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Breast augmentation with implants is one of the most commonly performed plastic surgical procedures, but has potential complications—asymmetry, implant displacement, rippling and wrinkling, capsular contracture, late seromas, and benign and malignant tumors—and potential financial costs. The auto-augmentation procedure, with mastopexy and lipofilling, is a second option to offer to patients who do not desire to continue with breast implants in secondary procedures. This study aimed to present a series of patients who intended to quit having breast implants, and they went to an auto-augmentation procedure, with mastopexy and lipofilling. The study included patients who underwent a mastopexy plus lipofilling following breast implant removal. The indications for the surgical procedure were: desire of not having breast implants anymore and smaller breasts, capsular contracture, and implant rupture. The surgical procedure is detailed. Fat grafting and mastopexy are done immediately at the time of explantation. A total of 26 patients (mean age 59.1 years) underwent mastopexy plus lipofilling following breast implant removal. The mean follow-up was 18 months. The mean amount of lipofilling was 258 cc. No major complications were observed, no infection, dehiscence, hematoma, or seroma. One patient had an oil cyst which was handled with resection. The auto-augmentation procedure after implant removal with local flaps and lipofilling is the better option for patients in whom breast implants are not an option anymore. Complication and reoperation rates are low and patient satisfaction is good. 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 www.springer.com/00266 .

Blepharoplasty is a very requested surgery for aesthetic rejuvenation of the eyes with grateful results. Lower blepharoplasty involving a variety of different techniques can be considered to refresh the oculopalpebral area. The approach of the treatment of the tear trough as releasing the tear trough ligament and plication of orbicularis oculi muscle in the palpebral portion to fill the tear trough concavity is essential in our surgical technique demonstrated here. From July 2014 to January 2020, 435 patients were submitted to blepharoplasty surgery for rejuvenation of the eyes. Lower blepharoplasty was performed with releasing of the tear trough ligament and suspension and fixation of the palpebral part of the orbicularis oculi muscle in the medial part of orbital bone corresponding to the tear trough area. The follow-up was 12 months. Patient satisfaction was high, and no complications were observed. Ten patients (2.2%) needed the addition of hyaluronic acid fillers in the tear trough 12 months after the surgery. We conclude that the use of the orbicularis oculi muscle suspension improves the long-term aesthetic results for the tear trough and the technique is easy to perform. 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 www.springer.com/00266 .

Chronic lymphocytic leukemia (CLL) is the most prevalent leukemia among adults. Despite its indolent nature, CLL remains an incurable disease. Herein we aimed to monitor CLL disease engraftment and, progression/regression in a xenograft CLL mouse model using ultra-small superparamagnetic iron oxide-magnetic resonance imaging (USPIO-MRI). Spleen contrast enhancement, quantified as percentage change in signal intensity upon USPIO administration, demonstrated a difference due to a reduced USPIO uptake, in the spleens of mice injected with CLL cells (NSG-CLL, n=71) compared to controls (NSG-CTR, n=17). These differences were statistically significant both after 2 and 4weeks from CLL cells injection. In addition comparison of mice treated with rituximab with untreated controls for changes in spleen iron uptake confirmed that it is possible to monitor treatment efficacy in this mouse model of CLL using USPIO-enhanced MRI. Further applications could include the preclinical in vivo monitoring of new therapies and the clinical evaluation of CLL patients.

Abdominoplasty surgery has spread universally, as both an aesthetic and a reconstructive procedure, and new techniques are appearing with the goal of minimizing ischemic complications of the flap and bettering body contour. The purpose of this article is to demonstrate that an abdominoplasty technique with limited undermining and preservation of the flap perforator vessels makes it possible to reduce the complication rate attributable to flap necrosis and seroma in abdominoplasty. Doppler flowmetry color study of the abdominal wall was performed before the surgical procedure and on postoperative day 15 after lipoabdominoplasty for a series of 20 patients to evaluate the blood supply of the abdominal wall. This study confirmed the preservation of perforator arteries in the periumbilicus area and right upper quadrant after abdominoplasty with liposuction and reduced undermining.

