Bone Resorption after Use of Silicone Chin Implants, Long-term Follow-up Study with Lateral Chin Radiography.

Silicone chin implants are frequently used in cosmetic surgery to enhance a harmonic face. Obtaining an aesthetically pleasing face is increasingly becoming more important for people, and a considerable part of this goal can be achieved through different aesthetic modifications of the chin. The purpose of this study was to analyze the presence of bone resorption after the insertion of silicone chin implants, with lateral chin radiographs. Fifteen patients were studied, all of whom had a chin silicone implant inserted at least 1 year ago using the same surgical technique. The surgery was done intraorally with insertion of the silicone implant under the periosteum of the chin. Fourteen patients presented bone erosion, with the maximum of 2.0 mm erosion. However, none of them manifested any symptoms of this erosion. In conclusion, even though the majority of the patients presented with bone erosion, the results were minimal and completely asymptomatic; thus, this technique produced an excellent final result.

Leadership in plastic surgery today.

This article was developed after the authors heard young plastic surgeons of their unit ask what attribute makes people want to follow a leader. What people most seek to find in a leader has been constant over time and shared in different countries, genders, and age groups. These qualities include honesty, a forward-looking perspective, inspiration, and competence (Kouzes and Posner, Clin Lab Manage Rev 8:340, 1994). However, the residents and fellows thought differently and told the authors how "they" wanted to be seen when they became leaders. They wanted to viewed as shifting engines pulling forward teams of plastic surgery as hard as possible, leaving space for followers to develop and grow. They also wanted to be seen as having impeccable behavior related to the assumption of obligations, and finally as having the "most" informal authority possible, an authority that is not negotiable because it is given by peers to the leader due to personal qualities and actions. Obtaining formal authority at a very young age is fine, but if a surgeon's associates have not given him or her informal authority, the surgeon is only the "boss" and not the leader of the group. Informal authority is constructed over a time line and given by others to the leader because of what he or she has in values and personal attitudes and because of what the leader has done and can go on doing with sustained credibility and competency. Therefore, it is the authors' opinion that the exercise of leadership in plastic surgery is supported by informal authority and that the leader of leaders will be the one who has the most of this attribute that never is given formally.

Recent developments in the ability to predict and modify breast cancer risk.

The identification of women at higher risk for breast cancer is a matter of public health and anyone who participates in any treatment modality of this condition (this includes the plastic surgeon) should be aware of the tools and predictive models of breast cancer. Screening for breast cancer in the community, and probably during the daily plastic surgery consultation, until recently, was limited to decisions about when to initiate a mammography study. New developments that predict and modify breast cancer risk must be clearly understood by our specialty through identification of women at higher risk for breast cancer and be familiar with the current issues related to screening and risk-reduction measures. In this review, we discuss current knowledge regarding the recent data of breast cancer risk, screening strategies for high-risk women and medical and surgical approaches to reduce breast cancer risk. Patients with breast cancer belong to one of three groups: a. Sporadic breast cancer (75%)--patients without family history or those who have a breast biopsy with proliferative changes. b. Genetic mutation breast cancer (5%)--women who have a genetic predisposition, and most of these are attributable to mutations in the breast cancer susceptibility gene 1 (BRCA1) and breast cancer susceptibility gene 2 (BRCA2). c. Cluster family breast cancer (20%)--seen in women with a relevant history of breast cancer in the family and breast biopsy with proliferative breast changes with no association with mutations.Those at high risk for breast cancer should investigate the family history with genetic testing consideration, clinical history, including prior breast biopsies and evaluation of mammographic density. Tools for breast cancer risk assessment include the Gail and Claus model, genetic screening,BRCAPRO and others that are evaluated in this review.