The endoscopic breast augmentation: the transumbilical insertion of saline-filled breast implants.

Initial aesthetic breast augmentation with inflatable saline implants has always had the distinct advantage of insertion through a small breast or axillary skin incision. Adapting established techniques utilized in suction-assisted lipectomy, operative endoscopy, and tissue expansion with inflatable saline implants, breast augmentation is possible through an umbilical incision. Under general anesthesia, an incision is made in the umbilicus; a new tubular instrument with an obturator [designated an endotube (Johnson) or mammascope (Christ)] is inserted into the umbilical incision like a suction cannula; it is pushed over the abdominal fascia across the costal margin until it literally pops under the breast fascia; through this tunnel is then inserted an implant coiled like a tobacco leaf; the implant is then inflated to 50 percent more than the final volume and manipulated to help expand the pocket; finally, the excess volume is removed, methyl-prednisolone acetate is placed in the final volume, and the fill tube is removed. The endoscope (laparoscope) is utilized to visualize positioning and to document the absence of bleeding. The umbilical incision is closed after insertion of both implants through the same incision. A series of 91 young women have undergone this procedure with 188 breast implantations without significant bleeding. Implants appear to ride high initially, but they settle into place by 6 weeks. Patients have reported less chest discomfort and some visible temporary upper abdominal swelling. The long-term follow-up is currently being monitored.

The quick-stick blepharoplasty.

A simple technique for temporary instant office blepharoplasty in selected patients is presented.

Ultrasound study of the nose and upper lip before birth.

A review of 2,000 patient scans was utilized in the evaluation of the development of the nose and lips. The results of this study clearly demonstrate that it is possible to identify easily and reliably the anatomical nose, nostrils, and upper lip from 15 weeks' gestation onward. It is also possible to show the nose and lips at 11 weeks. However, this is much more difficult owing to the relatively disproportionate size of transducer and fetus at that point of gestation. The utility of the technique of facial ultrasound is related to the detection of cleft lip and cleft palate as previously reported.

Rapidly evolving non-parasitic hepatic cyst.

A case of solitary non-parasitic hepatic cyst is presented; its evolution appears to have occurred rapidly (10 months). This and all previously reported cysts are unassociated with any clearly diagnostic signs, symptoms, laboratory or x-ray findings. The treatment of choice is total surgical extirpation since the incidence of recurrence of the cyst is appreciably high with subtotal excision, drainage, and marsupialization. This disease has been reported to carry a mortality of 5.1% to 6.6%.

Preservation of the orbital contents in cancer of the maxillary sinus.

Tumor invasion of the periorbita, posterior ethmoid cells, or orbital apex is considered an absolute indication for orbital exenteration. Preservation of the orbital contents in selected cases can be applied safely to the treatment of primary maxillary sinus cancer. Patient complaints relating to the preserved eye were more commonly associated with radiation therapy than the method of reconstruction used. Reconstruction of the orbital floor with a skin graft, even when combined with radiation therapy, gave a functional eye in the majority of cases while not compromising the oncologic safety or the procedure.

Application of the latissimus dorsi muscle to the heart.

A technique was investigated for possible application in the treatment of myocardial ischemia and for repair of ventricular aneurysms. Six dogs underwent operations to transpose the latissimus dorsi muscle onto the surface of a tangentially excised area of myocardium. Three dogs were reexplored at 4 months, and 1 was reexplored at 11/2 years. A firm union of latissimus dorsi to myocardium was demonstrated macroscopically, and there was microangiographic evidence of neovascularization. The latissimus dorsi muscle flap provides considerable bulk, leaves a minimal donor site defect, has the potential for neovascularization, may provide mechanical cardiac assistance, and is simple to transfer. Further investigation is indicated.

Silicone granuloma of the penis.

Injectable silicones have been applied to an undetermined number of men for penile augmentation. The practitioners of this art, whether lay or medical, have allegedly long discontinued treating penile size. In the literature to date, four men have been identified as having complications from this mode of therapy; three have had excisions of granulomatous masses secondary to the silicone; the third refused surgery. This paper reports an additional case of silicone granuloma of the penis, documented by biopsy, which necessitated two excisions to obtain a satisfactory size for copulation. Moreover, because of impotence, a Dow-Corning (Gerow design) penile prosthesis was inserted. The inflammatory response in this new case is identical to that found in other parts of the body, namely, multiple silicone droplets surrounded by multinucleated giant cells and chronic inflammatory cells.

Ultrasound diagnosis of cleft lip and cleft palate before birth.

Real-time ultrasonography in pregnancy can accurately detect gestational age, position of the fetus, position of the placenta, sex of the fetus, and many congenital anomalies before birth. To date, however, there has been no report of detection of a cleft lip-palate deformity by ultrasound. Two cases, in approximately 200 scans, have been found in patients with no previous family history of cleft lip-palate. The first case was a bilateral cleft lip-palate visualized at 28 weeks gestation. The second was a unilateral cleft lip-palate detected at 33 weeks gestation. Diagnosis of cleft lip-palate is dependent on appreciation of facial topography in multiple planes, adequate experience in the technique, and observation of the degree of excursion of the undulating tongue. Detection of the facial clefting in utero by ultrasound has resulted in our formulation of a routine for informing the parents of the deformity and referring them for consultation with a plastic surgeon. This is recommended before birth, so that the parents are well acquainted with what the deformity will look like and the sequential steps necessary for its correction. We encourage plastic surgeons, obstetricians, pediatricians, and ultrasonographers to be aware of the ability to diagnose cleft lip-palate before birth.