The Problem of Diagnostic Criteria of Breast Implant Illness in Women After Breast Reconstruction: Review and Discussion of a Case.

INTRODUCTION: There has been a rising trend in the use of silicone breast implants for breast reconstructions after breast cancer treatment, as well as in the aesthetic breast procedures. A cluster of non-specific symptoms related to the presence of silicone implant has been called breast implant illness (BII). However, there are no strict criteria of BII which would specifically define this term. The increasing interest in BII among patients and physicians urges verifying own cases of "on-demand" explantations. MATERIAL AND METHODS: In this paper, we discussed a case of a patient with initial BII diagnosis, after breast reconstruction, and reviewed the literature on the BII symptoms and aetiology. A decision for aesthetic revision, not explantation, was made as the diagnosis of BII was questioned, and somatisation due to dissatisfaction with the aesthetic result of breast reconstruction was diagnosed. RESULTS: Improving aesthetics by implant exchange and contralateral mastopexy caused a full recovery from patient's symptoms. CONCLUSION: Based on our case, we point on the fact that BII diagnosis in patients after breast reconstruction is challenging. We suggest that while considering such a diagnosis and further proceedings, e.g. explantation, especially in patients after breast reconstruction, some exclusion criteria should be considered. Dissatisfaction with the result of the surgery can also lead to somatisation and the presence of real clinical symptoms, which should not be confused with the possible autoimmune reaction to silicone particles. 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 .

The perception of lip aesthetics in the context of facial proportions-An eye-tracking-based analysis.

BACKGROUND: Minimally invasive lip volumizing and contouring soft tissue filler procedures are frequently requested by both female and male aesthetic patients. Guidance on how to achieve the most beautiful outcome is inconsistent. OBJECTIVE: To investigate what the most beautiful proportions are in relation to vermillion thickness, the distance of the upper and lower lip in relation to nose and chin, and relation to the bigonial distance. METHODS: This study included a total of n = 101 volunteers (52 females, 49 males, 100% Caucasian) who inspected frontal images of modified facial proportions and answered a related questionnaire showcasing the same images. Image presentation followed a randomized sequence both for the eye tracking and for the survey component of this study but was equal for all observers. RESULTS: The most attractive vertical position of lips was the 1:2 ratio in which the distance between lips and chin is double the length as the distance between lips and nose. For the ratio between the width of the lips and the bigonial distance, it was the 1:2.5 ratio, whereas for the thickness of the upper lip vermilion in relation to the upper lip ergotrid it was the 1:3/1:2 (male/female) ratio and for the lower lip vermilion and lower lip ergotrid it was the 1:4 ratio for both genders. CONCLUSION: The results of this eye tracking and survey-based investigation revealed that instead of one single universal ratio, multiple facial proportions exist that are perceived as most attractive/masculine/feminine. Regarding the perception of facial aesthetics, it appears there is a distinction between attractiveness and masculinity/femininity: the most attractive male/female face is not necessarily the most masculine or feminine.

The role of TGF-ß and antimicrobial peptides in basal cell carcinoma: a systematic review.

Introduction: Basal cell carcinoma (BCC) is the most common skin cancer in humans, occurring in more than 50% of Caucasians during their lifetime, with a frequency rate that is continually increasing. Material and methods: We present a systematic review summarizing the role of transforming growth factor ß (TGF-ß), cathelicidin, and human ß-defensins (HBDs) in the pathogenesis of BCC. The major online databases including PubMed, Scopus, Embase, Web of Science, Cochrane Library, and Google Scholar were searched to extract studies regarding the levels of TGF-ß, HBD, and cathelicidin in BCC. Results: A total of 14 studies met the inclusion criteria and were included in this systematic review. There were 6 studies that included initially established levels of TGF-ß in BCCs. A total of 87 BCCs were analysed, and a common result was that the TGF-ß levels increase in the BCCs compared to the control groups. Analogously, 2 studies contained numerical data on HBD levels but with a different in methodology. The level of cathelicidin was established in 108 BCCs and was significantly higher in the BCC group than in the control group. Conclusions: The presented review shows evidence that proteins like TGF-ß, HBD, and cathelicidin play a role in developing BCC. Protein levels or their expression are elevated in patients with BCC. Furthermore, a critical review of the literature was presented and discussed, highlighting its shortcomings.

