The waterfall effect in breast augmentation

The ‘waterfall effect’ is a descriptive term to indicate a sliding ptosis of parenchymal breast tissue over a fixed or encapsulated implant. It occurs more frequently than surgeons anticipate and especially over the longer term after augmentation. Certain breast implants are more prone to contribute to this problem as are implants placed in submuscular pockets that ride high, especially in women with anatomical musculoskeletal variance or asymmetry. This article describes the aetiology of sliding ptosis in more detail, the relevant anatomy and the surgical correction. Understanding the problem enables the surgeon to plan the appropriate procedure and obtain proper informed consent. It is possible that a two stage procedure is necessary should the upper pole of breast require a debulk, either early (3 to 12 months) or later as the breast may slide with ageing of the tissues. The waterfall effect of breast parenchyma over implants is only apparent when the upper torso of the woman is undressed and she is in an erect posture. A significant number of women are happy with this situation and therefore no further action is required. Those that want an improved appearance in these circumstances can try autologous fat transfer to rebulk the surrounding tissues but generally the most likely solution involves a mastopexy with or without implant exchange. The results are highly rewarding but the scars are the legacy. Mastopexy augmentation is a difficult procedure and should only be performed by experienced surgeons. Many surgeons prefer a two stage approach with either an implant based augmentation first to limit scars and see if the patient is happy with the outcome or a first stage mastopexy to decide whether implants or fat graft are actually required as a secondary procedure

The retention of Metrical Psalter Music in modern hymnody

Thesis (M.M.)--Boston Universit

Distortion in Heat Treated Tube: A Materials Engineering Approach

Problem: A tube heat treater was making heavily distorted tubes with “hooked” ends on their induction heat treating line. The first and last meter of every tube was more than 1cm out of straightness. Hypothesis: Non-uniform phase transformation can occur from asymmetric heating and cooling, and the observed distortion is due to asymmetric heating and cooling during heat treatment of the tube

Avian Pox (Fowl Pox)

This fact sheet addresses specifically fowl pox affecting backyard chickens

Principles of Feeding Small Flocks of Chickens at Home

Owning a small flock of chickens is increasing in popularity, particularly in areas prohibiting the raising of larger domestic animals. Chickens not only furnish a ready source of home-grown meat and eggs, but also provide great pleasure as exhibition stock and even as pets

Resolving large financial intermediaries: banks versus housing enterprises

This paper examines the policy issues with respect to resolving the possible failure of housing enterprises Fannie Mae or Freddie Mac. The authors compare and contrast these issues with those raised in the context of large bank failures and also identify important differences in the extant supervisory authorities. Based on these discussions, they offer a number of policy suggestions designed to minimize the cost of resolution and protect taxpayers from loss should a large bank or housing enterprise fail.