Breast Reduction with Implants or Augmentation Reduction: Patient-Reported Outcomes from a Single-Centre Retrospective Cohort Analysis.

Background and Objectives: The correction of breast hypertrophy and ptosis with implant placement has always posed a challenge for plastic surgeons. Various methods have been devised, yielding conflicting results. The purpose of this study is to describe our surgical technique of breast reduction with silicone implants, present the safety profile of the procedure, and report patient-reported outcomes. Materials and Methods: A retrospective review was performed on our case series of cosmetic breast surgery performed by the senior author between October 2020 and November 2023. Only patients who had over 300 g of breast tissue removed were included. The surgery and demographic characteristics were recorded. Patients were asked to complete a questionnaire about satisfaction with their breasts pre-operatively and after the surgery. Results: Over 745 cases were performed, and 25 were included in the analysis. In total, 78.3% of the patients presented with a Grade 3 ptosis. The mean implant size was 352.39 cc (range 300-455 cc). The breast tissue removed ranged from 312 to 657 g. The mean follow-up was 14.17 months. Only one case required revision surgery after developing capsular contracture and a waterfall deformity. Patients reported a statistically significant improvement across all domains of the questionnaire (p < 0.001). Conclusions: Breast reduction plus implants is a safe and effective alternative for patients with large ptotic breasts who wish to attain a full upper pole. It carries a similar risk profile to augmentation mastopexy and maintains its functional benefits in alleviating back, neck, and shoulder pain.

A rare case of Bowen's disease of the nipple: Literature review and management pathway.

INTRODUCTION: Bowen's disease or squamous cell carcinoma in situ is a precursor malignant neoplasm restricted to the epidermis. Clinically and histologically, Bowen's disease of the nipple can resemble Paget's disease. It is crucial to differentiate between the two with immunohistological staining in order to provide the appropriate treatment. This review of Bowen's disease of the nipple will examine the diagnostic and treatment modalities previously used. We also present our own case of Bowen's disease of the nipple and propose a clinical pathway for this rare disease process. METHODS: A review of published literature using MEDLINE, PubMed, and Google Scholar revealed seven articles were identified with a total of eight cases of Bowen's disease of the nipple. RESULTS: Treatment modalities varied within the literature. This ranged from photodynamic therapy to simple mastectomy and sentinel lymph node biopsy. Standard surgical margins are inadequate for Bowen's disease of the nipple, as it has been shown to spread along the lactiferous ducts. Our case is of a 57-year-old female with Bowen's disease of her right nipple, confirmed through immunohistological staining. Wide local excision with immediate full-thickness skin graft reconstruction was performed and is now disease-free with a healed graft. CONCLUSION: There is no accepted management pathway for Bowen's disease of the nipple. We propose a treatment algorithm that involves immunohistological staining to diagnose Bowen's disease of the nipple. This would then be followed by a wide local excision, complete nipple excision including underlying lactiferous ducts and glandular tissue and subsequent reconstruction.

Auricular reconstruction.

External ear abnormalities are common. These may affect ear shape, size, prominence and degree of development. They may also be associated with hearing loss. The early identification and management of hearing loss is essential. There are several options for reconstruction of the external ear using both autologous and non-autologous techniques. The aim of this article is to outline the different reconstructive options.

Concomitant Abdominoplasty and Laparoscopic Umbilical Hernia Repair.

BACKGROUND: Umbilical hernia is a common finding in patients undergoing abdominoplasty, especially those who are postpartum with rectus divarication. Concurrent surgical treatment of the umbilical hernia at abdominoplasty presents a "vascular challenge" due to the disruption of dermal blood supply to the umbilicus, leaving the stalk as the sole axis of perfusion. To date, there have been no surgical techniques described to adequately address large umbilical herniae during abdominoplasty. OBJECTIVES: To present an effective and safe technique that can address large umbilical herniae during abdominoplasty. METHODS: A prospective series of 10 consecutive patients, undergoing concurrent abdominoplasty and laparoscopic umbilical hernia repair between 2014 and 2017 were included in the study. All procedures were performed by the same general surgeon and plastic surgeon at the Macquarie University Hospital in North Ryde, NSW, Australia. Data were collected with approval of our ethics committee. RESULTS: At 12-month follow up there were no instances of umbilical necrosis, wound complications, seroma, or recurrent hernia. The mean body mass index was 23.8 kg/m2 (range, 16.1-30.1 kg/m2). Rectus divarication ranged from 35 to 80 mm (mean, 53.5 mm). Umbilical hernia repair took a mean of 25.9 minutes to complete (range, 18-35 minutes). CONCLUSIONS: We present a technique that avoids incision of the rectus fascia minimizes dissection of the umbilical stalk and is able to provide a gold standard hernia repair with mesh. This procedure is particularly suited to postpartum patients with large herniae (>3-4 cm diameter) and wide rectus divarication, where mesh repair with adequate overlap is the recommended treatment.

