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Diffuse dermal angiomatosis (DDA) is a cutaneous reactive angiomatosis. Typically presenting as ulcerated, erythematous, violaceous, or purpuric plaques on the breast or lower extremities, DDA is believed to be a reaction to tissue ischemia. Granuloma inframammary adultorum (GIA) is a type of irritant dermatitis of multifactorial etiology, clinically presenting as papules and nodules. Herein, we report an interesting rash presenting as fungiform papulonodules overlying a large violaceous plaque on the left breast. Biopsy revealed an exuberant epidermal proliferation and a diffuse and deep dermal proliferation, consisting of small slit-like blood vessels in between collagen bundles. In light of these clinical and histopathologic findings in the setting of an indurated plaque on a pendulous breast of a woman with multiple risk factors for local tissue ischemia, a diagnosis of concurrent diffuse angiomatosis of the breast (DDAB) and GIA was rendered. This case highlights the critical importance of clinicopathologic correlation in the diagnosis of multiple diagnostic entities.

Competing Interests: Conflict of interest: F.J.G.-F. received research contract from Biotronik and honoraria from lectures and speaker’s fees from Medtronic, Boston, and Abbott; E.T. received speakers’ bureau/honoraria research grant fellowship support from Abbott, Biotronik, and Medtronic, and consulting and speaker fees from Abbott, Biotronik, and Medtronic. All remaining authors have declared no conflicts of interest.

• Sacrococcygeal PNS is the commonest variant of the condition. • However, it can occur in other areas like umbilicus, hand, scalp intermammary, suprapubic, nose, etc. • Infra mammary PNS is an extremely rare condition, with no previous report. • This study aims to present and discuss a case of PNS occurring in both infra mammary regions. Pilonidal sinus (PNS) is a chronic inflammatory perianal disorder that rarely occurs outside sacrococcygeal region. The aim of this study is to report an extremely rare case of bilateral inframammary PNS with brief literature review. A 25-year-old female presented with a discharging sinuses in both inframammary region for two years. Examination showed multiple discharging sinuses with several centimeters of induration and tenderness. Under general anesthesia, complete excision of the sinuses with primary closure done. Histopathological examinations showed chronic foreign body granuloma surrounding hair shaft pictures consistent with PNS. Inframammary PNS has never been reported in the literature. As with intermammary PNS, in this case also it is associated with obesity and large breasts with tight brassieres. Diagnosis is usually clinical. In contrast to sacrococcygeal PNS, operation under general anesthesia is main treatment modality. Pilonidal sinus of inframammary region is an extremely rare condition. High index of suspicion is required for diagnosis. Excision with primary closure is the definitive therapy. [ABSTRACT FROM AUTHOR]

Background: Breast augmentation has gained widespread popularity since its inception. During recent decades, several techniques have developed. Debates concerning the superiority of a particular technique for achievement of optimal results exist. In this primary survey, we evaluate a selection of UK and European Aesthetic surgeons for their preferred techniques and practises of breast augmentation and the influence of patient choice on their favoured surgical approach. Methods: A 10-item questionnaire was sent to 715 European Aesthetic Surgeons by e-mail with a cover letter including the link using SurveyMonkey©. Contact details were obtained from respective national registries. Statistical analysis was carried out using SPSS 20. Results: One hundred aesthetic surgeons from Europe including Greece, Italy, UK, Switzerland, Denmark, Malta and Ireland made up the respondents. Of the 27 surgeons practicing in the UK, the majority (96.4 %) use the inframammary approach, with a single respondent from UK indicating preference for the periareolar incision. However, of the 68 surgeons outside the UK, including Ireland and Continental Europe, a significant proportion (28.4 %) utilise the periareolar incision. Majority of the UK surgeons (56 %) place the breast implant in the subglandular plane whilst in Continental Europe, the preference in 50 % of the responders is for the dual plane pocket ( p = 0.016). Most patients (54.3 %) express a preference for a certain incision with surgeons tending to comply with patients' wishes. When they do not, it is mostly due to unrealistic patient expectations (in 63.3 % of cases). The duration of oral antibiotics varies from 2 days (5.2 % of responders) to 1 week (25.9 % of responders). Conclusions: UK aesthetic surgeons prefer the inframammary incision and subglandular plane compared with alternative approaches undertaken by other Continental European counterparts. There remains an unestablished common approach for primary breast augmentation. In the current climate of division with UK leaving Europe, there remains a need for multiple Aesthetic Surgery Societies to collaborate, in order to produce robust multicentred data. Level of Evidence: Not ratable. [ABSTRACT FROM AUTHOR]

Objective: Skin creases are features of major anatomical, morphological, surgical, and functional interest. This study focuses on the histological comparison of creases of the trunk and participation of the elastic fibers in their formation. The histological structure is a key consideration for the reconstructive planning of the relevant area and its knowledge may contribute in such direction. Methods: Fresh cadaver specimens were collected from the inframammary (n = 15), infragluteal (n = 16), and inguinal creases (n = 14), the anterior axillary fold (n = 14), and the surrounding skin (n = 10). Specimens were fixed in 10% buffered formaldehyde. Collagen and muscle fibers were stained by Masson Trichrome and Van Gieson stains, reticular and collagen type III fibers by Reticulin stain, and elastic fibers by Verhoef and Orcein stains. Results: Skin creases of the trunk present well-defined dense bundles of collagen fibers, creating a beehive pattern with broad attachment to the dermis and denser in deeper sites related to the fascia of the underlying muscle. The elastic fibers participate in the collagen pattern and radiate in a parallel pattern in the reticular dermis and in a perpendicular fashion in the papillary dermis. The skin surrounding the creases lacks such organization. Conclusions: Creases of the trunk are formed by well-organized collagen bundles in a beehive pattern, attached to the dermis and related to the underlying muscle fascia. The elastic fibers participate in this structure and radiate in a parallel fashion in the reticular dermis and perpendicularly in the papillary dermis. [ABSTRACT FROM AUTHOR]

The inframammary approach in breast augmentation, still the most popular technique among plastic surgeons, has always been hampered by the undesirable appearance of its scar. The present paper describes a modified approach to inframammary augmentation with saline-filled prostheses. This approach uses a very short incision, thus resulting in a much less noticeable scar. The surgical technique is easy to learn, simple to execute, does not necessitate any special equipment and gives consistent results. Decreasing the scar length to an absolute minimum ensures higher patient and surgeon satisfaction.