Improving the Longevity and Results of Mastopexy and Breast Reduction Procedures: Reconstructing an Internal Breast Support System with Biocompatible Mesh to Replace the Supporting Function of the Ligamentous Suspension

The original publication is available at http://www.springerlink.com/Publication of this article was funded by the Stellenbosch University Open Access Fund.The reasons for recurrent ptosis in mastopexy and breast reduction procedures are twofold. First, available surgical techniques do not reconstruct the normal breast anatomy responsible for maintaining breast shape. Second, in many instances the techniques rely on atrophied tissue to provide long-term support. The discovery in 1997 of the ligamentous suspension (the supporting system of the breast) gave rise to the concept that reconstruction of this anatomical structure was needed to ensure a sustained postoperative result. Applying the latest knowledge regarding the structural and vascular anatomy of the breast in the surgical technique and utilizing material other than atrophied breast tissue enabled us to prevent the recurrence of breast ptosis. Methods A surgical technique was developed to replace the supportive function of a failed ligamentous suspension in 112 patients with ptotic breasts. This was done by reconstructing an internal breast-supporting system (IBSS) with biocompatible mesh. Results Satisfactory breast shape, nipple projection, and upper breast fullness was obtained with this technique in mastopexy patients with moderate-sized ptotic breasts. In patients with larger breasts good results were obtained with a simultaneous breast reduction. The longest follow-up is 6 years 3 months. Conclusions With this technique recurrent breast ptosis can be prevented in mastopexy and breast reduction procedures. The results are such that it eliminates the need for silicone prostheses to obtain satisfactory upper-breast fullness. The surgical technique is especially indicated in patients with skin of poor quality or patients with high expectations.Stellenbosch University Open Access FundPublishers' Versio

Alkali-activated slag cements produced with a blended sodium carbonate/sodium silicate activator

An alkali-activated slag cement produced with a blend of sodium carbonate/sodium silicate activator was characterised. This binder hardened within 12 h and achieved a compressive strength of 20 MPa after 24 h of curing under ambient conditions, which is associated with the formation of an aluminium substituted calcium silicate hydrate as the main reaction product. Carbonates including pirssonite, vaterite, aragonite and calcite were identified along with the zeolites hydroxysodalite and analcime at early times of reaction. The partial substitution of sodium carbonate by sodium silicate reduces the concentration of carbonate ions in the pore solution, increasing the alkalinity of the system compared with a solely carbonate-activated paste, accelerating the kinetics of reaction and supplying additional silicate species to react with the calcium dissolving from the slag as the reaction proceeds. These results demonstrate that this blend of activators can be used effectively for the production of high-strength alkali-activated slag cements, with a microstructure comparable to what has been identified in aged sodium-carbonate-activated slag cements but without the extended setting time reaction usually identified when using this salt as an alkali activator

Will Geopolymers Stand the Test of Time?

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The Dual Vascular Pedicle: A Novel Method to Approach Challenging Cases in Single-Stage Mastopexy/Augmentation.

BACKGROUND Age, pregnancy and weight change can affect the shape of the female breast. Various mastopexy/augmentation techniques have been described to address these changes which work well in primary and uncomplicated cases. However, there is a distinctive category of high-risk patients which includes post-bariatric, active smokers, those with poor skin quality, wanting larger implants or undergoing secondary surgery. The complications reported in this group of patients are as high as 32%. MATERIALS AND METHODS We describe a new technique of one-stage mastopexy/augmentation, using a wide dermo-glandular pedicle, and our early results with 51 consecutive patients. RESULTS Fifty-one patients were operated between January 2016 and September 2018, with a mean age of 40.0 years. Ten patients were smokers, eight were post-massive weight loss, six had previous mastopexy. At a mean follow-up of 22 months, only two patients had a unilateral bottoming out. There were no incidents of hematoma, seroma, capsular contracture or major tissue-related complications. CONCLUSION Plastic surgery has been described as a struggle between beauty and blood supply. We have performed a one-stage mastopexy/augmentation using a wide and thick dermo-glandular glandular pedicle to maximize the blood supply in a range of challenging patients with promising results. 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