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Background: Many reports have described various technical aspects of reduction mammaplasty and mastopexy procedures. The authors present their technique, which combines a number of techniques already described in the literature regarding repositioning of the nipple-areola complex, reduction of the diameter of the base of the breast, and long-term retention of mammary cone projection. This study evaluated the results for patients of various ages and phenotypes in terms of scar dimensions, breast positioning, and patient satisfaction in the short, medium, and long terms., Methods: Mammaplasty was performed using the inverted T technique. The preoperative skin markings differed from those described in the literature in that they did not use the future position of the nipple-areola complex as the main reference point. A running circular suture was used to fix the breast to the pectoralis major fascia and to reduce the diameter of the base of the breast, resulting in a reduced horizontal scar in the inframammary fold. The skin-marking technique allowed for better postoperative breast symmetry regardless of preoperative variations in shape and volume., Results: The outcomes were considered satisfactory in the majority of cases by both the patient (p = 0.78) and the physician (p = 0.58). Adequate fullness of the upper pole was maintained in 94.7 % of the breasts., Conclusions: The described technique results in a reduced diameter of the base of the breast, repair of ptosis, repositioning of the nipple-areola complex, and long-term upper pole fullness. Complications can occur with any technique, but it is important to choose a technique with good quality outcomes overall., Level of Evidence Iv: 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 .

Introduction: A survey of surgeons in Brazil on their experience with PERTHESE silicone breast implants was performed., Materials and Methods: Surgeons that used PERTHESE implants between 2002 and 2008 were surveyed on the shape and volume of the implants used, surgical incision site, surgical plane of insertion, key postoperative complications, and surgeon and patient satisfaction., Results: The survey had a response rate of 20%, with ten surgeons reporting data on 1447 patients. The majority of the implants used were 200-300 cc, round, and high profile. Preference for the traditional inframammary incision site (47% of patients) was favored over transaxillary (33%) and periareolar (19%), and both subglandular (55%) and submuscular (44%) planes of insertion were used. Over 97% of surgeons and patients were satisfied with the results and surgeons indicated that the implants were easy to use., Conclusions: This review demonstrates that these implants are safe, maybe easier to introduce than other implants, and result in a high level of surgeon and patient satisfaction.

A harmonious facial appearance is determined by a balanced relationship among all tissues of the face. With advancing age, balance is lost among the bone, muscle, fat, and skin as progressive changes occur in their volume, shape, position, and consistency. Study of clinical cases and fresh cadaver dissections has led to better understanding of the superficial musculoaponeurotic system (SMAS) and its relationship with the facial muscles and their bony insertions. From these anatomic studies we have developed an improved concept of rhytidectomy with the subperiosteal detachment of all soft tissues from the orbit, upper maxilla, malar bone, and nose. Following this detachment, the soft tissues of the cheek, forehead, jowls, nasolabial folds, lateral canthus, and eyebrows can be lifted to reestablish their youthful relationship with the underlying skeleton. Our 4-year experience includes 105 patients. Sixty percent of these patients were admitted to the hospital and had their procedure under general anesthesia; forty percent, however, had their procedure in an outpatient setting requiring only local anesthesia (lidocaine hydrochloride 1% plus epinephrine) and intravenous sedation (midazolam, ketamine). Complications have been minimal except for temporary paralysis of the frontal nerve in seven patients; guidelines for prevention have subsequently been developed. The subperiosteal rhytidectomy is excellent and appears more natural for rejuvenation of the upper and central face, eyebrows, periorbita, external canthus, cheeks, and nasolabial fold.

From a study of the deformities of each layer of the abdominal wall, we have categorized five types of abdominoplasties. For each type, we used a different surgical technique, aiming to sculpture the abdomen and treat each layer according to the deformity present in each patient. Two hundred thirty-eight patients were treated with this method, and the results were judged good to excellent by the surgeons and patients because of the more natural appearance of the final results.

The outer table of calvarium is a useful donor site for facial reconstruction after resection of tumors. Large defects, especially when associated with multiple operations and radiotherapy, are poor recipient beds for nonvascularized bone grafts. A technique for the transfer of vascularized outer table has been developed and used in 11 patients for reconstruction of tumor defects. Satisfactory correction of both functional and esthetic problems has been achieved with satisfactory long-term stability and low morbidity.

A one-stage method of total reconstruction of the external ear in microtic patients is described. The auricular framework is fashioned from autogenous rib cartilage. Cover is provided by a vascular pedicle of the conchal area and by the aponeurotic layer which protects the posterior surface supplemented by a full-thickness skin graft. The surgical technique is described and the indications for the operation are indicated.

