How to redefine the inframammary fold: the "slingshot" capsular flap.

BACKGROUND: Caudal dislocation of the inframammary fold (IMF) affects cosmetic appearance of the breast. Up until now, few methods have been proposed. The authors introduced a new capsular flap to improve long-lasting results. MATERIALS AND METHODS: Thirty consecutive patients affected by lower dislocation of the IMF have been retrospectively evaluated. Patients have been classified for age, degree of capsular contracture, and IMF dislocation (measured in centimeters). All dislocations have been corrected using a capsular flap cranially advanced on the chest wall in a "slingshot" fashion and anchored to the periosteum of the IV to V rib. RESULTS: No major complications have been registered. In 2 cases, recurrence of IMF dislocation occurred within 15 months. In 3 cases, hypodefinition of the fold in the long-term was recorded. CONCLUSIONS: The slingshot capsular flap seems a valid option to redefine the IMF, improving aesthetic appearance and stability of the result.

Panniculectomy Combined with Bariatric Surgery by Laparotomy: An Analysis of 325 Cases.

Surgical treatment of obese patients is much debated in the literature because of the significant intraoperative risks related to comorbidities presented by this type of patients. Recent literature suggests that panniculectomy should follow bariatric surgery after the patient's weight loss has been stabilized. However, when performed by laparotomy, bariatric surgery can be combined with panniculectomy. This paper presents the analysis of 325 cases of patients undergoing abdominal panniculectomy combined with bariatric surgery. The study highlights the risks, complications, and benefits of the combined procedure and describes a standardized technique for excision of a large abdominal panniculus in a short operating time.

Microbiological evaluation of tissue expanders in patients who had first stage breast reconstruction.

Capsular contracture is one of the most common complications associated to the use of foreign materials in reconstruction after mastectomy and aesthetic breast augmentation. Many risk factors, causes, and conditions seldom associated with capsular contracture have been identified but none of these have been confirmed by published data. Among these, subclinical infections (particularly those caused by Staphylococcus epidermidis) seem to be one of the most likely. In the present study we analysed the correlation between capsular contracture and the incidence of periprosthetic subclinical infection in two groups of patients who had first-stage breast reconstruction: one group of patients who were not having adjuvant or neoadjuvant radiotherapy for breast cancer (n = 25) and a second group of patients who had had quadrantectomy and radiotherapy (QUART) and successive radical mastectomy for recurrent disease (n = 25). Patients who had radiotherapy had a significantly higher incidence of subclinical infection (n = 13) than patients who did not (n = 1), but there was no statistical correlation between subclinical infection and capsular contracture. Subclinical infections seemed to present at a later stage and under certain local and systemic circumstances that favoured bacterial growth, such as radiotherapy.

Three cases of embolia cutis medicamentosa (Nicolau's syndrome).

Embolia cutis medicamentosa, also known as Nicolau's syndrome, is a rare complication due to i.m. injections. Its real incidence is actually underestimated. Many drugs have been associated with it, but at the time only a few studies showed a related pathogenetic mechanism. Symptoms consist of immediate local pain, edema and cutaneous, subcutaneous and even muscular necrosis occurring in the first 48 h. The type of treatment depends mostly on time of diagnosis. A medical resolution can be achieved through heparin and cortisone injections within the first 48 h. Surgical debridement has to be considered as the main treatment in case of late diagnosis. We present three cases of Nicolau's syndrome presenting to us in a short period of time that we treated with surgical debridement.

Periprosthetic breast abscess caused by Streptococcus pyogenes after scarlet fever.

We present a case of a 32-year-old white women, affected by breast cancer and treated with mastectomy, who underwent immediate breast reconstruction with a tissue expander. She presented a periprosthetic infection from Streptococcus pyogenes (group A streptococcus, GAS) after scarlet fever. S. pyogenes may be responsible for suppurative complications of the respiratory system and a variety of metastatic foci of infection such as suppurative arthritic, endocarditis, meningitis, or brain abscess. Even though, in the literature, several cases and types of infection associated with breast implantation have been described, to our knowledge this is the first case report of periprosthetic infection after scarlet fever. Signs, symptoms, diagnosis, and treatment of GAS infection that occurred 2 months after the surgery are discussed.

Digital photography in plastic surgery: how to achieve reasonable standardization outside a photographic studio.

Accurate photographic documentation has become essential in reconstructive and cosmetic plastic surgery both for clinical and scientific purposes. Digital imaging systems currently are popular, being reasonably affordable and much improved in quality. They offer multiple advantages in terms of quality, easy image storage and retrieval. Nevertheless, obtaining standardized, consistent, and relevant digital images is not easy outside a photographic studio. The purpose of this report is to define guidelines for accurate image capture in different anatomic areas, following elementary general criteria based on practical issues beyond the purely theoretical, to obtain reasonable standardization, consistency, and reproducibility.