Synthesis of orthogonally protected L-threo-beta-ethoxyasparagine.

Orthogonally protected L-threo-beta-ethoxyasparagine (Fmoc-EtOAsn(Trt)-OH, 1) was synthesized from diethyl (2S,3S)-2-azido-3-hydroxysuccinate 2 in eight steps as a building block for solid-phase peptide synthesis. The starting material is easily available in multi-gram scale from D-diethyltartrate. The transformation steps reported here are robust and scalable.

[Gynecomastia. Surgical treatment].

Gynecomastia is an increase in the size of the mammary gland of the male. It has a varied etiology, mainly associated with hyperestrogenism, although in many cases it is idiopathic. This anomaly produces a deformity of an aesthetic character that provokes alterations of a psychological order in the patient.

[Reconstruction of the tuberous breast].

The tuberous breast is a malformation that affects adolescent women uni- or bilaterally, becoming apparent at puberty with the growth of the breast. It is characterised by an alteration of the vertical and horizontal dimensions of the breast, which is translated into a lack of development of the breast and into the herniation of the glandular tissue within the areola with hypertrophy of the latter. Numerous terms have been employed to describe this deformity, besides that of tuberous breast: tubular breast, caprine breast, areolar hernia, hypoplasia of the lower pole or constricted breast.

[Breast reconstruction with latissimus dorsi musculocutaneous flap].

In breast reconstruction we try to achieve the greatest possible symmetry with the contralateral breast, with the smallest number of interventions, the least possible sequel and the greatest safety. When we find poor cutaneous quality in the thorax we must use techniques that provide a well vascularised tissue of good quality, which we obtain at a certain distance instead of using the thorax tissues themselves. This article reviews the latissimus dorsi musculocutaneous flap, the technique of elevation, variations of the flap, and the advantages and drawbacks involved.

[Breast reconstruction with expander prostheses].

Breast reconstruction with tissue expanders is a technique that has been known to clinical practice since 1978. The authors present their clinical experience in the Plastic and Reconstructive Surgery Service of the Virgen del Camino Hospital from 1980 to 2005. They describe breast reconstruction using tissue expanders and the evolution towards immediate breast reconstruction with durable expanders prostheses, which resemble conventional breast prostheses and try to emulate the extirpated breast.