The Modified Superomedial Pedicle Breast Reduction Technique for Cases with SN-N Distance Exceeding 33 cm.

BACKGROUND: Symptomatic breast hypertrophy affects the quality of life of a large number of women globally. Many reduction mammoplasty techniques have been described for patients with breast hypertrophy. The aim of this study was to provide our clinic's experience in utilizing the modified superomedial pedicle breast reduction technique in specific patients suffering from breast hypertrophy, with sternal notch-to-nipple distance of more than 33 cm. METHOD: Our study included twenty patients who underwent, from January 2022 to December 2023, the modified superomedial pedicle breast reduction technique due to symptomatic breast hypertrophy with sternal notch-to-nipple distance of more than 33 cm in the Plastic and Reconstructive Surgery Department at Nicosia General Hospital in Cyprus. Patient demographics, comorbidities, pre- and postoperative breast anthropometric measurements and surgical complications were recorded and analyzed. RESULTS: The average age at the time of the reduction was 48 years. The mean preoperative body mass index was 28.52 kg/m2. Patients' comorbidities included one (5%) patient with diabetes, seven (35%) with obesity and three (15%) with hypertension. The mean preoperative sternal notch-to-nipple distance was 35.25 cm for the right breast and 34.90 cm for the left breast, while the mean postoperative was 20.65 cm for both breasts. The total mean resection weight of both breasts was 1643.45 g. Surgical complications were minor including two (10%) cases of local hematoma and one (5%) case of T-Junction wound breakdown. All patients were relieved from their preoperative symptoms and were satisfied with the final result. CONCLUSION: Our modified superomedial pedicle technique is a safe, effective and versatile pedicle to be used with many advantages, in specific patients suffering from breast hypertrophy with sternal notch-to-nipple distance of more than 33 cm, including its shape and rotational abilities, viability of the nipple and excellent outcome of glandular plication and breast reshaping. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Carney complex: a case report of bilateral breast myxoid fibroadenomas.

Carney complex is a rare autosomal dominant familiar multiple neoplasia syndrome combined with cardiocutaneous manifestations. Our report describes a Carney complex case with bilateral myxoid fibroadenomas that led to a bilateral mastectomy. An 18-year-old female patient presented at our clinic with complaints of multiple palpable lumps in her breasts bilaterally. On physical examination the patient had also multiple pigmented lentiginous lesions on her face, body and her sclerae, blue nevi on her trunk and upper extremities and a round moon-shaped face. The diagnosis of Carney syndrome was decided upon imaging, biopsies and genetic analysis. The patient underwent a bilateral mastectomy as a prophylactic treatment plan with tissue expanders' placement. Breast myxomatosis due to Carney complex is a common characteristic in female patients. Prophylactic mastectomy must be considered as a therapeutic intervention in these cases since it provides a definite treatment, with minimal side effects and excellent outcomes.

The Normativity of Law: Has the Dispositional Model Solved our Problem?

In Legal Directives and Practical Reasons, Noam Gur has presented a novel account, called the dispositional model, to explain how law bears on our normative practical reasons. Gur holds that his model is superior to the current models, namely the standard weighing model and Joseph Raz's exclusionary model. Although his work provides useful insights into the practical impact of law, I argue that: (i) his challenge against the exclusionary model is valid only insofar as one accepts Raz's normal justification thesis and dependence thesis; (ii) his argument against the weighing model misses its target, because it attacks the model as a decision-making method, not as an account of practical reason; and (iii) his dispositional model solely constitutes a decision-making strategy and does not offer a third alternative answer to the question of how law affects our normative practical reasons. Hence, the dispositional model is not a competitor to the weighing and the exclusionary model, and the problem of accounting for the normativity of law remains.

Nonsurgical Correction of Stahl's Ear in Neonates: A Case Study.

Stahl's ear deformity is a congenital auricular anomaly characterized by a third crus in the auricular cartilage, giving rise to an irregular helical rim and a bent scaphoid fossa. This deformity is mainly treated surgically during childhood. However, studies regarding ear-molding techniques show that postpartum splinting offers a safer and more effective permanent correction, and that happens because of the high circulating levels of estrogen that neonates receive from their mothers right after birth, making the cartilage more malleable. We present a case that shows a newborn with unilateral Stahl's ear deformity, in which we used a molding device (EarBuddies) to permanently correct the ear's shape. After 3 weeks of treatment, the affected auricle regained its normal appearance. There were no complications. Long-term follow-up showed no recurrence. Splinting of this ear deformity seems to be a nonpainful, stress-free and, most importantly, effective nonoperative treatment. Postpartum clinical examination of the ears is crucial, as the sooner the nonsurgical correction of the deformity begins, the better the results are. A clinical screening for ear deformities should be established immediately after every child's birth to eliminate the risk for surgical intervention later in childhood.

A Modified Dissection of the Superomedial Pedicle.

