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Biomedical subjects

J B Tebbetts

Publications and source records attributed to J B Tebbetts.

At least 19 recordsLinked to original sources
PubMed2001

Dual plane breast augmentation: optimizing implant-soft-tissue relationships in a wide range of breast types.

In breast augmentation, surgeons usually choose a pocket location for the implant behind breast parenchyma (retromammary), partially behind the pectoralis major muscle (partial retropectoral), or totally behind pectoralis major and serratus (total submuscular). Each of these implant pocket locations has specific indications, but each also has a unique set of tradeoffs. When applied to a wide range of breast types, each pocket location has limitations. Glandular ptotic and constricted lower pole breasts offer unique challenges that often are not solved without tradeoffs when using a strictly retromammary, partial retropectoral, or total submuscular pocket. This article describes specific indications and techniques for a dual plane approach to breast augmentation in several different breast types, introducing techniques that combine retromammary and partial retropectoral pocket locations in a single patient to optimize the benefits of each pocket location while limiting the tradeoffs and risks of a single pocket location. A total of 468 patients had dual plane augmentation between January of 1992 and March of 1998 using the specific techniques of dual plane augmentation described in this article. All patients were treated as outpatients and received general anesthesia. Indications, operative techniques, results, and complications for this series of patients are presented. Dual plane augmentation mammaplasty adjusts implant and tissue relationships to ensure adequate soft-tissue coverage while optimizing implant-soft-tissue dynamics to offer increased benefits and fewer tradeoffs compared with a single pocket location in a wide range of breast types.

Adult↗
PubMed2001

A surgical perspective from two decades of breast augmentation: toward state of the art in 2001.

This article summarizes the author's perspective of two decades of breast augmentation based on clinical experience using virtually every type of implant, incision location, pocket location, dissection technique and instrumentation available from 1977 to 2001. Based on this experience, the author focuses on patient education, the importance of patient choice, patient evaluation and preoperative planning, surgical techniques, patient recovery, and factors to limit reoperations.

Breast↗
PubMed2001

Alternatives and trade-offs in breast augmentation.

Selection of alternatives for breast augmentation should be prioritized in the order in which those selections are most likely to affect short- and long-term outcomes. Every selection of alternative must be reconciled with patient priorities and patient tissue limitations. This discussion addresses selection of alternatives for breast augmentation sequenced in order of priority, including the following: assuring adequate soft tissue coverage (pocket location), implant size and type, patient tissue limitations, long-term implant-soft tissue dynamics, incision approach, intraoperative techniques and instrumentation to optimize control, and intraoperative techniques to minimize tissue trauma.

Breast Implants↗
PubMed2001

Patient evaluation, operative planning, and surgical techniques to increase control and reduce morbidity and reoperations in breast augmentation.

Current rates of reoperations and complications in augmentation mammaplasty are unacceptably high and can be improved. Risks, trade-offs, complications, morbidity, time to recovery, and reoperation rates in breast augmentation can be improved substantially by stringent patient selection, thorough tissue evaluation, implant selection based on tissue characteristics, and selection of pocket location and surgical techniques.

Breast Implants↗
PubMed2001

Breast augmentation with full-height anatomic saline implants: the pros and cons.

Full-height anatomic implants, like round implants, have advantages and disadvantages. Based on 21 years' experience using round implants and 10 years' experience using anatomic implants, the author believes that anatomically shaped implants offer substantial, significant advantages compared with round implants in more than 90% of primary augmentations. Anatomic implants are a significant addition to the armamentarium of any surgeon who performs primary breast augmentation, provided that the surgeon is willing to meet requirements for optimal use of these more sophisticated products: more stringent implant selection based on individual patient tissue characteristics, accurate pocket dissection under direct visualization, accurate implant positioning based on measured and visual parameters, and above all, detailed patient informed consent about the trade-offs of all implant options. Absent the willingness and skills development to meet these requirements, surgeons should avoid using anatomic implants.

Breast Implants↗
PubMed2001

The polyurethane-covered mammary prosthesis: facts and fiction (II): a look back and a "peek" ahead.

The senior author believes that there is a niche for polyurethane-covered devices in the new millennium if they in fact become available. During the span of this author's practice, he has never been able to match the number and quality of superior results exemplified by these patients when using other devices. Women seeking reconstruction after mastectomy or aesthetic improvement will be well served if the polyurethane-covered device once again becomes one of the choices of mammary prostheses available to them, in this author's opinion.

