The Suprapubic Dermoadipose Flap for Aesthetic Reshaping of the Postpregnancy Abdomen.

BACKGROUND: Postpregnancy full-length diastasis of the recti abdominis muscles is a common condition occasionally associated with atrophy of the subcutaneous fat located at the midline above and below the umbilicus. OBJECTIVES: The authors report a preliminary clinical experience with the suprapubic flap to prevent the late postoperative contour deformities of the postpregnancy abdomen. METHODS: Between January 2005 and January 2015, all female patients undergoing abdominoplasty with the suprapubic flap were included in the present study. Electronic clinical records were reviewed to analyze the patients' ages, body mass index (BMI) scores, pregnancies, risk factors, and operative times, followed by a telephone-based survey to measure patient satisfaction. RESULTS: Twenty-two patients were included. Their ages ranged from 19 to 36 years (mean, 27 years) and their BMI ranged from 17.5 to 22.5 kg/m2 (mean, 20.5 kg/m2). Postoperative follow up ranged from 12 months to 10 years (mean, 89 months). All patients had experienced at least one pregnancy and many of them multiple or twin pregnancies. Umbilical hernias were present in 18 patients. There were 5 unusual cases: one hematoma, one seroma, and three cases of hypertrophic scarring. Thirteen additional minutes were required, on average, to associate the flap. All patients were satisfied or very satisfied with the results. CONCLUSIONS: The suprapubic dermoadipose flap is an effective option to prevent the midline depression that would otherwise remain on the hypogastric region of postpregnant slim women with midline fat tissue atrophy.

Modified Island Technique for Prominent Ears.

There have been several methods described for the correction of prominent ears, including techniques that excise, bend, suture, score, or cut the auricular cartilage. The Island Technique, proposed by Pitanguy, is based on the creation of a cartilage island to define the antihelix and correct the conchoscaphal angle. Visibility of sharp edges has been the main criticism of this technique. To avoid them, we advise performing an internal bevel incision to round off the edges and achieve a more natural look. Also, sometimes prominent ears are asymmetric with different conchoscaphal angles, determining a residual but protruding upper pole, thus requiring different treatment on each side. For such cases, we propose the additional excision of a cartilage strip from the lower border of the auricular scapha, with a greater conchoscaphal angle. In this way, cartilage islands of similar width and identical antihelixes for both ears are created and a symmetric result is achieved. 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 .

Mastectomías con conservación de piel y reconstrucción inmediata: nuestra experiencia en el Hospital Italiano de Buenos Aires / Skin Sparing Mastectomy and Immediate Reconstruction: Our experience at the Hospital Italiano de Buenos Aires

La indicación de conservación de piel en la cirugía radical ha ido tomando un rol de mayor relevancia, asociado al aumento del número de reconstruccionesinmediatas. Objetivo: El objetivo de este trabajo fue describir las características de la población sometida a reconstrucción mamaria, compararlas con las de las pacientes no reconstruidas y describir los eventos durante el seguimiento (recaída local, a distancia y muerte). Material y método: Estudio retrospectivo de cohorte, que incluye a las pacientes con carcinomainvasor de la mama tratadas con mastectomía, con y sin reconstrucción inmediata, entre los años 2007 y 2013 en el Hospital Italiano de la Ciudad de Buenos Aires. Se evaluaron las características clínicas e histopatológicas. Resultados: En total, entre los años 2007 y 2013 hubo 466 pacientes sometidas a mastectomía, en 131 de las cuales se hizo reconstrucción inmediata. El número de mastectomías con reconstrucción inmediata creció exponencialmente durante los últimos años, aunque no se evidencia un aumento en la tasa global de mastectomía. Ambas poblaciones con y sin reconstrucción inmediataeran comparables en cuanto a la distribución de subtipos intrínsecos, pero hubo mayor edad y proporción de tumores G3 y mayores a 2 cm en las pacientes no reconstruidas. En relación con la sobrevida, observamos que hubo menor proporción de eventos en la población reconstruida. Conclusiones: En los últimos años, en nuestro servicio ha aumentado la indicación de reconstrucción inmediata. La población de pacientes reconstruidas fue más joven y con tumores más pequeños. Aunque aún falta tiempo de seguimiento, parecería ser que la reconstrucción inmediata sería una opción factible y segura en los cánceres de mama en estadios tempranos...

Capsular grafts and flaps in immediate prosthetic breast reconstruction.

