FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2330201710> ?p ?o ?g. }

• W2330201710 endingPage "270e" @default.
• W2330201710 startingPage "269e" @default.
• W2330201710 abstract "Sir: We would like to thank Drs. Mandrekas and Zambacos for their very kind comments and compliments, and for their outstanding prior work on aesthetic correction of tuberous breast deformity.1,2 In their correspondence, they have raised excellent points for discussion, including (1) differing approaches to the lower pole, (2) a fibrous ring hypothesis, (3) management of soft-tissue deficiency, (4) tissue expander use, and (5) the use of drains, on which we are very pleased to comment. In addressing this varied and complex developmental deformity, it is clear that numerous paths may be taken to safely and effectively arrive at a common destination. With breast base constriction, inframammary fold malposition, inferior skin insufficiency, and deficient parenchyma, tuberous breast correction is almost entirely “about the lower pole.” In our experience, the route that seems to confer the safest and most consistent aesthetic results, and in contouring of the lower pole in particular, is delineated in our treatment algorithm.3 Among the fundamental underpinnings of our strategy are periareolar access, transglandular dissection, and radial scoring, all of which play a role in releasing the ubiquitous fibrous ring constriction that we agree is present to varying degrees in all tuberous breast morphology. Rather than simply envisioning an isolated periareolar “ring,” we feel the constriction is more pervasive and extends to include the entirety of the hypoplastic lower pole breast parenchyma. The periareolar transglandular approach bisects the gland horizontally, “breaking the ring” in two places (when cutting any ring in one place, it is likely to maintain its shape; a minimum of two cuts are required to “break” the circle). The constriction is then incised radially, producing additional “break-points” in the ring to more completely overcome the deformity. Unlike subcutaneous approaches, our method of lower pole coverage is inherent in the transglandular dissection, as the gland is maintained in continuity with the lower pole skin, creating a “dermoglandular flap.” Even with significant hypoplasia, the scored parenchyma and soft tissue have provided adequate coverage. In our experience with implant-based postmastectomy breast reconstruction, although we have seen excellent shape results with acellular dermal matrix, it does not confer very much volume. Alternatively, autologous fat transfer has shown more promise in increasing breast volume and implant coverage. Although we have not had occasion to apply these techniques to the treatment of tuberous breast deformity, they certainly merit further investigation. Tissue expanders are used selectively in patients with type II and III deformities desiring fuller size, and in any deformity with a recalcitrant inframammary fold. This facilitates better control of lower pole shape and position, and an opportunity for fine tuning at the second stage. One of the more arduous tasks in the selection of a two-stage approach is patient education. Often fiscally conscious, intent on instant gratification, and occasionally thinking they merely require breast augmentation, patients may have seen other surgeons who have not only suggested one-stage correction but, more frequently, also failed to adequately define the degree of tuberous deformity or even identify the deformity entirely, recommending conventional augmentation mammaplasty techniques. Although the majority of tuberous corrections in our hands are still performed in one stage, we uniformly have tissue expanders available for cases in which lower pole distensibility is in question, and inform patients accordingly. Given the extent of dissection, we use closed suction drains in all cases. We do not routinely use vasoconstrictor solution, as the possibility of delayed bleeding gives us pause, and rely on obtaining meticulous hemostasis with electrocautery. Whereas we have had no hematomas to date (yet), this has nothing to do with the presence of drains; their sole function is to evacuate serous fluid. We do feel that the absence of seromas and low capsular contracture and malposition rates may be at least in part a result of our consistent use of drains. We have routinely noted daily effluent of 50 to 75 ml for several days, and occasionally more. Drains are maintained until productive of less than 30 ml in 24 hours, and generally removed between postoperative days 4 and 7. Like Drs. Mandrekas and Zambacos, we have long been intrigued by the complexities of tuberous breast deformity,4 and although some of our methods may differ, we share much in common in our commitment to progress in safety, cosmesis, and reproducibility. We would like to thank them once again for raising these topics for discussion that we hope will further improve our collective understanding of this challenging spectrum of deformities, and ultimately advance the care of our patients. DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication. Adam R. Kolker, M.D. Meredith S. Collins, M.D. Icahn School of Medicine at Mount Sinai New York, N.Y." @default.
• W2330201710 created "2016-06-24" @default.
• W2330201710 creator A5015137439 @default.
• W2330201710 creator A5057771866 @default.
• W2330201710 date "2015-08-01" @default.
• W2330201710 modified "2023-09-26" @default.
• W2330201710 title "Reply" @default.
• W2330201710 doi "https://doi.org/10.1097/prs.0000000000001429" @default.
• W2330201710 hasPublicationYear "2015" @default.
• W2330201710 type Work @default.
• W2330201710 sameAs 2330201710 @default.
• W2330201710 citedByCount "1" @default.
• W2330201710 countsByYear W23302017102019 @default.
• W2330201710 crossrefType "journal-article" @default.
• W2330201710 hasAuthorship W2330201710A5015137439 @default.
• W2330201710 hasAuthorship W2330201710A5057771866 @default.
• W2330201710 hasBestOaLocation W23302017101 @default.
• W2330201710 hasConcept C105702510 @default.
• W2330201710 hasConcept C134018914 @default.
• W2330201710 hasConcept C141071460 @default.
• W2330201710 hasConcept C165383583 @default.
• W2330201710 hasConcept C174940676 @default.
• W2330201710 hasConcept C2775862295 @default.
• W2330201710 hasConcept C2779982284 @default.
• W2330201710 hasConcept C2781411149 @default.
• W2330201710 hasConcept C71924100 @default.
• W2330201710 hasConceptScore W2330201710C105702510 @default.
• W2330201710 hasConceptScore W2330201710C134018914 @default.
• W2330201710 hasConceptScore W2330201710C141071460 @default.
• W2330201710 hasConceptScore W2330201710C165383583 @default.
• W2330201710 hasConceptScore W2330201710C174940676 @default.
• W2330201710 hasConceptScore W2330201710C2775862295 @default.
• W2330201710 hasConceptScore W2330201710C2779982284 @default.
• W2330201710 hasConceptScore W2330201710C2781411149 @default.
• W2330201710 hasConceptScore W2330201710C71924100 @default.
• W2330201710 hasIssue "2" @default.
• W2330201710 hasLocation W23302017101 @default.
• W2330201710 hasOpenAccess W2330201710 @default.
• W2330201710 hasPrimaryLocation W23302017101 @default.
• W2330201710 hasRelatedWork W1995044000 @default.
• W2330201710 hasRelatedWork W2019517015 @default.
• W2330201710 hasRelatedWork W2029992525 @default.
• W2330201710 hasRelatedWork W2274744783 @default.
• W2330201710 hasRelatedWork W2405434905 @default.
• W2330201710 hasRelatedWork W2972528184 @default.
• W2330201710 hasRelatedWork W3031738920 @default.
• W2330201710 hasRelatedWork W3210994522 @default.
• W2330201710 hasRelatedWork W4212934921 @default.
• W2330201710 hasRelatedWork W823718041 @default.
• W2330201710 hasVolume "136" @default.
• W2330201710 isParatext "false" @default.
• W2330201710 isRetracted "false" @default.
• W2330201710 magId "2330201710" @default.
• W2330201710 workType "article" @default.