The authors present six cases of nose reconstruction and four ear repairs using large composite grafts. The post-auricular area is the best donor site. Very large composite grafts can be taken and in one patient a composite graft of 30 sq cm was successfully transferred. The surgical technique should be as atraumatic as possible in order to preserve intact the transplanted vascular tissue in the graft and in the recipient bed. An important feature of this surgical manoeuvre is the modified post-operative dressing technique that is described in detail.

The vascularization of the scalp and calvarium was studied in cadavers to better define the design of vascularized split- or full-thickness calvarial bone flaps. Selective dye injections of the superficial temporal and internal maxillary arteries established a horizontal and vertical network of vessels within and between each layer of the scalp. The periosteum of the frontoparietal region continues over the temporal aponeurosis as a separate, distinct layer, the innominate fascia, which is irrigated by numerous proximal branches of the superficial and deep temporal arteries. The periosteum can sustain the outer table of the calvarium by means of multiple small, vertical perforators. Between the periosteum and the outer table is a thin areolar layer of subperiosteum which continues beneath the temporal muscle. We feel that vascularized outer-table calvarial flaps can safely be pedicled using only the temporal aponeurosis, innominate fascia, and periosteum without including the galea or temporal muscle.

Based on an anatomic study of the vascularization of the calvarium in cadavers, a technique for the transfer of vascularized outer-table calvarial bone has been developed. The outer table of the calvarium receives numerous small perforators from its overlying periosteum. The periosteum is continuous with a distinct fascial layer overlying the temporal aponeurosis which we have termed the innominate fascia. Because of a network of anastomosing vessels from proximal branches of the superficial temporal artery and perforating branches of the deep temporal artery, the outer table of the calvarium can be carried on a pedicle which contains the temporal aponeurosis, innominate fascia, and periosteum. Thirty-seven vascularized outer-table calvarial bone flaps have been performed for a variety of craniofacial reconstructive deformities. Remarkable stability and lack of resorption have led the authors to favor this method of reconstruction particularly in poorly vascularized or previously infected recipient beds.

The authors present a method for replacing silicone implants in breast reconstruction. The method is suitable in selected patients and consists of the rotation of a deepithelialized rectus abdominis musculocutaneous island flap to form the mammary mound. Two patients who had already had breast reconstruction but with insufficient volume underwent this surgery.

Roentgenograms of 26 bone grafts from 21 patients ranging in age from 8 to 64 were reviewed to study the osseous regeneration of the donor area. They were followed from six to seventy-two months--most about twenty-four months. Complete regeneration occurred only in patients under 30 and did not occur in those over 30 within the time period studied. It took place more rapidly in young people starting from the bone stumps and in no case did it start from the periosteum, which seems to behave mainly as a conductor in the deposition of bone. Donor areas of bone grafts may be reused in young patients and with complete assurance in those under 20.

The prominent ear must always be seen as an aesthetic unity made up of a large number of anatomic details so that a natural and not a surgically corrected result is obtained. To achieve this goal no standard techniques should be used. Each anatomic detail must be treated in each ear.

We present a case with a full-thickness bony defect in the frontal area. It was corrected successfully by a free bone graft to the outer table from the parieto-occipital area, partly covered by a flap of periosteum from the same area.

This article describes a 20-year-old man with widespread polyostotic fibrous dysplasia that resulted in massive craniofacial deformity with unilateral exorbitism and oronasal obstruction. The patient illustrates the rare occurrence of fibrous dysplasia with major malformation of the face and skull, requiring multiple stages of surgical "sculpture" to improve function and appearance. The disease entity, differential diagnosis, and treatment are discussed.

The author presents the evolution of his technique of undermining the major oblique musculature to reduce the diameter of the waist and also reduce the diameter of the superior abdomen by resecting cartilage from the seventh and eighth ribs when the anterior projection is exaggerated. Treatment of the aponeurotic muscle wall plays an important role in obtaining good aesthetic results because this wall will serve as a base for the cutaneous tegument upon healing.

A contralateral transverse rectus abdominis island musculocutaneous flap was employed in the treatment of a unilateral burned breast. The vascularization of the flap was based on the superior epigastric pedicle. The advantages of this method are that a transverse island musculocutaneous flap of the rectus muscle can be used with good results in the reconstruction of the burned breast; and that in patients with hypertrophic contralateral breasts, the inferior pole of the opposite breast can be added to obtain a larger area of the flap. The cutaneous color and the texture offered by this method assure a more symmetrical appearance in the area.

Pregnancy produces changes in the body contour due to skeletal modifications and flaccidity of the cutaneous and musculoaponeurotic tissues. A new technique is proposed to treat the musculoaponeurotic flaccidity and thus achieve a good abdominal contour. The major oblique muscle is sutured to the rectus fasciae. The results of this procedure and the physiopathology of the modification of the abdomen during pregnancy and obesity are discussed. Possible future scientific methods are considered.