Cesarean section as a risk factor for the development of adenomyosis uteri.

OBJECTIVE: To estimate whether there is an association between cesarean delivery and the subsequent development ofadenomyosis uteri based on pathologic diagnosis. STUDY DESIGN: A total of 601 patients who had had a hysterectomy at a community hospital were identified. Data were collected from their medical records, focusing on uterine pathology and prior obstetric history. These data formed the basis for a case-control study to disclose an association between cesarean delivery and the subsequent development of adenomyosis uteri. RESULTS: Among 189 women with adenomyosis, cesarean delivery had occurred in 25%. This contrasted with 14% cesarean deliveries among those 178 women without adenomyosis, for an odds ratio of 2.08. These 2 groups were comparable in make-up in regard to demographic variables and medical history. CONCLUSION: There is strong association between adenomyosis and previous cesarean section. This association raises important questions about whether technical aspects of cesarean section may contribute to the consequence of adenomyosis.

Paediatric dog bite injuries: a 10-year retrospective cohort analysis from Sydney Children's Hospital.

BACKGROUND: Dog bite injuries are largely preventable yet present the most common animal related cause of hospitalisation. This study examines the demographics and clinical cost of patients with dog bite related injuries who presented to Sydney Children's Hospital (SCH) from 2010 to 2020. The results from our study will be used to raise awareness regarding the impact of dog bite injuries in our community. METHODS: Data was obtained from the SCH database using ICD-10-AM code W54.0, which captures all patients presenting to SCH with dog bite injuries from 2010 to 2020. A chart review was then performed to retrieve demographic data for analysis. Data analysis was performed using SAS® software version 9.4 and cost for each patient retrieved from the SCH clinical costing department. RESULTS: A total of 628 patients presented to SCH with dog bites during the study period. 273 (43.5%) patients received treatment in ED only with the remaining 355 (56.5%) patients admitted for treatment. The average age was 5.69 years old. There were 321 males (51.1%) and 307 females (48.9%). Facial and other head & neck injuries were most common (64.4%). Pitbull, Labrador and Rottweiler were the most commonly documented offending breeds (25%) with the family dog most likely to offend (49%). The mean clinical cost for per dog bite injury was $2968. CONCLUSION: As part of the largest single centre study exploring dog bite injuries, we expect that this study will stimulate potential public health campaigns targeted at educating parents and children on interacting with dogs to minimise these injuries.

A Simple Bedside Technique for Quantifying Volumetric Defects Prior to Hydroxyapatite Cranioplasty.

Contour irregularities following pediatric craniofacial surgery are common. Hydroxyapatite cranioplasty is a successful technique for optimizing the aesthetic outcome in these patients. We describe a simple technique that can be carried out at the bedside to calculate the volume of hydroxyapatite needed and therefore optimize the preoperative planning for hydroxyapatite cranioplasty.

Towards a high peak capacity of 130 using nanoflow hydrophilic interaction liquid chromatography.

Hydrophilic interaction liquid chromatography, HILIC, is a relatively new HPLC mode. Compared with other HPLC modes, HILIC is a high resolution chromatographic mode with high peak capacity for separations of complex mixtures. Although the separation mechanism is still not completely clear, HILIC has been widely used for analysis of hydrophilic compounds which are difficult for reversed phase chromatography to retain and separate. In this study, we fabricated and investigated nanoHILIC columns in terms of separation efficiency, van Deemter curves and more importantly, we focused on long packed capillary columns, and studied their extreme resolution for protein digests. Using meter long nanoHILIC columns packed with 5 µm particles, we realized a high peak capacity of 130. Based on nanoLC-MS, we compared the resolution and protein identification capabilities of nanoHILIC and nanoRPLC. The results indicate both nanoHILIC and nanoRPLC can provide high resolution for protein sequencing but neither mode is significantly better than the other. Among the 99 digest peptides identified, 17 were uniquely identified by nanoHILIC-MS and 20 were uniquely identified by nanoRPLC-MS and 62 were identified by both methods. Although at this moment in time, nanoRPLC is the most popular microseparation tool in proteomics, the excellent complementarity of nanoHILIC and nanoRPLC suggests their combined use in achieving deep-coverage in MS-based proteomics.