Reducción mamaria sin cicatriz vertical. Experiencia clínica y aportes personales / Breast reduction without vertical scar. Clinical experience and personal contributions

Introducción y objetivo: La técnica de reducción mamaria sin cicatrices verticales o técnica de Passot ha recibido una atención cada vez mayor durante la última década y, en ocasiones, se la denomina como nuevo método.Presentamos una revisión de 152 mamas operadas con dicha técnica sin cicatriz vertical y con modificaciones adicionales personales para facilitar la disección y dar mejor forma final a las mamas.Material y método: Descripción de las modificaciones a la técnica y revisión retrospectiva de historias clínicas de pacientes entre junio 2015 y junio 2021, tabulando datos de edad, índice de masa corporal, distancia entre el manubrio esternal y pezón, y peso del tejido mamario resecado. Registramos también valoración de satisfacción de las pacientes a 3 meses de postoperatorio mediante encuesta por correo electrónico.Resultados: La edad de las pacientes intervenidas fue de 36 años promedio, con índice de masa corporal promedio de 32.9 kg/m2. La distancia promedio manubrio esternal a pezón fue de 36 cm. La cantidad resecada de una sola mama promedió fue de 552 gr. Realizamos fijación a la pared torácica y conificación de los pilares mamarios lateral y medial.Las respuestas de las pacientes sobre alivio de los síntomas preoperatorios y conformidad con el resultado obtenido fue del 95%.Conclusiones: Presentamos nuestra experiencia y aportaciones para una técnica de reducción mamaria de pedículo inferior de base ancha, particularmente adecuada para reducción o mastopexia en ptosis de moderada a severa, eliminando la cicatriz vertical con el beneficio adicional que esto supone en pacientes con tendencia a la cicatrización hipertrófica. (AU)

Background and objective: No vertical scar technique of breast reduction or Passot technique has received increasing attention over the past decade and is sometimes referred to as a new method.We present a review of 152 breasts operated with this technique (no vertical scar) and with additional personal modifications to facilitate dissection and give the breasts a better final shape.Methods: We describe our modifications to the original technique and conduct a retrospective review of all patients’ medical records from June 2015 to June 2021. Data including age, body mass index, sternal notch to nipple distance and weight of breast tissue resected were tabulated. We also recorded satisfaction assessment of the patients 3 months postoperatively through an email survey. Results: The age of the operated patients was an average of 36 years, with an average body mass index of 32.9 kg/m2. The average sternal notch to nipple distance was 36 cm. The average amount resected from a single breast was 552 gr. We perform fixation to the chest wall and coning of the lateral and medial mammary pillars. Patients´ responses regarding relief of preoperative symptoms and compliance with the results obtained was 95%. Conclusions: We present our experience and contributions for an inferior-wide pedicle breast reduction technique, particularly suitable for reduction or mastopexy in moderate to severe ptosis, eliminating the vertical scar with the additional benefit that this entails in patients with a tendency to hypertrophic scarring. (AU)

2-AG limits Theiler's virus induced acute neuroinflammation by modulating microglia and promoting MDSCs.

The innate immune response is mediated by primary immune modulators such as cytokines and chemokines that together with immune cells and resident glia orchestrate CNS immunity and inflammation. Growing evidence supports that the endocannabinoid 2-arachidonoylglycerol (2-AG) exerts protective actions in CNS injury models. Here, we used the acute phase of Theiler's virus induced demyelination disease (TMEV-IDD) as a model of acute neuroinflammation to investigate whether 2-AG modifies the brain innate immune responses to TMEV and CNS leukocyte trafficking. 2-AG or the inhibition of its hydrolysis diminished the reactivity and number of microglia at the TMEV injection site reducing their morphological complexity and modulating them towards an anti-inflammatory state via CB2 receptors. Indeed, 2-AG dampened the infiltration of immune cells into the CNS and inhibited their egress from the spleen, resulting in long-term beneficial effects at the chronic phase of the disease. Intriguingly, it is not a generalized action over leukocytes since 2-AG increased the presence and suppressive potency of myeloid derived suppressor cells (MDSCs) in the brain resulting in higher apoptotic CD4+ T cells at the injection site. Together, these data suggest a robust modulatory effect in the peripheral and central immunity by 2-AG and highlight the interest of modulating endogenous cannabinoids to regulate CNS inflammatory conditions.