Submammary placement of implantable cardioverter defibrillators: a Singapore plastic surgeon experience

The use of implantable cardioverter defibrillators (ICDs) in young women has been increasing in recent years owing to greater awareness about inherited cardiac conditions that increase the risk of sudden death. Traditional placement of ICDs in the infraclavicular region among young women often leads to visible scars, a constant prominence that causes irritation from purse or bra straps and can result in body image concerns and device-related emotional distress. In this case series, two women with long QT syndrome required placement of ICDs for prevention of sudden cardiac death. Submammary placement of ICDs was performed in collaboration with electrophysiologists. We describe our local experience and technique in submammary placement of ICDs as well as the challenges faced.

Application of reconstruction of submammary fold with lateral thoracic wall adipofascial flap after nipple-areola complex sparing mastectomy in elderly breast cancer / 国际外科学杂志

Objective To evaluate the value of reconstruction of submammary fold with lateral thoracic wall adipofascial flap after nipple-areola complex sparing mastectomy (NSM) in elderly patients with breast cancer.Methods To retrospective analysis 20 cases of elderly patients with breast cancer were admitted from March 2016 to June 2018 in Beijing Tongren Hospital,Capital Medical University using reconstruction of submammary fold with lateral thoracic wall adipofascial flap after NSM (study group).Twenty-two elderly patients with breast cancer who had breast-conserving and sentinel lymph node biopsy were selected as control group.The operation time,drainage tube retention time,postoperative hospitalization time,postoperative complications,breast contour satisfaction were statistically analyzed.The measurements were expressed as mean ± standard deviation (Mean ± SD),and t-test was used for inter-group comparison,and Chi-square test was used for inter-group comparison of counting data.Results All cases were followed up for 3-27 months without local recurrence and distant metastasis.The difference in operative time between the study group and control group was statistically significant [(2.085 ±0.163 1) h vs (1.918 ± 0.159 3) h,P =0.002].There was no significant difference between the study group and control group in drainage tube removal time(5.25 ± 0.910) d vs (5.27 ± 0.767) d,hospitalization days (6.25 ± 0.910) d vs (6.27 ± 0.767) d,breast contour satisfaction rate (90.0％ vs 81.8％) (P ＞ 0.05).Postoperative necrosis and liquefaction of adipofascial flaps occurred in 1 case in the study group and delayed healing occurred.Conclusion For some early-stage elderly breast cancer,reconstruction of submammary fold with lateral thoracic wall adipofascial flap after NSM,at the same time of radical surgery,can ensure the basic breast shape,avoid the chest wall deformity caused by traditional radical mastectomy,and improve the appearance and quality of life after mastectomy.

Unilateral Nevoid Acanthosis Nigricans with a Submammary Location

Unilateral nevoid acanthosis nigricans (AN) is an exceedingly rare form of AN, which is a benign disorder of keratinization. The lesions of unilateral nevoid AN are distributed unilaterally while the histopathologic findings are similar to the common form of AN, and this is characterized by hyperkeratosis, papillomatosis and moderate acanthosis. A 19-year-old female presented with asymptomatic brownish pigmented plaques on the medial side of the left submammary area. Based on her clinical and histopathologic findings, a diagnosis of unilateral nevoid AN was made. She was treated with topical tretinoin and her skin lesions were almost cleared 9 months after her first visit to our clinic. Various previous reports have described the localization of this disorder, but there has been no previous case report with the clinical manifestations on the unilateral submammary area. Therefore, we herein report the first case of unilateral nevoid AN with an unusual submammary location.

Incisão submamária para esternotomia mediana / Submammary incision for median sternotomy

Objetivo - Avaliar as indicaçöes, complicaçöes e os resultados estéticos e funcionais da incisäo submamária para esternotomia mediana em jovens e crianças do sexo feminino. Métodos - Duzentos e oitenta pacientes do sexo feminino com idades entre 2 meses e 42 anos (média = 5 anos, desvio padräo = 9 anos) foram submetidas a intervençöes cardíacas com o emprego de incisäo submamária para esternotomia mediana nos hospitais Sírio-Libanês e Matarazzo, de janeiro 1981 a outubro de 1991. Resultados - A exposiçäo foi adequada e, todos os pacientes, sem dificuldades técnicas ou complicaçöes maiores e os resultados estéticos e funcionais excelentes. Conclusäo - Os resultados justificam o emprego rotineiro da incisäo submamária para esternotomia mediana em pacientes do sexo feminino

Purpose - To evaluate the indications, complications, cosmetic and functional results with submammary skin incision for a median sternotomy in femules. Methods - Two hundred and eighty female patients have undergone submammary skin incision for a median sternotomy between 1981 to 1991 ages rangedirom 2 months to 42 years (m = 5 ± 9 years). Results - Adequate exposure of the heart was achived in every case, there were no technical problems, no major complications and the cosmetic and functional results are excellent. Conclusion - Complications associated with this incision are insignificant and the cosmetic and functional results are excellent justified routinely this approach for young women