Lasting success in teenage reduction mammaplasty.

Symptomatic relief of macromastia following reduction mammaplasty in the adult female population is well documented. Teenagers undergoing breast reduction may be at risk for recurrent symptoms secondary to postoperative breast development. The psychological consequences of prominent scars, sensory loss, and inability to breastfeed may overshadow the early symptomatic relief gained from reduction mammaplasty. Eighty-six patients who had undergone bilateral reduction mammaplasty prior to 20 years of age from 1970 to 1990 were identified from hospital and office charts. Forty-eight patients (56%) were successfully contacted and completed a detailed questionnaire evaluating preoperative, postoperative, and present symptoms as well as physical and psychological consequences of their surgery. Patient age ranged from 15.0 to 19.9 years with a mean of 17.8 years. Average length of follow-up time was 5.9 years, ranging from 1.4 to 20.4 years. Sustained relief of symptoms in those patients with preoperative back pain, neck pain, shoulder strap pain, and submammary rash occurred in 76%, 78%, 89%, and 93%, respectively, despite the fact that 72% reported at least some regrowth of breast tissue. Seventy-three percent reported being happy with their current breast size, 94% would have the procedure now if they had not had the surgery as teenagers, and 94% would recommend breast reduction to a friend with macromastia. Teenage patients who undergo reduction mammaplasty do not suffer from marked return of symptoms, and long-term satisfaction remains high.

Rectal prolapse. An update on the rectal sling procedure.

The rectal sling procedure has been used successfully in treating rectal prolapse for over three decades. Recurrences are rare; however, difficulties have developed from excessive reaction to some prosthetic slings and the failure of others to allow tissue ingrowth. Gore-Tex is presented as an ideal material for correction of the rectal sling because of its inert properties and porous structure which allows tissue incorporation. The problem of postoperative fecal impaction created by pulling the sling too tight has also been circumvented by placing the sling posteriorly, leaving the anterior rectal wall free to distend. The Ripstein procedure is described in detail, and a series of 23 patients is presented who have had successful rectal prolapse repair using the new rectal sling procedure. There have been no recurrences and minimal morbidity in these cases.