Reconstruction of breasts following mastectomy with polyurethane-covered, gel-filled prostheses.

This article describes a simple, one-stage procedure to reconstruct breasts following radical and subcutaneous mastectomy by using subcutaneous placement of Natural-Y prostheses (polyurethane-covered, gel-filled implants with an internal Y-shaped septum). Breast reconstruction after mastectomy or immediately following subcutaneous mastectomy was performed in 36 patients using 62 Natural-Y prostheses. All patients still had implants in place six months to five years later. Neither spherical capsular contractures, infection, nor skin necrosis developed around any implants. Transfer of pedicle flaps was not required in any patient and the reconstructive procedures resulted in minimal scarring. Wrinkling of skin and a palpable implant edge in the superior quadrant were noticeable in some breast reconstructions following subcutaneous mastectomy but rarely in breasts reconstructed following mastectomy because the taut skin conformed to the implant.

Congenital arteriovenous malformations of the upper extremity.

The embryology and the clinical management of congenital AV fistulas of the upper extremity are discussed. Early excisional surgery of asymptomatic lesions should be confined to ones of a very limited extent. Excisional surgery on extensive lesions should be limited to those which are symptomatic and have decreasing hand function. Possibly of limited effectiveness in some lesions may be the selective occlusion of vascular feeders by injecting cyanoacrylate glue through a catheter.

Diabetes insipidus caused by craniofacial trauma.

A patient is presented with diabetes insipidus secondary to craniofacial trauma. Diabetes insipidus can occur in any patient within ten days of craniofacial trauma. Even the masked disease in the unconscious patient can be diagnosed by observation of intake and output, urinary specific gravities, and appropriate chemical studies. The disease can recur following operative reduction of facial fractures. Diabetes insipidus can be successfully treated by intramuscular Pitressin and appropriate fluid intake.

Subcutaneous mastectomy. The excess skin problem.

Subcantaneous mastectomy through a lateral approach, with preservation of the nipple and areola on a dermal pedicle, removing the excess skin at the time of aubautaneous mastectomy, is a safe procedure which results in esthetically acceptable breasts. The surgical approach greatly facilitates the removal of the entire glandular portion of the breast. The need for a second surgical procedure is eliminated. Lateral biopsy scars can be reinforced by the dermal sling support, thereby decreasing the chances of exposure of the implant. The implant is also successfully and easily held in position by the use of the dermal-fat sling support. The nipple and areola survive quite well on the dermal pedicle, with preservation of contractility and sensation, as well as of blood supply.

Further experience with lateral wedge resection mammaplasties.

The lateral wedge resection method of reduction mammaplasty results in breasts with a single oblique radial scar in the outer quadrant, good contour, the nipples with sensation, erectile capacity and forward projection. It is suitable for cases of moderate enlargement and for ptotic breasts.