The incidence of partial nipple necrosis was high and was related to circumareolar incisions. Most cases of nipple necrosis are superficial and heal uneventfully. Preservation of the nipple improves the aesthetic outcome of immediate breast reconstruction.

Prior breast augmentation in patients desiring post-mastectomy reconstruction provides a unique opportunity for capsular preservation and immediate, single-step implant reconstruction. We report a case series of a single-surgeon experience with immediate implant reconstruction after skin-sparing mastectomy in patients with prior subpectoral augmentation. Final implant volumes, complications, and outcomes were examined. Twenty patients (15 bilateral, total 35 breasts) were included. Eighteen (90%) patients were treated for cancer. Mean augmentation-to-reconstruction interval was 9 years (range, 3-19 years). Mean patient age was 45.1 years (range, 37-64 years). Eight patients (40%) received postoperative chemotherapy and two (10%) radiation. Mean mastectomy weight was 321 g. Mean weight of the implants removed was 346 g. Mean volume of new implants was 487 mL. All patients underwent capsulotomy (100% superior, 85% medial, 30% inferior, 5% lateral). Mean operative time was less than 1 hour for bilateral reconstruction. With average follow-up of 25.6 months, 2 patients were re-operated on for asymmetry (implant malposition, synmastia). Thirty-day complications included 1 implant loss due to infection, 1 drain placement with implant salvage, 1 hematoma requiring evacuation, and 1 cellulitis treated with antibiotics. There were no late complications and no capsular contractures. None have required further oncologic surgery. No cancer recurrences have been detected. In patients who desire prosthetic reconstruction similar to their original submuscular augmentation, capsule preservation and implant replacement with a larger prosthetic inserted within the old capsule is safe, fast, and aesthetically pleasing without compromising oncologic principles.

Conclusions:Our data suggest that LA is a superior anesthetic option for EVAR compared with GA or RA due to its lower duration of anesthesia and a lower instance of pneumonia, urinary tract infection, and urinary retention. With LA, the total procedure time is decreased relative to RA or GA. Objective:The anterior approach to the lumbar spine has been increasingly used to treat numerous conditions. The iliolumbar vein (ILV) is especially vulnerable when the L4 and L5 vertebrae are exposed, and its ligature is recommended to avoid hemorrhage. Anatomic variations of the ILV have been described in cadaveric studies; to date however, there are no studies on the presence of anomalous ILV in patients undergoing spinal surgery. Surgeons should be aware of these anatomic variations to avoid complications during surgical procedures.Methods: A retrospective study was performed on 159 patients (51% men; average age 49.7 years) undergoing anterior spinal surgery by a single-access surgeon and spine surgeons at two different hospitals. Variables assessed were preoperative diagnosis at the L4-L5 level (spondylolisthesis, herniated nucleus pulposus, scoliosis, degenerative disk disease, and stenosis), age, gender, comorbidities, surgical history, number of levels exposed, and ILV description. ILV was classified into missing ILV, one, two, three, or more than three ILVs. Associations between the variables and the number of ILVs found were evaluated with 2 analysis.Results: The ILV was present in 157 patients (98.7%) and was not seen in the course the exposure in 2 patients (1.3%). A single ILV was found in 116 patients (73%), and multiple ILVs were found in 25.8%: 27 (17%) had two ILVs, 11 (6.9%) had three ILVs, and 3 (1.9%) had more than three ILVs. Men had a higher frequency of multiple (Ͼ2) veins than women (P ϭ .07). Diagnosis, comorbidity, and pelvic surgical history were not associated with the number of veins found.Conclusion: A high frequency of multiple veins was observed when the spine was exposed during the anterior approach. This knowledge is crucial and will help surgeons avoid the potentially catastrophic complications of an avulsion of an unexpected extra vein.

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