Breast reduction for symptomatic macromastia: can objective predictors for operative success be identified?

The purpose of this paper is to assess symptomatic macromastia, the relief of symptoms by operation, and predictors of symptom relief. The methods used have been retrospective chart review and a self-assessment patient questionnaire. One-hundred and thirty-three patients underwent an average 1660-gm reduction. Ninety-three percent reported a postoperative decrease in symptoms such as shoulder grooves and shoulder, neck, and back pain. Correlation between breast size and sign or symptom severity achieved significance only for the preoperative submammary rash (r = 0.33, p < 0.001). Patients lost an average of 8.9 lb postoperatively and were less overweight (49 versus 40 percent). Activity level increased postoperatively in 63 percent. Postoperative chest size correlated inversely with activity level (r = 0.35, p < 0.001). Thirty-nine percent of patients who took pain medications preoperatively were able to eliminate these postoperatively. The quantity of tissue removed did not correlate with outcome. A model predictive of symptom relief could not be developed (total R2 = 0.03). Reduction mammaplasty promoted relief of signs and symptoms of macromastia, but a predictive model of successful operation could not be developed.

Liposuction. What it will and won't do.

Liposuction is used most often to contour the body. Usually, it is done on an outpatient basis under general or regional anesthesia. Results are better in patients who have good skin turgor and are at or near their ideal weight. The recovery period is short and relatively pain-free. While there have been serious complications in a few cases, the procedure is safe when done by experienced physicians who are careful in selecting patients and cautious about the magnitude of the procedure they perform. Patient satisfaction is high, particularly when patients are selected carefully and are well-informed concerning the expected outcome.

Innervated cross-leg tensor fascia lata fasciocutaneous flap for foot reconstruction.

A traumatic, extended first ray amputation in a child was treated with an innervated cross-leg tensor fascia lata fasciocutaneous flap. The flap provided thin composite tissue coverage, immobilization in a position of relative comfort, and sensory innervation to the weight-bearing surface. Consideration of this flap is recommended when dealing with large defects of the foot.

Sexual identity and prophylactic mastectomy.

The psychological adjustment of women following prophylactic mastectomy with reconstruction has not been evaluated. This study reviews this problem in 9 women chosen at random from the practice of two surgeons. The sexual identity of the women and its effect upon the outcome of their surgery was of particular interest. The surgeon's perception of problems of adjustment and the difference in the patient's and surgeon's evaluation of operative results were considered. The study included interviews with a psychiatrist, a questionnaire for the surgeon, and a subjective evaluation of operative results by both patient and surgeon. A high degree of psychopathology, particularly depression, was encountered. Most women had a relatively weak sexual identity preoperatively. In most instances the surgeon was not alerted to the patient's troubled feelings. Though psychopathology was evident, it does not seem to indicate that the patient will have difficulty accepting the results of surgery. We suggest that women who deny their sexuality might adjust to this surgery more easily. Psychiatric consultation appears to aid patient management.

Excision of massive hemangioneurofibroma of the face.

Nevus flammeus (cutaneous hemangioma, port-wine stain) may develop proliferative hamartomatous changes and go on to form monstrous deforming tumors. Excision is feasible, and it may be best to do it early. The mentally retarded, institutionalized patient can also benefit from the reconstruction. In 3 cases it was possible to preserve function of the muscles of facial expression, because of the superficial location of the tumor. Techniques to decrease blood loss are of variable value during the operative procedure.

Finger tip amputations. Review of procedures and applications.

Repair of finger tip amputations depends upon the slope of transsection and how much of the tip has been amputated. Type 1 and 2 injuries are easily handled in the emergency room by local flaps with results acceptable by functional and economic criteria. Type 3 amputations with losses of less than 25 percent can be repaired by primary closure. Losses of 50 percent or over are best treated by local or "distant" flaps from the involved or adjacent fingers or palm. Each style of flap and technique has advantages and disadvantages.