No explanation is given for the significant difference resected material has to be identified for its location. In- in the incidence of carcinoma in a specimen from the formation about the different parts of the breast should clinically cancer-free breast in different studies. If one be reported on. 3. Glandular tissue has to be given priority to fat tissue takes into consideration that reduction mammaplasty during resection in these cases where we want to draw a means a biopsy volume much bigger than the usual blind biopsy, a higher rate would be expected. A 4.5% inci- histological map of the breast. dence is lower than in all former blind biopsy studies, 4. The selection of the operative technique for reduction Smith reporting 5.3%, Urban 7.6%, and Wanebo 11%. If mammaplasty is important. Techniques which work, al- we consider the accuracy of histological examination though the greatest part of the glandular structures is re- comparable in all the studies, the technique of taking the moved, should be favored. For example, reduction mam- biopsies must be responsible for these differences. Might maplasty with free nipple/areola transplantation gives acceptable aesthetic results by remodelling the breast it be that the most important part of the gland was not from the fat tissue left and buried deepithelized flaps. biopsied by the reduction mammaplasty in some cases? There is very low risk for the survival of the transplanted As a consequence of these thoughts I personally fol- low some rules when reduction mammaplasty is used in nipple/areola complex but almost no glandular tissue is combination with breast reconstruction in breast canceer left. Especially the central and retroareolar tissue can be removed. The operative technique should be based on a patients: clear understanding of aesthetic, function, and oncologi- 1. I recommend this operation to my patients not only cal needs in the individual patients. for aesthetic reasons and for improvement of the overall Hopefully, in the future, we can expect more standard- result of reconstruction, but also for diagnostic and even- tually therapeutic reasons. Some of the women not want- ized recommendations in this field by multicenter stud- ies with extremely detailed documentation. The authors ing their "healthy" side touched decided then for the op- have made an important step in this direction. eration. 2. The resected breast tissue must be investigated by the pathologist in a systematic way. As a precondition the European ][~1 ,,0 J ..... Iof IV I ~ll~l'ld~ SuF N' " © Springer-Verlag 1997 Eur J Plast Surg (1997) 20:250 Jemec, B.I.E., Jemec G.B.E.: Principles and practice of skin Martlnez Sahuquillo, A.: Cirugia phistica de los pfirpados. excisions. Amsterdam: Elsevier Science 1996. 308 pages, Barcelona: Masson 1996. 202 pages. ISBN 84-458-0407-3. US$250.00. ISBN 0-444-82341-7. This book has been written by Dr. Angel Martfnez-Sahuquillo This well produced text is addressed primarily to dermatolo- with contributions by Dr. Jos~ Martfnez-Sahuquillo, Dr. Jos6 Mig- gists, ophthalmologists, ENT specialists, general practitioners, uel Martfnez-Sahuquillo and Dr. Antonio Pifiero Bustamante. I and those training in these fields. It is written by a plastic surgeon consider it a most desirable reference book. It has a huge personal and a dermatologist from Denmark. The contents of this 293 page experience on revision of problems in reconstructive surgery of volume: the anatomy and physiology of the skin, skin tumors, in- the eyelids as well as a good bibliography. Doctor Martfnez has cising the skin, the equipment, the preoperative visit, anesthesia, already published on several aspects in aesthetic surgery. This the operation, 19 chapters on the various body areas and their spe- book is excellent for residents in plastic surgery who are Spanish cific problems for beginners, free transplants, after surgery care, speaking, unfortunately this book is not in English. There is no and general complications. As the authors state, this book is in- mention of microsurgical procedures but I have no doubt that tended to be a "practical primer" for the above-mentioned special- Doctor Martlnez will address this in his next edition. For Spanish- ists and for those who "occasionally engage in dermatosurgery speaking plastic surgeons interested in the eyelid and orbital area, without being dermatologic surgeons". With this concept, this re- this book is recommended. (E. Gadsden, Southfield) viewer disagrees. He firmly believes that a practical primer cannot be a book, but must be an engaged teacher. A book like this can be recommended as a theoretical basis for a practical art we have all been looking for in the past without being able to replace the dedi- cated teacher. Thus, my chief was sometimes guiding my knife- holding hand. But, theoretical knowledge was a prerequisite. If not present, back to the library to read this book! (L. Clodius, Ztirich)
European Journal of Plastic Surgery – Springer Journals
Published: Sep 1, 1997
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