The Passot Technique Revisited: No Vertical Scar Reduction Mammoplasty in Unmarried Females: A Case Series.

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.

Draft genome of Ompok bimaculatus (Pabda fish).

OBJECTIVE: Pabda (Ompok bimaculatus) is a freshwater catfish, largely available in Asian countries, especially in Bangladesh, India, Pakistan and Nepal. This fish is highly valued for its fabulous taste and high nutritional value and is very popular as a rich source of proteins, omega-3 and omega-6 fatty acids, vitamins and mineral for growing children, pregnant females and elders. We performed de-novo sequencing of Ompok bimaculatus using a hybrid approach and present here a draft assembly for this species for the first time. DATA DESCRIPTION: The genome of Ompok bimaculatus (Fig. 1: Table 1, Data file 3) from Ganges river, has been sequenced by hybrid approach using Illumina short reads and PacBio long reads followed by structural annotations. The draft genome assembly was found to be 718 Mb with N50 size of 81 kb. MAKER gene annotation tool predicted 21,371 genes.

Climato-environmental influence on breeding phenology of native catfishes in River Ganga and modeling species response to climatic variability for their conservation.

The main objectives of the present study were to quantify the environmental, especially temperature and rainfall, effects on breeding phenology of selected catfish species and to predict changes in breeding phenology of the selected species in relation to climatic variability for the Ganga River Basin. The study showed that changes in rainfall pattern may have the most profound effect on gonad maturation and breeding of Mystus tengara and Mystus cavasius followed by the effect of increased water temperature due to rising air temperature. Indication of region-specific adaptation was noticed in reproductive phenology of Eutropiichthys vacha based on local trends of warming climate. The other habitat parameters, such as dissolved oxygen, alkalinity, nitrate, and phosphate, were correlated with gonad maturity and spawning. Climatic variability may bring region-specific changes in breeding phenology of fish species in the Ganga River. Under a warming climate, changes in precipitation pattern manifested into riverine flow pulse may be the key driver in dictating breeding phenology. Our study indicates E. vacha as a climate sensitive species that may be selected as a target species for climate change impact studies.

Benchmarking pre-spawning fitness, climate preferendum of some catfishes from river Ganga and its proposed utility in climate research.

The concept of threshold condition factor (Fulton), beyond which more than 50% of the female fish population may attain readiness for spawning coined as pre-spawning fitness (K spawn50), has been proposed in the present article and has been estimated by applying the non-parametric Kaplan-Meier method for fitting survival function. A binary coding strategy of gonadal maturity stages was used to classify whether a female fish is "ready to spawn" or not. The proposed K spawn50 has been generated for female Mystus tengara (1.13-1.21 units), M. cavasius (0.846-0.945 units), and Eutropiichthys vacha (0.716-0.799 units). Information on the range of egg parameters (fecundity, egg weight, egg diameter) expected at the pre-spawning stage was also generated. Additional information on species-specific thermal and precipitation window (climate preferendum) within which K spawn50 is attained was also generated through the LOESS smoothing technique. Water temperatures between 31 and 36 °C (M. tengara), 30 and 32 °C (M. cavasius), and 29.5 and 31 °C (E. vacha) and monthly rainfall between 200 and 325 mm (M. tengara), > 250 mm (M. cavasius), and around 50 mm and between 350 and 850 mm (E. vacha) were found to be optimum for attainment of K spawn50. The importance of parameterization and benchmarking of K spawn50 in addition to other conventional reproductive biology parameters has been discussed in the present article. The purposes of the present study were fulfilled by generating baseline information and similar information may be generated for other species replicating the innovative methodology used in this study.

Gigantomastia due to retromammary lipoma: An aesthetic management.

INTRODUCTION: A "giant" lipoma is defined as a tumor having dimensions greater than 10 cm. Giant lipomas are rare and giant breast lipomas are exceptionally uncommon. Only six cases have been described in world literature till date. Herein we describe a case of giant breast lipoma and discuss its surgical management. CASE REPORT: A 43-year-old lady presented with left sided unilateral gigantomastia. Clinical examination, radiology and histopathology diagnosed lipoma. Excision of the tumor was planned, together with correction of the breast deformity by reduction mammoplasty using McKissok technique. A tumor measuring 19 cm × 16 cm × 10 cm and weighing 1647 grams was removed. The nipple areola complex was set by infolding of the vertical pedicles and the lateral and medial flaps were approximated to create the final breast contour. The patient is doing well on follow up. DISCUSSION: Giant lipomas are rare and of them, giant breast lipomas are extremely uncommon. They can grow to immense proportions and cause significant aesthetic and functional problems. The treatment is excision. But reconstruction of the breast is almost always necessary to achieve a symmetric breast in terms of volume, shape, projection and nipple areola complex symmetry compared to the normal opposite breast. Few authors have used various mammoplasty techniques for reconstruction of the breast after giant lipoma excision. Our case has the following unique features: (i) It is the third largest breast lipoma described in the literature till date, weighing 1647 grams; (ii) The Mckissock technique has been used for parenchymal reshaping which has not been previously described for giant breast lipoma. CONCLUSION: This case demonstrates that reduction mammoplasty after giant lipoma removal is highly rewarding, resulting in a smaller-sized breast that is aesthetically more pleasing, has better symmetry with the contralateral breast, and provides relief from functional mass deficit.

