Our surgical approach to treatment of congenital, developmental, and acquired breast asymmetries: a review of 30 cases.

BACKGROUND: Peer pressure and the modern definition of beauty have led people to strive for breast perfection. The aim of our study was to emphasize the importance and frequency of nonmastectomy-related breast asymmetry and explain our approach to such patients using a combination of techniques. METHODS: We retrospectively reviewed 30 patients with nonmastectomy breast asymmetry (i.e., patients with Poland's syndrome, tumors, burns, and tuberous breasts) admitted to our clinic between 2001 and 2011. Patients were followed up for a mean of 25 months postoperatively (range 4-72 months). These patients completed a satisfaction questionnaire regarding scarring, size, symmetry, shape, and nipple-areola complex sensation. RESULTS: Patient distribution and preferred treatment method according to etiology were screened. For mild Poland's syndrome, breast implants with symmetrization procedures (when needed) were used. In two patients, however, fat grafting was sufficient to correct the deformity. For severe Poland's syndrome, a tissue expander was first placed and wrapped by regional local flaps, such as the pedicled latissimus dorsi muscle flap, accompanied by fat grafting for infraclavicular depression and an absent anterior axillary fold. After adequate expansion of the skin and muscle flap, a silicone prosthesis replaced the tissue expanders. CONCLUSIONS: Tissue expanders with or without muscle flaps along with fat grafting in multiple sessions are necessary steps in the treatment of breast asymmetry. Knowledge and application of multiple techniques in a step-by-step fashion helps the surgeon to achieve optimal functional and aesthetic results for each patient. 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 http://www.springer.com/00266 .

Congenital hand deformities - a clinical report of 191 patients.

OBJECTIVE: To evaluate the incidence, therapy results and complications of operatively treated congenital disorders of the hand in a large state hospital during a 14-year period. METHOD: The institutional database was retrospectively analysed for patients with congenital disorders of the hand during a 14-year period (1998-2012). Disorders were classified according to the modified Swanson classification. For each entity, the incidence, the patients age at the time of the operation and operation techniques were evaluated. RESULTS: A total of 191 patients was treated operatively for the congenital disorders of the hand with syndactyly being present in 87, polydactyly in 66, constriction ring syndrome in 7, clinodactyly in 5, macrodactyly in 10, camptodactyly in 8, cleft hand in 5 and thumb hypoplasia in 3 cases. Patients age at the time of the operation was 5.2 as a mean value. CONCLUSION: Congenital hand deformities were seen 1.5 times in male patients compared with female patients. In complex cases where bone deformities seem to disrupt the soft tissue envelope development, surgery is indicated at a preschool age.

Combined triggering at the wrist and fingers and severe carpal tunnel syndrome caused by macrodystrophia lipomatosa. Case report and review of literature.

Macrodystrophia lipomatosa (MDL) is a rare, congenital, developmental anomaly causing localized overgrowth of a digit(s) or extremity. Trigger wrist is a relatively rare entity, which may be caused by a mass originating from a tendon, an anomalous muscle or intracarpal pathologies. A 42-year-old male patient presented with triggering during active motion of the fingers and intractable pain and numbness in fingers to our emergency department. He had hypertrophy of the entire right upper extremity and his huge thumb was amputated due to MDL four years ago. The index finger was bigger than the other fingers and thenar eminence area of the hand looked like a large mass. Resection of hypertrophic carpal bone and debulking of large soft tissue mass removed the carpal tunnel symptoms and limited the range of motion of the wrist and fingers. This is a case report of triggering at the wrist and severe carpal tunnel syndrome due to carpal bone enlargement and lipofibromatous hamartoma (LH) of the median nerve in a patient with MDL.

Giant malignant melanoma: a case report.

Malignant melanoma is an aggressive tumor of melanocytes whose primary function is producing melanin pigment. Though they vary according to the microscopical subtype, these tumors often arise in the sun-exposed skin of elderly individuals, in the acral regions and in the palms and soles of the hands and feet. A 56-year-old patient visited the emergency department of our hospital with complaints of a sudden hemorrhage from a mass on her left thigh which had appeared five months ago. On physical examination a brown-black mass with dimensions of 18 x 16 x 5 cm, protruding from the skin with a partially and actively hemorrhagic, ulcerated surface, was found on the left gluteal region. The mass was excised surgically with 3 cm safe surgical margins. Histopathologically the lesion was diagnosed as "nodular malignant melanoma - Clark level 5". A malignant melanoma of such a large size is very exceptional in the literature; thus it is presented here with its interesting rapid clinical course.