The "dermal cage": a modification of the inferior pedicle breast reduction

In spite of more recent techniques for breast reduction, the inferior pedicle technique has proven to be enduring and still a very popular option in the plastic surgeon's armamentarium despite certain shortcomings. This technique is especially important for treating large breasts with a long sternal notch-to-nipple distance. The modifications we describe in this article overcome some of the main drawbacks of the standard inferior pedicle technique and make the procedure particularly effective when used on appropriately selected patients. This is achieved principally by the creation of a strong, durable, and internalized "dermal cage" that remains fixed to the chest wall in the upper part, as well as on both sides, to support the majority of the remaining breast tissue. This serves several purposes, including narrowing the breast thereby giving good projection and reduction of the N-IMF length of the inferior pedicle. Through suspension and fixation of the inferior pedicle to the chest wall, one can mitigate the effects of gravity on the inferior pedicle. The benefits of this include reduced tension on the T junction, thereby reducing the incidence of wound dehiscence in the immediate postoperative period, while reduction of tension on the nipple-areola complex reduces "bottoming" out over the long term. This process has been the main shortcoming of the inferior pedicle technique to date. The technique was used on 26 patients over a 7-year period with a mean long-term follow-up of 41 months. The results demonstrate the short- and long-term effectiveness of our own particular combination of modifications to previously described techniques and modifications of the inferior pedicle breast reduction. ----- LEVEL OF EVIDENCE V: 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

História e memórias do banco de leite humano do Instituto de Medicina Integral Prof. Fernando Figueira (1987-2009) em Recife, Pernambuco, Brasil History and memories of the human milk bank of the Instituto de Medicina Integral Prof. Fernando Figueira (1987-2009) in Recife, Pernambuco, Brazil

OBJETIVOS: reconstituir a história do Banco de Leite Humano (BLH) do Instituto de Medicina Integral Professor Fernando Figueira (IMIP), enfocando os idealizadores e a inauguração do serviço. MÉTODOS: estudo descritivo, transversal com enfoque histórico, orientado pela metodologia da história oral. Privilegiou-se a consulta a fontes bi¬bliográficas e a entrevista direta a sete participantes, com roteiro estruturado. A análise das falas desvelou duas categorias: "Criação do banco de leite humano do IMIP: os idealizadores e suas influências"; e "A inauguração". RESULTADOS: o BLH do IMIP foi criado em 1987, com a idealização e o incentivo do Professor Fernando Figueira e da Dra. Vilneide Braga, e para suprir as necessidades da Maternidade e da unidade de terapia intensiva neonatal. Da inauguração, participaram autoridades políticas, autoridades em aleitamento materno, celebridades da mídia e profissionais do hospital. CONCLUSÕES: o entrelaçamento entre história e memória, conduzido pelas trilhas da história oral, foi matriz para a construção da origem e evolução do BLH do IMIP, a partir da fala de sujeitos envolvidos nos fatos. A história do BLH do IMIP é um processo inacabado, vivo, é uma força geradora de transformação, sonhos e esperança, que mantém aceso o ideal de um mundo melhor para as crianças, para as mães e para a sociedade.<br>OBJECTIVES: to recount the history of the Instituto de Medicina Integral Professor Fernando Figueira (IMIP)'s Human Milk Bank (HMB), focusing on its pioneers and the introduction of the service. METHODS: a descriptive transversal study with historical focus based on the methods of oral history. The main materials used were bibliographical sources and direct structured interviews with seven participants. Content analysis revealed two categories: "the Creation of the IMIP's Human Milk Bank: its pioneers and their influences"; and "the Introduction of the Service". RESULTS: the IMIP's HMB, set up in 1987, was the brainchild of Professor Fernando Figueira and Dr. Vilneide Braga and its aim was to meet the needs of the Maternity hospital and its neonatal intensive care unit. The inauguration was attended by politicians, breastfeeding experts, TV celebrities and hospital staff. CONCLUSIONS: the methods of oral history were used to build up a history of the origins and evolution of the IMIP's HMB based on the testimony of the individuals involved. The history of the IMIP's HMB is an ongoing, living process and force that produces change, dreams and hope and keeps alight the ideal of a better world for children, mothers and for society at large