The teres major muscle flap in breast reconstruction.

We describe the teres major as a muscle flap. The results of anatomical and radiographic studies demonstrate the surgical anatomy. The details of 4 clinical cases illustrate its application in breast reconstruction. The teres major flap offers advantages over previously described muscle flaps in selected cases of breast and chest contour reconstruction.

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.

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.

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.

Breast reconstruction after mastectomy.

The authors' experience in 100 consecutive cases of breast reconstruction after mastectomy, all done by one standardized method, is presented. An analysis is made of the types of candidates, their eligibility for the procedure, lengths of stay in the hospital, complications, and results. Several representative cases are shown.

The effective duration of the delay phenomenon in the rat.

In standard skin flaps in the rat, the effect of a delay was undetectable for the first 3 weeks and the maximum benefit was not apparent until the sixth week. At all time intervals the delay phenomenon was not as pronounced in the rat as in other species. The delay phenomenon in the rat lasts at least 30 weeks. The rat does not appear to be an ideal model for the study of skin flaps.

One-stage coverage of the large chest wall defect with a giant bepedicled flap. Case reports.

We present a method of closing chest wall defects with a large bepedicled flap from the adjacent chest wall and abdominal tissue.

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.

The superomedial dermal pedicle for nipple transposition.

A new method for nipple transposition employing a superomedial dermal pedicle is described for use in reduction mammaplasty and dermal mastopexy. The advantages include superior mobility, viability, sensation and normal appearing nipples and areolae.

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.