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Introduction: Breast reduction surgery is one of the most frequently performed surgeries amongst plastic and reconstructive surgeons worldwide. Previous studies have shown decreased risk of breast cancer development in women undergoing breast reduction surgery of up to 28%. We aimed to evaluate the relative risk of breast cancer development in our patients after breast reduction surgery in relation to the general female population of Austria. Methods: A total of 637 women underwent breast reduction surgery between 2003 and 2017 at our department. From those women, 513 patients completed a follow-up assessment of breast cancer development and were included into the study sample. The age-specific incidence rate data of the general female population of Austria served as the control group and basis for the calculation of the standardized incidence ratio (SIR) and Poisson test. Results: Relative to 5.66 expected cases of breast cancer, our cohort showed 1 subject with breast cancer after breast reduction surgery (SIR = 0.1765). An exact Poisson test was carried out to determine the level of significance of the difference between the incidence rate observed in the sample compared to the expected rate based on the age-specific incidence rates of the general population (p = 0.023, α = 0.05). Discussion: Our study underlines the strong evidence of previous studies for significant breast cancer reduction in patients after reductive mammoplasty. In comparison to the general female population of Austria, our cohort showed a reduction in breast cancer incidence of about 82%. The authors believe that different techniques in reduction mammoplasty have different levels of safety regarding the prevention and risk reduction for breast cancer. Further investigation must be conducted to evaluate the reduction of breast cancer risk with different surgical techniques.

Aesthetic rhinoplasty can be quite challenging with the possibility of cartilage damage during manipulation, while there is a relevant risk of injury to the surgeon. To minimize both risks to the patient and surgeon, this paper presents a new cartilage tweezer, which also allows more precise handling during cartilage resection. At its distal end, the developed tweezer consists of a bent section, which forms a narrow scalpel guide for cartilage dissection with a partly overlapping branch design to improve accuracy during resection. At the apex of the tweezers’ cartilage guide, a ruler ensures meticulous measurement, which facilitates precise excision without the risk of over resection, which results in the preservation of cartilage stability. Additionally, the design includes an adjustable radius of the curvature of the two gripping jaws, allowing a variable resection size of lower lateral cartilage, without causing any crushing or bruising of the non-resected cartilage. The tweezer was tested during 21 functional-aesthetic nose surgeries at the department for Plastic and Reconstructive Surgery and Otorhinolaryngology of the Klinik Landstrase Hospital in Vienna. The presented instrument simplifies cartilage incision and the removal of excess cartilage during rhinoplasty, especially during cephalic trimming of the lower lateral cartilages. Level of evidence: Level V, therapeutic study.

Aneurysms of the ulnar artery and its palmar arch are usually rare events, which are mostly related to repetitive trauma of the extremity. This syndrome is also known as hypothenar hammer syndrome, which presents two pathologic entities: the aneurysmal type and the thrombotic type. Whereas surgical treatment is not necessary within the thrombotic type, it is the gold standard to treat aneurysms of the palm with resection of the aneurysm and reconstruction of the vessel with either end-to-end anastomosis, venous or arterial grafts. We report a case of a young male patient with an aneurysm of the right ulnar artery at the wrist with history of repetitive trauma. Reconstruction with a venous forearm graft showed recurrence of the aneurysm after 2 years from surgery. The authors want to elaborate an algorithm for surgical treatment to make the right decision for choice of reconstruction. Level of evidence: Level IV, therapeutic study.

CRPS (complex regional pain syndrome) is well documented as a reflex sympathetic dystrophy. It mostly has been reported to occur in the extremities and has only been mentioned anecdotally in the breast after breast surgery or trauma of the chest wall. Recent literature describes a post-mastectomy pain syndrome (PMPS), which mimics CRPS symptoms and, despite the nomenclature, is not only limited to mastectomy procedures but also any other surgical procedure involving breast parenchyma. We report PMPS in a 39-year-old patient after revision operation of breast reduction surgery. Postoperatively, the patient showed symptoms of severe persistent pain, swelling, cutaneous temperature changes, and hyperhidrosis in the affected breast. Subcutaneous infiltration with triamcinolone acetonide and prilocaine only relieved the symptoms temporarily. Botox injections did not relieve her symptoms of sweating either. Two intercostal nerve branches were identified with ultrasonography and dissected in general anesthesia. This procedure relieved her symptoms. Surgeons should consider CRPS and PMPS as differential diagnosis of chronic disproportionate pain after breast surgery. Early identification and treatment will help alleviate persistent CRPS symptoms and avoid chronic soft tissue changes. Level of evidence: Level IV, diagnostic/therapeutic study.

