Modified Central Pedicle in Breast Reduction and Mastopexy: The Dermal Suspension Technique.

BACKGROUND: Breast reduction and mastopexy surgery are among the most performed plastic surgery operations throughout the world. Despite development of a variety of surgical techniques for mastopexy surgeries, problems associated with this operation are not yet fully eliminated. OBJECTIVES: The aim of this paper is to show the favorable reliability of the central pedicle surgery and introduce the modification with dermal suspension flaps for glandular repositioning and skin envelope reinforcement. METHODS: The modified central pedicle reduction mastopexy with dermal suspension surgical technique is explained with details on flap planning, skin dissection, parenchyma resection, breast shaping and nipple-areola repositioning and skin re-drape and closure. RESULTS: The breast contour is formed by shaping of the central gland and wrapping of the central gland by the deepithelized dermal flaps like a brassiere after peripheric resection. This results in an aesthetically pleasant glandular shaping, better longevity of the breast shape and tensionless skin closure, followed by high quality scars. Results from over 1850 cases are discussed. CONCLUSIONS: Even though the central pedicle reduction mammoplasty technique requires more experience and has a steeper learning curve in comparison with other popular techniques used today, the long run advantages such as better projection, upper pole fullness and less breast sagging are far more satisfying. In this method, the envelope formed by the skin does not define the breast contour. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Duodenal varices as an unusual cause of gastrointestinal bleeding due to portal hypertension: a case report.

Duodenal varices that develop in patients with portal hypertension rarely cause hemorrhage, but varix rupture is a serious and often fatal event. We report the case of a 38-year-old man with hepatic vein occlusion who was referred to our hospital for gastrointestinal hemorrhage of unknown origin. Upper gastrointestinal endoscopy revealed varices in the distal third of the duodenum. These varices were identified as the source of the bleeding. The patient was treated with endoscopic band ligation, and with coil embolization of a shunt between the superior mesenteric vein and the left renal vein.