Publications by authors named "Elizabeth J Hall-Findlay"

28 Publications

  • Page 1 of 1

Invited Discussion on: Superomedial Pedicle Breast Reduction for Gigantic Breast Hypertrophy: Experience in 341 Breasts and Suggested Safety Modifications.

Aesthetic Plast Surg 2021 04 5;45(2):386-389. Epub 2021 Jan 5.

Banff Plastic Surgery, 106, 75 Dyrgas Gate, Canmore, Alberta, T1W 0A6, Canada.

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http://dx.doi.org/10.1007/s00266-020-02065-7DOI Listing
April 2021

Invited Discussion on: Is There a Breast Augmentation Outcome Difference Between Subfascial and Subglandular Implant Placement? A Prospective Randomized Double-Blind Study.

Aesthetic Plast Surg 2019 12 6;43(6):1437-1438. Epub 2019 Sep 6.

106-75 Dyrgas Gate, Banff Plastic Surgery, Canmore, AB, T1W 06, Canada.

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http://dx.doi.org/10.1007/s00266-019-01491-6DOI Listing
December 2019

Response to "Scientific Evidence or Personal Beliefs?"

Aesthet Surg J 2019 07;39(8):359-360

Private practice in Banff, AB, Canada.

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http://dx.doi.org/10.1093/asj/sjz095DOI Listing
July 2019

Commentary on: A Step Forward Toward the Understanding of the Long-Term Pathogenesis of Double Capsule Formation in Macrotextured Implants: A Prospective Histological Analysis.

Aesthet Surg J 2019 10;39(11):1200-1202

Division of Plastic Surgery and Reconstructive Surgery, University of Alberta, Edmonton, AB, Canada.

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http://dx.doi.org/10.1093/asj/sjy336DOI Listing
October 2019

Late Seromas in Natrelle 410 Form-Stable Silicone Breast Implants.

Plast Reconstr Surg 2017 09;140(3):500e-501e

Banff Plastic Surgery, Banff, Alberta, Canada.

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http://dx.doi.org/10.1097/PRS.0000000000003615DOI Listing
September 2017

Principles of Breast Re-Reduction: A Reappraisal.

Plast Reconstr Surg 2017 Jun;139(6):1313-1322

Christchurch, New Zealand; and Banff, Alberta, Canada.

Background: This article examines outcomes following breast re-reduction surgery using a random pattern blood supply to the nipple and vertical scar reduction.

Methods: A retrospective review was conducted of patients who underwent bilateral breast re-reduction surgery performed by a single surgeon over a 12-year period. Patient demographics, surgical technique, and outcomes were analyzed.

Results: Ninety patients underwent breast re-reduction surgery. The average interval between primary and secondary surgery was 14 years (range, 0 to 42 years). The majority of patients had previously undergone primary breast reduction using an inferior pedicle [n = 37 (41 percent)]. Breast re-reduction surgery was most commonly performed using a random pattern blood supply, rather than recreating the primary pedicle [n = 77 (86 percent)]. The nipple-areola complex was repositioned in 60 percent of patients (n = 54). The mean volume of tissue resected was 250 g (range, 22 to 758 g) from the right breast and 244 g (range, 15 to 705 g) from the left breast. Liposuction was also used adjunctively in all cases (average, 455 cc; range, 50 to 1750 cc). Two patients experienced unilateral minor partial necrosis of the areolar edge but not of the nipple itself (2 percent).

Conclusions: Breast re-reduction can be performed safely and predictably, even when the previous technique is not known. Four key principles were developed: (1) the nipple-areola complex can be elevated by deepithelialization rather than recreating or developing a new pedicle; (2) breast tissue is removed where it is in excess, usually inferiorly and laterally; (3) the resection is complemented with liposuction to elevate the bottomed-out inframammary fold; and (4) skin should not be excised horizontally below the inframammary fold.

Clinical Question/level Of Evidence: Therapeutic, IV.
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http://dx.doi.org/10.1097/PRS.0000000000003383DOI Listing
June 2017

Discussion: The Blood Supply of the Breast Revisited.

Plast Reconstr Surg 2016 May;137(5):1398-1400

Banff, Alberta, Canada.

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http://dx.doi.org/10.1097/PRS.0000000000002123DOI Listing
May 2016

Breast Reduction.

