The Ideal Nipple Reconstruction Shield.

Reconstruction of the nipple-areola complex is the culmination of a long road for patients who have suffered breast cancer. The postoperative dressing of the reconstructive nipple must protect it from mechanical forces, trauma, and infection. A broad array of dressings has been used for the reconstructed nipple. The authors propose the use of a readily available adhesive eye protector as a simple and cost-effective dressing for the reconstructed nipple-areola complex.

Incidence of 'Incidentalomas' in over 100 consecutive CT angiograms for preoperative DIEP flap planning.

The gold standard in breast reconstruction is the deep inferior epigastric perforator (DIEP) flaps, although muscle-sparing tranverse rectus abdominis myocutaneous (TRAM) flaps are still being performed due to variations in the abdominal vasculature and to reduce flap complications. Recently, there has been a rise in interest in preoperative imaging, in particular, by means of computer tomography angiogram (CTA). CTA has been shown to delineate the vascular anatomy, improve preoperative decision making and possibly reduce operating time and constitutes a routine preoperative investigation in our unit. Of the 104 consecutive patients who had undergone CTA prior to breast reconstruction, we have found a 13% incidence of unexpected findings or 'incidentalomas' in otherwise asymptomatic women. None were malignant, but changes to the initial operative plan included deferring immediate breast reconstruction, further surgery and further investigations for these incidentalomas. We recommend that all women are counselled of the possibilities of incidentalomas prior to CTA. Furthermore, clinicians need to be receptive to the possibility of a delayed or alternative reconstruction, and closely liaise with other specialties to avoid damage to the deep inferior epigastric vasculature.

Age- and gravity-related changes in facial morphology: 3-dimensional analysis of facial morphology in mother-daughter pairs.

PURPOSE: There is increasing focus on the effects of gravity and age on facial appearance. Understanding these effects on facial morphology requires an accurate means of measuring surface topography. We present a preliminary study on the changes in facial topographic landmarks in a cohort of mothers and their daughters. MATERIALS AND METHODS: The faces of mother-daughter pairs (N = 15, aged 13 to 61 years) were imaged by stereophotogrammetry in the upright and supine positions. Twenty anthropometric surface landmarks were placed, and the corresponding x, y, and z coordinates were generated with custom software. The relative excursion of each landmark from the upright to the supine position was calculated. RESULTS: Movement of up to 7.3 mm occurred in the horizontal (x) plane, 5.7 mm in the vertical (y) plane, and 7.6 mm in the dorsoventral (z) plane. Significant movement (P < .05) in the vertical plane occurred in the upper lip, lateral canthi, labial commissures, and gonia. There was no significant movement in the dorsoventral plane. Maximal movement occurred in the lower third of the face in both groups but was more marked in the mothers. CONCLUSIONS: Age- and gravity-related effects on the face can be accurately measured and documented with 3-dimensional imaging. This technique will allow comparison of rejuvenation techniques and a better understanding of the mechanisms of facial aging.