Temporary or long-lasting loss of grip force after open carpal tunnel release (CTR) in carpal tunnel syndrome (CTS) patients is well known and caused by changes in biomechanical conditions through sectioning of the transverse carpal ligament. We hypothesize to find predicting factors for loss of grip strength. We performed dynamometer testing of overall hand grip, tip pinch, and key pinch grip prior, 3 and 6 months after open CTR in 42 CTS subjects. Changes in these three main variables related to pre-operative grip, tip pinch and key pinch forces as well as gender and age were analyzed for significant results (t test, Pearson and Spearman correlations, descriptive statistics; 2-tailed p = .05). At 3-month post-CTR, overall hand grip force decreased significantly by 11.7% (p = .006), whereas key pinch and tip pinch only decreased by 5.6 and 3.5% (p

Deep inferior epigastric artery perforator flap (DIEP/DIEAP) procedure is a common method for breast reconstruction after mastectomy. For unilateral breast reconstruction, harvesting of the flap can be done contralaterally or ipsilaterally. The aim of this study is to demonstrate a possible side difference in quality of abdominal skin perfusion from left to right and its causes, which could have implications on our selection of flap harvesting side, operating time, and flap design itself. We performed thermographic imaging after induced hypothermia of the abdominal skin in 17 females to evaluate the quality of blood supply to each side of the abdominal wall. Additionally, we examined the diameter of the deep inferior epigastric artery, whether there is a difference in size correlating to the quality of blood supply of each side. Evaluation of our pre-operative thermographic imaging method was performed in four patients which underwent unilateral DIEP flap reconstruction regarding reduction of surgery time and assessment of overall outcome. Every subject showed a dominant side of perfusion (greater area of perfusion after set time). Furthermore, we discovered a side difference between left and right diameter of the deep inferior epigastric artery in each patient (0.2-mm mean difference; p = 0.0002). The rewarming process of the abdominal skin was faster (16 out of 17 subjects; 94.1%) (greater area of rewarming after set time) on the side with the greater diameter deep inferior epigastric artery. In our DIEP patients using thermographic imaging of the abdominal skin, we only performed perforator dissection on the preferable side. The consequence was a reduction in operating time of 25 minutes compared to careful dissection of both sides. None of our patients showed complications such as wound-healing disorders. Thermographic assessment of the abdominal skin after hypothermia is easy to conduct and gives reproducible information about different areas of skin perfusion quality. The difference in rewarming speed from left to right is thought to be due to a larger diameter deep inferior epigastric artery, which translates into a superior perfusion, but does not necessarily correlate with the size of the perforators itself. The presented technique offers the potential to improve outcome, especially by lowering perfusion-related complications and reducing operation time by fast dissection of the non-dominant side while carefully dissecting the area of interest with fast thermographic rewarming results, and must therefore be investigated in future studies by measuring objective outcome results. Level of Evidence: Level III, risk/prognostic

Rosacea is a rather common and frequently diagnosed condition of the skin and may in some cases progress to rhinophyma. This is a case report of a patient with a giant rhinophyma of 358 g. He claimed his first symptoms 5 years prior to our first clinical assessment. We performed an excision of the tumor mass by scalpel and a CO2 laser treatment of the remaining skin surface. Post-surgical therapy only included topical treatment with an ointment containing bacitracin zinc and neomycin sulphate to prevent infections. After stable wound closure, we had the chance to examine the patient after a period of 7.5 years with remarkable aesthetical results. Level of Evidence: Level V, therapeutic study.