[Alternatives of the augmentation mammaplasty combined with breast ptosis].

Combining breast augmentation with mastopexy is a through challenge due to the difficulty of precise judgment of the tissue surplus and the necessity of keeping part of it for implant coverage. For those reasons, many authors prefer two stage procedure: augmentation with subsequent mastopexy or vice versa mastopexy with implantation of prostheses at a next stage. The present article reveals the results of one stage treatment of 98 patients with breast ptosis. Five basic techniques of mastopexy with augmentation were utilized. Very good result was registered in 85% of the cases, in another 11%--acceptable, and in 4% of the patients bad result was encountered.

[Subcutaneous mastectomy with reduction mammaplasty--challenge for the surgeon and possible alternative for breast cancer patients].

INTRODUCTION: Breast Cancer surgery with breast removal is associated with critical decrease in women quality of life. Oncoplastic surgery offer different techniques for removal of the tumor and remodelating the breast to achieve acceptable end results--oncological and aesthetical ones. MATERIAL AND METHODS: We present the clinical case of M.G. M -72 year old, St.IIIA--breast cancer patient, who refuses removal of the breast and any chemotherapy. RESULTS: We perform subcutaneous mastectomy through inverted T - incision, including the areolo - mammilary complex in mastectomy specimen; L1, L2, L3 - lymphadenectomy through lateral skin flap. Skin - island flap was designed, based on superior flap for areolar replacement. Areolar reconstruction and reduction for symmetry were planed as a second step procedure because of the patient informed consent. CONCLUSIONS: 1. Subcutaneous mastectomy with reduction mammaplasty is an acceptable and possible operative way for breast cancer patient. 2. Preoperative planning is critical for best end results. 3. All precautions must by take for primary wound healing to achieve best time between operation and postoperative irradiation. 4. Further researches are needed to evaluate late aesthetic and oncologic results.

[Latissimus dorsi myocutaneous flap in the surgical treatment of locally advanced breast cancer].

UNLABELLED: Locally advanced breast cancer (LABC) usually have a poor prognosis. In some cases surgical treatment is not performed at all due to technical problem: mastectomy defect closure. Even all additional forms of treatment are involved there is a little chance to reduce a huge tumor mass and get tumor growing under control. MATERIAL AND METHODS: We present a case of LABC in 46-year woman with history of three-year breast cancer (T4NxMI - supraclavicular). RESULTS: Because of tumor formation in left breast and pathologically confirmed left supracla-vicular lymph node metastasis at 2003, the whole course of neoadjvant therapy was performed - including radio and chemotherapy. With signs of new spread of disease the patient was admitted in 3rd Surgical Clinic, Medical University - Plovdiv. After a proper preoperative preparation the patient was operated. The ontological part of procedure involved simple mastectomy during which the soft tissues 34/14 cm defect was occurred. In the reconstructive phase of the operation a LDF was disained and with additional V-Y-plasty the mastectomy defect was completely covered. CONCLUSIONS: 1. Even with a poor prognosis the LABC must by a surgical case in order to maximum tumor mass redusing. 2. LDF is a technical possible way for postmasrectomy soft tissue defect reconstruct-tion. 3. It is necessity to include the LDF in a earlier treatment stage.

[Health-related quality of live in breast cancer patients--actuality and problems]. / Zdravnoopredelenoto kachestvo na zhivot pri patsientki s rak na mlechnata zhleza--aktualnost i problemi.

Women with early breast cancer have three surgical options fir this current moment: conservative treatment (lumpectomy, quadrantectomy); mastectomy alone and mastectomy plus reconstruction (immediate or delayed). When randomized trials showed oncological safety of breast--conservative treatment compared with mastectomy, the question of cosmetic results assessment become actual, because of its impact on quality of live. The current state of the art permits achievement of good oncological results and good cosmetics ones. There are some technical factors affecting cosmetic results after breast--conservative treatment: orientation of resection; the breast / resection ratio; tumor localization; orientation of axillary dissection. Combination of extended resection (quadrantectomy) plus axillary dissection through the same incision results in cosmetic failure. After operation there is a remarkable breast asymmetry, retraction of the mammilla and inferior contour distortion. The main reasons for cosmetic failures are: volume of resection (lumpectomy, quadrant-ectomy), postoperative radiotherapy, deviation from normal breast morphology and tumor location. There are a lot of questionnaires for quality of live assessment. For Bulgarian population N. Mashonov created and adopted original questionnaire. The author investigated quality of live among patients with hard failure during recovery period.

