Rate of diffusion of Solu-Medrol across the silastic membranes of breast prostheses-an in vitro study.

Many plastic surgeons have used steroids in breast prostheses in augmentation and postmastectomy reconstruction to prevent capsular contracture. The detection and incidence of complications have increased during the last several years. It is probable that the incidence of complications is related to two factors. First, clinicians have used the same doses in the smaller outer compartments of bilumen implants, giving a much higher concentration of steroid. Second, the more recent implants have thinner envelopes. Tritiated Solu-Medrol was placed in the outer lumen of the bilumen Heyer-Schulte, McGhan, and Surgitek prostheses, and in the only lumen of inflatable Mammatech and Heyer-Schulte prostheses. Diffusion of the Solu-Medrol from each of these identically sized prostheses into the surrounding saline bath was measured with a liquid scintillation counter. Diffusion rates provided concentration-dependent, as predicted by Donnan-Gibbs equilibrium. The silicon gel in bilumen implants was found to represent a second Donnan-Gibbs equilibrium and result in a lower diffusion rate because of affinity for the steroid.

Case report: implantation of breast cancer in a transplanted nipple: a plea for preoperative screening.

A 45-year-old, white woman, following mastectomy for a large inflammatory carcinoma of the left breast with multiple involved nodes, had her nipple body-banked in her left groin. She subsequently developed locally recurrent breast carcinoma in the areola of the transplanted nipple with metastases to the groin nodes, for which she received a radical groin dissection. Clinical and pathologic criteria for screening the nipples to be preserved are reviewed, and a plea is made for employing similarly stringent screens to eliminate future cases such as this.

Screening the nipple for involvement in breast cancer.

On the basis of independent clinical and pathological screens, mastectomy patients can be effectively classified into high-risk and low-risk groups for neoplastic involvement of the nipple-areolar complex. Clinical criteria included gross nipple signs, cutaneous signs, and tumor location, size, and bilaterality. Pathological criteria comprised subareolar involvement multicentricity, and nodal involvement. Fifty consecutive women undergoing mastectomy for cancer at the New York Hospital-Cornell University Medical Center underwent classification into high-risk and low-risk groups on the basis of these criteria. Fifty-four percent of the patients studied passed the screens and were included in the low-risk group. The incidence of nipple involvement in this group was 0. In the remaining 46%, failing either or both of the screens and constituting the high-risk group, the incidence of neoplastic involvement of the nipple was 35%. All involved nipples fell into this group.

An aid to tailoring the alar cartilages in tip rhinoplasty.

An aid to achieving a more precisely symmetric and individualized result in tip rhinoplasty is presented as an aid to both neophytes and experienced surgeons. It is thought to be particularly helpful in teaching variations of tip rhinoplasty and anticipating the results of proper resection.

Transplantation of the cryopreserved nipple-areolar complex.

The full nipple-areolar complex of dogs has been successfully removed, cryopreserved using a controlled-rate freeze protocol, and reimplanted without loss of viability. The technique for reimplantation calls for the use of a new fixed double bolus technique that prevented dislodging or contamination in all but 2 cases. The feasibility of performing this procedure in humans is discussed.

Breast reconstruction after mastectomy: problems in position, size, and shape.

Having learned that healed mastectomy wounds will stretch sufficiently to accommodate an implanted prosthesis, we must pay more attention to the position, and shape of the breast mound created by the prosthesis. We have briefly discussed our methods and the considerations we feel are important in this regard, but, even after extensive experience, we confess that the problems are still with us. Clearly, surgical methods and prostheses must improve.

Silicone elastomer sheeting in the development of pedicle flaps.

A "delay" of a pedicle flap stimulates improvement in the flap circulation, probably through partial ischemia. The degree of stimulation prsent at any given time is inversely proportional to the length of time that has passed after the delay because progressive revascularization across the delay lines reduces the ischemis stimulus. This revascularization can ve prevented by placing silicone elastomers (Silastic) sheeting between the flap and its bed.

Lymphatic drainage of the breast on and through the pectoral muscles: importance in breast cancer.

As proponents of lesser procedures have called into question the necessity of removing the pectoral muscles in surgery for cancer of the breast, there has been a need to establish accurately the relationship of the lymphatics to the pectoral muscles and their fascia. This problem has been approached using the technique of high resolution autoradiography. After histologic review of pectoral muscles from rabbits into whom a tritiated high-molecular-weight dextran was injected subareolarly, a high degree of labeling was found deep within the septa of the pectoral muscle bundles as well as along the investing fascia. It was concluded that lymphatic draining mammary lymph pass deep within the pectoral muscles in this species.