume resection, incision location, and other clinical profile information were evaluated.
Among 4973 patients who underwent aesthetic breast surgery, the minor complication rate was 0.54%, and SSI was 0.68%. Augmentation with prosthesis implantation had the highest SSI rate (4.23%), which was significantly associated with increasing age (relative risk [RR] 1.12; P < 0.01) and periareolar incision (RR 5.87, P < 0.01). After augmentation with autologous fat transplantation, postoperative antibiotic use (RR 6.65, P < 0.01) was an independent risk factor for SSI. After adjusting for weight, volume resection over 1500 g (RR 14.7, P < 0.01) was an independent risk factor for SSI of reduction-mastopexy surgery. The complication rate of reduction mammaplasty (1.01%) and gynecomastia correction was lower (0.75%), and there was no record of complication in mastopexy procedures (n = 161).
The incidence of postoperative complications following aesthetic breast surgery is low. Risk factors for complications mainly include increasing age, perioperative antibiotic use, periareolar incision, and extensive volume resection. Much more attention should be focused on those high-risk patients in clinical practice to decrease breast infection.
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

BACKGROUND: Augmentation mammoplasty is one of the most common esthetic procedures worldwide. A wide range of motivations leads women to undergo this procedure, among them socioeconomic status and age group. The aim of this study was to identify the motivation spectrum for augmentation mammoplasty through different age groups.
METHODS: We conducted a cross-sectional prospective survey given to Israeli women seeking augmentation mammoplasty consults in a hospital and private clinic settings, using a 17-item Motivation for Augmentation questionnaire. Three motivation domains were examined: appearance, sexuality and social. Study participants were divided into three age groups: 18-29, 30-39 and over 40 years.
RESULTS: A total of 101 women participated in the study. Motivations were rated similar among all age groups. Appearance and sexuality domains were rated significantly higher compared with the social domain throughout all age groups (3.28 ± 0.91 and 3.15 ± 1.03 vs. 1.88 ± 1.16, p < 0.001, respectively).
CONCLUSIONS: Motivations in Israeli women seeking breast augmentation do not change with age. The desire to improve one\'s appearance and sexuality is more prominent than improving social and work status.
UNASSIGNED: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

BACKGROUND: Periareolar augmentation mastopexy is one of the most demanded operations at Plastic Surgery clinics. Nevertheless, it is one of the leads of malpractice claims in United States caused by the high patient expectations and the standard surgical techniques which may result in common complications. The aim of this report is to present a new surgical approach to solve these complications.
METHODS: After establishing a working hypothesis, we performed a revision study of our patients and we came to the following conclusion: in order to perform a periareolar mastopexy for ptosis correction, breast has to be tuberous at any level and to have abnormally short inferior pole. These findings may explain the main complications from periareolar augmentation mastopexy with the standard surgical techniques. Consequently, we started a prospective observational study including 56 patients following a new surgical technique which deals the cases as tuberous breasts.
RESULTS: During three years, fifty-six periareolar mastopexies were performed with this new surgical approach with one year follow-up. No major complications were observed and 40 of the patients (71%) described the results as very positive.
CONCLUSIONS: \"If a periareolar mastopexy can be performed, then it must be a tuberous breast\". According to this, a new surgical technique for periareolar augmentation mastopexy has been developed obtaining an improvement in our surgical results and achieving a totally different view on this pathology, which has not been reported in literature yet.