Giant Angioleiomyoma of Knee Presenting as Painless Ulcer: The First Case Report.

Angioleiomyomas are benign tumors originating in the vascular smooth muscle. The tumor typically presents as painful, solitary, small (<2 cm), slow growing, subcutaneous nodule. Angioleiomyoma of the knee is rare, and only few cases have been reported so far. We have described herein a giant angioleiomyoma of the knee presenting as a painless ulcer in a 22-year-old man. There was no intra-articular extension of the tumor, and total excision was curative. This is the first case report of giant angioleiomyoma of the knee as well as the first case report of angioleiomyoma presenting as a painless ulcerative lesion.

Skin sparing mastectomy with preservation of nipple areola complex and immediate breast reconstruction in patients with breast cancer: a single centre prospective study.

Background. Skin and nipple areola sparing mastectomy (NASM) has recently gained popularity as the management of breast cancer. This study aims to evaluate the aesthetic outcome, patient satisfaction, and oncological safety of NASM. Methods. The study prospectively analyzes the results of NASM and immediate breast reconstruction in 34 women with breast cancer. The criteria for inclusion were core biopsy-proven, peripherally located breast cancer of any tumor size and with any "N" status, with documented negative intraoperative frozen section biopsy of retroareolar tissue, and distance from the nipple to tumor margin >2 cm on mammography. Results. The median age of the patients was 45 years. The majority had either stage II or stage III breast cancer. The median mammographic distance of tumor from nipple areola complex (NAC) was 3.8 cm. The overall operative morbidity was minimal. The NAC could be preserved in all the patients. There was no local recurrence of tumor at median follow-up of 28.5 months. The aesthetic outcomes were satisfactory. Conclusion. NASM and immediate breast reconstruction can be successfully achieved with minimal morbidity and very low risk of local recurrence in appropriately selected breast cancer patients, with acceptable aesthetic results and good patient satisfaction.

Paraspinal transposition flap for reconstruction of sacral soft tissue defects: a series of 53 cases from a single institute.

STUDY DESIGN: Case series. PURPOSE: To describe paraspinal transposition flap for coverage of sacral soft tissue defects. OVERVIEW OF LITERATURE: Soft tissue defects in the sacral region pose a major challenge to the reconstructive surgeon. Goals of sacral wound reconstruction are to provide a durable skin and soft tissue cover adequate for even large sacral defects; minimize recurrence; and minimize donor site morbidity. Various musculocutaneous and fasciocutanous flaps have been described in the literature. METHODS: The flap was applied in 53 patients with sacral soft tissue defects of diverse etiology. Defects ranged in size from small (6 cm×5 cm) to extensive (21 cm×10 cm). The median age of the patients was 58 years (range, 16-78 years). RESULTS: There was no flap necrosis. Primary closure of donor sites was possible in all the cases. The median follow up of the patients was 33 months (range, 4-84 months). The aesthetic outcomes were acceptable. There has been no recurrence of pressure sores. CONCLUSIONS: The authors conclude that paraspinal transposition flap is suitable for reconstruction of large sacral soft tissue defects with minimum morbidity and excellent long term results.

Posterior arm flap in management of axillary contracture.

INTRODUCTION: Management of post burn contracture can be difficult, particularly for the axilla. Any handicap related to upper limb has a detrimental physical, psycohological, and economical effect. PATIENTS AND METHODS: We have released 20 axillae in 16 patients. These patients had axillary contracture for long duration and 5 had been operated previously by release and skin graft. We used posterior arm fasciocutaneous flaps for coverage of the defect after release of contracture. RESULTS AND CONCLUSION: All the patients had a good post op release. Their range of movement is excellent. No post op splintage was utilised in any of the cases with no incidence of recontracture.

A new technique for one-stage total lower lip reconstruction: Achieving the perfect balance.