Plast Reconstr Surg 2015 Oct;136(4):531e-544e

Banff, Alberta, Canada; and Pittsburgh, Pa. From Banff Plastic Surgery and the University of Pittsburgh School of Medicine, Magee-Women's Hospital, and the Aesthetic Plastic Surgery Center of University of Pittsburgh Medical Center.

Learning Objectives: After studying this article, the participant should be able to: 1. Identify the anatomy of both the vascular supply and the innervation to the breast to design the appropriate pedicle in breast reduction. 2. Understand various approaches to breast reduction to be able to maximize both functional and aesthetic results. 3. Understand each step in the operative procedure to be able to provide consistent predictable results in breast reduction.

Summary: The objective with breast reduction surgery is to reposition the nipple, remove excess parenchyma, and tailor the skin to fit the new shape. This is a CME article meant to provide an overview of principles while trying not to provide a single practitioner viewpoint. The article includes a brief history, a review of the anatomy, and patient selection. The preoperative markings and operative technique for both inverted-T and vertical approaches are detailed. Postoperative care and potential complications are included.
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http://dx.doi.org/10.1097/PRS.0000000000001622DOI Listing
October 2015

Discussion: Breast implant-associated anaplastic large cell lymphoma: a systematic review.

Plast Reconstr Surg 2015 Mar;135(3):721-722

Banff, Alberta, Canada From Banff Plastic Surgery.

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http://dx.doi.org/10.1097/PRS.0000000000001038DOI Listing
March 2015

Vertical Scar Breast Reduction: Does Gathering the Incision Matter?

Ann Plast Surg 2016 Jan;77(1):25-31

From the *Section of Plastic Surgery, University of Calgary, Calgary, AB, Canada; †Division of Biostatistics, Department of Surgery, University of Calgary, Calgary, AB, Canada; ‡Faculty of Chiropractic, D'Youville College, Buffalo, NY; and §Plastic Surgery, Banff, AB, Canada.

Background: The vertical scar bilateral breast reduction is a highly effective technique to reduce breast volume and create long-lasting aesthetic improvements. A cited disadvantage is the inability to adequately shorten the vertical scar, leading to chest wall scars or inframammary puckers. Gathering or cinching sutures have been described as a strategy to confront this issue. This article aims to determine if suture gathering is an effective methods to (1) reduce the incision length, (2) shorten the areola-to-inframammary fold (IMF) distance, and (3) reduce the pucker revision rate.

Methods: All patients undergoing vertical breast reduction performed by the senior author (E.H.F.) from 2001 to 2007 were included. The patient population was divided into "gather" and "no gather" groups depending on how the vertical incision was closed.

Results: There were 203 patients in the "no gather" group and 193 in the "gather" group. Age, body mass index, and resection weight were statistically but not clinically different. The percent reduction in vertical incision length was significantly greater in the "gather" group (34.2 ± 9.9% vs. 12.2 ± 5.9%). Both groups showed a gradual lengthening of areola-to-IMF distance postoperatively. Suture gathering had no impact on the pucker revision rate but increased healing complications.

Conclusion: Gathering sutures significantly reduce the incision length in the operating room but do not change the areola-to-IMF distance or pucker revision rate. Gathering negatively influences skin vascularity and wound healing. It is acceptable and necessary to have a longer areola-to-IMF distance in a vertical reduction to accommodate increased projection.
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http://dx.doi.org/10.1097/SAP.0000000000000234DOI Listing
January 2016

How Does Volume of Resection Relate to Symptom Relief for Reduction Mammaplasty Patients?

Ann Plast Surg 2015 Oct;75(4):376-82

From the *Department of Plastic and Reconstructive Surgery, James Cook University Hospital, Middlesbrough, UK; and †Banff Plastic Surgery, Banff, Alberta, Canada.

Background: Reduction mammaplasty surgery is well known to produce improvement in a wide range of symptoms associated with macromastia. Health care insurers frequently stipulate a minimum resection volume to qualify for coverage, limiting access to surgery for many. The authors aimed to identify whether small volume resections do produce symptomatic improvement, comparing preoperative and postoperative experience of symptoms across a range of tissue resection volumes.

