A different strategy in the surgical treatment of capsular contracture: leave capsule intact.

The authors present their experience with the surgical treatment of capsular contracture to achieve better results in a safe, predictable, and practical way, and discuss the possible treatment modalities. They simply advise leaving the capsule intact, even if it is calcified, and create another pocket, rarely in the front or, more typically, at the back of the capsule. If the breast tissue is also ptotic, a mastopexy procedure may be added to the procedure, in addition to augmentation, with a rather small prosthesis placed in the new pocket or, occasionally, in the old one. External, forceable massage is not advisable to treat the capsule. Open capsulotomy and/or partial capsulectomy can be applied to release the capsule. However, it is not advisable since recurrence is usually inevitable. The purpose of this paper is to present a series of surgical procedures to avoid the problems created by the capsule and present different cases with good results.

Unsatisfactory results of periareolar mastopexy with or without augmentation and reduction mammoplasty: enlarged areola with flattened nipple.

A method of repair is described for correction of abnormally enlarged nipple-areola complex following both periareolar mastopexy and pregnancy. Although during periolar mastopexy or reduction mammoplasty regular subcuticular dermal sutures may control the enlargement of nipple-areola complexes initially, the periareolar scar becomes hypertrophic and areolar spreading occurs to some extent. Periareolar mastopexy techniques are indeed advisable only for minimal hypertrophies or ptosis of the breast, especially for areolar asymmetry, if an acceptable, normal-size areola is expected. The authors believe that in periolar mastopexy or reduction mammoplasty cases resulting in enlarged nipple-areola complexes, the size of the areola can also be corrected by reduction mammoplasty or mastopexy using vertical bipedicle techniques. Although surgery results in an inverted T incision, the shape of the breast is more acceptable and the size of the areola does not enlarge with time.

Silicon in temporomandibular joint ankylosis surgery.

Temporomandibular joint ankylosis frequently occurs succeeding untreated or not adequately treated mandible fractures. Treatment of this condition with combined condylectomy and silicon sheet/block application was investigated in the literature. Thirty-eight patients with temporomandibular joint ankylosis were included in this study, and postoperative results were presented. Mean preoperative and postoperative sixth-month interincisor opening values were 5.8 and 28.8 mm, respectively. In two patients (5.2%), another operation to remove silicon material was needed because of infection and exposure of the silicon. One patient (2.6%) was operated on again for limited mouth opening. It was concluded that interpositional arthroplasty with silicon was proved to be a low-cost, easy approach with satisfactory long-term results.

Septo-orbitoperiostoplasty for the treatment of palpebral bags: a 10-year experience.

The orbital region is sensitive to the undesirable effects of any surgical intervention, because of its anatomical location and the importance of the eyelids in facial sign language. The procedures performed for correction of baggy eyelids may have remarkable undesired results. In recent years, we have made a special effort to analyze the causes, to minimize these undesirable effects, and to be able to offer patients more natural and safer results. We have designed a new technique called septo-orbitoperiostoplasty for the treatment of baggy eyelids, based on preservation of orbital fat and correction of the supportive layer. This technique consists of placing the orbital fat back into the orbital cavity and its retention by suturing the lax septum to the periosteum of the orbital rim. Neither an incision on the orbital septum nor an excision of the orbital fat is performed. It can be performed for both upper and lower eyelids. This paper describes the surgical procedure and shows the results obtained from 74 patients who had been treated with this technique over a 10-year period. All patients were followed up for an average of 5 years.