Growth rate of basal cell carcinoma: a meta-analysis and systematic review.

Introduction: Basal cell carcinoma (BCC) is the most common skin cancer, especially in fair-skinned adults, and the lifetime risk of its incidence in this population is estimated to be approximately 30%. We present a meta-analysis and systematic review summarizing the size of the growth rate in BCC, depending also on its subtypes. Material and methods: To find all relevant studies, online medical databases such as PubMed, Scopus, Embase, Web of Science, and Google Scholar were searched regarding the growth rate of BCC. Results: A total of 7 studies were included in this review. Five studies contained data on the growth rate of basal cell carcinomas. The mean growth rate for the longer axis of the BCC was established to be 0.71 mm/month (standard error: 0.22). Conclusions: The presented analysis shows that BCC is generally a slow-growing tumour, with a mean growth rate of about 0.7 mm/month. However, it was proven that this growth rate differs depending on the BCC subtype.

External ear carcinoma: evaluation of surgical and reconstructive management with postauricular island flap.

Introduction: Cancers of the auricle and the external auditory canal (EAC) remain a relevant oncological problem. Aim: Presentation of the results after resections of conchal bowl and EAC carcinoma (with or without radical mastoid surgery) and after reconstructions (postauricular island flap - PIF). Material and methods: We analysed results of 37 patients with cancers of the auricular conchal bowl and EAC after tumour resection and reconstruction (2000-2017). Results: The cancers were completely excised in all patients, with no recurrences within at least 5 years after surgery. We noted venous congestion in 22 (59.4%) cases, pinning of the operated ear in 18 (48.6%), prominent earlobe in 14 (37.8%), and EAC constriction in 6 (16.2%) cases treated without radical mastoid surgery. Conclusions: Retroauricular approach in cancer of the auricular concha and EAC allowed for accurate evaluation of the tumour extent and proper surgical access, which facilitated complete removal of the tumour. Use of radical mastoid operation with conchal bowl resection and PIF reconstruction in patients with aquamous cell carcinoma or infiltrating basal cell carcinoma of auricular concha and osseous EAC resulted in cancer extirpation and good aesthetic outcomes, despite minor functional consequences. In these cancers mastoidectomy offered a wider access to determine the radicality of oncological resection.

Immunoexpression of Bmi-1, CK15, Bcl-2 in different types of basal cell carcinomas.

Introduction: Basal cell carcinoma (BCC) occurs in aggressive and non-aggressive forms. The expression of immunohistochemical markers varies in different types of BCC. Aim: Immunohistochemical analysis of selected proteins in BCCs. Material and methods: The immunohistochemical method was used to examine the immunoexpression of Bmi-1, CK15 and Bcl-2 in 56 cases of BCC divided into four groups. Results: Positive Bmi-1 staining 3-4+ level (nodular type) was seen in 91.3% of samples, 4+ (infiltrative) in 92.3%, 4+ (nodular/infiltrative) - 69.2%, 3+ - 30.8%, in BSC 3+ - 42.8%, and 28.6% each for 2+ and 4+. Low grade positivity (0-1+) in CK15 staining was present in 52.1% of nodular BCC, 46.2% - nodular/infiltrative, 92.3% - infiltrative, and 100% - BSC, but levels 2-3+ in nodular BCC in 47.8%, nodular/infiltrative BCC - 53.8%, infiltrative - 7.7%. Bcl-2 positivity (3-4+) was revealed in nodular BCC in 95.6%, (1-2+) in 100% of BSC, infiltrative and infiltrative/nodular BCC, but the lowest (0-1+) in 76.9% of nodular/infiltrative BCC, 71.4% of BSC, and in 38.4% of infiltrative BCC. Conclusions: Positive Bmi-1 staining was the highest in the aggressive infiltrative subtype of BCCs, whereas the lowest in basosquamous cell carcinomas (BSC). Infiltrative BCC was characterized by a lower level of CK15 expression than nodular BCC and nodular/infiltrative BCC. Differentiation of Bcl-2 expression depended on the type of tumour; the highest level was found in nodular BCC, low grade in nodular/infiltrative and infiltrative BCCs, and BSC.

