Gigantomastia as a Cause of Pulmonary Hypertension.

Reduction mammaplasty is the gold standard treatment for gigantomastia. We report one female patient with juvenile gigantomastia associated with severe pulmonary hypertension where her pulmonary pressure decreased significantly after the surgery, improving her quality of life. A 22-year-old female patient with gigantomastia since 10 years old, tricuspid regurgitation, and pulmonary thromboembolism antecedent was admitted to the emergency department. Her oxygen saturation was 89%. Acute heart failure management was initiated. An echocardiogram reported left ventricle ejection fraction (LVEF) of 70% with severe right heart dilation, contractile dysfunction, and arterial pulmonary pressure (PASP) of 110 mm Hg. A multidisciplinary team considered gigantomastia could generate a restrictive pattern, so a Thorek reduction mammoplasty with Wise pattern was performed. Presurgical measurements were: sternal notch to nipple-areola complex, right 59 cm, left 56 cm. Three days after surgery, the patient could breathe without oxygen support. In the outpatient follow-up, patient referred reduction of her respiratory symptoms and marked improvement in her quality of life. Six months after surgery, a control echocardiogram showed a LVEF of 62% and PASP of 85 mm Hg. Pulmonary hypertension may be present in patients with gigantomastia. Reduction mammoplasty may be a feasible alternative to improve the cardiac signs and symptoms in patients with medical refractory management.

Aesthetic surgery of female external genitalia.

Aesthetic surgery of the external genitalia in women encompasses many procedures and may address the labia minora, clitoral hood, labia majora, mons pubis, or vaginal opening. During the initial evaluation, the surgeon should consider all aspects of the external genitalia to develop an appropriate surgical plan. It may be necessary to perform 2 or more procedures during the same surgical session to achieve the desired aesthetic result. In this continuing medical education (CME) article, we review the literature and summarize the available cosmetic techniques for female external genitalia. Resection of the labia minora has been described in several peer-reviewed reports. We also discuss the procedures and modifications to direct resection, wedge resection, and deepithelialization of the labia minora. Aesthetic surgery of the clitoral hood may involve straight-line resection, extended wedge resection, or inverted V hoodoplasty. The mons pubis may be treated with mons pubis pexy, wedge resection, or lipomodeling. The labia majora can be managed with direct resection or lipomodeling, and hymenoplasty may be performed to correct a wide vaginal opening.

Refreshing labioplasty techniques for plastic surgeons.

BACKGROUND: Patient requests for plastic surgery of the female genitalia have become more common. There are several technical options to manage hypertrophic labia minora, including direct excision, wedge resection, and deepithelialization. Labia majora hypertrophy and hypoplasia can also be managed surgically. The aim of this study was to summarize labioplasty techniques to date, and describe the senior author's technique for labia minora and majora labioplasty. METHODS: Seventy-four patients underwent direct labia minora excision with or without clitoral hood molding and management of labia majora by the senior author from January 2009 to August 2011. RESULTS: The average follow-up time was 6 months. The range of the patients' ages was wide with an average age of 35 years. One patient had an infection and one had wound dehiscence. Six patients had palpable fatty cysts in the labia majora after fat injections; the cysts of five of these patients reabsorbed before 6 months. In one patient a palpable mass persisted 8 months after surgery; however, it was not visible or painful and the patient was satisfied with the result. No cases of scar contracture, painful scar, or discomfort because of labial edge distortion were noted. The satisfaction rate was close to 100 %. CONCLUSION: The direct excision of the excess labia minora is a good technique and does not produce scar-associated problems. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article.