BACKGROUND: Patients with previously augmented breasts and a diagnosis of breast cancer who are candidates for immediate prosthetic reconstruction can benefit from capsular tissues used for splinting the position of the pectoralis major muscle. METHODS: A retrospective clinical review of patients with previously augmented breasts who are undergoing mastectomy and immediate prosthetic reconstruction with capsular tissues was undertaken. The bottom of the periprosthetic capsule was tailored in a novel and versatile fashion as grafts or flaps and used as a sling between the pectoralis major and the inframammary fold. RESULTS: Of the 21 patients in this study, 19 had unilateral reconstruction, whereas 2 had bilateral reconstructions. Capsular tissues were harvested as free capsular grafts in 15 cases and raised as a capsular flap in the remaining 8 cases. During the follow-up period, complications were detected in 7 patients (1 seroma, 1 infection, 1 hematoma, 1 superficial epidermolysis, 2 cases of rippling, and 1 mild capsular contracture). CONCLUSIONS: For eligible patients, the use of capsular tissues offers a readily available and cost-effective alternative to acellular dermal matrices with a negligible complication rate. Patient selection is key to ensuring a safe oncologic approach and must be carefully carried out in close collaboration with the breast surgeon. 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 .

New method of tunnelling for omental transposition in the treatment of a complex radionecrotic groin ulcer.

Omental transposition is often used for reconstruction of soft tissue in the groin. However, the potential for incisional hernia is a relative contraindication. We report the cure of a groin ulcer with omental transposition using a new method of tunnelling to avoid herniation.

Pocket work for optimising outcomes in prosthetic breast reconstruction.

Implant breast reconstruction is a recommendable alternative for women who have undergone mastectomy and lack the necessary subcutaneous fat tissue for an autologous reconstruction. On the other hand, many women reject the morbidity of the donor site, prolonged recovery periods and muscular weakness associated with autologous reconstruction. Therefore, muscle and skin expansion has become one of the most popular approaches used in breast reconstruction. Nevertheless, the expansion process may be hindered by events like seroma formation, implant rotation, moving upward or downward altering the location or shape of the submammary crease, capsule contracture or extrusion. Since the advent of the anatomical expander, two-stage reconstruction with the expander/implant sequence has become the most popular choice in prosthetic breast reconstruction (PBR). The second surgical stage, in which the tissue expander is exchanged for the permanent implant, offers a unique opportunity for pocket work. Pocket work strategies and their indications should be known and applied by the surgeon who aims at optimising PBR aesthetic results.

Dermolipectomy of the thighs and buttocks to solve a massive silicone oil injection.

Despite scientific literature replete with stories of disastrous results and disfigurement, illicit subcutaneous injections of massive quantities of highly viscous fluids are still performed, often by unqualified persons. The authors present a devastating long-term outcome of subcutaneous injections of a massive volume of silicone oil in the buttocks of a 46-year-old female patient and its resolution through dermolipectomy of the thighs and buttocks.

Gauzoma mimicking siliconoma after breast augmentation surgery.

Gauzoma is a rare iatrogenic mass caused by the retention of gauze fibers during surgery. This intraoperative complication represents a diagnostic problem for radiologists besides being a medicolegal problem for surgeons. We present a patient in whom a retained surgical sponge after breast augmentation surgery mimicked a siliconoma and discuss imaging appearance and differential diagnosis.

The owl technique combined with the inferior pedicle in mastopexy.

Mastopexy patients usually are concerned with aesthetic outcomes, making the procedure a challenging one. Besides recreating a youthful, firm breast, a major concern is reducing the extent of scarring. Over recent decades, a number of short-scar techniques have emerged as alternatives. In 2002, Ramirez reported the owl technique, which combines the features of the periareolar and the vertical techniques. Nevertheless, the ideal technique also should improve shape and breast contour to withstand the test of time. The authors aim to show the results from combining the owl technique with the inferior pedicle for the treatment of patients who have mammary ptosis with or without hypertrophy.

Immediate prosthetic breast reconstruction: the ensured subpectoral pocket (ESP).

Implant exposure due to cutaneous necrosis is one of the most feared complications of mastectomy with immediate prosthetic reconstruction. A key issue is to ensure good blood supply to the skin and complete integrity of the submuscular pocket. The latter is created with the pectoralis major and supplemented with the serratus anterior, the rectus abdominis sheat, the obliquus mayor and the pectoralis minor. The main drawback is that those muscles, when sutured to create a complete pocket, only allow the setting of small-sized implants. The authors present the application of polyglycolic mesh in an original fashion, mimicking the anatomy of the muscles usually employed in pocket creation. The proposed technique has been denominated Ensured Subpectoral Pocket and has proved to be a valid strategy in immediate single stage prosthetic breast reconstruction. It allows the setting of bigger implants without previous tissue expansion while preventing implant displacement. In addition, it reduces emotional trauma on patients and lowers surgical costs.

Versatility of the 360 degrees periareolar approach for the treatment of mammary pathology.

In 2001, the authors published the 360 degrees periareolar approach as a new method for breast augmentation in patients with small nipple-areolar complex diameters. This approach provides an adequate surgical field with an excellent view of the surgical pocket, allowing placement of the implant without damage to either the device or the skin margins. Since its implementation, results have been highly satisfactory, encouraging the authors to expand its indication to other mammary pathologies such as tubular breasts, benign breast tumors, and gynecomastia, conditions for which this method also has proved to be useful.