Methods: Reduction mammaplasty patients were given a custom-designed questionnaire at routine postoperative follow-up appointments, asking them to rate their preoperative and postoperative experience of 9 symptoms related to macromastia. Results were compiled and analyzed alongside data from patient case notes. Of 661 patients identified as being eligible for inclusion in the study, 410 had sufficiently complete data to proceed to statistical analysis. Patients were divided into 6 groups based on volume of breast tissue resected. A Schnur sliding scale percentile was also calculated for all patients. Statistical analysis of preoperative symptom prevalence and postoperative symptom change was carried out. Further analysis to examine for evidence of trend in symptom improvement across groups was implemented using the Jonckheere-Terpstra test for ordered alternatives.

Results: Patients who go on to have larger volumes of breast tissue resected were found to experience back pain, shoulder grooves, breast pain, rashes under the breast, exercise intolerance, and poor posture more frequently than those who go on to have smaller resections (P < 0.0005 for all). However, across the range of resection volumes, preoperatively symptomatic patients experienced significant improvement in several symptoms. Results suggested that a larger resection volume may correspond with greater improvement in back pain, neck pain, and poor posture.

Conclusions: We found that reduction mammaplasty has a positive impact on a range of symptoms, even with lower volume resections and regardless of body surface area-calculated adjustments. This adds further weight to the argument that patients should not be denied access to the surgery based on arbitrary volume restrictions. We advocate freedom for the surgeon to make a decision on potential benefits of surgery based around the needs of each individual patient.
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http://dx.doi.org/10.1097/SAP.0000000000000190DOI Listing
October 2015

Incompatibility of betadine mixed with marcaine as an irrigant for breast implant pockets.

Plast Reconstr Surg 2013 Feb;131(2):299e-300e

Banff Plastic Surgery, Banff, Alberta, Canada.

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http://dx.doi.org/10.1097/PRS.0b013e318278d7c6DOI Listing
February 2013

Discussion: late seromas and breast implants: theory and practice.

Plast Reconstr Surg 2012 Aug;130(2):436-438

Banff, Alberta, Canada From private practice.

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http://dx.doi.org/10.1097/PRS.0b013e31825910cbDOI Listing
August 2012

Discussion: a measurement system for evaluation of shape changes and proportions after cosmetic breast surgery.

Plast Reconstr Surg 2012 Apr;129(4):993

Banff, Alberta, Canada From private practice.

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http://dx.doi.org/10.1097/PRS.0b013e3182454377DOI Listing
April 2012

Breast implant complication review: double capsules and late seromas.

Plast Reconstr Surg 2011 Jan;127(1):56-66

Banff, Alberta, Canada From private practice.

Background: The problem of double capsules and late seromas is a relatively new phenomenon in breast augmentation surgery.

Methods: The author's experience with double capsules in 14 patients is outlined. The author reviewed all primary bilateral breast augmentations and primary bilateral mastopexy-augmentations after the moratorium in 1992. There were 209 patients with saline implants, 160 patients with CML and CMH Microcell textured surface implants, 105 patients with Biocell textured surface silicone gel breast implants, and 152 patients with smooth round silicone gel breast implants. Complications and revisions were reviewed to see if any patterns emerged.

Results: Fourteen patients were found to have double capsules. Double capsules were only seen with the Biocell textured surface implant. Three patients developed late seromas (more than a year after their original surgery), with two patients requiring urgent drainage of an expanding seroma/hematoma. Seven patients were found to have double capsules as an incidental finding for procedures, such as asymmetry and bottoming out, and five patients were found to have double capsules when surgery was performed for capsular contracture. The review of complications and revisions showed that the silicone gel implants were far better than saline implants. Highly cohesive Microcell textured CMH and CML implants had by far the best capsular contracture profile. Biocell texturing increased the capsular contracture rate.

Conclusions: Double capsules and late seromas are a relatively new problem in breast augmentation surgery. The problem was not seen in smooth saline or smooth silicone gel breast implants but only in aggressively textured implants.
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http://dx.doi.org/10.1097/PRS.0b013e3181fad34dDOI Listing
January 2011

Evidence-based patient safety advisory: blood dyscrasias.

Plast Reconstr Surg 2009 10;124(4 Suppl):82S-95S

Arlington Heights, Ill. From the American Society of Plastic Surgeons' Patient Safety Committee.