Breast Implants↗
PubMed2000

Patient acceptance of adequately filled breast implants using the tilt test.

Adequate fill of any breast implant, regardless of shell characteristics, shape, or filler material, is important to prevent implant shell wrinkling, folding, or collapse that could potentially decrease the life of the implant. Implant shell life is a major factor that affects reoperation rates. The greater the necessity of reoperations, regardless of implant type, the greater the rate of local complications, necessitating additional surgery with additional risks and costs to patients. Palpable shell folding, visible wrinkling or rippling, palpable shifts of filler material, sloshing, and compromised aesthetic results can result from an under-filled implant. Any of these complications can necessitate reoperations with increased risks and costs to patients. This is a study of 609 consecutive patients from January of 1993 to December of 1998 who were given detailed preoperative informed consent and a choice of implant shape and type and who chose the increased firmness associated with an implant that is adequately filled to pass the tilt test. This study addresses two questions: (1) Will patients accept the increased firmness of an implant that is filled to pass the tilt test? and (2) Is adequate fill by the tilt test useful clinically to help reduce the incidence of postoperative rippling, wrinkling, and spontaneous deflation in saline implants? Patients were followed by postoperative examinations and questionnaires. No patient requested implant replacement to a softer implant postoperatively, and no reoperations were performed for visible rippling or wrinkling. The spontaneous deflation rate over this 6-year period was 9 of 1218 implants, or 0.739 percent. If patients will accept more firmness with an adequately filled implant, regardless of the filler material, surgeons might worry less about recommending an adequately filled implant to patients, and manufacturers might feel more comfortable producing adequately filled implants and redefining fill volumes for underfilled implants. More adequately filled implants could potentially reduce risks of reoperations by reducing premature shell failure and shell wrinkling complications.

Adolescent↗
PubMed1998

Minimizing complications of ultrasound-assisted lipoplasty: an initial experience with no related complications.

Numerous complications and increased operating times were reported with ultrasonically assisted lipoplasty in the first several months after introduction of the technology in the United States. The purpose of this study was to review early reported complications and management regimens, evaluate possible causes of problems, and apply indications and techniques to attempt to minimize complications during an initial experience with this technique beginning in January of 1997. Seven specific indications and modifications of existing techniques were developed and applied to an initial clinical series of 70 consecutive patients who underwent ultrasound-assisted suction lipoplasty between January 10, 1997, and August 1, 1997. Follow-up ranged from 1 to 7 months. No perioperative or postoperative complication occurred in any patient in this series. In this series of ultrasound-assisted lipoplasty cases, application of the following criteria resulted in a series of 70 patients with 1 to 7-month follow-up without complications: (1) selecting patients with well localized fat deposits who were no more than 20 percent above their ideal body weight; (2) infusing a solution of Ringer's Lactate containing 1 cc of 1:1000 epinephrine per 1000 cc into the area of fat removal, stopping infusion when the tissues first become firm, not infusing to marked tissue turgor or skin induration; (3) restricting the level of energy application to a minimum of 1 cm from the undersurface of the dermis; (4) limiting ultrasonic energy application in each area to approximately 1 minute per estimated 100 cc of total aspirate in a wet to superwet environment; (5) not performing ultrasound-assisted lipoplasty in the same area as another procedure that could potentially compromise tissue vascularity; (6) using a Lysonix 2000 generator and 5-mm golf tee tip probe at a power setting of 8 to apply ultrasonic energy to the area of fat removal, ceasing energy application when tissue resistance to the passage of the probe decreases and moving the cannula as rapidly as tissue resistance allows; and (7) using a standard elastic garment without adherent foam or other materials for 2 weeks postoperatively, encouraging all normal activity immediately, and restricting aerobic activities for 2 weeks.

Adolescent↗
PubMed1996

Rethinking the logic and techniques of primary tip rhinoplasty. A perspective of the evolution of surgery of the nasal tip.

Historically, destructive tip-shaping and positioning techniques, although effective to some degree, have created large numbers of secondary deformities. Tip grafts, necessary in secondary rhinoplasty, have been applied widely in primary rhinoplasty, introducing additional variables and a significant reoperation rate. Nondestructive tip-shaping and positioning techniques offer the surgeon a wider range of alternatives, more control and predictability, and a lower reoperation rate. We are making major changes in the way we think about primary tip rhinoplasty. Most importantly, we are learning (or relearning) that preservation of normal anatomy and structural integrity is a surgical principle epitomized in primary rhinoplasty, and that when we can achieve the desired result using that normal anatomy and preserving its structural integrity, the long-term result is more predictable.

