ABCS Breast and Body Contouring Surgery 2 — Questions and Answers
Question 1: A patient undergoes liposuction to the abdomen and flanks. Intraoperatively, the surgeon notices significant blood-tinged aspirate. Which technique modification best minimizes blood loss during tumescent liposuction?
- Increasing aspirate vacuum pressure
- Ensuring adequate epinephrine concentration in the tumescent solution (Correct answer)
- Using a smaller-gauge cannula
- Extending the infusion-to-aspiration interval to 30 minutes
Correct answer: Ensuring adequate epinephrine concentration in the tumescent solution
Epinephrine in the tumescent solution causes vasoconstriction that substantially reduces blood loss during liposuction.
Question 2: When performing an abdominoplasty, the surgeon plans plication of the rectus diastasis. Which anatomical structure is being repaired with midline plication?
- Transversalis fascia
- External oblique aponeurosis
- Linea alba (Correct answer)
- Scarpa's fascia
Correct answer: Linea alba
Diastasis recti involves stretching and thinning of the linea alba, and plication approximates the medial edges of the rectus sheaths at this midline structure.
Question 3: A 38-year-old woman develops seroma 3 weeks after brachioplasty. Conservative aspiration fails after two attempts. What is the most appropriate next step?
- Open drainage and quilting sutures (Correct answer)
- Compression dressing alone for 4 more weeks
- MRI to rule out lymphatic injury
- Sclerotherapy with doxycycline
Correct answer: Open drainage and quilting sutures
Persistent seroma after brachioplasty that fails repeated aspiration is best managed with open drainage and quilting sutures to obliterate dead space.
Question 4: In high-definition liposuction body contouring, which muscle group is most commonly accentuated in female patients to create athletic abdominal definition?
- Transversus abdominis
- External oblique
- Rectus abdominis (Correct answer)
- Internal oblique
Correct answer: Rectus abdominis
High-definition liposuction in women focuses on etching the rectus abdominis segments to create visible six-pack definition.
Question 5: A patient requests correction of gynecomastia. Glandular tissue is firm and centrally located with minimal excess skin. Which technique is most appropriate?
- Liposuction alone
- Skin excision with periareolar scar
- Periareolar incision with direct glandular excision and liposuction (Correct answer)
- Free nipple graft with complete mastectomy
Correct answer: Periareolar incision with direct glandular excision and liposuction
Firm, central glandular gynecomastia is best treated with periareolar direct excision combined with liposuction to address any surrounding fatty component.
Question 6: During a thigh lift, which nerve is most at risk during the medial thigh dissection near the femoral triangle?
- Obturator nerve
- Saphenous nerve (Correct answer)
- Lateral femoral cutaneous nerve
- Ilioinguinal nerve
Correct answer: Saphenous nerve
The saphenous nerve runs along the medial thigh and is at significant risk for injury during medial thigh lift dissection near the femoral triangle.
Question 7: A patient has 280 cc smooth round silicone implants placed in the dual-plane position. At 6-month follow-up, she exhibits lower pole animation deformity with pectoralis contraction. Which factor most likely contributed?
- Implant placed too high on the chest wall
- Insufficient pectoralis major muscle release inferiorly (Correct answer)
- Capsular contracture formation
- Implant malrotation
Correct answer: Insufficient pectoralis major muscle release inferiorly
Inadequate inferior release of the pectoralis major in dual-plane placement results in persistent muscle attachment over the lower implant pole, causing animation deformity with contraction.
ABCS Breast and Body Contouring Surgery 2
A patient undergoes liposuction to the abdomen and flanks.
Intraoperatively, the surgeon notices significant blood-tinged aspirate.
Which technique modification best minimizes blood loss during tumescent liposuction?