Surgical management of the patient with invasive carcinoma discovered at reduction mammoplasty.

The diagnosis of invasive carcinoma presents a surgical dilemma when discovered incidentally at breast reduction mammoplasty. Subsequent surgical and therapeutic management for such cases have not been established. Although management and treatment may vary according to patient preference, a review of the literature of the past four decades yielded scant discussion of the topic. We describe two cases of occult breast carcinomas that were not evident on preoperative breast screening, but were discovered on the pathology exam of reduction mammoplasty specimen. The purpose of our publication is to recommend a surgical approach for the patient in such a situation.

Acquired thoracic scoliosis following minimally invasive repair of pectus excavatum.

The minimally invasive pectus excavatum repair as described by Nuss et al. is rapidly gaining acceptance as an effective method of repair of severe pectus excavatum deformities in the pediatric population. It potentially offers several advantages over previous techniques. The incidence of major complications of the procedure has been reduced by recent modifications including utilization of video-assisted thoracoscopy during placement of the Lorenz pectus bar as well as utilizing the pectus bar stabilizer that provides more rigid fixation of the strut. We report two cases of acquired thoracic scoliosis following minimally invasive repair of severe pectus excavatum deformity. This particular complication has not been reported in previous literature and warrants concern. In both cases the thoracic scoliosis slowly improved with physical therapy and range-of-motion exercises.