@article{BrebantWeihererNoisseretal., author = {Br{\´e}bant, Vanessa and Weiherer, Maximilian and Noisser, Vivien and Seitz, Stephan and Prantl, Lukas and Eigenberger, Andreas}, title = {Implants Versus Lipograft: Analysis of Long-Term Results Following Congenital Breast Asymmetry Correction}, series = {Aesthetic Plastic Surgery}, volume = {46}, journal = {Aesthetic Plastic Surgery}, publisher = {Springer Nature}, doi = {10.1007/s00266-022-02843-5}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:898-opus4-32404}, pages = {2228 -- 2236}, abstract = {Aims Congenital breast asymmetry represents a particular challenge to the classic techniques of plastic surgery given the young age of patients at presentation. This study reviews and compares the long-term results of traditional breast augmentation using silicone implants and the more innovative technique of lipografting. Methods To achieve this, we not only captured subjective parameters such as satisfaction with outcome and symmetry, but also objective parameters including breast vol-ume and anthropometric measurements. The objective examination was performed manually and by using the Vectra H2 photogrammetry scanning system. Results Differences between patients undergoing either implant augmentation or lipograft were revealed not to be significant with respect to patient satisfaction with surgical outcome (p= 0.55) and symmetry (p= 0.69). Furthermore, a breast symmetry of 93 \% was reported in both groups. Likewise, no statistically significant volume difference between the left and right breasts was observed in both groups (p\0.41). However, lipograft patients needed on average 2.9 procedures to achieve the desired result, compared with 1.3 for implant augmentation. In contrast, patients treated with implant augmentation may require anumber of implant changes during their lifetime. Conclusion Both methods may be considered for patients presenting with congenital breast asymmetry.}, language = {en} } @article{EigenbergerFelthausSchratzenstalleretal., author = {Eigenberger, Andreas and Felthaus, Oliver and Schratzenstaller, Thomas and Haerteis, Silke and Utpatel, Kirsten and Prantl, Lukas}, title = {The Effects of Shear Force-Based Processing of Lipoaspirates on White Adipose Tissue and the Differentiation Potential of Adipose Derived Stem Cells}, series = {cells}, volume = {11}, journal = {cells}, number = {16}, publisher = {MDPI}, address = {Basel}, doi = {10.3390/cells11162543}, pages = {13}, abstract = {Autologous lipotransfer is a promising method for tissue regeneration, because white adipose tissue contains a heterogeneous cell population, including mesenchymal stem cells, endothelial cells, immune cells, and adipocytes. In order to improve the outcome, adipose tissue can be processed before application. In this study, we investigated changes caused by mechanical processing. Lipoaspirates were processed using sedimentation, first-time centrifugation, shear-force homogenization, and second-time centrifugation. The average adipocyte size, stromal vascular cell count, and adipocyte depot size were examined histologically at every processing step. In addition, the adipose derived stem cells (ADSCs) were isolated and differentiated osteogenically and adipogenically. While homogenization causes a disruption of adipocyte depots, the shape of the remaining adipocytes is not changed. On average, these adipocytes are smaller than the depot adipocytes, they are surrounded by the ECM, and therefore mechanically more stable. The volume loss of adipocyte depots leads to a significant enrichment of stromal vascular cells such as ADSCs. However, the mechanical processing does not change the potential of the ADSCs to differentiate adipogenically or steogenically. It thus appears that mechanically processed lipoaspirates are promising for the reparation of even mechanically stressed tissue as that found in nasolabial folds. The changes resulting from the processing correspond more to a filtration of mechanically less stable components than to a manipulation of the tissue.}, language = {en} } @article{HartmannNieberlePalmetal., author = {Hartmann, Robin and Nieberle, Felix and Palm, Christoph and Br{\´e}bant, Vanessa and Prantl, Lukas and Kuehle, Reinald and Reichert, Torsten E. and Taxis, Juergen and Ettl, Tobias}, title = {Utility of Smartphone-based Three-dimensional Surface Imaging for Digital Facial Anthropometry}, series = {JPRAS Open}, volume = {39}, journal = {JPRAS Open}, publisher = {Elsevier}, doi = {10.1016/j.jpra.2024.01.014}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:898-opus4-70348}, pages = {330 -- 343}, abstract = {Background The utilization of three-dimensional (3D) surface imaging for facial anthropometry is a significant asset for patients undergoing maxillofacial surgery. Notably, there have been recent advancements in smartphone technology that enable 3D surface imaging. In this study, anthropometric assessments of the face were performed using a smartphone and a sophisticated 3D surface imaging system. Methods 30 healthy volunteers (15 females and 15 males) were included in the study. An iPhone 14 Pro (Apple Inc., USA) using the application 3D Scanner App (Laan Consulting Corp., USA) and the Vectra M5 (Canfield Scientific, USA) were