Three-dimensional laser imaging as a valuable tool for specifying changes in breast shape after augmentation mammaplasty.

BACKGROUND: Three-dimensional (3D) terrestrial laser scanning (TLS) is a valuable method for measuring shapes of objects and for obtaining quantitative measurements. These qualities of the 3D laser scanner have proved to be useful in reconstructive breast surgery. This study investigated various 3D parameters to obtain an optimal objective visualization of the breast after cosmetic augmentation mammaplasty. METHODS: The objects are represented in a point cloud, which comprises millions of x, y, and z coordinates representing a virtual image. The quantification of 3D points shows changes in height (z coordinate) at any chosen point on the augmented breast (x and y coordinates). To give visual feedback on the change in dimensions, a color elevation scheme was applied on the reconstructed surface of the breast. As a quantifying description, a sagittal B-spline was chosen in a plane through the nipple to obtain the breast shape via the lateral profile. RESULTS: Pre- and postoperative clear images were obtained. The color elevation model showed an increased projection and upper pole fullness after augmentation. The B-spline showed the gain in projection in a sagittal plane through the nipple. CONCLUSIONS: Three-dimensional TLS is capable of objectifying changes in shape after augmentation mammaplasty. This imaging technique represents superior visualization of the breast shape and can serve as a valuable tool to determine the changing dimensions of the breasts after augmentation mammaplasty.

Combined use of ultrasonic-assisted liposuction and semicircular periareolar incision for the treatment of gynecomastia.

BACKGROUND: Of the wide range of excisional and liposuction techniques used to correct gynecomastia, so far, no single one was suitable for all grades of gynecomastia. We introduce ultrasonic-assisted liposuction (UAL) combined with conventional liposuction and partial gland resection without skin excision as the standard surgical technique for all such grades. PATIENTS AND METHODS: Twenty-eight men (aged 17 to 80 years) were consecutively treated from March 2004 through April 2006 for grade Ia (n = 3), Ib (n = 2), IIa (n = 6), IIb (n = 6), III (n = 8), or IV (n = 3) gynecomastia. Their characteristics and the outcome of surgery were retrospectively assessed. RESULTS: A mean of 848 mL (range, 300 to 1400 mL) of liquefied breast tissue was aspirated, and 31 g (range, 3 to 180 g) of fibroglandular tissue were excised per breast. No immediate or delayed adjuvant skin reduction was needed in any of the patients. Moderate postoperative ecchymosis was observed in 2 patients, but no complications were encountered in this series. The cosmetic outcome was good to excellent in all. CONCLUSIONS: UAL in combination with gland resection through a minimal caudal semicircular periareolar incision and conventional liposuction effectively corrects all grades of gynecomastia. This combination has little morbidity, requires no skin excision, and leads to uniformly good esthetic results.

Anatomically shaped breast prosthesis in vivo: a change of dimension?

BACKGROUND: In addition to the already existing round cohesive gel-filled breast prostheses, anatomically shaped breast prostheses were introduced in 1990 to provide a more natural shape to the augmented or reconstructed breast. To date, however, it is unclear whether the anatomic configuration of the prostheses is maintained after subpectoral implantation. Recently, a three-dimensional (3D) magnetic resonance imaging (MRI) technique became available, offering a precise visualization of the prosthesis in vivo. Using this 3D MRI technique, this study aimed to compare the shape of commercially available round and anatomically shaped silicone gel-filled breast prostheses before and after implantation. METHODS: Using 3D MRI, 6 conventionally round and 12 symmetrically shaped silicone gel-filled prostheses were scanned in vitro. Scans were made in vivo 6 weeks after subpectoral implantation of these prostheses in nine patients. The in vivo 3D images were compared with the in vitro 3D images. RESULTS: Overall, a 3.5% decrease in projection was found on the in vivo images, as compared with the in vitro images. On the craniocaudally oriented images, a slight lateral shift of the cohesive gel was observed in the majority of the prostheses. Inamed Style 510 prostheses showed the best in vivo preservation of their configuration. CONCLUSIONS: The results show that both the round and the anatomically shaped silicone prostheses in vivo largely maintain their original in vitro configuration after subpectoral implantation.

Visual evoked potentials during suppression in exotropic and esotropic strabismics: strabismic suppression objectified.

BACKGROUND: We performed an electrophysiological study in order to objectify suppression in strabismus. The extent of cortical involvement in the process of interocular suppression was also explored. Possible differences in the suppressive process of esotropic and exotropic strabismics were also studied. METHODS: An electroencephalographic recorder with eight leads was applied to the posterior one-third of the skull; three occipital, three parietal, and two temporal leads. We measured the activity of these visual cortical areas during stimulation of each eye under monocular as well as binocular viewing conditions with hemisinusoidal light pulses in a nature-like complex visual background. Recordings were made from six primary esotropic strabismic subjects and four primary exotropic and one consecutive exotropic strabismic subject. Also, five normal controls were studied. RESULTS: A characteristic, triphasic response complex was found at approximately 80 ms following the start of each light pulse under monocular viewing conditions in the dominant and the nondominant eye. However, under dichoptic viewing conditions in the nondominant eye of all esotropic cases as well as in the nondominant eye of three of five exotropic cases, this response complex was completely absent. They showed approximately 100% reduction of their cortical response activity. CONCLUSIONS: These results show the vast extent of the cortex that is involved in the suppressive process, giving a good insight in the power of suppression.