Breast reconstruction after nipple-sparing mastectomy in the large and/or ptotic breast: A systematic review of indications, techniques, and outcomes.

Background: Surgeons remain reluctant to perform nipple-sparing mastectomy (NSM) in large breasts due to a higher risk of necrosis. We performed a systematic review of the literature to evaluate indications, techniques, and outcomes in immediate or delayed breast reconstructions in large and/or ptotic breasts.

Methods: The following search terms were used for both titles and key words: [NSM AND ("breast ptosis" OR "ptotic breast" OR "large breast" OR "breast hypertrophy" OR "gigantomastia")].

Flap surgery for pressure sores: should the underlying muscle be transferred or not?

Background: Musculocutaneous flaps have become the first choice in the surgical repair of pressure sores, but the indication for including muscle in the transferred flaps still remains poorly defined. This study compares outcomes after muscle and non-muscle flap coverage of pressure sores to investigate whether it is still necessary to incorporate muscle tissue as part of the surgical treatment of these ulcers.

Methods: A retrospective revision of 94 consecutive patients with ischial or sacral pressure sores operated between 1996 and 2002 was performed.

The latero-central glandular pedicle technique for breast reduction.

The relatively high number of complications and disadvantages of the conventional techniques in breast reduction combined with our expertise in restoring sensation in breast reconstructive procedures, led to the development of a new technique that was crystallised from the traditional techniques and is able to overcome most of their disadvantages. The key issue of the technique is that the nipple is vascularised and innervated on a column of glandular tissue that remains in contact in its posterior part with the pectoralis muscle and its perforators and in its lateral aspect to the lateral pillar of breast tissue. Due to the ptosis that develops during the process of hypertrophy, this column will gain sufficient length to be turned upwards into the new position of the nipple.