Correction of the severely inverted nipple: areola- based dermoglandular rhomboid advancement.

Inverted nipple is a relatively common aesthetic problem presenting to a plastic surgeon. Along with the functional problems; recurrent inflammation/infection and an inability to nurse, most patients seek intervention because of the abnormal appearance. Many different surgical techniques have been described, suggesting that no one technique is universally successful. Most techniques employ, either individually or in combination, methods to tighten the nipple base or the use of areolar dermal flaps to support the nipple. We propose two modifications to the dermal flap technique. Firstly, the rhomboid dermal flaps are designed solely on the areola, the bases directed peripherally, improving vasularity and allowing true medial advancement. Secondly, the lactiferous ducts and tethering fibrous bands are released in a conical fashion allowing closure with a vertical V-Y advancement. This gives better projection and support to the nipple proper with medial recruitment of glandular tissue closing the dead space created. This technique has been used successfully by the senior author in 20 patients over a 16 year period, with a high rate of preserved nipple evertion and patient satisfaction. The technique is simple, reliable and provides sustained results over long term follow-up for the correction of the more severely inverted nipple.

A study of the personal use of digital photography within plastic surgery.

The advent of digital photography has greatly increased the use of medical illustration within specialties dealing with visible pathologies. It offers improved communication between medical professionals, education and counselling of their patients and forms an important aspect of their medical records. With the increased availability of digital cameras there is an increased tendency for clinicians to take digital photographs of patients themselves. In doing so, clinicians take on the responsibility to act in accordance with the regulations governing this practice issued by the UK Department of Health. This study sought to investigate the prevalence of this practice by way of an anonymous questionnaire distributed to three representative plastic surgery units within the UK. It looked at the awareness of and compliance with the present governing regulations. The results showed that of the 60 distributed questionnaires, 30 of 42 respondents took digital photographs of patients themselves. Photographs were taken for the purposes of inclusion in the medical records, education, development of personal libraries and publication. Consent was usually taken but was often only in a verbal form. Processing, storage and security measures highlighted potential risks for breaches in confidentiality. Knowledge relating to the NHS Confidentiality Code of Practice, the Data Protection Act and the need for registration with the Data Commissioner when acting in a private capacity were often not known. This small study highlights a number of important points surgeons need to be aware of when taking photographs of patients themselves and makes recommendations for its practice within a plastic surgery department.