[Lower blepharoplasty with and without fat resection. Analysis of 175 patients]. / Dolna blefaroplastika s's bez rezektsiia na mastnite kherniatsii. Analiz na rezultatite pri 175patsienti.

Blepharoplasty I certainly one of the most demanding and commonly performed aesthetic procedures. In young individuals the main desire is to get rid of the baggy eyelids with make the person look tired. In older age group there is skin excess associated with the herniated fat as well as muscle festoons, which may descend below the orbital rim. The analysis of the results of lower blepharoplasty with and without fat removal in 175 patients shows the benefit of fat conservation technique for the final aesthetic result. Real increase in the volume of orbital far can be found in Graves disease and this is the sole indication.

[Hair transplantation with Calvitron - experience with 25 patients (preliminary report)]. / Transplantatsiia na kosa s Calvitron pri 25 patsienti (predvaritelno s'obshtenie).

Between 20 and 30% of the male and 5% of the female population is affected by baldness. This 'androgenic' alopecia is linked to a genetic and hormonal characteristic. The surgical options for the treatment of the alopecia are numerous, however none of it do not produced single solution that is applicable to all problems. In approximately 90% of the cases treated, the hair graft transplants comes to the forefront of the therapeutic methods. The method is applied in 25 patients and the Calvitron was used for the purpose. The patients were followed for 6 months after the implantation. From 300 to 620 grafts or 600 to 1200 hair follicules were implanted in one section.

[Complications in plastic surgery breast reconstruction with TRAM flap. Preventive methods and treatment modalities]. / Uslozhneniia pri rekonstruktsiia na biusta s TRAM-lambo. Sposobi za tiakhnata profilaktika i nachini za tretiraneto im.

The breast reconstruction with the TRAM-flap is sophisticated and demanding procedure, requiring careful planning and technical proficiency. Despite these efforts, the outcome of the breast reconstruction can be compromised by factors such as vascular insufficiency, scar contraction, errors in planning of the flap, or in the technique of building the new breast. Preventing the problems and complications in breast reconstruction require careful preoperative study, proper patient selection, accurate analysis of the results and immaculate technical performance.

[Cosmetic rhinoplasty: open versus closed access. Results with 70 patients]. / Otvoren ili zatvoren dost'p pri estetichnata rinoplastika? Rezultati ot lechenieto na 70 patsienti.

Because of its central location, the nose is an important element in facial aesthetics. The size and the shape is conditioned by the volume and the strength of the osteocartilaginous framework and the thickness of the soft-tissue cover. Rhinoplasty is a complex procedure requiring understanding of the anatomy and how each element contributes to the shape of the nose. In an attempt to obtain a pleasing aesthetic result and to have a satisfied patient 70 patients were operated. The results of open and closed approaches in rhinoplasty and the indications for the open approach are discussed.

[The comparative characteristics of methods for breast reconstruction after a mastectomy]. / Sravnitelna kharakteristika na metodite za rekonstruktsiia na mlechnata zhleza sled mastektomiia.

Ablation of the breast because of cancer is a damaging operation leading the patients on a heavy psycho trauma. At the background of the main disease--cancer, deformation of the chest wall, caused by mastectomy their depression deteriorates. Therefore the breast reconstruction today is considered as an indivisible part of the complex treatment process. The techniques by means of witch the reconstruction could be achieved are: implantation of breast prosthesis, pedicle or free myocutaneous flaps. We enclose the comparative characteristic of the treatment results of 70 patients using different techniques.

[Planning the TRAM flap in reconstructive breast surgery after mastectomy. Transverse rectus abdominis muscle]. / Planirane na TRAM-lamboto v rekonstruktivnata khirurgiia na gurdata sled mastektomiia.