employed to create 3D surface models. For each participant, 19 anthropometric measurements were conducted on the 3D surface models. Subsequently, the anthropometric measurements generated by the two approaches were compared. The statistical techniques employed included the paired t-test, paired Wilcoxon signed-rank test, Bland-Altman analysis, and calculation of the intraclass correlation coefficient (ICC). Results All measurements showed excellent agreement between smartphone-based and Vectra M5-based measurements (ICC between 0.85 and 0.97). Statistical analysis revealed no statistically significant differences in the central tendencies for 17 of the 19 linear measurements. Despite the excellent agreement found, Bland-Altman analysis revealed that the 95\% limits of agreement between the two methods exceeded ±3 mm for the majority of measurements. Conclusion Digital facial anthropometry using smartphones can serve as a valuable supplementary tool for surgeons, enhancing their communication with patients. However, the proposed data suggest that digital facial anthropometry using smartphones may not yet be suitable for certain diagnostic purposes that require high accuracy.}, language = {en} } @article{HartmannWeihererSchiltzetal., author = {Hartmann, Robin and Weiherer, Maximilian and Schiltz, Daniel and Baringer, Magnus and Noisser, Vivien and H{\"o}sl, Vanessa and Eigenberger, Andreas and Seitz, Stefan and Palm, Christoph and Prantl, Lukas and Br{\´e}bant, Vanessa}, title = {New aspects in digital breast assessment: further refinement of a method for automated digital anthropometry}, series = {Archives of Gynecology and Obstetrics}, volume = {303}, journal = {Archives of Gynecology and Obstetrics}, publisher = {Springer Nature}, address = {Heidelberg}, issn = {1432-0711}, doi = {10.1007/s00404-020-05862-2}, pages = {721 -- 728}, abstract = {Purpose: In this trial, we used a previously developed prototype software to assess aesthetic results after reconstructive surgery for congenital breast asymmetry using automated anthropometry. To prove the consensus between the manual and automatic digital measurements, we evaluated the software by comparing the manual and automatic measurements of 46 breasts. Methods: Twenty-three patients who underwent reconstructive surgery for congenital breast asymmetry at our institution were examined and underwent 3D surface imaging. Per patient, 14 manual and 14 computer-based anthropometric measurements were obtained according to a standardized protocol. Manual and automatic measurements, as well as the previously proposed Symmetry Index (SI), were compared. Results: The Wilcoxon signed-rank test revealed no significant differences in six of the seven measurements between the automatic and manual assessments. The SI showed robust agreement between the automatic and manual methods. Conclusion: The present trial validates our method for digital anthropometry. Despite the discrepancy in one measurement, all remaining measurements, including the SI, showed high agreement between the manual and automatic methods. The proposed data bring us one step closer to the long-term goal of establishing robust instruments to evaluate the results of breast surgery.}, language = {en} } @article{HartmannWeihererSchiltzetal., author = {Hartmann, Robin and Weiherer, Maximilian and Schiltz, Daniel and Seitz, Stephan and Lotter, Luisa and Anker, Alexandra and Palm, Christoph and Prantl, Lukas and Br{\´e}bant, Vanessa}, title = {A Novel Method of Outcome Assessment in Breast Reconstruction Surgery: Comparison of Autologous and Alloplastic Techniques Using Three-Dimensional Surface Imaging}, series = {Aesthetic Plastic Surgery}, volume = {44}, journal = {Aesthetic Plastic Surgery}, publisher = {Springer}, address = {Heidelberg}, doi = {10.1007/s00266-020-01749-4}, pages = {1980 -- 1987}, abstract = {Background Breast reconstruction is an important coping tool for patients undergoing a mastectomy. There are numerous surgical techniques in breast reconstruction surgery (BRS). Regardless of the technique used, creating a symmetric outcome is crucial for patients and plastic surgeons. Three-dimensional surface imaging enables surgeons and patients to assess the outcome's symmetry in BRS. To discriminate between autologous and alloplastic techniques, we analyzed both techniques using objective optical computerized symmetry analysis. Software was developed that enables clinicians to assess optical breast symmetry using three-dimensional surface imaging. Methods Twenty-seven patients who had undergone autologous (n = 12) or alloplastic (n = 15) BRS received three-dimensional surface imaging. Anthropomorphic data were collected digitally using semiautomatic measurements and automatic measurements. Automatic measurements were taken using the newly developed software. To quantify symmetry, a Symmetry Index is proposed. Results Statistical analysis revealed that there is no dif- ference in the outcome symmetry between the two groups (t test for independent samples; p = 0.48, two-tailed). Conclusion This study's findings provide a foundation for qualitative symmetry assessment in BRS using automatized digital anthropometry. In the present trial, no difference in the outcomes' optical symmetry was detected between autologous and alloplastic approaches.