Autologous Costal Cartilage Harvest for Rhinoplasty with Simultaneous Breast Surgery: A Safe and Efficient Technique

Overview

Rib cartilage is often needed for revision and difficult primary rhinoplasty, and harvesting it normally leaves a separate chest scar. Patients already having breast surgery have an incision in the right area. This retrospective review reports the outcomes of taking the cartilage through that existing incision.

Sections of note

• Retrospective review of the senior author's experience with the technique.
• Data collected included demographics, operations performed, operative time, perioperative problems, and postoperative complications.
• Rates of capsular contracture and rhinoplasty revision were compared with national averages.
• 31 female patients were included.
• 10 breast complications occurred, 32.3 percent.
• 6 rhinoplasty complications occurred, 19.4 percent: 1 infection and 5 revisions.
• Capsular contracture rate 6 percent; rhinoplasty revision rate 16 percent, both described as comparable to the procedures performed separately.
• No perioperative deaths or major complications occurred.

What it means for a patient

• Combining the two operations avoids a separate chest scar for the cartilage harvest and one round of anesthesia.
• Complication rates for both parts were in line with published rates for each procedure done alone.
• Nearly a third had some breast complication and roughly one in five had a rhinoplasty complication, so the combined burden is not trivial.
• Limits: 31 patients, one surgeon, retrospective, no direct comparison group, and comparison made against national averages rather than matched controls.

Why this paper matters

Donor site scarring and pain are the main deterrents to using rib cartilage, and this removes the scar entirely for a specific group of patients. The concern it addresses is whether harvesting through a breast incision raises implant complications. The small sample means the capsular contracture comparison is imprecise.

Terms

• Autologous costal cartilage: Rib cartilage taken from the patient's own chest.
• Capsular contracture: Tightening of the scar capsule around a breast implant.
• Donor site: The place a graft is taken from.
• Perioperative morbidity: Problems occurring around the time of the operation.
• Revision rate: The proportion of patients needing a further operation.