ABSTRACT
BACKGROUND: Understanding the female breast fascial system is of paramount importance in breast surgery. Little was written about breast ligaments. Most articles refer to Cooper's work without further anatomical studies. Lately, a horizontal septum has been described conveying nerves and vessels to the nipple areola complex. METHODS: During the surgical dissection of the lower part of the breast, in supero-medial technique for breast reduction operations, a fascial septum between the lower two quadrants was detected. This fibrous septum was studied through anatomic dissection of breast tissues during routine breast reshaping procedures that was done on 30 female patients. Magnetic resonance imaging (MRI) was performed preoperatively in all cases and correlated with the intraoperative findings. In the other five cases, outside the clinical study, the imaging was done during routine investigation for breast swellings. RESULTS: A vertical septum was identified in the lower part of the breast, lying at the breast meridian between the two lower quadrants. It is a tough bi-laminated structure that extends from the middle of the infra-mammary crease caudally to nipple-areola complex cranially and from the pectoral fascia posteriorly to the overlying skin anteriorly. This was proved by MRI findings. CONCLUSIONS: This study describes a new inferior vertical septum which separates the lower half of the breast into two definite anatomical compartments: medial and lateral.
ABSTRACT
Primary surgical correction of cleft-lip nose deformity is now well accepted. Despite various surgical techniques proposed, perfect nasal symmetry has not been persistently attained. The main reason is that the maxillary deficiency is frequently overlooked.This paper presents 62 cases of unilateral cleft lip repaired over the last 20 years by using the author's modification of the Millard primary lip nose repair. Each of these patients had a minimum follow-up of 1 year (range 1-12 years).The technique consists of raising a small subcutaneous alar base flap (SCAB) from the nasolabial region. The flap is turned over like a book page to add bulk to the deficient maxilla and to elevate the depressed ala. It also controls alar rotation and permits its permanent fixation to the anterior nasal spine.The results show that this modification has improved the alar contour and symmetry in patients undergoing primary cleft-lip nasal repair. There was minimal increase in the operating time and the final scar is similar to the original Millard technique.