BACKGROUND: Reconstruction of extensive lower lip defects is difficult. The authors describe a new technique of one-stage total lower lip reconstruction, with the ultimate goal being achievement of the delicate balance between adequate mouth opening and competent mouth closure, with satisfactory aesthetic outcome. METHODS: The authors applied their new reconstructive technique in a patient with extensive lower lip defect following excision of squamous cell carcinoma. Bilateral inferiorly based nasolabial flaps were used for reconstruction of lower lip. For vermillion reconstruction, a bucket-handle mucomuscular flap from upper lip was designed primarily using the pars marginalis portion of orbicularis oris. Compared with previously described techniques, this procedure is unique with respect to the alignment of the nasolabial flaps in relation to one another. Furthermore, this technique of vermillion reconstruction is a one-stage procedure with minimal morbidity, enables preservation of the vascular pedicle and innervation and maintains the orientation of orbicularis oris, thus providing a competent oral sphincter. To the authors' knowledge, this mucomuscular upper lip flap has not been described earlier and has definite advantages over the commonly used methods of vermillion reconstruction. RESULTS: The functional and aesthetic outcomes are satisfactory on follow-up, with normal lip movements and sensation, adequate mouth opening and oral competence, good colour and texture match with adjacent tissues, and excellent volume and quality of the vermillion. No subsequent corrective surgery is required. CONCLUSIONS: This technique is simple and achieves the main goals of total lower lip reconstruction in a single stage with minimal morbidity.

HISTORIQUE: La reconstruction d'importantes anomalies de la lèvre inférieure pose tout un défi. Les auteurs décrivent une nouvelle technique de reconstruction totale de la lève inférieure en une étape, dont l'objectif ultime consiste à obtenir l'équilibre délicat entre une ouverture convenable et une occlusion compétente de la bouche, tout en parvenant à un résultat satisfaisant sur le plan esthétique. MÉTHODOLOGIE: Les auteurs ont mis en application leur nouvelle technique de reconstruction chez un patient ayant une importante anomalie de la lèvre inférieure après l'excision d'un carcinome spinocellulaire. Les chirurgiens ont utilisé des lambeaux prélevés sur la partie nasolabiale inférieure bilatérale pour reconstruire la lèvre inférieure. Pour reconstruire le vermillon, les chirurgiens ont préparé un lambeau mucomusculaire en anse de seauextrait surtout de la partie marginale de l'orbiculaire des lèvres. Par rapport aux techniques déjà décrites, cette intervention est unique pour ce qui est de l'alignement des lambeaux nasolabiaux. De plus, cette technique de reconstruction du vermillon se fait en une étape, s'associe à une morbidité minimale, permet de préserver le pédicule vasculaire et l'innervation et préserve l'orientation de l'orbiculaire des lèvres, ce qui assure la compétence du sphincter oral. En autant que le sachent les auteurs, ce lambeau mucomusculaire de la lèvre supérieure n'a jamais été décrit auparavant et comporte des avantages évidents par rapport aux méthodes de reconstruction du vermillon communément utilisées. RÉSULTATS: Les résultats fonctionnels et esthétiques sont satisfaisants au suivi. Les mouvements et les sensations de la lèvre sont normaux, l'ouverture et la compétence de la bouche sont convenables, la couleur et la texture s'agencent bien avec les tissus adjacents et le vermillon est d'une excellente qualité et d'un volume parfait. Il n'est pas nécessaire de procéder à d'autres chirurgies correctives. CONCLUSIONS: La présente technique, très simple, permet de procéder à une reconstruction totale de la lèvre inférieure en une seule étape, tout en s'associant à une morbidité minime.

Revisiting Gavello's procedure for single-stage reconstruction of the earlobe: The vascular basis, technique and clinical uses.

BACKGROUND: Deformities or loss of the earlobe may be congenital, or acquired due to trauma, bites, burns or tumour excision. A variety of single-stage and two-stage procedures have been described for earlobe reconstruction, of which Gavello's procedure was one of the earliest. OBJECTIVE: To revisit Gavello's procedure with reference to the vascular supply of the flap, and discuss the relevance of the technique in current practice. METHODS: The authors discuss the vascular basis of Gavello's flap, and describe the clinical application of the single-stage Gavello's procedure in diverse clinical situations, including congenital absence of earlobe, post-burn earlobe deformity and traumatic amputation of the earlobe. RESULTS: Excellent cosmetic results have been achieved in all different clinical situations in the authors' experience, with preservation of earlobe shape and volume, good colour match and a well-concealed scar in the donor area. DISCUSSION: Gavello's procedure is a simple, one-stage procedure that relies entirely on local tissue for earlobe reconstruction; the flap has a predictable vascular supply, skin grafting is not required and the procedure can be used for large defects. An intact donor area over the postauricular mastoid region is a prerequisite. CONCLUSION: The simple, century-old Gavello's procedure is still of great value for reconstruction of earlobe defects of diverse etiology.