Diffusion-weighted imaging (DWI) may improve the diagnostic performance of conventional breast magnetic resonance imaging (MRI). Diffusion tensor imaging (DTI) is an extension of DWI. If DTI-derived measurements are to be clinically useful, particularly for predicting and/or monitoring therapeutic effects, they must be robust and reliable. The purpose of this study was to assess intra- and interobserver reproducibility of DTIderived fractional anisotropy (FA) and apparent diffusion coefficient (ADC) at 3.0 T. This prospective study was approved by the Institutional Review Board, and participants provided written informed consent. Sixty normal contralateral breasts of 60 patients (28–85 years, median 57) were analysed with a DWI sequence following a standard MRI protocol. Four authors performed all postprocessing and analyses independently and in different sessions. The same authors, blinded to the initial results, repeated the image postprocessing and analysis 4 weeks after the initial session. Mean ADC and FA for DTI sequences were, respectively, 1.92±0.30 and 0.32±0.09. Intra- and seinterobserver agreement of the four radiologists for ADC and FA were good (acceptable). Kappa values for ADC were intra-R1=0.82; intra-R2=0.84; intra-R3=0.89; intra-R4=0.88; inter-R1-R2=0.73; inter-R1-R3=0.74; inter-R1-R4=0.81; inter-R2-R3=0.76; inter-R2-R4=0.77; inter-R3-R4=0.83. Kappa values for FA were intra-R1=0.60; intra-R2=0.72; intra-R3=0.84; intra-R4 = 0.66; inter-R1-R2=0.64; inter-R1-R3=0.69; inter-R1-R4=0.72; inter-R2-R3=0.80; inter-R2-R4=0.71; inter-R3-R4=0.73. Within-subject coefficient of variation was 15% for ADC and 30% for FA. Repeatability with α=0.05 was 0.37×10−3 mm2/s for ADC and 0.112 for FA. ADC and FA measurements obtained with DTI are reproducible and may be valid, reliable and sensitive to change. ADC values obtained with DTI are more reproducible than FA.

To estimate intrastudy, intraobserver and interobserver reproducibility of DTI-derived measurements and fibre tractography (FT) at 3.0 T MR imaging in subjects without known brachial plexus pathology.IRB approval and written informed consent were obtained. Forty healthy volunteers underwent bilateral 3.0-T DTI of the brachial plexus. Postprocessing included FT and analysis of fractional anisotropy (FA) and apparent diffusion coefficient (ADC). Four authors performed postprocessing and analysis independently and in different sessions at baseline and after 4 weeks. Non-parametric tests and Bland-Altman statistics were used.Minimum and maximum percent variability were 6% and 20% for FA (85%-93% reproducibility). For ADC minimum and maximum percent variability were 6% and 18% (86%-97% reproducibility). Quality of fibre tract was rated equal in 80% and slightly different in 20% of subjects. Minimum detectable differences between limb were 37% for FA and 32% for ADC. Intra- and inter-observer agreement were good. Evaluating the combined influence of the observer and of the repeated measurements the reproducibility was 81-92%.DTI of brachial plexus nerves is reliable. The healthy contralateral side can be used as an internal control considering that changes in FA and ADC values of less that 37% and 32% will not be clinically detectable with confidence.

Nowadays, obesity is epidemic all around the world. Statistics of some studies report the prevalence of obesity in more than 1.7 billion people in the world. In the United States, around 5% of people have morbid obesity. This health problem has a lot of causes that include the sedentary life and the foods habits [1]. An important aspect of body contouring after massive weight loss is the reshape of the breast and the upper body. The treatment requires the correct diagnoses and understanding of the anatomy. There are a lot of different types of breast after the patient lost weight. Usually, the ptosis and the laxity of the skin are extensive and is common the decreased inframammary crease in continues with the upper back roll. Some patients have an adequate quantity of fat and glandular tissue to perform the mastopexy. But in general, despite excess skin, the breast lose majority of fat, and has excess of skin and tissue in the lateral aspect of the breast and the back (the upper back roll).