Background: The superomedial pedicle is a widely used technique in mammaplasty, with various modifications formed over the years. This technique is often used in patients requiring major reduction in size, and optimization of the steps involved in the technique during the operation is of utmost importance to the plastic surgeon. Methods: We included 27 female patients who underwent mammaplasty between January 2018 and December 2020, with the modified superomedial pedicle technique. The technique of dissection is described in detail, by changing some of the steps of the pedicle dissection. We then assessed for patient satisfaction, complication rate, and operative duration, compared with a control group of 27 patients who underwent superomedial pedicle mammaplasty without the modification. Result: The use of this technique resulted in major reduction in operative time, with a similar complication rate and a high satisfaction rate among the patients. Conclusion: By changing some of the steps in the dissection of the superomedial pedicle, the surgeon can achieve optimal results and safety, with major gain in operative time reduction and surgical flexibility.

Survival of umbilicus on a superiorly based flap after fleur-de-lis abdominoplasty: A case report.

INTRODUCTION: Massive weight loss patients have a midline excess of abdominal adipose and skin tissue that contributes to an increased abdominal girth. This excess of tissue in these patients is not resolved with traditional techniques of abdominoplasty and usually the fleur-de-lis abdominoplasty technique is employed. PATIENT CONCERNS: A 22-year-old male patient came to our clinic after a massive weight loss of 170 kg, requesting an abdominoplasty for the excess adipose and skin tissue. DIAGNOSIS: Massive weight loss patient, with excess of adipose and skin tissue in the midline abdominal area. INTERVENTIONS: Fleur-de-lis abdominoplasty technique was employed for treatment of massive weight loss. OUTCOMES: During the surgery, it was decided that the umbilicus blood supply via the inferior epigastric artery and median umbilical ligament needed to be ligated, to remove more tissue for better aesthetic result. The umbilicus survived on the collateral blood supply from ligamentum teres and superior epigastric collaterals. CONCLUSION/LESSONS: In this case report we review our experience treating a massive weight loss patient using a fleur-de-lis abdominoplasty technique without preserving the umbilicus blood supply via the inferior epigastric artery and median umbilical ligament. We eventually relied on the collateral blood supply from ligamentum teres and superior epigastric collaterals, something that proved advantageous both in the survival of the umbilicus on the long run despite cutting off the main blood supply, and, the removal of further excess adipocutaneous tissue for a better aesthetic outcome.

Treatment of giant siliconomas of the breasts after injection of silicone.

Breast enhancement by injectable materials is known to be used for decades. Possible complications can lead to complex management issues for treating physicians. This case demonstrates the challenges in managing giant siliconomas of the breasts, especially concerning breast reconstruction, in the quest for an aesthetically pleasing outcome with minimum risks.

CDKN2A and MC1R variants found in Cypriot patients diagnosed with cutaneous melanoma.

The prevalence of genetic variants associated to cutaneous melanoma (CM) has never been determined within Cypriot melanomas. This study evaluates the frequency of variants in cyclin-dependent kinase inhibitor 2A (CDKN2A) and melanocortin-1 receptor (MC1R) in 32 patients diagnosed with CM. Other characteristics and risk factors were also assessed. CDKN2A p.Ala148Thr was detected in three of 32 patients, while the control group revealed no variations within CDKN2A. MC1R screening in 32 patients revealed the following variations: p.Val60Leu in 11 patients, p.Arg142His in four patients, p.Thr314Thr in one patient, p.Arg160Trp in one patient, p.Val92Met/p.Thr314Thr in one patient and p.Val92Met/p.Arg142His/p.Thr314Thr in one patient. The control group revealed only p.Val60Leu (in 10 of 45 individuals), which is frequently found in general populations. Two unrelated patients carried CDKN2A p.Ala148Thr in combination with MC1R p.Arg142His, suggesting digenic inheritance that may provide evidence of different gene variants acting synergistically to contribute for CM development. This study confirms the presence of CDKN2A and MC1R variants among Cypriot melanomas and supports existing evidence of a role for these variants in susceptibility to melanoma.

Obsessive-Compulsive Symptomatology, Religiosity Levels and the Illusion-of-Control Paradigm in a Non-Clinical Undergraduate Sample.

The present research employed the illusion-of-control paradigm to investigate the relationships between Obsessive-Compulsive disorder (OCD) symptoms, religiosity levels, and illusory sense of control (SC). An opportunistic sample of 60 undergraduate students was presented with a pre-programmed series of neutral visual stimuli (i.e. lines) and was expected to try to control the sequence through the use of keyboard presses. Participants assessed their perceived level of control twice throughout the computerised task. In addition, the study was interested at examining the relationship between religiosity and OC behaviour and the Santa Clara Strength of Religious Faith Questionnaire (SCSRF) was employed. In proportion to predictions, OCD symptoms were correlated with higher illusory SC; furthermore, religiosity levels were related to some degree to OCD symptoms. The essential role of mental control in OCD is discussed, particularly the significant clinical implications of such an association. Furthermore, the possible contribution of religious affiliations to the maintenance of OC behaviour is further discussed.