Inferolateral Pectoralis Sling Technique for Augmentation Mastopexy.

BACKGROUND: Augmentation mastopexy remains a challenging procedure. The goal is to achieve correction of breast ptosis whilst adding implant volume, and avoid complications of premature waterfall deformity, bottoming out and further revision surgery, particularly when using smooth implants. We aim to describe and evaluate a technique to reduce implant malposition in augmentation mastopexy. METHODS: This is a technical description and retrospective review of a single surgeons' cases from 2019 to 2022 of all patients who underwent 1 stage subpectoral breast augmentation mastopexy with the inferolateral pectoralis sling. RESULTS: Over the four year period, 284 patients (568 breasts) underwent augmentation mastopexy with the inferior pectoralis sling. Mean implant size was 360.7cc (range 180-625cc). There were no early complications and 6 (2.1%) patients had late minor complications, with five (1.8%) undergoing revision mastopexy with implant repositioning and 1 (0.4%) undergoing areola scar revision. 20 patients (7%) underwent an implant upsize procedure with the average volume increase being 218.5cc and the average time to upsize 13.6 months (range 6-36 months) CONCLUSIONS: Use of the inferolateral pectoralis muscle sling allows successful one stage augmentation mastopexy with low complication and revision rates. 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 .

Paediatric dog bite injuries: a 10-year retrospective cohort analysis from Sydney Children's Hospital.

BACKGROUND: Dog bite injuries are largely preventable yet present the most common animal related cause of hospitalisation. This study examines the demographics and clinical cost of patients with dog bite related injuries who presented to Sydney Children's Hospital (SCH) from 2010 to 2020. The results from our study will be used to raise awareness regarding the impact of dog bite injuries in our community. METHODS: Data was obtained from the SCH database using ICD-10-AM code W54.0, which captures all patients presenting to SCH with dog bite injuries from 2010 to 2020. A chart review was then performed to retrieve demographic data for analysis. Data analysis was performed using SAS® software version 9.4 and cost for each patient retrieved from the SCH clinical costing department. RESULTS: A total of 628 patients presented to SCH with dog bites during the study period. 273 (43.5%) patients received treatment in ED only with the remaining 355 (56.5%) patients admitted for treatment. The average age was 5.69 years old. There were 321 males (51.1%) and 307 females (48.9%). Facial and other head & neck injuries were most common (64.4%). Pitbull, Labrador and Rottweiler were the most commonly documented offending breeds (25%) with the family dog most likely to offend (49%). The mean clinical cost for per dog bite injury was $2968. CONCLUSION: As part of the largest single centre study exploring dog bite injuries, we expect that this study will stimulate potential public health campaigns targeted at educating parents and children on interacting with dogs to minimise these injuries.

The effect of operative time on complication profile and length of hospital stay in autologous and implant-based breast reconstruction patients: An analysis of the 2007-2012 ACS-NSQIP database.

BACKGROUND: It is a generally accepted relationship that an increase in operative time results in an increase in postoperative morbidity. However, few studies have investigated the minute by minute effect of increased operation time on outcomes in reconstructive breast surgery. The authors examined the association between operation time and postoperative outcomes for autologous and implant-based breast reconstructions. METHODS: Data used in these analyses were extracted from all plastic surgery procedures identified in the 2007-2012 ACS-NSQIP datasets. Logistic regression models were used to examine associations between operation time and adverse outcomes. Generalized linear models using a Poisson distribution and a logarithmic link function were used to examine the association between the two continuous variables of operating time and the length of hospital admission. RESULTS: The results drawn from the database show a statistically significant association between operating length for autologous breast reconstructions and both surgical and medical complications. The OR of 1.0018 and 1.0015 for surgical and medical complications, respectively, reflects a minute by minute increase. For implant-based reconstructions, a similar association was seen with surgical complications with an OR of 1.004. Across both subgroups of breast reconstruction, there was a significant association between an increase in OR time and the length of hospital stay. CONCLUSION: We have shown a linear relationship that conveys a minute by minute increase in the complication profile and the chance of a longer hospital stay for breast reconstruction patients with regard to operative time.

What Is the Standard Volume to Increase a Cup Size for Breast Augmentation Surgery? A Novel Three-Dimensional Computed Tomographic Approach.