Prenatal oestrogen-testosterone balance as a risk factor of migraine in adults.

BACKGROUND: Migraine is a common neurological disease with extremely debilitating, but fully reversible symptoms. Women suffer from migraine more often than men. It was assumed that fluctuation of oestrogen level during menstrual cycle is one of many factors responsible for more frequent migraine attacks. The second-to-fourth digit ratio (2D:4D) is considered as an indicator of prenatal sex steroids. Balance of prenatal androgens (testosterone) and oestrogen has been studied in numerous diseases that are affected by hormones. However, the relationship between migraine and the sex steroids balance in prenatal development is still unexplained. The aim of this paper is to provide an evidence of relationship between prenatal oestrogen and testosterone exposure following 2D:4D digit ratio, and migraine prevalence in adults. METHODS: We examined a group of 151 adults (33 males, 118 females) with migraine and a control group of 111 adults (45 males, 66 females). 2D:4D digit ratio of both hands was measured using sliding Vernier calliper. RESULTS: Significant differences were found in the right hand. Female migraineurs had lower value of 2D:4D ratio than the control group and the right 2D:4D was lower than left 2D:4D (Δ2D:4D), suggesting prenatal testosterone dominance. The opposite relationship was observed in males. Male migraineurs had higher value of 2D:4D ratio and Δ2D:4D was greater than the control group, suggesting prenatal oestrogen dominance. CONCLUSIONS: Our results suggest that depending on sex, different proportion of prenatal sex steroids might be a risk factor of migraine in adults. Women with migraine were presumably exposed in prenatal life to higher testosterone levels relative to oestrogen, while men with migraine were probably exposed in prenatal life to higher levels of oestrogen relative to testosterone.

Elevated serum levels of cathelicidin and ß-defensin 2 are associated with basal cell carcinoma.

Antimicrobial peptides (AMPs) are one of the primary mechanisms used by the skin in the early stages of immune defense. AMPs have a broad antibacterial activity and also show antifungal and antiviral attributes. Various studies have also shown that levels of antimicrobial peptides change with the development of neoplasia. The aim of this paper is to assess the associations between the presence of basal cell carcinoma (BCC) and the plasma concentrations of cathelicidin and ß-defensins (HBD1-3). We examined 108 patients (56 women, 52 men). The BCC group consisted of 49 patients with mean age 69.8 ±12.3 and the control group consisted of 59 participants with mean age 62.1 ±11.1. A statistical analysis of data was performed. The median serum concentration of cathelicidin was almost 3 times higher and the median concentration of HBD-2 more than 6 times higher in BCC patients than in the control group (p < 0.001). The logistic regression model revealed in univariate analysis that patients who had a detected cathelicidin level above ~1500 pg/ml had 9.9× higher likelihood of having BCC identified in the histopathology in comparison with the control group. In patients who had a HBD-2 level above ~1.2 ng/ml the OR of having BCC identified in the histopathology was 12.6 (p < 0.001). Elevated concentrations of cathelicidin and ß-defensin 2 are associated with the presence of basal cell carcinoma. Additionally, the specificity of cathelicidin and ß-defensin 2 in detecting basal cell carcinoma is high. However, it should be remembered that these factors are not specific only to this condition and further studies are needed.

The superficial temporal artery: A meta-analysis of its prevalence and morphology.

