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Breast Thermography
Published in James Stewart Campbell, M. Nathaniel Mead, Human Medical Thermography, 2023
James Stewart Campbell, M. Nathaniel Mead
A common artifact that causes a markedly warm area over the upper anterolateral chest wall in women with large breasts is due to inflammation of Cooper's ligaments, also known as the fibrocollagenous septa (Figure 9.23). Attached to the pectoral fascia, these ligaments are strong connective tissue bands that suspend the breast against gravity and maintain its structural integrity. Strain-induced “Cooperitis” is usually seen bilaterally, though it may be unilateral, especially in women with unequal breast sizes. When the Cooper's ligaments are chronically stretched or strained, this may suggest that a better bra is needed. It could also indicate that the individual may benefit from reduction mammaplasty if other therapies fail.
Chest wall deformities
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Robert E. Kelly, Marcelo Martinez-Ferro, Horacio Abramson
In patients with aplasia of the ribs, the endothoracic fascia is encountered directly below the attenuated subcutaneous tissue and pectoral fascia (Figure 20.42). The pectoral muscle flap is elevated on the contralateral side and the pectoral fascia, if present, on the involved side. Subperichondrial resection of the costal cartilages is then carried out, as shown by the bold dashed lines in the figure. Rarely, this must be carried to the level of the second costal cartilages.
Adult Autopsy
Published in Cristoforo Pomara, Vittorio Fineschi, Forensic and Clinical Forensic Autopsy, 2020
Cristoforo Pomara, Monica Salerno, Vittorio Fineschi
Incise the pectoral fascia, up to the posterior axillary line. Underlying the skin is the triangle-shaped pectoralis major muscle. At its lateral apex, it attaches to the major tubercle of the humerus, located at the base of the medial sternocostal convex insertion. Sever the insertion with a continuous, half-moon-shaped movement of the scalpel, so that the incision runs vertically from above to below. Then, cut the clavicular portion of the muscle from its insertion into the clavicle. Reflect the muscle lateral to its humeral insertion (Figure 2.20). Finally, the costal insertions of the pectoralis minor are incised, and the muscle is then severed from its bony attachments with combined traction–dissection; invert the muscle laterally on the coracoid process of the scapula, paying attention not to accidentally cut the subclavian vein or any of its branches. If necessary, separate incisions can be made into the costal insertion of the serratus anterior muscle. This allows the sternal–costal area to be easily examined for evidence of traumatic alterations (e.g., hemorrhagic infiltrations, rib fracture line, and malformations) (Figures 2.21 and 2.22).
Secondary reduction mammaplasty: does initial pedicle design matter?
Published in Journal of Plastic Surgery and Hand Surgery, 2019
Joseph R. Spaniol, Patrick J. Buchanan, Richard J. Greco
Here, we present a retrospective cohort study examining secondary reduction mammaplasty and postoperative outcomes without the use of free nipple grafts and without partial or full NAC loss. When the primary pedicle was known, the authors included the primary pedicle in their operative plan for the secondary reduction. However, when the initial reduction pedicle was not known, we proposed a novel, modified central mound (MCM) reduction technique. Although similar to the McKissock technique, the MCM reduction technique respects the vascular supply to the NAC by preserving any remaining vascularity that is present from the horizontal septum as described by Wuringer [8], while also maintaining both the superior and inferior vascular pedicles. Unlike the true McKissock technique, the superior aspect of the bipedicle is left intact and is not elevated off of the pectoral fascia. As illustrated in Figure 1(a–g), pedicles superior to and inferior to the NAC are de-epithelialized and a central mound of breast tissue remains intact. Skin flaps are then created medially and laterally. The underlying breast tissue is then resected, leaving only a central mound of breast tissue intact in which the NAC is positioned on. The skin flaps are then approximated into position. Pre- and post-operative patient photographs are shown in Figures 2 and 3.
External partial breast irradiation in prone position: how to improve accuracy?
Published in Acta Oncologica, 2018
Chris Monten, Liv Veldeman, Katrien Vandecasteele, Luiza Oltéanu, Werner De Gersem, Tom Vercauteren, Thomas Mulliez, Rudy Van Den Broecke, Herman Depypere, Wilfried De Neve, Yolande Lievens
Conformity exercises demonstrate that even in controlled circumstances, precision of tumor bed delineation in breast cancer is low: breast tissue is a homogeneous structure with little reference points for localization. When prone position is applied, the antero-posterior diameter of the breast increases and landmarks for delineation change. Tissue distortion is a radiological sign, indicating high-density regions (glandular tissue and edema) versus fat tissue. In supine position, (a)symmetry between left and right breast may to some extent help to differentiate between edema and glandular structures, but not in prone position, where compression of the contralateral breast on the breast board precludes this comparison. Indirect tumor bed localizers such as clips, seroma or tissue distortion do not always correlate with preoperative imaging. Although they indicate the surgical trajectory, tunneling upon the pectoral fascia may lead to unnecessarily large irradiated volumes, close to lungs and heart, thus losing the advantages of prone position and PBI [15]. The omission of ‘irrelevant clips’ may solve this, however at the cost of lower interobserver conformity, even if preoperative mammography is available [16]. As already suggested by Kirby et al. [17], surgeons plays an important role and should be informed on the implication of clips on irradiated volumes. Insertion of a minimum of 5–6 clips is recommended, but re-resections may accidently remove such clips. Kirova et al. [18] found that preoperative CT (supine position) mainly corrected for left-right discrepancy in tumor bed delineation. According to Verhoeven et al. [19], this does not translate into a better Jaccard index. However, with folding of the breast over the thoracic wall, antero-posterior uncertainty is reduced by natural borders.
Efficacy of bilateral PECS II block in postoperative analgesia for ultrafast track pediatric cardiac anesthesia
Published in Egyptian Journal of Anaesthesia, 2022
Farouk Kamal, Ahmed Abd El-Rahman, Rasha Mahmoud Hassan, Amr Fouad Helmy
The theory of local anesthetic diffusion can be applied to any interfacial plane block; however, some types of interfacial planes may have a broader local anesthetic spread than others, according to Elsharkawy et al. In addition, the deep pectoral fascia is thinner and more mobile than fasciae from other anatomical sites, which could explain how easily local anesthesia diffuses throughout the thoracic wall; nevertheless, further research is needed to validate this concept [27].