E3390. Imaging of Usual, Unusual, Botched, and Complicated Plastic Surgeries for the Unsuspecting Radiologist
  1. Nadia Solomon; Yale School of Medicine
  2. Alexander Sasse; Yale School of Medicine
  3. Douglas Katz; NYU Langone Health
  4. Megan Lubner; University of Wisconsin School of Medicine and Public Health
  5. Perry Pickhardt; University of Wisconsin School of Medicine and Public Health
  6. Vincent Mellnick; Mallinckrodt Institute of Radiology (MIR) at Washington University School of Medicine
  7. Margarita Revzin; Yale School of Medicine
Over the past several decades, the practices of performing and receiving plastic surgery have become commonplace, with patients undergoing these procedures all over the world. In fact, modern plastic surgery involves the implantation of cosmetic devices in almost any part of the body. Although plastic surgery has become ubiquitous, it is not without risk or complication, even when performed properly by an expert surgeon. Lacking understanding of the risk and complexity involved in surgical procedures, many patients journey abroad to regions where plastic surgery is less expensive, putting themselves at greater risk of a "botched" or complicated procedure. Time is also a factor, as many procedures require interval upkeep. Although a successful "tummy tuck" may be a one-time procedure, implants can migrate, deform, and calcify over time. As a result, it is not uncommon to see one of these patients in the emergency department at some point during their plastic surgery journey.

Educational Goals / Teaching Points
This exhibit aims to introduce the radiologist to the international medical and psychosocial phenomenon that is plastic surgery, including historical context and evolution of various procedures. It aims to familiarize the radiologist with the diversity of plastic surgeries performed, with particular focus on the innumerable potential locations of implants, including typical and atypical locations and their appearances on medical imaging studies. This exhibit will also describe potential short- and long-term complications of plastic surgeries and implant procedures that may prompt a visit to the emergency department, and the imaging findings associated with complicated and “botched” procedures.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This exhibit will introduce the radiologist to plastic surgeries and implant placements, including a brief history of plastic surgery, the wide variety of potential surgeries available to patients, and the sociocultural drivers behind these practices. This exhibit will describe the expected imaging findings associated with of a variety of plastic surgeries, featuring examples of both common (breast and buttock augmentation, abdominoplasty) and less common procedures ("six-pack" creation, pectoral muscle enhancement, chin augmentation). The exhibit will also discuss the role of imaging in identifying complications and "botched" cases, including seromas, hematomas, and even retained foreign bodies related to surgery, as well as implant infection, migration, deformity, and rupture. Cases examples will also be used to highlight which imaging modality (ultrasound, CT, or MRI) would be most useful to evaluate various procedures and their complications.

Given the normalization of plastic surgery in many parts of the world, the wide variety of procedures performed, and the range of acute and chronic complications which can lead to emergency department presentation and work-up, it is important for radiologists to be familiar with the imaging findings associated with plastic surgeries and implant procedures so they can rapidly recognize their complications and help guide clinical management.