}, subject = {Mammoplastik}, language = {en} } @article{HeineEigenbergerBrebantetal., author = {Heine, Norbert and Eigenberger, Andreas and Brebant, Vanessa and Hoesl, Vanessa and Brix, Eva and Prantl, Lukas and Kempa, Sally}, title = {Comparison of skin sensitivity following breast reconstruction with three different techniques: Autologous fat grafting, DIEP flap and expander/implant}, series = {Clinical Hemorheology and Microcirculation}, volume = {80}, journal = {Clinical Hemorheology and Microcirculation}, number = {4}, publisher = {IOS Press}, issn = {1875-8622}, doi = {10.3233/ch-219203}, pages = {389 -- 397}, abstract = {BACKGROUND: Autologous fat grafting (AFG) has been established over the past two decades as an additive technique during and after breast reconstruction. Complete reconstruction of the breast mound with AFG alone represents an exceptional technique that has been published mostly in case reports or in studies with limited cases.The purpose of this study is to investigate the influence of three different techniques for breast reconstruction on the recovery of skin sensitivity at the reconstructed breast. METHODS: The study included 30 patients after mastectomy following breast cancer. Three groups were examined: A) breast reconstruction by autologous fat grafting (AFG), B) breast reconstruction by deep inferior epigastric artery perforator flap (DIEP) and C) breast reconstruction by expander/implant (TE).Biometric data were compared; sensitivity tests were performed using Semmes-Weinstein monofilaments.The non-operated, healthy contralateral breasts of the patients were used as a reference. RESULTS: While the traditional reconstruction techniques by microsurgical anastomosed perforator flap or expander/implant showed a strongly decreased or completely missing sensitivity of the skin, the tests after reconstruction by AFG represented high values of sensory recovery, which came close to the reference group of non-operated breasts. CONCLUSION: To our knowledge, this is the first study to compare skin sensitivity after AFG-based reconstruction to established techniques for breast reconstruction. We could demonstrate in a limited group of patients, that breast reconstruction by autologous fat grafting can achieve higher values of skin sensitivity compared to traditional techniques.}, subject = {Mammoplastik}, language = {en} } @article{HeineEigenbergerBrebantetal., author = {Heine, Norbert and Eigenberger, Andreas and Brebant, Vanessa and Kempa, Sally and Seitz, Stephan and Prantl, Lukas and Kuehlmann, Britta}, title = {The effect of radiotherapy on fat engraftment for complete breast reconstruction using lipofilling only}, series = {Archives of Gynecology and Obstetrics}, journal = {Archives of Gynecology and Obstetrics}, publisher = {Springer}, doi = {10.1007/s00404-022-06610-4}, pages = {7}, abstract = {Purpose Lipofilling has been established as a standard technique for contour enhancement following breast reconstruction. However, there is a paucity in current literature regarding the use of this technique for complete reconstruction of the female breast as an alternative to conventional techniques, such as expander or flap-based procedures. In particular, the influence of pre-operative irradiation for successful reconstruction has rarely been examined in published studies. Here, the authors describe their experience with successful fat injection in pre-radiated breasts in comparison with non-pre-radiated patients. Methods In this retrospective study, we examined a total of 95 lipofilling treatments on 26 patients (28 breasts). All of them experienced mastectomy following breast cancer; local breast defects after partial resection of the gland were not included in this study. In total, 47 lipofilling procedures in 12 non-irradiated patients (14 breasts) and 48 procedures in 14 irradiated women (also 14 breasts) were performed. Per session, approximately 297 +/- 112 cc of adipose tissue was grafted in group A (no radiotherapy) and approximately 259 +/- 93 cc was grafted in group B (radiotherapy). Results Among the group of women without pre-operative radiation, 71\% of breast reconstructions limited to lipofilling only showed constant engraftment of fat tissue with a successful reconstructive result, whereas only 21\% of the patients with pre-radiated breasts showed complete reconstruction of the breast with a permanent fat in-growth. Conclusion Preoperative radiotherapy significantly impedes successful completion of breast reconstructions planned only by autologous fat transfer. Patients should be selected individually and carefully for complete breast reconstruction using lipofilling only.