HISTORIQUE: Les anomalies ou la perte du lobe de l'oreille peuvent être d'origine congénitale ou être acquises en raison d'un traumatisme, de morsures, de brûlures ou d'excision d'une tumeur. Diverses interventions en une ou deux étapes ont été décrites pour reconstruire le lobe de l'oreille. L'intervention de Gavello est l'une des plus anciennes. OBJECTIF: Examiner l'intervention de Gavello compte tenu de la capacité vasculaire du lambeau et exposer la pertinence de cette technique dans la pratique actuelle. MÉTHODOLOGIE: Les auteurs abordent la base vasculaire du lambeau de Gavello et décrivent l'application clinique de l'intervention de Gavello en une étape dans diverses situations, y compris l'absence congénitale de lobe d'oreille, une malformation du lobe de l'oreille après une brûlure et une amputation traumatique du lobe de l'oreille. RÉSULTATS: Les auteurs ont remarqué d'excellents résultats esthétiques dans toutes sortes de situations cliniques, qui permettent de préserver la forme et le volume du lobe de l'oreille ainsi que d'obtenir une bonne correspondance de la couleur et une cicatrice bien cachée au foyer du donneur. EXPOSÉ: L'intervention de Gavello est une intervention simple en une étape qui fait entièrement appel à des tissus locaux pour reconstruire le lobe de l'oreille. Le lambeau a une capacité vasculaire prévisible, la greffe de peau est inutile et l'intervention peut être utilisée pour des anomalies importantes. La région de la mastoïde postauriculaire du donneur doit être intacte. CONCLUSION: L'intervention de Gavello, qui est simple et existe depuis un siècle, est toujours très précieuse pour la reconstruction d'anomalies du lobe de l'oreille d'étiologies variées.

A rare case of Reifenstein's syndrome in two siblings.

The conditions like gynaecomastia and hypospadius are not uncommon. Approximately 40% of normal men have palpable breast tissue. Hypospadius affects in excess of 1 in 300 boys. But the two conditions together occur very rarely and that too in the siblings. Two brothers in the same family of 16 and 14 years of ages reported with the complaints of bilateral gynaecomastia and hypospadius. USG of breasts of both the brothers revealed well developed duct system. LH, FSH, testosterone, oestradiol levels were within normal limits. Hypospadius was corrected by staged procedure. Gynaecomastia was treated by subcutaneous mastectomy. During 3-year follow-up they reported that their social life was restored, which was disturbed earlier.

Rapidly growing extraocular sebaceous carcinoma occurring during pregnancy: a case report.

Sebaceous carcinoma is a very rare, aggressive, malignant tumor derived from the adnexal epithelium of sebaceous glands. It is traditionally classified into two groups: tumors arising from the ocular adnexa and those arising in extra-ocular sites. Despite the widespread anatomic distribution of sebaceous glands, extraocular sebaceous carcinoma is very rare, comprising only (1/4) of all reported cases of sebaceous carcinoma. Extraocular sebaceous carcinoma in the post-auricular region or in the external auditory canal is very rarely described in the literature. A case of a rapidly growing sebaceous carcinoma of the pinna occurring in a pregnant woman is reported here for its rarity.

Preservation of nipple-areola complex in breast cancer--a clinicopathological assessment.

BACKGROUND: Skin-sparing mastectomy (SSM) with immediate breast reconstruction (IBR), which traditionally includes the nipple-areola complex (NAC), is the modern way of improving the cosmetic and aesthetic outcome of advanced breast cancer surgery. However, with nipple and areola lacking, it fails to simulate the original breast. This study is directed at exploring the possibility of NAC preservation in selected mastectomy patients. METHODS: A retrospective analysis of the breast specimens of 219 consecutive mastectomy patients was performed after categorising the tumour characteristics on the basis of their TNM staging. The relationship of malignant involvement of the NAC with positive regional lymph nodes (pN), tumour size (T), site, stage and skin involvement by the breast tumour was noted and analysed. Chi-square analysis was performed for different characteristics vis-à-vis NAC involvement. Two-sided lists, wherever possible, had been performed at the 5% level of significance and P values were evaluated. RESULTS: The total frequency of malignant involvement of NAC was 44 (20%) out of 219. The frequency of NAC involvement in stage I and II tumours was found to be 9.38% compared to stage III tumours where it was 30%. The NAC was involved in 4 (2.5%) of 160 patients with peripheral tumours compared with 40 (68%) of 59 patients with tumours located centrally. Only 2 (1.5%) of 130 peripheral tumours bigger than 5 cm had malignant NAC involvement while the number in their central counterparts was much bigger (59%). Not a single breast cancer patient with skin involvement in the peripheral quadrants had any nipple-areola involvement. CONCLUSIONS: NAC can be preserved in patients having stage I, II and III diseases with peripheral tumours less than 5 cm in size, irrespective of the nodal status and skin involvement.