Background: Giant tumours of the breast tend to occur in the adolescent age group. Racial predilection has been noted in the literature. The mass often occupies most of the breast, leading to its distortion. Many authors have advocated a mastectomy for benign tumours that severely distort the breast. Giant benign tumours when treated by simple excision risk persistence of asymmetry. To avoid this asymmetry, some authors have resorted to excision and immediate reduction mammaplasty. The aim of this retrospective study was a report on giant tumours of the breast presenting to a plastic surgery unit and to analyse demographic factors, clinical presentations, tumour pathology, management, complications, as well as patient and breast outcomes. Methods: Medical records of patients with giant tumours were retrospectively analysed for assessing demographic factors, clinical presentation, tumour pathology, the technique of surgery performed and patient and breast outcomes in a single hospital setting. Breast outcomes were rated by panel of 4 experienced plastic surgeons using the 4 Point Likert scale. Their ratings were statistically analysed for inter-rater agreement. Results: Twenty-three subjects were identified to have giant tumours of the breast. Of these South African patients, 19 were black, 3 were Indian and 1 was of mixed ethnicity. The age range was 12-49 years(y) with an average of 19y. All masses were palpable. The final pathological diagnosis was fibrocystic disease in 3, giant fibroadenoma in 14, phyllodes tumour in 4, and hamartoma in 2. The size range was 10-45 cm with a median size of 18 cm. All but one patient had simple excision followed by immediate reduction mammaplasty. Twenty patients were assessed after operation. A minimum of 1 to a maximum of 4 patients per reviewer showed unsatisfactory outcomes and a minimum of 18 to a maximum of 21patients per reviewer showed satisfactory to excellent outcomes. The overall agreement between assessors for this was 84%. Conclusion: Benign giant tumours (> 10 cm) of the breast are suitably managed by excision of the mass and a reduction mammoplasty technique of reconstruction. Keywords: Giant tumour breast reduction mammaplasty, giant fibroadenoma of breast, phyllodes tumour, hamartoma breast S Afr J Surg 2018;56 (3) http://dx.

Perioperative celecoxib administration in patients undergoing augmentation mammaplasty significantly reduced postoperative narcotic use, pain, and nausea. Its use should facilitate the patient's ability to resume everyday activities following surgery.

Erdheim Chester disease (ECD) is a rare and complex non-Langerhans histiocytic systemic disease that affects multiple organ systems, including the bones, heart, lungs, and central nervous system. Fewer than 1,000 cases have been reported in the medical literature and dermatological manifestations of the disease are rare but can provide valuable diagnostic clues for this challenging disease. The cutaneous manifestations of ECD can take many forms, including nodules, plaques, papules, and xanthomas. These lesions can occur on any part of the body and may be solitary or multiple. Cutaneous manifestations of ECD have been reported to occur in up to 20% of cases, but the true prevalence may be higher, as many cases may go undiagnosed.We present the case of a 62-year-old gentleman with a history of ECD currently on vemurafenib who presented with multiple painless subcutaneous nodules on his back after an excision biopsy under local anesthetic revealed histological features of ECD. The objective of this case report is to raise awareness of ECD and its dermatological manifestations. Further research is warranted to better understand the pathogenesis and morphology of cutaneous involvement in ECD.

Background/Aims The excision of skin lesions is one of the most common procedures in plastic surgery. Following the disruptions associated with the COVID-19 pandemic, this study investigated patient preferences communicating the results of skin lesion excision surgery. Methods A retrospective analysis was conducted with patients who had undergone elective minor surgical procedures over a 30-day period. A questionnaire was distributed to 103 patients to assess their preferences regarding delivery of the outcomes of their procedure in terms of which healthcare professional contacted them and whether this occurred in person or remotely. The outcomes of this were used to adapt the service and a repeat analysis was conducted 3 months later. Results If the lesion was benign, 45.0% of participants preferred to be contacted via email, letter or text, while 38.8% preferred either a telephone call or in-person appointment with their GP, and only 16.3% preferred direct contact from their hospital doctor. If the lesion was malignant, 55.0% preferred to be contacted by their GP, 30.0% by their hospital doctor and 15.0% via letter, email or text. The repeat analysis saw the proportion of patients who received their results via remote consultation with a hospital clinician increase from 12.8% to 16.1%, while the proportion of patients who received their results at an in-person outpatients appointment decreased from 14.5% to 9.3%. Conclusions This study shows that a substantial proportion of patients would prefer to receive the results of skin lesion surgery from their GP over the telephone, suggesting that this would be a better means of delivering results than an in-person hospital appointment. This method could also reduce the number of patients returning to the clinic in person, helping to streamline follow up and improve clinic efficiency.