Clinical experiences with the use of ULTRAPRO® mesh in single-stage direct-to-implant immediate postmastectomy breast reconstruction in 102 patients: A retrospective cohort study.

BACKGROUND: Acellular dermal matrices have been used for direct-to-implant (DTI) breast reconstruction (BR), eliminating the load of the lower pole skin envelope. However, the available allograft matrices add considerable health care costs. This study examined the long-term follow-up of synthetic ULTRAPRO® mesh as a low-cost potential alternative to biological matrices. PATIENTS AND METHODS: A retrospective cohort study was performed between January 2013 and January 2016, involved 112 early-stage breast cancer and/or BRCA 1/2 patients, and evaluated 189 immediate DTI BRs following skin-, areola- or nipple-sparing mastectomy using ULTRAPRO® mesh. Patient characteristics and postoperative complications were recorded, and quality of life was rated by the patients using the EORTC-QLQ-C30-BR23 questionnaire. Aesthetic outcomes and palpability of the implants were evaluated by four breast surgeons on a 5-point Likert scale. All recorded parameters were statistically analysed. RESULTS: Ten patients were lost-to-follow-up, resulting in 102 patients and 174 breast surgery cases analysed. The mean age was 43 years, with 23.4 months of follow-up on average. Forty-six patients (45.1%) had previous radiotherapy with pre-existing scars. In total, 32 complications (18.3%) were recorded, including 12 minor (6.9%) and 20 major (11.4%) complications requiring revision. All median quality of life scores were above 83 points, representing a high score, with an average 4-point rating for the aesthetic outcome and natural consistency of the breast. CONCLUSION: Partially absorbable ULTRAPRO® mesh could be used successfully in DTI BR, offering a safe, less expensive alternative to biological matrices. Adequate indications and patient selection are necessary.

Bilateral juvenile fibroadenosis of the breast: management with subcutaneous mastectomy and silicone implant placement.

Bilateral fibroadenosis is a rare, benign disorder, affecting adolescents or women of childbearing age. Choosing the most optimal therapy that manages both the physical and psychological aspects of the disease is a challenge. The goals of the treatment are complete resection of the lesions with optimal cosmesis. Options range from cryoablation, ultrasound-guided vacuum-assisted eradication and simple excision of the lesions to subcutaneous mastectomy with reconstruction. We present a case of a 25-year-old woman with 37 complex fibroadenomas affecting both breasts who was treated with nipple-sparing subcutaneous mastectomy and silicone implant reconstruction to both the surgeons' and patient's satisfaction.

Mammaplasty with a periareolar dermal cloak for glandular support.

Analyzing the main surgical element of mammaplasty, almost all procedures incorporate a smaller or bigger dermal flap. The periareolar dermal cloak is a dermis flap corresponding to the skin pattern and pedicled to the nipple areola. The shape of the flap can be tailored as required but 2 cm of the dermis flap around the nipple should not be touched. The periareolar dermal flap has been used as a cloak; this dermal cloak is suitable for positioning the nipple and covering a part of the glandular tissues with support. With fastening of the cloak, a better tone of the breast tissues can be achieved. Mastopexy, reduction mammaplasty presented by technical detail of dermal cloak positioning and glandular support, has been done in 178 breast operations since 1992. The dermal cloak technique was used in 114 cases. The technique, clinical results, advantages, disadvantages, and complications are discussed.

Combination of the vertical and periareolar mammaplasty.

Vertical mammaplasty has been perfected and popularized by Madeline Lejour; this technique is one of the most versatile methods of mammaplasty today. The vertical scar from the nipple areola to the submammary line is often much longer and distorted than the conventional mammaplastys. The length of the vertical scar can be reduced by 2-3 cm by combining the skin pattern of the periareolar and vertical mammaplasty. The aesthetic result can be improved by shortening the vertical scar.

[Plastic surgery in the context of surgery for breast cancer. Breast reconstruction using the patient's own tissue]. / Az emlödaganatok mütéteinek plasztikai sebészeti vonatkozásai. Emlö-helyreállító mütétek saját szövetek felhasználásával.

The breast reconstructions after mastectomies are overviewed. The criteria of a successful operation are discussed. The result of breast reconstruction with latissimus dorsi and rectus abdominis musculocutaneous flaps are presented. The spectrum of 106 breast reconstructions of from 1987 to 1993 is published. The methods of adequate reconstructions mall, middle size and large breasts are discussed. With the reconstruction of large breasts the best results have been achieved by the transfer of rectus abdominis musculocutaneous flap with micro vascular anastomoses. This flap has the best blood supply and this procedure causes the less damage to the donor area. It is stated that the breast reconstructions with living tissues are superior and preferable.

A neurovascular island flap from the first web space of the foot to repair a defect over the heel: case report.

A case of chronic recurrent trophic ulceration over the heel is presented in which a neurovascular island flap from the first web space was used successfully to repair the calcaneal defect.

Experimental microvascular sleeve anastomoses.

Microvascular sutures are the most essential parrt of microsurgery. The three basic types of anastomosis, i.e. end to end (ETE), end to side (ETS) and end in end (EIE), differ, beside the flow parameters, also in the succession, number and depth of the sutures as well as in the technique of suturing. In clinical microsurgery ETE and ETS anastomoses are applied. Several authors have attempted to telescope the vascular ends into each other to simplify the technique of anastomosis, to reduce the time of operation as well as to eliminate intraluminar suturing [1, 3, 6, 9].

Repair of trochanteric trophic ulcer with bilateral iliofemoral pedicle flaps.

Details of the advantages of treating trochanteric trophic ulcers with iliofemoral axial pattern flaps are presented.