INTRODUCTION: The superficial temporal artery (STA) is a terminal branch of the external carotid artery. It supplies the regions of scalp and face. The morphometrical data concerning STAs are not consistent; therefore, in this systemic review and meta-analysis, we aimed in this to provide an up-to-date data on its anatomic features. MATERIAL AND METHODS: In order to do this, PubMed, Embase, ScienceDirect, and Web of Science were searched. We followed the Preferred Reporting Items and Review and Meta-Analyses guidelines for the meta-analysis. Studies that reported the prevalence and anatomical data regarding STA were included in further analyses. RESULTS: Out of 1,446 studies initially evaluated, 21 were included in the meta-analysis (874 patients/donors). The STA diameter was 1.5 mm (95% confidence interval [CI]: 1.47-1.53 mm). The frontal and parietal branches of the STA were present in 97.6% (95% CIs: 94.6-99.5%) and 96.4% (95% CIs: 93.5-98.5%) of the cases, respectively. The STA bifurcation point was located above the zygomatic arch in 79.1% (95% CI: 68.0-84.3), below the zygomatic arch in 6.7% (95% CI: 2.4-12.1), and on the zygomatic arch in 11.1% of the cases (95% CI: 5.4-17.5). There was no bifurcation of the STA in 3.1% of the cases (95% CI: 0.4-7.3). CONCLUSION: The most comprehensive analysis of STA morphological features is presented. The results from this evidence-based anatomical study will improve understanding of the clinical STA anatomy, which in turn has major implications for understanding the STA in clinical practice.

Neurofibromatosis type 1 - social aspects of functioning and public attitude.

The neurofibromatosis type 1 (NF-1) is the most common phacomatosis. Its clinical picture is variable and the course of the disease is progressive. AIM: The aim of this paper is to present social aspects of living with neurofibromatosis type 1. MATERIALS AND METHODS: We examined 17 patients with NF-1 in the age between 22 to 61 years. In the group there were 11 women and 6 men. A special questionnaire was prepared for the study; it included questions concerning learning problems, difficulties in finding job, problems with getting into relationships and social reaction to NF-1. RESULTS: More than 20% of patients had learning problems and worse marks than other students. Most of respondents did not have problems with making social relationships and difficulties in finding job. However more than 70% of patients thinks that they are different and they were harmed by the nature. Almost 1/3 of respondents do not recognize themselves as good life partner. CONCLUSIONS: Neurofibromatosis type 1 decreases the self-confidence and self-esteem in patients with NF-1. The knowledge of this disease and its character is still poor in social audience. The patients' awareness of disease inheritance is high and their will to have children is small.

Clinical picture and treatment of cutaneous lesions in patients with neurofibromatosis type 1.

INTRODUCTION: The most common type of neurofibromatosis is Recklinghausen disease (NF-1). A major feature of NF1 is the development of localized cutaneous neurofibromas. Such types of lesions are manifested in > 99% of adults with NF1 and are responsible for major negative effects on quality of life. AIM: To present the clinical picture of patients with NF-1 and to report authors' own observations related to their surgical treatment. MATERIAL AND METHODS: A retrospective study aiming to present a group of patients with Recklinghausen disease was planned. The study was carried out in 39 patients with NF-1. RESULTS: All patients had cutaneous neurofibromas localized in different parts of the body. The three most frequent localizations were the abdomen, back, and face. Surgical treatment was performed in 31 patients. All patients had discomfort due to the presence of cutaneous nodules especially because their visibility and multiplicity. CONCLUSIONS: Due to the polymorphism of the clinical picture and unpredictable course of the disease, there is no one standard of treatment of patients with Recklinghausen disease. Excision of tumours in the early stage of their development gives better functional and aesthetic results.

A New Tool for Breast Anthropometric Measurements: Presentation and Validation for Women and Men.

