Background: A variety of complications after injection of nonpermanent fillers for facial rejuvenation have been reported so far. However, to date, the overall complication rate is still a matter of debate. The aim of this study was to perform a systematic review of literature to assess the type and severity of associated complications following injections in different anatomical regions of the face. Methods: The entire PubMed/Medline database was screened to identify case reports and clinical studies describing complications that have occurred after injection of nonpermanent fillers in the face. These complications have been reviewed and analyzed according to their occurrence in different anatomical regions of the face. Results: Forty-six articles including a total of 164 patients reported on a total of 436 complications during the time period between January 2003 and February 2020. The majority of the complications were reported after injections to the nose and the nasolabial fold (n = 230), the forehead and the eyebrows (n = 53), and the glabellar region (n = 36). Out of 436 complications, 163 have been classified as severe or permanent including skin necrosis (n = 46), loss of vision (n = 35), or encephalitis (n = 1), whereas 273 complications were classified as mild or transient, such as local edema (n = 74), skin erythema (n = 69), and filler migration (n = 2). The most severe complications were observed in treatments of nose, glabella, and forehead. Conclusions: Nonpermanent facial fillers are associated with rare but potentially severe complications. Severity and impact of complications depend on the anatomical region of the face and eventually require profound knowledge of facial anatomy.

Breast cancer is the leading cause of cancer death in women worldwide. Its surgical approach has become less and less mutilating in the last decades. However, the overall number of breast reconstructions has significantly increased lately. Nowadays breast reconstruction should be individualized at its best, first of all taking into consideration oncological aspects of the tumor, neo-/adjuvant treatment and genetic predisposition, but also its timing (immediate versus delayed breast reconstruction), as well as the patient’s condition and wish. This article gives an overview over the various possibilities of breast reconstruction, including implant- and expander-based reconstruction, flap-based reconstruction (vascularized autologous tissue), the combination of implant and flap, reconstruction using non-vascularized autologous fat, as well as refinement surgery after breast reconstruction.

Introduction: Recent data suggest that margins ≥2 mm after breast-conserving surgery may improve local control in invasive breast cancer (BC). By allowing large resection volumes, oncoplastic breast-conserving surgery (OBCII; Clough level II/Tübingen 5-6) may achieve better local control than conventional breast conserving surgery (BCS; Tübingen 1-2) or oncoplastic breast conservation with low resection volumes (OBCI; Clough level I/Tübingen 3-4). Methods: Data from consecutive high-risk BC patients treated in 15 centers from the Oncoplastic Breast Consortium (OPBC) network, between January 2010 and December 2013, were retrospectively reviewed. Results: A total of 3,177 women were included, 30% of whom were treated with OBC (OBCI n = 663; OBCII n = 297). The BCS/OBCI group had significantly smaller tumors and smaller resection margins compared with OBCII (pT1: 50% vs. 37%, p = 0.002; proportion with margin <1 mm: 17% vs. 6%, p < 0.001). There were significantly more re-excisions due to R1 (“ink on tumor”) in the BCS/OBCI compared with the OBCII group (11% vs. 7%, p = 0.049). Univariate and multivariable regression analysis adjusted for tumor biology, tumor size, radiotherapy, and systemic treatment demonstrated no differences in local, regional, or distant recurrence-free or overall survival between the two groups. Conclusions: Large resection volumes in oncoplastic surgery increases the distance from cancer cells to the margin of the specimen and reduces reexcision rates significantly. With OBCII larger tumors are resected with similar local, regional and distant recurrence-free as well as overall survival rates as BCS/OBCI.

Over the last years, prepectoral implant-based breast reconstruction has undergone a renaissance due to several technical advancements regarding mastectomy techniques and surgical approaches for the placement and soft tissue coverage of silicone implants. Initially abandoned due to the high incidence of complications, such as capsular contraction, implant extrusion, and poor aesthetic outcome, the effective prevention of these types of complications led to the prepectoral technique coming back in style for the ease of implant placement and the conservation of the pectoralis muscle function. Additional advantages such as a decrease of postoperative pain, animation deformity, and operative time contribute to the steady gain in popularity. This review aims to summarize the factors influencing the trend towards prepectoral implant-based breast reconstruction and to discuss the challenges and prospects related to this operative approach.

