Search

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.

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

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.

In abdominal cutaneous island flaps of rats (n = 16), either the artery or the vein was clamped, while flap perfusion was simultaneously monitored with laser Doppler flowmetry (LDF) and photoplethysmography (PPG) to identify the occluded vessel responsible for insufficient perfusion. The LDF signal decreased promptly after arterial clamping. After venous clamping, only a slow decrease was noted. The LDF amplitude differed statistically significantly between arterial and venous clamping only up to 90 sec after onset but not thereafter, allowing no further distinction between the two types of vessel occlusion. Power spectral analysis of the LDF signal did not show clear differences in frequency ranges between arterial and venous occlusion. In contrast, PPG measurements demonstrated significant differences between both perfusion disorders throughout the entire observation period. These results suggest that dependable differentiation between prolonged arterial and venous vessel occlusion is not possible based on the amplitude or power spectral analysis of the LDF signal alone. PPG may be reliably used to differentiate between arterial and venous perfusion disorders.