The 5 D's to Dunk the Dog: A Retrospective Clinical Review to Prevent Dog-Ear Contour Abnormalities in Vertical Breast Reductions and Breast Lifts.

Background: In 2020, reduction mammoplasties and mastopexies comprised 34.2% of all breast surgeries performed by plastic surgeons. Various approaches for the skin incision of these procedures have been described. The vertical pattern has become an increasingly popular option due to its lower scar burden. However, it is prone to dog-ear formation along the caudal aspect of the incision. Herein, we describe 5 technical steps to eliminate the dog-ear in patients undergoing vertical mammoplasties. Methods: A retrospective chart review was performed on all patients who underwent vertical breast reduction and mastopexy between the years 2008 and 2020 performed by the senior author. The 5 steps employed in eliminating the dog-ear are delineated and depicted pictorially. Results: A total of 58 patients and 89 breasts were operated upon. A majority of 66.6% were Caucasian, 33.3% were African American, and 1 patient was of Hispanic descent. The mean age was 53.2 years (19-73 years), and average BMI was 31.5 kg/m2 (21.3-42.7 kg/m2). The average resection weights for reduction and mastopexy patients were 479 grams (100-1500 grams) and 58.1 grams (18-100 grams), respectively. Mean follow-up was 10.5 months (1-35 months). Only one patient developed a dog-ear (1.7%) in bilateral breasts (2.2%); however, the patient did not request a revision. Our revision rate over 13 years remained at 0%. Conclusions: Utilizing these 5 technical steps reduces the risk of dog-ear deformity and thereby diminishes the overall need for revisional surgery in patients undergoing short scar vertical mammoplasties.

Breast Reconstruction With Local Flaps: Don't Forget Grandma.

Objective: Lateral breast defects of various causes can be reconstructed with random patterned local flaps utilizing oncoplastic techniques. These local flaps are used frequently in other areas but are infrequent in breast reconstruction despite affording excellent utility in small lateral defects. We sought to demonstrate this with a case series involving 5 patients who underwent oncoplastic breast surgery with random patterned flap reconstruction. Methods: From 2016 to 2017, 3 different varieties of random flaps were used in 5 women requiring lateral breast defect reconstruction secondary to resection of localized cancer or cutaneous lesion. The local flaps included a rhomboid flap, the bilobed flap, and a rotational flap. Patients were then evaluated in the clinic 10 to 12 months postoperatively for complications, symmetry, and satisfaction of reconstruction. Results: In 4 of 5 patients, the local flap remained fully viable and there was no incidence of seroma, infection, or further complications. One patient developed a post-operative hematoma requiring evacuation and a second patient experienced distal flap necrosis and delayed wound healing. Patients reported satisfaction with the reconstruction. Conclusions: Several random patterned local flaps exist for a variety of breast defects. They can yield excellent cosmetic results, high patient satisfaction, and bolster a low rate of complications. Our case series emphasizes the utility of random patterned flaps for lateral breast oncoplastic reconstruction.

Basic suture technique: Instructional videos explaining suturing for medical students in a qualitative study.

BACKGROUND: Understanding basic surgical skills is important for medical students prior to entering residency regardless of future specialty. In these videos we provide instruction for suturing as it relates to skin closure. MATERIAL AND METHODS: Instructional videos were created by the senior faculty (R.A. and M.K.) to teach medical students at the University of Louisville suturing techniques. RESULTS: Entering and exiting the needle at an angle of 90° or greater allows for tissue eversion. Inadequate eversion of tissue or inadequate angling of the needle will lead to tissue inversion. When suturing uneven edges, a deep bite on the low side and a shallow bite on the high side will allow for appropriate tissue leveling. For buried sutures, skin eversion with substantial dermal bites and proper knot location is essential. CONCLUSION: Understanding the basics of skin apposition will provide students with knowledge about primary wound healing and prepare them for residency.

Earplug Umbilicoplasty: A Simple Method to Prevent Umbilical Stenosis in a Tummy Tuck.

Objective: An aesthetically pleasing umbilicus is a vital component of patient satisfaction following an abdominoplasty. An umbilicus that is moderate to small is desired to achieve the best aesthetic result, but a small umbilicus has potential for stenosis. This article presents a method for umbilical stenting that creates a modest umbilicus, while preventing stenosis. Methods: All patients underwent abdominoplasty with an umbilical reconstruction using an inverted U-flap method between 2015 and 2017. An earplug was placed into the umbilicus at 2 weeks postoperatively for a total of 4 to 6 week. Patients were evaluated subjectively on the aesthetic outcome. Results: Twenty-one female patients were evaluated 6 weeks postsurgery. In all cases, both the patient and the surgeon were 100% satisfied with the final size. Umbilical size ranged from 1.8 to 2.2 cm. Conclusions: Use of an earplug for umbilical stenting is a simple and reproducible method to create an aesthetically pleasing umbilicus and avoid stenosis.