BACKGROUND: Breast augmentation surgery poses many challenges, and meeting the patient's expectations is one of the most important. Previous reports equate 100 cc to a one-cup-size increase; however, no studies have confirmed this between commercially available bras. The aim of this study was to identify the volume increase between cup sizes across different brands and the relationship with implant selection. METHODS: Five bra cup sizes from three different companies were analyzed for their volume capacity. Three methods were used to calculate the volume of the bras: (1) linear measurements; (2) volume measurement by means of water displacement; and (3) volume calculation after three-dimensional reconstruction of serial radiographic data (computed tomography). The clinical arm consisted of 79 patients who underwent breast augmentation surgery from February 1, 2014, to June 30, 2016. Answers from a short questionnaire in combination with the implant volume were analyzed. RESULTS: Across all three brands, the interval volume increase varied between sizes, but not all were above 100 cc. There was some variation in the volume capacity of the same cup size among the different brands. The average incremental increase in bra cup size across all three brands in the laboratory arm was 135 cc. The mean volume increase per cup size was 138.23 cc in the clinical arm. CONCLUSIONS: This article confirms that there is no standardization within the bra manufacturing industry. On the basis of this study, patients should be advised that 130 to 150 cc equates to a one-cup-size increase. Bras with narrower band widths need 130 cc and wider band widths require 150 cc to increase one cup size.

ALK1-Negative Anaplastic Large Cell Lymphoma of the Breast from a Nonprosthesis Cyst.

SUMMARY: Anaplastic large cell lymphoma of the breast is a rare malignancy associated with prosthetic breast implants. We present a case of a woman with no prior history of breast implants who developed anaplastic lymphoma kinase-1 negative anaplastic large cell lymphoma on a background of a previous benign cyst aspiration.

Vascular anatomy of the medial sural artery perforator flap: a new classification system of intra-muscular branching patterns.

BACKGROUND: The medial sural artery perforator (MSAP) flap is a versatile fasciocutaneous flap. The main difficulty encountered when raising the MSAP flap is in obtaining adequate pedicle length during intra-muscular dissection. The objective of this study was to determine the pattern of intra-muscular course of the MSAP flap pedicle. METHODS: 14 cadaveric specimens were dissected and CT angiograms of 84 legs were examined. The intra-muscular branching pattern and depths of the medial sural artery branches were analyzed. The number of perforators, position of the dominant perforator and both intra-muscular and total pedicle length were also recorded and compared to existing anatomical data. RESULTS: Three types of arterial branching pattern were identified within the medial gastrocnemius, demonstrating one (31%), two (59%) or three or more (10%) main branches. A dominant perforator from the medial sural artery was present in 92% of anatomical specimens (13/14). Vertically, the location of the perforator from the popliteal crease was on average 13 cm (±2 cm). Transversely, the perforator originated 2.5 cm (±1 cm) from the posterior midline. Using CT angiography it was possible in 10 consecutive patients to identify a more superficial intra-muscular branch and determine the leg with the optimal branching pattern type for flap harvest. CONCLUSIONS: This study is the first to describe the variability of the intra-muscular arterial anatomy of the medial head of gastrocnemius muscle. Surgeons utilizing the MSAP flap option should be aware of the possible branching pattern types and consequently the differing perforator distribution and depths of intra-muscular branches. Routine use of pre-operative CT angiogram may help determine which leg has the most favorable branching pattern type and intra-muscular course for flap harvest.

Reconstruction of pharyngolaryngectomy defects using the jejunal free flap: a 10-year experience from a single reconstructive center.

BACKGROUND: Reconstruction following pharyngolaryngectomy presents a complex reconstructive challenge, and a single-stage, reliable reconstruction allowing prompt discharge from the hospital and return of swallowing and speech function is required. The authors present their 10-year experience of 43 jejunal free flaps for pharyngolaryngectomy reconstruction by a single team and outline their operative algorithm to minimize postoperative morbidity. METHODS: The data for patients who underwent jejunal free flap reconstruction of circumferential pharyngoesophageal defects between March of 2000 and September of 2009 were reviewed retrospectively. All cases were included for analysis. RESULTS: There were 31 male patients and 12 female patients, with 100 percent acute flap survival. The authors' overall benign pharyngocutaneous fistula rate was two of 43 (5 percent), with two of 29 (7 percent) occurring in the group without a prophylactic pectoralis muscle flap and zero of 14 occurring in the group that had a prophylactic pectoralis muscle flap. No fistulas occurred when the anastomosis was performed with the gastrointestinal stapler (zero of 48). The authors' overall benign stricture rate was six of 43 (14 percent). Thirty-six patients received either a primary or secondary tracheoesophageal puncture; of these, 28 of 36 (78 percent) used their tracheoesophageal puncture as their primary mode of communication. CONCLUSION: The authors' recommendations for minimizing fistulas and stricture rate, following free jejunal reconstruction, include the gastrointestinal stapler for bowel anastomosis whenever possible, and the use of a prophylactic pedicled pectoralis major muscle flap for patients exposed to previous radiotherapy.