}, language = {en} } @article{KnoedlerBaecherKaukeNavarroetal., author = {Knoedler, Leonard and Baecher, Helena and Kauke-Navarro, Martin and Prantl, Lukas and Machens, Hans-G{\"u}nther and Scheuermann, Philipp and Palm, Christoph and Baumann, Raphael and Kehrer, Andreas and Panayi, Adriana C. and Knoedler, Samuel}, title = {Towards a Reliable and Rapid Automated Grading System in Facial Palsy Patients: Facial Palsy Surgery Meets Computer Science}, series = {Journal of Clinical Medicine}, volume = {11}, journal = {Journal of Clinical Medicine}, number = {17}, publisher = {MDPI}, address = {Basel}, doi = {10.3390/jcm11174998}, abstract = {Background: Reliable, time- and cost-effective, and clinician-friendly diagnostic tools are cornerstones in facial palsy (FP) patient management. Different automated FP grading systems have been developed but revealed persisting downsides such as insufficient accuracy and cost-intensive hardware. We aimed to overcome these barriers and programmed an automated grading system for FP patients utilizing the House and Brackmann scale (HBS). Methods: Image datasets of 86 patients seen at the Department of Plastic, Hand, and Reconstructive Surgery at the University Hospital Regensburg, Germany, between June 2017 and May 2021, were used to train the neural network and evaluate its accuracy. Nine facial poses per patient were analyzed by the algorithm. Results: The algorithm showed an accuracy of 100\%. Oversampling did not result in altered outcomes, while the direct form displayed superior accuracy levels when compared to the modular classification form (n = 86; 100\% vs. 99\%). The Early Fusion technique was linked to improved accuracy outcomes in comparison to the Late Fusion and sequential method (n = 86; 100\% vs. 96\% vs. 97\%). Conclusions: Our automated FP grading system combines high-level accuracy with cost- and time-effectiveness. Our algorithm may accelerate the grading process in FP patients and facilitate the FP surgeon's workflow.}, language = {en} } @article{KnoedlerDeanKnoedleretal., author = {Knoedler, Leonard and Dean, Jillian and Knoedler, Samuel and Kauke-Navarro, Martin and Hollmann, Katharina and Alfertshofer, Michael and Helm, Sabrina and Prantl, Lukas and Schliermann, Rainer}, title = {Hard shell, soft core? Multi-disciplinary and multi-national insights into mental toughness among surgeons}, series = {Frontiers in Surgery}, volume = {11}, journal = {Frontiers in Surgery}, publisher = {Frontiers}, doi = {10.3389/fsurg.2024.1361406}, pages = {7}, abstract = {Background: With the prevalence of burnout among surgeons posing a significant threat to healthcare outcomes, the mental toughness of medical professionals has come to the fore. Mental toughness is pivotal for surgical performance and patient safety, yet research into its dynamics within a global and multi-specialty context remains scarce. This study aims to elucidate the factors contributing to mental toughness among surgeons and to understand how it correlates with surgical outcomes and personal well-being. Methods: Utilizing a cross-sectional design, this study surveyed 104 surgeons from English and German-speaking countries using the Mental Toughness Questionnaire (MTQ-18) along with additional queries about their surgical practice and general life satisfaction. Descriptive and inferential statistical analyses were applied to investigate the variations in mental toughness across different surgical domains and its correlation with professional and personal factors. Results: The study found a statistically significant higher level of mental toughness in micro-surgeons compared to macro-surgeons and a positive correlation between mental toughness and surgeons' intent to continue their careers. A strong association was also observed between general life satisfaction and mental toughness. No significant correlations were found between the application of psychological skills and mental toughness. Conclusion: Mental toughness varies significantly among surgeons from different specialties and is influenced by professional dedication and personal life satisfaction. These findings suggest the need for targeted interventions to foster mental toughness in the surgical community, potentially enhancing surgical performance and reducing burnout. Future research should continue to explore these correlations, with an emphasis on longitudinal data and the development of resilience-building programs.}, language = {en} } @article{KnoedlerBerkinMoogetal., author = {Kn{\"o}dler, Leonard and Berkin, {\"O}zdemir and Moog, Philipp and Prantl, Lukas and Broer, P. Niclas and Kn{\"o}dler, Christoph and Rieger, Ulrich M. and Perl, Markus and von Isenburg, Sarah and Gassner, Ulrich M. and Obed, Doha and Haug, Valentin and Panayi, Adriana C and Kn{\"o}dler, Samuel}, title = {Thinking like a Lawyer - Human Rights and Their Association with the Plastic Surgeon of Today}, series = {Aesthetic Plastic Surgery}, volume = {114}, journal = {Aesthetic Plastic Surgery}, publisher = {Springer-Verlag GmbH}, address = {Heidelberg}, doi = {10.1007/s00266-022-02990-9}, pages = {8}, abstract = {Plastic surgeons are trained to perform a wide repertoire of surgeries-ranging from standard local procedures to highly specialized operations. Therefore, plastic surgeons treat a plethora of clinical presentations and address multiple patient needs. Their daily workflow is increasingly entwined with legal topics. The concrete legal interpretation falls within the remit of legal experts. However, by understanding the legal basics of selected surgical procedures, plastic surgeons may generate synergies in patient care and clinical practice. The legal situation is to be elucidated based on the German Basic Law (GBL) and the European Convention on Human Rights (ECHR).}, language = {en} }