Outcomes of Reduction Mammaplasty in Adolescents vs Average-Age Patients: A 3-Year Single-Center Retrospective Analysis.

Background: The onset of macromastia symptomatology occurs most often at puberty, yet most females undergo breast reduction surgery during the fifth decade of life. Adolescent patients with macromastia may benefit from reduction mammaplasty, yet outcome data are limited to a small number of institutions. Methods: We conducted a retrospective medical records review of all patients who underwent reduction mammaplasty at our institution during the years 2016 to 2019. Patients were divided into 2 cohorts based on age: adolescent (10 to 24 years) and average age (≥44 years). Demographics and outcome measures were collected from follow-up evaluations at 1-week, 1-month, 3-month, 6-month, and 12-month intervals postoperatively. Results: A total of 141 patients met the inclusion criteria for the study. Mean age at surgery was 19 ± 3.2 years in the adolescent group and 53 ± 7.4 years in the average-age group. No significant differences in complications related to wound healing (42.9% vs 50.0%, P=0.418) or total postoperative complications (18.4% vs 19.6%, P=0.863) were found between adolescent and average-age patients, respectively. Conclusion: Complications related to wound healing are common in reduction mammaplasty, although rates of life-threatening complications are rare. In this 3-year review comparing the outcomes of adolescent vs average-age patients who underwent reduction mammaplasty at the same institution, no significant differences in postoperative complication rates were found. Our data suggest that adolescent patients with macromastia should not defer reduction mammaplasty out of concern for higher complication rates because of age alone.

Routine Pathology Examination of Breast Tissue in Adolescent Reduction Mammaplasty: Not Cost Effective in a 7-Year Review.

BACKGROUND: Routine pathology examination of breast tissue in reduction mammaplasty (RM) is performed with aims of detecting incidental malignancy or risk-increasing lesions. In adolescent patients, the reported incidence ranges between 0% to 0.01%, and costs of pathology claims range between $23 and $614 per analysis. We aim to investigate the rate of incidental findings and the cost-effectiveness of routine pathology examination in adolescent RM. METHODS: A single-center retrospective review of the pathology results for 132 breast specimens from 66 consecutive RM patients was performed. Data collected for analysis included breast cancer risk factors, demographic information, and operative variables. RESULTS: Zero cases of incidental malignant or risk-increasing lesions were found among the 132 breast specimens from 66 patients aged between 10 and 24 years. Of the 132 specimens, 34 (26%) contained benign fibrocystic disease, which was significantly associated a body mass index greater than 30 kg/m 2 and tissue resection weight greater than 1000 g per breast ( P = 0.003, P = 0.007) respectively. CONCLUSIONS: Based on the available data, the use of routine specimen analysis costs more than US $150 million for one breast cancer diagnosis during RM in this age group. In our study, zero atypical, precancerous, or cancerous lesions were detected in a 7-year analysis. The results of this study support the current literature, which reports no occurrence of incidental findings in young women and may promote a greater understanding of evidence-based healthcare spending while concomitantly decreasing the strain placed on histopathology services.

Perineal Surgery: A Novel Use for the Keller Funnel.

What are the effects of radiation therapy on local tissue and structures seen in anterior perineal resection requiring vertical rectus abdominis myocutaneous flap coverage?What are the indications and benefits of the Keller Funnel?What are important factors that affect vertical rectus abdominis myocutaneous flap viability in anterior perineal resection?Why was the Keller Funnel indicated compared with other techniques in the setting of a narrow pelvic inlet?

Left Ventricular Assist Device Salvage with Omental Flap.

A large number of people are affected with heart failure annually and require left ventricular assist device placement as a bridge to heart transplant or as destination therapy. When these devices become infected, it is a challenge to eradicate the infection. Failure ultimately results in a significant morbidity and mortality. Source control along with debridement and antibiotics can eradicate the infection of the patient, but many times there is a large defect that needs soft-tissue coverage. Many options for soft-tissue coverage have been suggested, but omentum may be an excellent choice due to its vascularity, bulk, and immunological properties. In this case report, the omental flap is employed for salvage of the left ventricular assist device with excellent results.