The guidelines for postmastectomy breast reconstruction are the contralateral healthy breast. We tend to provide symmetrical reconstruction without or with minimal modification of the contralateral breast. The technique we are using for preoperative planning allows immediate de-epithelialization and tailoring of the dermoadipose extensions of the flap at the beginning and not at the end of the operation. This reduced operative time and the need for secondary correction and contralateral mammaplasty.

The double folded pectoralis major musculocutaneous flap for pharyngostome closure. Case report.

A case is reported in which a double-folded pectoralis major musculocutaneous flap was successfully transferred for pharyngostome closure after partial horizontal laryngectomy. The double-folded flap was used for external and internal lining.

Breast reconstruction following mastectomy.

Immediate reconstruction contributing to prompt elimination of the postmastectomy psychological sequelae, and not interfering with the postoperative adjuvant treatment, is recommended in clinical stages T1, 2N1M0 patients. Delayed reconstruction is recommended in the other clinical stages, and in tumors located in the inner quadrants. In case of limited peritumoral tissue excision the reconstruction is effected by simple techniques with expanders and implants. In case of extensive peritumoral tissue removal myocutaneous flaps have to be used. The methods of breast and nipple-areola reconstruction should be considered with a reference to the individual requirements of the patient and the experience of the surgeon.

Rare location of Recklinghausen's disease (case report).

The Recklinghausen disease may affect all systems of human body. This requires a multidisciplinary approach to diagnosis and treatment of the disease. Plastic surgery is mainly concerned with the cutaneous stigmata of the disease. An unusual case of a huge angioneurofibroma involving the vulva and surrounding structures, causing difficulty in the intercourse of a 26 year old woman, is presented. A two-stage operation was performed and a subtotal removal was achieved. The removed portion measured 60 X 42 cm and weighed 1,690 g. The post-operative period was uneventful. The patient is satisfied with the result.

[Reconstruction of large facial and neck defects with skin-muscle flaps]. / Rekonstruktsiia na golemi litsevi i shiini defekti s kozhno-muskulni lamba.

Operative interventions for malignant neoplasms and other large tumors in the facial-maxillary area produce large defects, which require reconstruction for functional and esthetic purposes. Arterialized skin-muscle flaps furnish reliable opportunities for reconstructions, as they are more resistant to the unfavourable conditions after radiation treatment and have functional and esthetic advantages over skin plasty and the plasty with Filatov's stem. Three patients with malignant neoplasms in the facial-maxillary area are reported. Reconstruction was accomplished with skin-muscle flaps m.latissimus dorsi and m.pectoralis major.

[One-step breast reconstruction]. / Ednomomentna mamarna rekonstruktsiia.

The mental trauma induced by removal of the mammary gland for cancer may be overcome by reconstruction of the breast. One-step reconstruction applied on 4 patients showed considerable advantages over a postponed reconstruction: technically it is easier to perform; a single stay of the patient in hospital makes it cheaper. It is no obstacle to perform pre- and postoperative radio- and chemotherapy. According to available data in the literature, implanted prosthesis or transposed flap do not veil a local relapse.

[Short-acting anesthesia in cosmetic surgery of the breasts]. / Kratkotraina anesteziia pri niakoi estetichni operatsii vurkhu mlechnite zhlezi.

Fourteen patients subjected to short-term cosmetic operations on the mammary glands comprise the study group. Anesthesia was performed with ketamine 0.07 mg/kg/min, applied against the background of droperidol 0.1 mg/kg or diazepam 0.2 mg/kg and spontaneous ventilation with nitrous oxide and oxygen in proportion 3:1. At the end of the ketamine anesthesia 1.0 g pyracetam was applied. There was negligible decrease in the systolic arterial pressure and decreased occurrence of psychotic reactions during the early postoperative period.

[The mask lift--an improved concept for correcting the aging face]. / Maskliftut--podobrena kontseptsiia pri korektsiia na zastariavashtoto litse.

The operative interventions for correction of the ageing face have passed through an almost centenary development. Starting from simple skin excision, then through broad skin separation, reshaping of the platysma and cutting bands from the superfascial musculo-aponeurotic layer, one reaches to the present method of subperiosteal facial correction. Mask lift allows to obtain a more radical esthetic effect, creating facilities for remodelling of individual elements of the facial skeleton as well. The technique was applied on three patients with a very good esthetic result.