Vertical Reduction Using Atlantoaxial Facet Spacer in Basilar Invagination with Atlantoaxial Instability

Although posterior segmental fixation technique is becoming increasingly popular, surgical treatment of craniovertebral junctional disorders is still challenging because of its complex anatomy and surrounding critical neurovascular structures. Basilar invagination is major pathology of craniovertebral junction that has been a subject of clinical interest because of its various clinical presentations and difficulty of treatment. Most authors recommend a posterior occipitocervical fixation following transoral decompression or posterior decompression and occipitocervical fixation. However, both surgical modalities inadvertently sacrifice C0-1 and C1-2 joint motion. We report two cases of basilar invagination reduced by the vertical distraction between C1-2 facet joint. We reduced the C1-2 joint in an anatomical position and fused the joint with iliac bone graft and C1-2 segmental fixation using the polyaxial screws and rods C-1 lateral mass and the C-2 pedicle.

Recent Trend of the Reduction Mammaplasty and comparing with Vertical Reduction Method and Inverted T-scar Method

PURPOSE: The goal of reduction mammaplasty is breast with natural cone shape, minimizing scars, well-placed and sensate nipple-areolar area and maintaining breast physiology. In order to satisfy that goal, variable reduction mammaplasty methods are performed, however, two methods such as vertical reduction method and inverted T-scar method are currently most used. We compared indications and advantages of the two methods and set up useful guidlines. METHODS: For 15 years from 1995 to 2010, we experienced 84 patients(162 breasts). We performed vertical reduction method as Lejour's superior pedicle technique(45 patients) and inverted T-scar method as Goldwyn's inferior dermal flap technique(39 patients). We evaluated the result of the operation comparing patient's age, amount of resected tissue, complications and post-operative scars of the two methods. RESULTS: The mean age was 36 years and the vertical reduction group was 3 years younger than inverted T-scar group. The mean breast tissue resection amount per one breast, inverted T-scar group(712 gm) was lagger than vertical reduction group(395 gm). CONCLUSION: There is no ideal method for reduction mammaplasty until now. However, we suggest that guide line, the vertical reduction method is effective for minimal and moderate macromastia in young and middle aged women and inverted T-scar method is appropriate for severe macromastia with ptosis in elderly women. Recently, all procedures tried shorter and smaller scar on the vertical line as small I, J or L shape scar, and inframammary fold as short inverted T-scar.

Breast Reconstruction Make Use of Contralateral Breast Tissue after Mastectomy

PURPOSE: Unilateral breast reconstruction after mastectomy confront the challenges of recreating a natural appearing breast mound and achieving symmetricalness of the breasts. If the patient's remaining breast is large compared to reconstructed breast, the most common procedure is reduction mammoplasty of the large breast side. The authors experienced a new method of breast reconstruction using the excess breast tissue from the contralateral breast after breast reduction. METHODS: The excess tissue from the contralateral breast after vertical reduction mammoplasty with superior pedicle and remaining lower breast tissue were transferred to the mastectomy site breast through the subcutaneous tunnel on the chest wall. The main blood supplies of the flap are perforator branches of the 4th, 5th and 6th anterior intercostal artery. After elevating and detaching the flap on the lower lateral area of the breast, the turned over flap is fixed on the upper portion of the chest wall of the mastectomy site. RESULTS: On two cases of the breast reconstructions, remaining excess breast tissue from reduction mammoplasty was transferred to the contralateral breast side as pedicles. Both patient and operator were satisfied with the outcome of the reconstruction as the breasts were symmetrical and in natural shape. CONCLUSION: We have performed unilateral breast reconstruction using the excess breast tissue after reduction mammoplasty of the contralateral breast. As Oriental women's breasts are relatively smaller than those of Caucasian women, delayed breast reconstruction cases of Oriental women with large breasts(macromastia) seem to be ideal for this procedure.

Use of 2-Octylcyanoacrylate (Dermabond(R)) on Breast Surgery

This study is to compare a tissue adhesive, 2-octylcyanoacrylate (Dermabond(R)), with conventional wound closure techniques for vertical reduction mammaplasty. Twenty patients presenting large breast from November to December 2005 were enrolled into this prospective clinical trial study. These patients' breasts were randomly assigned to treatment with either 2-octylcyanoacrylate or 5-0 monofilament sutures. Photography taken at six months after treatment were rated by two plastic surgeons and six layperson blinded to the method of closure. There was no significant difference between the two groups for appearance scores based on a visual analog scale(81.9mm for 2-octylcyanoacrylate versus 75.7mm for 5-0 monofilament sutures). The length of time for periareoalr repair was decreased in the 2-octylcyanoacrylate group(2.7 minutes for 2-octylcyanoacrylate versus 8.3 minutes for 5-0 monofilament sutures, p<0.001). The patients' satisfaction rate in the 2-octylcyanoacrylate group was high. Moreover, the use of 2-octylcyanoacrylate obviates the need for suture removal. In conclusion, the use of 2-octylcyanoacrylate for vertical reduction mammaplasty is an acceptable alternative which includes several advantages to conventional suturing with a comparable cosmetic outcome.

Medial Pedicle Vertical Reduction Mammoplasty

Most recent breast reduction techniques tend to get natural cone shaped breast with minimal scar. On this purpose, we have performed 7 cases of vertical reduction mammoplasty with medial pedicle from August 2003 to August 2005. The mean age of patient was 29, and the average resection amount was 760 gram per breast. The most of the patient were satisfied with their postoperative size, shape and scar. As compared with classical superior pedicle vertical reduction mammoplasty, by using medial pedicle, this technique could use short and wide-ranging pedicle, avoid skin undermining, evade exposure of pectoralis major fascia and remove the fixation as well. And this technique did not operate liposuction. As descrived above, the advantages of vertical mammoplasty using a medial pedicle are as follows: 1. Limited postoperative scar of incision. 2. More effective preservation of sensation to the nipple-areolar complex and physiological function as breast feeding. 3. More aesthetic shape of breast. 4. The procedure is easy to perform. 5. Shortening the period of postoperative care.

Clinical Application of Reduction Mammaplasty with Various Methods

Breast has been considered as the symbol of the female. Ideal size of the breast was related to the age and culture. The goal of reduction mammaplasty is breast with natural cone shape, minimizing scars, well-placed and sensate nipple-areolar area and maintaining breast physiology. The ideal breast reduction should create beautiful breast with limited scars. We performed 37 cases of reduction mammaplasty. The techniques used were inferior dermal flap technique for 16 cases, vertical reduction mammaplasty for 18 cases, and periareolar round block technique for 3 cases. We compared advantages and disadvantages of the techniques and set up useful guide-lines to match the technique with the problem of each individual. The guidelines are as follow: 1. Inferior dermal pedicle technique is suitable for moderate to severe macromastia with ptosis. 2. Vertical reduction technique is effective for moderate macromastia in young women. 3. Periareolar round block technique is effective for mild to moderate macromastia in young women.