Hintergrund: Die autologe Fetttransplantation ist eine in letzter Zeit zunehmend verbreitete operative Prozedur und umfasst die Entnahme, Bearbeitung und Transplantation von Fettgewebe sowie die fachgerechte Nachsorge. Dieser operative Eingriff ist ein Verfahren, das sowohl nach traumatischem, krankheits- oder altersbedingtem Volumenverlust der Weichteile als auch zur Weichteilaugmentation eingesetzt werden kann. Aufgrund der zunehmenden Anwendung aber noch bisher wenig definierten Variablen in der Fettgewinnung, Indikationsstellung und Art der Transplantation in der rekonstruktiven und ästhetischen Chirurgie besteht ein großes Interesse an der Entwicklung einer Leitlinie. Methodik: In einer Konsensuskonferenz im Rahmen eines nominalen Gruppenprozesses der anwendenden Fachgesellschaften wurden alle im Delphi-Verfahren strittigen Punkte diskutiert und mit starken Konsens (>95%) beschlossen. Die Literatur der letzten 10 Jahre in den gängigen medizinischen Informationsportalen und Datenbanken wurde abgefragt, studiert und unter Berücksichtigung auch wichtiger älterer Arbeiten entscheidende Aussagen der Leitlinie belegt. Ergebnisse: Unter Einschluss aller relevanten Fachgesellschaften wurden hinsichtlich nachfolgender Punkte konsensbasierte Empfehlungen in Form dieser Leitlinie formuliert. 1. Definition, 2. Indikation/Kontraindikation, 3. Präoperative Maßnahmen, 4. Entnahmetechniken, 5. Bearbeitungstechniken, 6. Transplantation, 7. Nachsorge, 8. Aufbewahrung und Lagerung, 9. Effizienz, 10. Dokumentation, 11. Bewertung der Sicherheit. Zusammenfassung: Klare Indikationsstellung und fachliche Expertise sind Grundvoraussetzung um die autologe Fetttransplantation durchzuführen. Der Erfolg dieses operativen Eingriffs ist abhängig vom Einsatz der richtigen Methoden sowie der speziellen Instrumente und Materialen. Aufgrund der niedrigen Rate an postoperativen Komplikationen und Spätfolgen ist die autologe Fetttransplantation als sicheres Verfahren in der rekonstruktiven und ästhetischen Medizin anzusehen. Teile dieses Artikels sind wörtlich aus der Leitlinie entnommen [1] Introduction: Autologous fat transfer has recently become an increasingly popular surgical procedure and comprises harvesting, processing and transplantation of adipose tissue, as well as professional follow-up care. This method, as a surgical procedure, can be utilised for trauma-, disease- or age-related soft tissue volume deficits and soft tissue augmentation. As usage is increasing, but the variables of fat harvest, specific indications and fashion of fat transfer are poorly defined, there is a great demand for development of a guideline in the field of reconstructive and aesthetic surgery. Methods: All relevant points were discussed within the scope of a consensus conference including a nominal group process of all societies involved in the procedure and ratified with a strong consensus (>95%). Literature from the standard medical databases over the last 10 years was retrieved, studied and specific guidelines were concluded. Results: Consensus was achieved among all professionals involved on the following points: 1. definition 2. indication/contraindication, 3. preoperative measures 4. donor sites 5. techniques of processing 6. transplantation 7. follow-up care 8. storage 9. efficacy 10. documentation 11. evaluation of patient safety. Conclusion: Definite indications and professional expertise are paramount for autologous fat tissue transfer. Successful transfers are based on the use of correct methods as well as specific instruments and materials. Autologous adipose tissue transplantation is considered to be a safe procedure in reconstructive and aesthetic surgery, due to the low rate of postoperative complications and sequelae. ^* Leitlinienkoordination: Prof. Dr. Hans-Oliver Rennekampff, Leverkusen, Steuergruppe (DGPRÄC): Prof. Dr. Riccardo Giunta, München Prof. Dr. Dennis von Heimburg, Frankfurt Prof. Dr. Ulrich Kneser, Ludwigshafen Dr. Florian Lampert, Freiburg Prof. Dr. Hans-Günther Machens, München Prof. Dr. Norbert Pallua, Aachen Prof. Dr. Lukas Prantl, Regensburg Dr. Klaus Ueberreiter, Birkenwerder Prof. Dr. Peter M. Vogt, HannoverAutoren: Prof. Dr. Riccardo Giunta, München Prof. Dr. Yves Harder, Viganello Prof. Dr. Dennis von Heimburg, Frankfurt Dr. Norbert Heine, Regensburg Priv.-Doz. Christian Herold, Hameln Prof. Dr. Ulrich Kneser, Ludwigshafen Dr. Florian Lampert, Freiburg Prof. Dr. Hans-Günther Machens, München Priv.-Doz. Dr. Dr. Ursula Mirastschijski, Bremen Priv.-Doz. Dr. Daniel-Felix Müller,München Prof. Dr. Lukas Prantl, Regensburg Dr. Jan-Thorsten Schantz, München Dr. Alexander Schönborn, Potsdam Dr. Klaus Ueberreiter, Birkenwerder Dr. Christian Witzel, Berlin