INTRODUCTION: Anthropometric measurements of breasts are crucial for planning surgical procedures; however, there are no practical solutions for their quick, digital performance. The aim of the study was to present and validate a self-designed web application BreastIdea (BI) designed for indirect breast anthropometry. METHODS: Ten male and 10 female volunteers had their chests measured directly according to the routine clinical practice. Then their chests were photographed in non-standardised conditions. Corresponding measurements were performed using BI. Accuracy and both relative and absolute reliability of BI measurements were investigated. RESULTS: Breast assessments using BI yielded highly accurate results and presented near-perfect precision when compared to direct anthropometric measurements of the breast. Indirect anthropometry eliminates the necessity to trace the body's curves, which usually introduces a bias to linear measurements. CONCLUSION: BI web application is a reliable tool for indirect breast measurements in a clinical setting, providing accurate results regardless of chest pathology and photograph standardisation. 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 .

Do skin and hair pigmentation in prepubertal and early pubertal stages correlate with 2D:4D?

OBJECTIVES: In most human populations women are less pigmented than men. However, before puberty, boys tend to have lighter skin than girls. Previous research has shown that skin pigmentation in European women is negatively correlated with digit ratio (2D:4D). Therefore, it has been hypothesized that skin pigmentation in females is partially controlled by prenatal hormones. The aim of this study was to examine the correlation between 2D:4D and pigmentation in girls and boys in the prepubertal or early pubertal stages of ontogenesis. METHODS: The study group consisted of 598 Polish children (275 boys), aged 6.5-10.5 years. All underwent spectrophotometric measurements of skin and hair melanin index (SMI and HMI) and had the second and the fourth finger on both hands measured directly. RESULTS: SMI (in girls) and HMI (in girls and boys) were positively correlated with age but 2D:4D was not. We regressed SMI and HMI on age and used the residuals as a measure of age-independent pigmentation. In girls, positive correlations were found between resSMI and 2D:4D for the right hand, but there was no correlation with left 2D:4D. In boys, resSMI did not correlate with 2D:4D. The resHMI was not related to 2D:4D in girls or boys. CONCLUSION: Skin pigmentation in prepubertal or early pubertal girls is related to 2D:4D such that high 2D:4D is associated with higher pigmentation. This relationship may be mediated by the individual rate of sexual maturation.

Complications After Scalp Suturing Posttraumatic Avulsion.

Scalp avulsion is a rare but severe trauma. Most cases of this injury happened as a result of hair entrapment in a high-speed rotating machine. Treatment of scalp avulsion can be challenging. Nowadays, microsurgical scalp replantation has become the treatment of choice. However, there are situations in which replantation or even usage of scalp as composite grafts is not possible. The aim of this paper is to present 2 cases of scalp avulsion, which needed split-thickness skin graft for covering posttraumatic scalp loss. Closing large scalp defects after its avulsion by skin graft is still a viable option, especially when replantation and even usage of scalp as a composite graft is not achievable. Scalp shaving is mandatory before any surgical procedures.

CAN BODY PROPORTIONS SERVE AS A PREDICTOR OF RISK-TAKING BEHAVIOURS IN WOMEN AND MEN?

The second to fourth digit ratio (2D:4D) is claimed to be a biomarker of prenatal sex steroids. This study compared 2D:4D and waist-hip ratio (WHR) in men and women with nose deformity caused by injuries suggesting risky behaviour with those of unaffected controls. This kind of facial trauma was accepted as an indicator of risk-taking behaviour. The study involved 100 patients (50 women aged 30.74±8.09 years and 50 men aged 30.98±10.86 years) who underwent rhinoplasty due to nose trauma in a hospital in Lódz, Poland, in 2015. For comparison purposes, a control sample of 70 women (aged 23.03±3.36 years) and 70 men (aged 22.87±3.46 years) was recruited. In both groups the following measurements were taken: body height, waist and hip circumferences, II and IV digit lengths and body weight. The results showed that women and men who had suffered nose injury had significantly higher values of WHR than controls. The 2D:4D in women with post-traumatic nose deformity was significantly different than the ratio in control women (p<0.0001) and presented the male pattern. It is concluded that in women risky behaviours seem to be associated with prenatal sex hormone influence, while differences in WHR suggest that this tendency is also related to postnatal hormonal factors. Risky behaviours in men should be linked to postnatal hormonal changes rather than to increased prenatal androgen exposure.

