The Double Donut: A Safe and Simple Option for Immediate Nipple Areolar Complex Reconstruction in Skin-Sparing Mastectomy Patients With Contraindications to Nipple-Sparing Mastectomy.

Background: Restoration of the nipple areolar complex (NAC) has been shown to improve quality of life (QoL) in post-mastectomy patients. Despite expansion of nipplesparing mastectomy inclusion criteria, many patients remain ineligible and are relegated to bilateral skin-sparing mastectomy. In this study, we evaluated immediate NAC reconstruction with the double donut areolar graft and split nipple composite graft reconstruction (DDSNS). Methods: A single-center prospective study was performed for patients undergoing immediate post-mastectomy reconstruction with the DDSNS technique. Demographics and post-reconstruction endpoints were collected, focusing on aesthetic and functional outcomes. Results: A total of 31 patients and 62 breasts underwent immediate reconstruction with the DDSNS technique. Four of 62 (6.4%) nipple composite grafts and 1 of 62 (1.6%) areolar grafts experienced partial graft loss. All incidents of initial loss healed to a satisfactory result. All patients were able to proceed with adjuvant therapy, if indicated, without delay. Conclusions: The DDSNS technique can be successfully applied to achieve cosmetically satisfactory results in the post-mastectomy patient. This technique has shown reliable outcomes with respect to graft success and patient satisfaction with their NAC reconstruction.

Electrode Effect on Ferroelectricity in Free-Standing Membranes of PbZr0.2Ti0.8O3.

We report the effects of screening capacity, surface roughness, and interfacial epitaxy of the bottom electrodes on the polarization switching, domain wall (DW) roughness, and ferroelectric Curie temperature (TC) of PbZr0.2Ti0.8O3 (PZT)-based free-standing membranes. Singe crystalline 10-50 nm (001) PZT and PZT/La0.67Sr0.33MnO3 (LSMO) membranes are prepared on Au, correlated oxide LSMO, and two-dimensional (2D) semiconductor MoS2 base layers. Switching the polarization of PZT yields nonvolatile current modulation in the MoS2 channel at room temperature, with an on/off ratio of up to 2 × 105 and no apparent decay for more than 3 days. Piezoresponse force microscopy studies show that the coercive field Ec for the PZT membranes varies from 0.75 to 3.0 MV cm-1 on different base layers and exhibits strong polarization asymmetry. The PZT/LSMO membranes exhibit significantly smaller Ec, with the samples transferred on LSMO showing symmetric Ec of about -0.26/+0.28 MV cm-1, smaller than that of epitaxial PZT films. The DW roughness exponent ζ points to 2D random bond disorder dominated DW roughening (ζ = 0.31) at room temperature. Upon thermal quench at progressively higher temperatures, ζ values for PZT membranes on Au and LSMO approach the theoretical value for 1D random bond disorder (ζ = 2/3), while samples on MoS2 exhibits thermal roughening (ζ = 1/2). The PZT membranes on Au, LSMO, and MoS2 show TC of about 763 ± 12, 725 ± 25, and 588 ± 12 °C, respectively, well exceeding the bulk value. Our study reveals the complex interplay between the electrostatic and mechanical boundary conditions in determining ferroelectricity in free-standing PZT membranes, providing important material parameters for the functional design of PZT-based flexible nanoelectronics.

Breast Implants Save Lives: Gunshot Wound to a Silicone Gel Implant.

What is the incidence of gunshot injuries involving breast implants?What are the considerations for managing a patient with a gunshot wound to a breast implant?Can a breast implant alter the trajectory of a bullet to the chest?What are the considerations for reconstructing a breast after a gunshot wound?

Red Breast Syndrome: Complete Resolution Following Replacement of Acellular Dermal Matrices With Acellular Collagen Matrices.

What is red breast syndrome (RBS)?What causes RBS?How often do patients present with RBS?What are effective treatments for RBS?

Restoring Breast Volume in High BMI Patients: A Single-Center Review of Breast Reconstruction Using Hyperinflated Saline Implants.

Background: Breast reconstruction in the obese patient is often fraught with poor patient satisfaction due to inadequate volume restoration. The off-label hyperinflation of saline implants is a direct yet controversial solution to this problem, with limited studies in the literature. This study sought to determine the safety and efficacy of this technique for breast reconstruction. Methods: A retrospective chart review was performed to identify all patients with a body mass index (BMI) greater than or equal to 30 kg/m2 who underwent breast reconstruction between the years 2013 to 2020 with saline implants filled beyond the manufacturer's maximum recommended volume. Results: The 21 patients identified had an average age of 49 years. The mean BMI was 39.5 kg/m2. A total of 42 implants were placed; 34 were 800 mL, 4 were 750 mL, and 4 were 700 mL. The average overfill volume was 302 mL (138%). Mean follow-up was 65.0 months. Of these, 1 (4.8%) patient with a history of chest wall radiotherapy underwent reoperation for unilateral implant exposure 27 days after the index procedure, no patient sustained spontaneous leak or rupture, and 1 patient had unilateral deflation following emergent central line and pacemaker placement 2 years after the implant was placed for an unrelated cardiovascular event. Conclusions: Hyperinflation of saline implants beyond the maximum recommended volume may be considered for volume replacement in obese patients undergoing implant-based breast reconstruction. This practice is well tolerated, has a complication rate comparable to using implants filled to the recommended volume, and has the potential to restore lost breast volume in the obese patient post mastectomy.

Complete Penile Amputation: An Anatomical Reference and Surgical Pearls to Ensure a Successful Replantation.

How common are penile amputations, and how are they treated?What key anatomic structures are involved?What are some technical pearls for a successful replantation?What are common complications, and how can they be prevented/treated?

Prevention of Implant Malposition in Latissimus Dorsi Myocutaneous Flap Breast Reconstruction Using an Acellular Dermal Matrix With Pectoralis Muscle Following Mastectomy for Breast Cancer: A Clinical Review.

Background: Latissimus dorsi myocutaneous (LDM) pedicled flaps are a well-established method for breast reconstruction in women with inadequate soft tissue coverage following mastectomy for breast cancer. The robust nature of the latissimus blood supply can accommodate immediate implant placement to increase breast volume; however, a known risk factor with this technique is implant malposition. By utilizing an acellular dermal matrix (ADM) in subpectoral implant-based LDM reconstruction, it is hypothesized that patients will experience a lower incidence of implant malposition. This 13-year retrospective review aims to evaluate the effectiveness of breast reconstruction using this technique. Methods: A retrospective review was conducted to identify all patients who underwent breast reconstruction following mastectomy with a LDM flap, subpectoral implant, and an ADM from 2007 to 2020 by a single surgeon at a single institution. Demographic and clinical data were collected and analyzed. Results: A total of 40 patients (LDM flaps, N = 51) were identified. Mean participant age was 50.25 ± 9.67 years and mean body mass index (BMI) was 30.85 ± 6.15 kg/m2. Comorbidities included hypertension (40.0%), diabetes mellitus (17.5%), and current smoking (25.0%). Mean follow-up was 31.52 ± 29.51 months. The most common complication was seroma formation (9.8%). No patients experienced implant malposition or flap necrosis. Conclusions: The use of a LDM flap and an ADM in implant-based breast reconstruction are each well described in the literature. This 13-year series supports the efficacy of these techniques utilized in combination to provide an aesthetic result while mitigating implant malposition during breast reconstruction of oncologic patients.