Rarely, patients with blood disorders may seek to undergo plastic surgery. Although plastic surgeons are not expected to diagnose or manage blood disorders, they should be able to recognize which patients are suitable for surgery and which should be referred to a hematologist before a procedure. This practice advisory provides an overview of the perioperative steps that should be completed to ensure appropriate care for patients with blood disorders.
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http://dx.doi.org/10.1097/PRS.0b013e3181b54640DOI Listing
October 2009

The three breast dimensions: analysis and effecting change.

Plast Reconstr Surg 2010 Jun;125(6):1632-1642

Banff, Alberta, Canada From The Banff Plastic Surgery Centre.

Background: This article reviews the three breast dimensions and how they can be changed. The first two dimensions constitute the breast footprint. The third dimension is the shape of the breast on the footprint.

Methods: All four breast footprint borders are reviewed along with the third dimension, which is the breast shape and how it sits on that footprint. An analysis of the "normal" position of the footprint and the "normal" shape of the breast is given. It is important for the surgeon to understand how change in each of the parameters can be effected. The upper and lateral breast borders are relatively mobile, but the inferior and medial breast borders are relatively fixed. All four borders can be changed with certain surgical maneuvers, and these have been measured and analyzed. The breast is a skin structure that is held in place by skin/fascial zones of adherence, and the breast itself is mobile over the pectoralis fascia.

Results: Measurements before and after breast augmentation, breast reduction, mastopexy, and mastopexy-augmentation have been obtained so that the surgeon can better predict results. The change in suprasternal notch-to-nipple distance and the change in suprasternal notch-to-inframammary fold distance have been measured.

Conclusion: Being able to explain the issues and the potential changes makes it easier for a surgeon to manage patients' expectations.
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http://dx.doi.org/10.1097/PRS.0b013e3181ccdb97DOI Listing
June 2010

Vertical breast reduction.

Semin Plast Surg 2004 Aug;18(3):211-24

Private Practice, Banff, Alberta, Canada.

The vertical approach to breast reduction surgery has achieved increasing popularity. The learning curve can be a problem for surgeons starting to incorporate vertical techniques into their practices; the medial pedicle approach is outlined in detail. Designing and creating the medial pedicle is straightforward and rotating it into position is easy. An elegant curve to the lower pole of the reduced breast can thus be created. Current concepts related to the skin brassiere, breast sutures, and the longevity of results are reviewed. It is important for the surgeon to understand that the skin resection pattern and the pedicle design are separate issues when discussing breast reduction surgery.
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http://dx.doi.org/10.1055/s-2004-831908DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2884717PMC
August 2004

Pedicles in vertical breast reduction and mastopexy.

Clin Plast Surg 2002 Jul;29(3):379-91

Any pedicle can be used to achieve a good breast reduction. We need to look at the skin pattern as separate from the pedicle design. There are numerous (and good) combinations available. Different situations will determine which combination is preferable. The author performed a standard inferior pedicle Wise pattern technique for the first 11 years of her practice and has now used variations of the vertical technique for the past 8 years. She has personally found that the medial pedicle gives the best breast reduction results in her hands. On the other hand, a lateral pedicle is used for mastopexies so that the inferior and lateral tissue can be rotated up under the areola. When faced with a re-reduction of a previous inferior pedicle, the vertical technique can still be used, and an adaptation of the inferior pedicle can be very acceptable. The superior pedicle is reserved mainly for very small reductions or mastopexies, but the author still finds the medial pedicle allows better lateral resection even in small reductions, and the lateral pedicle with recruitment of tissue allows for some auto-augmentation in mastopexies.
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http://dx.doi.org/10.1016/s0094-1298(02)00008-1DOI Listing
July 2002

Vertical breast reduction with a medially-based pedicle.

Aesthet Surg J 2002 Mar;22(2):185-94

Reduced scarring, improved shape, long-term shape retention, and good nipple sensation are advantages of medial pedicle vertical breast reduction. This technique precludes the concept of the skin brassiere as holding breast shape and discards the 5-cm vertical rule and the chasing of dogears. The author provides a detailed description of her operative technique. (Aesthetic Surg J 2002;22:185-194.).
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http://dx.doi.org/10.1067/maj.2002.123052DOI Listing
March 2002
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