Classification of congenital nasal deformities: a proposal to amend the existing classification.

Congenital nasal anomalies are rare malformations with a broad spectrum of defects. The only existing classification strictly relating to nasal anomalies was presented by Losee et al. (Plast Reconstr Surg 113(2):676-689, 2004). The aim of this paper is to propose some suggestions, based on our current knowledge and experience gained by treating our patients in the clinic, in creating a specification of patients with congenital nasal anomalies. All patients with congenital nose defects treated in our health center were selected for this study. The research was retrospective and included years from 1995 to 2015. Nasal anomaly associated with cleft lip and palate was excluded. Patients were classified into four categories of congenital nasal anomalies, according to Losee et al. CLASSIFICATION: In the period of 20 years, 191 patients with congenital nasal anomalies were treated in our health center. Type 1 defects were found in 124 patients, type 2 in 15, type 3 in 32 and type 4 in 20 patients. The nasal defect accompanying craniofacial syndrome is the most common type of nose malformation. The nose cleft is not always a part of craniofacial clefts; isolated forms of such malformations can occur. Vascular anomalies, due to different etiology, categorization and treatment, should not be recognized as nasal malformation.

Gynecomastia Surgery-Impact on Life Quality: A Prospective Case-Control Study.

OBJECTIVE: To evaluate the results of surgical treatment of gynecomastia in the context of quality of life and satisfaction after the surgery. METHODS: Fifty male patients (mean age, 25.1 years [SD = 8 years]) who underwent surgery for gynecomastia and completed both (preoperative and postoperative) stages of the study were included in the analysis. The quality-of-life evaluation instrument was The Short Form-36 Health Survey Questionnaire. Additionally, we used a short questionnaire including 2 questions about patient satisfaction with gynecomastia surgery. RESULTS: The overall change in life satisfaction after gynecomastia surgery was 1 point on Likert scale (sign test, P < 0.0001). Participants after gynecomastia surgery scored significantly higher than before the procedure in all Short Form-36 Health Survey Questionnaire domains as well as in 2 main scales Psychical and Physical Health. The changes were especially visible for the domain social functioning and a scale Psychical Health (P < 0.0001). CONCLUSIONS: Gynecomastia surgery significantly improved men's life quality in all aspects and especially in the social aspect and psychical health. This indicates that adult men with gynecomastia are a specific group of patients, in which surgery may result in life quality improvement even over the average scores.

Skin color parameters and Fitzpatrick phototypes in estimating the risk of skin cancer: A case-control study in the Polish population.

BACKGROUND: Light skin pigmentation is a known risk factor for skin cancer. OBJECTIVE: Skin color parameters and Fitzpatrick phototypes were evaluated in terms of their usefulness in predicting the risk of skin cancer. METHODS: A case-control study involved 133 individuals with skin cancer (100 with basal cell carcinoma, 21 with squamous cell carcinoma, 12 with melanoma) and 156 healthy individuals. All of them had skin phototype determined and spectrophotometric skin color measurements were done on the inner surfaces of their arms and on the buttock. Using those data, prediction models were built and subjected to 17-fold stratified cross-validation. RESULTS: A model, based on skin phototypes, was characterized by area under the receiver operating characteristic curve = 0.576 and exhibited a lower predictive power than the models, which were mostly based on spectrophotometric variables describing pigmentation levels. The best predictors of skin cancer were R coordinate of RGB color space (area under the receiver operating characteristic curve 0.687) and melanin index (area under the receiver operating characteristic curve 0.683) for skin on the buttock. LIMITATIONS: A small number of patients were studied. Models were not externally validated. CONCLUSIONS: Skin color parameters are more accurate predictors of skin cancer occurrence than skin phototypes. Spectrophotometry is a quick, easy, and affordable method offering relatively good predictive power.