Challenges in Breast Evaluation: Breast Asymmetry, Macromastia, and the Surgically Altered Breast.

Many breast conditions that warrant referral to a plastic surgeon may first be identified in a routine gynecologic or primary care setting. These range from asymmetric anomalies and macromastia to sequelae of previous aesthetic and reconstructive procedures. The purpose of this reference article is to provide an overview of common breast deformities and discuss their unique challenges in evaluation.

Connexin 43-Based Therapeutics for Dermal Wound Healing.

The most ubiquitous gap junction protein within the body, connexin 43 (Cx43), is a target of interest for modulating the dermal wound healing response. Observational studies found associations between Cx43 at the wound edge and poor healing response, and subsequent studies utilizing local knockdown of Cx43 found improvements in wound closure rate and final scar appearance. Further preclinical work conducted using Cx43-based peptide therapeutics, including alpha connexin carboxyl terminus 1 (αCT1), a peptide mimetic of the Cx43 carboxyl terminus, reported similar improvements in wound healing and scar formation.

Axillary Lymphadenectomy and Wound Complications in Implant-Based Breast Reconstruction.

Background: The most common method of breast reconstruction in the United States today is implant-based reconstruction. However, reported complication rates are high, from 30% to 50%. Thus, it is important for reconstructive surgeons to identify factors associated with or contributing to wound complications after breast reconstruction.

Evidence-Based Practice in Liposuction.

Background: The goal of this study is to examine the existing peer reviewed literature comparing modern adjunctive techniques in liposuction including laser-assisted liposuction (LAL) and ultrasound-assisted liposuction (UAL) to standard suction-assisted liposuction (SAL). We intend to interpret these findings into a literature-based clinical application to influence practice patterns.

Methods: A literature review was conducted using a keyword search in PubMed.

Cell-populated collagen lattice contraction model for the investigation of fibroblast collagen interactions.

The fibroblast-populated collagen lattice (FPCL) was intended to act as the dermal component for "skin-equivalent" or artificial skin developed for skin grafting burn patients. The "skin-equivalent" was clinically unsuccessful as a skin graft, but today it is successfully used as a dressing for the management of chronic wounds. The FPCL has, however, become an instrument for investigating cell-connective tissue interactions within a three-dimensional matrix.

Complex abdominal wall reconstruction: an outcomes review.

Background: Complex abdominal wall reconstruction (AWR) remains challenging. Techniques for repair are numerous and include primary fascial approximation, separation of components (SOC), and use of various biologic and synthetic meshes. Given the vast expanse of available techniques and lack of consistent algorithms, an analysis of outcomes in AWR is presented.

Capsular contracture after breast reconstruction: collagen fiber orientation and organization.

Background: Breast implant capsular contracture is a common complication of implant-based breast reconstruction. To develop nonsurgical interventions to combat breast capsular contractures, a clearer understanding of the process is required. Comparing breast implant-related capsular contracture to the fibrotic scarring process, the hypothesis is that these processes differ with regard to the compaction of collagen fibers within the connective tissue matrix.

Technique for seroma drainage in implant-based breast reconstruction.

Seromas are a common complication associated with breast reconstructive surgery. In expander based breast reconstructions, a seroma can pose a particularly difficult problem related to final tissue envelope shape as well as an increase in the risk of infection and possible tissue necrosis. Unfortunately, the literature describes few non-image related techniques to drain a seroma with a breast implant in place.

Pedicled rectus femoris flap for coverage of complex open pelvic fractures.

Complex open pelvic fractures are highly morbid injuries. Distant soft tissue transfer is often necessary for reconstruction. We report two cases of traumatic open pelvic fractures in which a pedicled rectus femoris flap was used for soft tissue coverage.

Rat mast cells enhance fibroblast proliferation and fibroblast-populated collagen lattice contraction through gap junctional intercellular communications.

Background: Mast cells' association with fibrosis is known, but the mechanics of that association are unclear. The hypothesis is that mast cells promote fibroblast profibrotic activities through heterocellular gap junctional intercellular communications. Casting populated collagen lattices with both human mastocytoma cell line (HMC-1), an established mast cell line, and fibroblasts enhances lattice contraction via gap junctional intercellular communications.

Plastic surgery within the Veterans Affairs Medical System: proposed modified indications for operative procedures.

Many plastic surgery procedures span the divide between aesthetic ("cosmetic") and reconstructive surgery. However, definitions and guidelines may be inconsistent, which may decrease patients' access to legitimate procedures. The article aims to assist Veterans' Health Administration-affiliated plastic surgeons in continuing to provide optimal care to the Nation's Veterans and family members, and should be regarded as an open discussion.

Soft-tissue defects and exposed hardware: a review of indications for soft-tissue reconstruction and hardware preservation.

Background: Traditionally, management of exposed hardware has included irrigation and débridement, intravenous antibiotics, and likely removal of the hardware. Increasingly, the goal of wound closure without hardware removal using plastic surgical techniques of soft-tissue reconstruction has been emphasized. Identification of parameters for retaining exposed hardware may assist surgeons with management decisions and outcomes.

Metabolic and functional characterization of human adipose-derived stem cells in tissue engineering.

Background: The use of adipose-derived stem cells for tissue engineering involves exposing them to metabolically adverse conditions. This study examines the metabolism, proliferation, and differentiation of adipose-derived stem cells under various conditions.

Methods: Adipose-derived stem cells were cultured in 16 media conditions containing 0.

Calmodulin-myosin light chain kinase inhibition changes fibroblast-populated collagen lattice contraction, cell migration, focal adhesion formation, and wound contraction.

Wound healing requires fibroblast migration, synthesis of new extracellular matrix, and organization of that matrix, all of which depend upon myosin ATPase activation and subsequent cytoplasmic actin-myosin contraction. Myosin ATPase activity is optimized by phosphorylation of myosin light chain at serine 19. Several different signaling pathways can perform that phosphorylation, the focus here is calcium saturated calmodulin dependent -myosin light chain kinase (CaM-MLCK).

Mast cells promote fibroblast populated collagen lattice contraction through gap junction intercellular communication.

The release of mast cell granules is commonly associated with inflammation and fibrosis. However, does direct communication between mast cells and fibroblasts through gap junction intercellular communication (GJIC) occur? Fibroblast populated collagen lattice (FPCL) cast with mast cells show enhanced lattice contraction. Do released granules or GJIC between mast cells and fibroblasts promote enhanced lattice contraction? Mast cells preloaded with a fluorescent dye that readily passes through gap junctions were cast in FPCL.

Systemic vanadate ingestion modulates rat tendon repair.

The chronic ingestion of vanadate prevents the appearance of myofibroblasts within granulation tissue of full excision wounds in rats, yet these wounds close at an optimal rate. Myofibroblasts are reported in the repair of transected tendons. Here we investigate tendon repair in the absence of myofibroblasts.

Topical vanadate optimizes collagen organization within granulation tissue.

Systemic ingestion of vanadate, a nonspecific inhibitor of tyrosine phosphatases, doubles wound breaking strength, enhances the packing of collagen fibers, and prevents the appearance of myofibroblasts in granulation tissue. Will the local application of vanadate mimic the systemic effects? Pairs of polyvinyl alcohol sponges, each with a central reservoir and attached injection port, were subcutaneously implanted in rats. Daily, one implant received 0.

Dupuytren's disease: physiologic changes in nodule and cord fibroblasts through aging in vitro.

The pathogenesis of the fibrotic disease Dupuytren's contracture remains unclear. The disease process includes two structurally distinct fibrotic elements, the nodule and the cord. It has been proposed that as the disease progresses, nodules develop into cords.