Posterior wedge resection: a more aesthetic labiaplasty.

BACKGROUND: Hypertrophy of the labia minora is of concern to a subset of adolescents and adult women. The posterior wedge resection is a new labiaplasty technique with an anatomic approach to yield the optimal aesthetic outcome and yet continue the functional achievement of prior techniques. OBJECTIVE: The authors describe the results of their posterior wedge resection technique in a retrospective series of patients. METHODS: A retrospective chart review was performed of 22 consecutive patients who underwent posterior wedge resection labiaplasty between February 2009 and February 2012. Complications and aesthetic outcomes were reviewed. RESULTS: The average age of the patients in this study was 35 years (median, 33 years). Follow-up ranged from 2 weeks to 1.5 years. Two minor complications occurred without further sequelae. At follow-up, none of the patients reported any paresthesias, pain, or problems with penetrating vaginal intercourse. CONCLUSIONS: An increasing number of labiaplasties are being performed for aesthetic and functional concerns. The posterior wedge resection enables the surgeon to perform labiaplasty easily, safely, and effectively, ensuring symmetry and maintenance of the natural pigment, color, and texture of the defining free edge of the labia minora.

Predicting patients at low probability of requiring postmastectomy radiation therapy.

BACKGROUND: Postmastectomy radiation therapy (PMRT) is recommended for patients with four or more positive lymph nodes (LN+). Given the ramifications of PMRT for immediate reconstruction, we sought to create a model using preoperative and intraoperative factors to predict which patients with a positive sentinel lymph node will have less than four LN+. METHODS: The database from a prospective multicenter study of 4,131 patients was used for this analysis. Patients with one to three positive sentinel lymph nodes (SLN) and tumors < 5 cm (n = 1,133) in size were randomly divided into a training set (n = 580) and a test set (n = 553). Multivariate logistic regression was used on the training set to create a prediction rule that was subsequently validated in the test set. RESULTS: Median patient age was 57 (range, 27-100) years, and median tumor size was 2.0 (range, 0.2-4.8) cm. In the training set, factors associated with having four or more LN+ on multivariate analysis were: tumor size [odds ratio (OR) = 2.087; 95% confidence interval (CI): 1.307-3.333, P = 0.002), number of positive SLN (P < 0.0005), and proportion of positive SLN (OR = 3.602; 95% CI: 2.100-6.179, P < 0.005). A predictive model was established with a point assigned to each positive SLN, T2 (vs. T1), and if proportion of positive SLN was > 50%, for a maximum of five points. In both the training and test sets, patients with one point had a low probability of having four or more LN+ (3.8% and 3.3%, respectively). CONCLUSION: Tumor size, number of positive SLN, and the proportion of positive SLN influence whether patients will have four or more LN+. A simple model can predict the probability of requiring PMRT.