Esthetics↗
PubMed1994

Shaping and positioning the nasal tip without structural disruption: a new, systematic approach.

This paper presents a new, comprehensive, and systematic approach to analysis, planning, and techniques of primary nasal tip rhinoplasty, emphasizing techniques that limit uncontrollable variables before proceeding to techniques which increase uncontrollable variables and risk secondary deformity, including (1) maintenance of structural integrity of the alar rim strips, limiting use of scoring or morselization techniques which reduce support and introduce potential secondary deformities, (2) shaping and positioning the lateral and medial crura in a reversible, nondestructive manner using permanent suture and nonvisible control graft techniques, (3) minimizing uncontrollable postoperative variables by decreasing the need for visible grafts to shape the tip complex in primary rhinoplasty, achieving the same results with existing alar structural elements, (4) integrating these concepts with specific sequences of surgical techniques--bilateral alar arch components individually positioned, then shaped and unified for symmetry, and finally positioned for rotation and projection--and (5) introducing an integrated set of surgical techniques and sequencing of tip surgery to achieve the objectives listed above in most primary and some secondary rhinoplasties. The concepts and techniques of this approach are based on the principle that preservation of structural integrity of alar complex elements (medial and lateral crural arch elements) preserves support and reduces the incidence of secondary deformities (kinking, buckling, discontinuity) that can result from shaping techniques which disrupt that integrity. If shaping and positioning of the tip can be achieved with reversible, nondestructive techniques, the need for placement of visible grafts (with their additional variables) is greatly reduced. Shaping and positioning can be performed incrementally and reversibly without jeopardizing structural integrity and support in the surgical process. Ten fresh cadaver dissections were utilized in the development of the surgical techniques. A total of 233 rhinoplasties (220 primary and 13 secondary) with 1 to 9 years of follow-up have been performed using this approach. Only two secondary procedures for tip deformity have been performed.

Cadaver↗
PubMed1994

The self-lined superiorly based pull-through velopharyngoplasty: plastic surgery-speech pathology interaction in the management of velopharyngeal insufficiency.

We present a rationale and step-by-step description of a previously unpublished innovative surgical technique designed to overcome velopharyngeal insufficiency. This procedure maintains the anatomic integrity and physiologic function of the velopharynx by limiting interpalatal dissection and incorporates a method for flap attachment through the velum that is accessible, predictable, and versatile. The efficacy of this procedure in eliminating velopharyngeal insufficiency was evaluated by using rigorously controlled quantitative psychophysical scaling procedures of presurgical and postsurgical perceptual ratings of resonance, nasal emission, and intelligibility and instrumental acoustic analyses. The results indicated significantly better postsurgical speech outcomes by individuals treated with the pull-through velopharyngoplasty than did patients treated with other procedures designed for the secondary management of velopharyngeal insufficiency. Based on our experience with more than 150 patients, we believe that the self-lined superiorly based pull-through velopharyngoplasty represents an advancement in the surgical treatment of velopharyngeal insufficiency.

Adolescent↗
PubMed1992

Blepharoplasty. A refined technique emphasizing accuracy and control.

Although these techniques may seem demanding in controlling bleeding and avoiding use of local anesthetic, they provide distinct advantages: (1) Morbidity of tissue staining and subsequent ecchymosis is dramatically reduced. (2) Although edema still occurs, additional resolution time for breakdown of hemoglobin in the tissues is reduced, and the patient can resume normal activities with less camouflage makeup more rapidly. (3) Intraoperatively, lack of tissue staining and lack of distortion by local infiltration enable the surgeon to see anatomic structures, detail, and contour irregularities that are simply not visible or identifiable when infiltration has been performed, increasing both the accuracy and safety of the procedure. (4) Strict adherence to the principles of avoiding any dissection and of controlling bleeding deep to the plane of the orbital septum avoids the most dangerous potential complications of blepharoplasty while improving aesthetic results by avoiding overresection of soft-tissue components of the eyelids. (5) All of these techniques increase the accuracy, control, predictability, and safety of blepharoplasty.

Adult↗