Women are concerned about breast size and breast contour when requesting breast augmentation. Different techniques have been developed to offer a better result concerning scar position and natural contour of the breast. The major advantage of transaxillary breast augmentation is to not place a scar in the breast unit. The disadvantages of submuscular placement include a more invasive procedure, increased postoperative discomfort, and visible flattening or distortion of the breast when the pectoral muscle is contracted. If the muscle is released inadequately medially, the implant may ride too high, or if the muscle is released excessively, the implant may be displaced inferiorly and laterally. The position of an implant in the subglandular space has significant disadvantages if the soft tissue cover is inadequate. In addition to implant palpability and visibility, the rates of fibrous capsular contracture, rippling, and nipple sensation alteration, such as numbness, are higher. The subfascial plane is well recognized and widely used among plastic surgeons to improve the results in breast augmentation.

The quest for better results in the midface after a face lift has led to the repositioning of a structure called the malar fat pad. Finger-assisted malar elevation (FAME) consists of detaching the malar fat pad from the underlying SMAS, which allows for the elevation of this structure. Two hundred five patients (189 females and 16 males) from January 2002 to August 2007 underwent a facial rejuvenation procedure comprising short-scar rhytidoplasty, SMASectomy, and FAME, with or without a simultaneous endobrow, blepharoplasty, and lipofilling. The midface fixation technique consisted of a stitch from the malar fat pad and SMAS flap to the periosteum at the zygomatic arch which was performed in every case. Elevation of the midface and improvement of the nasolabial fold and the mandible contour were obtained in all cases. Facial aging should be evaluated as a global process instead of a segmented one. Aging occurs in every structure of the face in different ways, depending on the vector of descent, thereby treatment must be individualized. We have observed improvement of the midface when using the FAME procedure in a rhytidoplasty with SMASectomy with deep fixation.

Aesthetic improvements of the upper third of the face have been a challenge for nearly a century. Brow ptosis management has undergone evolutionary changes from the classic coronal open brow and anterior hairline techniques to the more recently described less-invasive techniques such as minimal incision lateral brow lift and endoscopic brow lift [2].

An upper body lift is needed whenever a massive weight loss patient presents with a "dropped out" lateral inframammary crease. It is a combination of a brachioplasty, upper-back resection, and breast reconstruction. The operation is designed to reverse the particular deformity a patient presents with. This article describes three patterns of resection, one for males and two for females.

In performing brachioplasty, the authors have created a double-ellipse marking technique to avoid overresecting and leave adequate skin for closure. After resecting, they prevent the interference of soft-tissue swelling during wound closure by immediately closing each segment with temporary staples. Their technique is ideal for patients with massive weight loss.

e22132 Background: The Ca2+-sensing receptor (CaSR) regulates the Ca2+ signaling and its expression is present in both normal and malignant breast tissues. Recently, we demonstrated in a pre-clinical setting the CaSR expression in breast cancer mouse model by manganese enhanced MRI (Baio G et al. Eur Rad 2011). Alteration in choline phospholipid metabolism as detected by MRI, is a common feature of breast and many other cancer cells or tumors. Since CaSR-ChoK signaling plays an important role in breast cancer, we compared the MRS (MR spectroscopy) choline peak by a 3T MR scanner between calcium sensing receptor positive and negative breast cancers. Methods: Breast MRI of 16 consecutive patients with breast lesions were performed by a 3T MR and MRS findings were defined as positive by the visual inspection for the presence or the absence of choline peak. MRS imaging were compared with histologic findings and the pattern of CaSR by immunohistochemistry. The immunohistochemical results were qualitatively classified according to intensity and pattern of the staining, using a 6-point scale to score the intensity of the CaSR expression (0, absent; 5, intense, widespread expression). Results: A choline peak was present in 10 of 15 malignant lesions and the CaSR expression was between 3 to 5 score at immunohistochemestry analysis (p