RESUMEN
BACKGROUND: Macromastia in adolescent girls is a distressing condition. There is an increase in the number of patients opting for reduction mammoplasty in the late teens. The semicircular horizontal method of breast reduction, first described by Passot in 1925 has the advantage of being able to do larger reduction, particularly suitable for pendulous breasts and having a hidden scar in the inframammary fold. METHODS: Eleven patients of adolescent macromastia were included in this study. It was conducted over a period of 4 years (2013-17) at two teaching institutions in Kolkata and Rishikesh, India. The mean age of the patients was 19.2 years. The Passot technique of reduction mammoplasty was performed in each case and the volume of resected breast tissue recorded by weighing the specimen. The aesthetic outcome was assessed by Lowery scale (volume, contour, placement of the breast mound and inframammary fold). Patient satisfaction was assessed after 6 months of follow up on a scale of 1 to 10, where 1-4 was poor, 5-6 fair, 7-8 good and 9-10 excellent. RESULTS: Mean total reduction per breast was 856 gm. Patients reported a mean decrease of cup size by 1.5. The aesthetic outcome was excellent in 6 patients and good in 5 patients. Patient satisfaction was excellent in 9 patients and good in 2 patients. CONCLUSION: Passot technique is a safe and effective technique of reduction mammoplasty and is especially useful in adolescent macromastia where the absence of visible scar on the breasts is very satisfying for the patients.
RESUMEN
BACKGROUND: Reports of injuries caused by bear attacks are scarce in the Himalayan region of India, such as Uttarakhand, which is surrounded by hills and thick forests. We retrospectively studied 18 patients attacked by Himalayan black and sloth bears to understand the pattern of the attacks and their management. MATERIALS AND METHODS: Patients attacked by bears between January 2018 to December 2019 were retrospectively studied. RESULTS: Most of the patients were of low socioeconomic status. The incidence was highest between June and December. The attacks mostly caused soft tissue injuries. There were also fractures of facial bones noted in some cases, but there was no mortality. The best outcomes were found in those cases that were managed with generous tissue preservation, rather than aggressive debridement. We could also follow the bear attack pattern. Himalayan black bears and sloth bears were found to be involved in the attacks. CONCLUSION: Injuries due to bear attacks mainly affect the face and neck. Although there were no cases of mortality in this study, facial disfigurement had a long-lasting impact on survivors. Tissue preservation and early reconstruction had the best outcomes.
