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

Fat grafting the buttock: facts and myths

1. There is a place for fat grafting into buttocks. 2. Fat embolism occurs during fat harvest but is unlikely to cause death and more likely to be apparent as a confused state up to two days postoperatively. 3. Fatal fat embolism is more likely by venous inoculation of fat under pressure into the sub-gluteal space [7]. It is estimated that the risk of mortality from massive fat graft to buttock is 1 in 3000. 4. It is unlikely, in my opinion, that macroscopic fat embolism results from a direct cannulation of gluteal veins, as suggested by some authors [7], in these cases, because under tissue tension we should expect the gluteal veins to collapse and the cannulae are larger than 3mm, making direct cannulation difficult. I suggest that it is more likely that there is tension avulsion of the gluteal veins as they are stretched in the sub-gluteal space resulting in direct access to fat embolism. 5. Fat graft into the gluteus maximus provides better fullness in the upper and mid buttock regions. Fat injected into subcutaneous tissue gives a broad but flatter buttock. 6. Only 200 to 300mls of fat maximum should be injected into each buttock and under no tension using a 3mm or larger diameter cannula, with as few passages as possible to avoid trauma to veins. The cannula is inserted, a pull back on the syringe plunger excludes direct venous cannulation, and fat is injected whilst slowly withdrawing with a thin subcutaneous tissue layer the space for multiple separated passages is narrow therefore fewer are possible. 7. Staged small volume injection of fat graft may give a better result with less risk. Injecting fat under tension is against the principles and understanding of basic wound healing and tissue revascularisation. 8. The mid and upper buttock give a more precise fullness if the fat is injected intramuscularly. This fat must not be injected under pressure and never from the inferior buttock crease

Postmortem Examination of Turkeys

Examine the outside of birds for parasites, scratches, animal bites, and other signs of injury

Avian Pox (Fowl Pox)

This fact sheet addresses specifically fowl pox affecting backyard chickens

Treating The Ageing Neck with Ellevate Plus

The ageing and sagging neck cannot always be successfully corrected using standard facelift techniques, even those that include extensive SMAS lift [1]. Adjuncts to treatment can include liposuction, radiofrequency or similar skin tightening procedures, open or closed platysmaplasty, extensive SMAS relocation perhaps including excision of submandibular gland and even direct neck skin excision [2]. The concept of suture suspension of the neck is not new and was clearly referenced by Mueller et al. in 2012 [3], but can involve simple biodegradable threads, synthetic ribbons and even fascial slings

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

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