No abstract

A summary of Hans May's biography of Erich Lexer is reproduced, followed by a translation of Lexer's first publication, in Spain in 1921, on the correction of pendular breasts. Lexer's fundamental contributions to mammaplasty are analyzed. This author was the first in the history of mammaplasty to perform breast reduction with an "open" nipple-areola complex transposition, with preservation of the continuity of the skin to the remaining gland. This feature was far ahead of its time, as the techniques based on this concept did not become popular until after 1955. Lexer also was the first to propose subcutaneous mastectomy for treatment of fibrocystic disease, to perform breast augmentation in the ptotic hypoplastic breast with fat flaps, and to use free fat grafts taken from the abdomen or hips for augmentation mammaplasty.

Techniques for treatment of severe and moderate macrotia and for hypertrophy of the earlobe are described. For macrotia, the excision of cartilage at the scapha, helical arch, and skin are performed at different levels to prevent a notching, mainly at the helix. For hypertrophies of the earlobe, through-and-through excisions of two triangular pieces are used with reinsertion of the remaining earlobe at the base.

The classification of malformations of the auricle is reviewed. Hinderer's technique is described. It is based on long oblique skin and cartilage flaps of the upper pole of the ear, taken in opposite directions for expansion of the helical arch, thus preventing a later visible notching at the helical rim. The remaining scapha is straightened and the superior crus and antihelical fold are formed by scratching and sandpaper abrasion of the lateral surface. A deep concha is treated by a cartilage strip expansion from the posterior conchal wall.

A technique for correction of prominent ears is described. It combines the advantages of simplicity and accuracy and provides satisfactory results. Essential points of the technique are perichondrial cartilage scratching at the superior crus and antihelical fold according to Stenström, mattress sutures applied to the perichondrium and soft tissues at the medial surface, and to these we add the trimming of the tail of the helix, thinning of the antitragus, and a double-spindle skin excision at the medial auricular surface. In patients with insufficient curling of the helical rim ("shell-ear" deformity) the base of the helical arch is scratched at its medial surface.