Biomedical subjects
Publications and source records attributed to B C Mendelson.
Surgical procedures for the midface and nasolabial fold demand that the surgeon possess a magnified knowledge of the facial anatomy and its structural relationships. With this knowledge, the surgeon limits complications while achieving better results. This article reviews the anatomy of the midfacial subcutaneous soft tissues.
The extended SMAS facelift techniques gave plastic surgeons the ability to correct the nasolabial fold and medial cheek. Retensioning the SMAS transmits the benefit through the multilinked fibrous support system of the facial soft tissues. The effect is to provide a recontouring of the ptotic soft tissues, which fills out the cheeks as it reduces nasolabial fullness. Indirectly, dermal tightening occurs to a lesser but more natural degree than with traditional facelift surgery. Although details of current techniques may be superseded, the emerging surgical principles are becoming more clearly defined. This article presents these principles and describes the author's current surgical technique.
The bulging fat of aging eyelids has always been described as a hernia; yet, the treatment has not been that of a true hernia. Rather, the contents (orbital fat) have been excised and the hernia wall left unrepaired. It is possible to treat bulging lower eyelids as a hernia by replacing both the fat and the sac into the original location within the orbital cavity, and then repairing the retaining wall.
Cosmetic surgery is unique in that the results are qualitative. Recent technical advances now allow the skilled and artistic surgeon to achieve the degree of change requested by most patients, without the obvious operated look. General practitioners should extend their professional relationship with cosmetic surgery patients. Preliminary counselling can reduce patient's anxiety by clarifying their objectives and by providing relevant information and support. The relationship of trust so engendered is helpful for post operative support and allows the practitioner to share in the satisfaction experienced by the patient as a result of surgery.
The nasolabial fold has defied satisfactory correction with the face lift operation. This is despite variations of the SMAS technique over the last 20 years. In this study, the nasolabial fold is shown to be part of the overall aging deformity that affects the cheek and perioral region. The key to surgical correction, not previously appreciated, is the complete release of the anterior SMAS from the zygoma and zygomaticus major muscle. This allows a dramatic mobilization of the nasolabial fold without tension. The advanced SMAS is then reattached to the zygomatic periosteum by a series of permanent sutures. Each suture, by its location and direction of lift, corrects one of the four nasolabial regions including the jowl. The relevant anatomy is reviewed and the safety of the procedure is assessed in a personal series of 135 patients. It is concluded that the two principles of this technique, i.e., complete SMAS release and reattachment to the zygoma, safely and effectively achieve a natural-appearing rejuvenation of the cheek and nasolabial fold.
The most common female malignancy, cancer of the breast, affects one in 15 women in Australia. A significant number of those who have had a mastectomy seek the advice of their general practitioner about breast reconstruction. The counsel of the past--that they should think themselves fortunate to have survived the mastectomy and 'leave well enough alone'--is no longer valid. This article discusses the need for reconstruction, its worth and the procedures available.
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The surgical objectives for an improved breast reconstruction are defined. In 30 latissimus dorsi flap breast reconstructions only 1 major flap complication occurred. There were 7 lesser complications involving the donor wound on the back (n = 4), the flap (n = 2) and the mastectomy skin (n = 1). Several refinements in the technique provide for a more accurate replacement of the missing breast yet minimize complications on the back. A one-stage reconstruction (with immediate insertion of the prosthesis) is shown to be safe, except in the presence of recognizable damage to the thoracodorsal vascular pedicle. It is concluded that refinements in the use of the flap allow for a better breast reconstruction and that major complications are avoidable.
Reconstruction of the nipple-areola complex is being performed for about a quarter of postmastectomy breast reconstruction patients. The methods used and results achieved in thirteen reconstructions were reviewed. Full thickness skin grafts from the upper inner thigh were used for the areola, with 100% success. For the nipple proper, most (eight) had a composite graft from the opposite nipple, with 100% take if the dressing was kept in place for 10-12 days. Earlobe tissue made an excellent nipple reconstruction for bilateral cases (four). It is concluded that nipple-areola reconstruction is safe, simple and predictable. A second operation is recommended for this surgery to ensure symmetry of nipple position, a fundamental requirement for a good result.
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This paper reviews a series of 40 consecutive breast reconstructions. Women of all ages, even many years after mastectomy, are seeking this form of rehabilitation. Breast reconstruction is now a practical proposition because of the low rate of complication and the minimal stay in hospital required.
Questions regarding local recurrences are a major concern in considering mastectomy patients for breast reconstruction. A critical analysis of the literature on local recurrences indirectly provides answers to several of these concerns. Local recurrence is a relatively predictable event, and is uncommon in those with a favourable breast cancer. Its presence reflects concurrent systemic disease which is usually lethal within a short time. Concern over subsequent local recurrences should not be a contraindication to breast reconstruction in selected patients.
The anatomical basis and operative technique for insertion of mammary prostheses in the completely submuscular position are described. The results of 38 completely submuscular prostheses used for reconstructive breast surgery form the basis of this report. The two major advantages of the method, freedom from major complications, and a reduced incidence of deforming fibrous capsular contracture, have important implications in reconstructive breast surgery.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The major factor limiting reconstruction of major postmastectomy deformities (especially after a radical mastectomy, such as that of Halsted) has been the lack of a satisfactory flap operation. The latissimus dorsal flap fills this need, as it allows a safe one-stage breast reconstruction, with an improved aesthetic result. It should be considered whenever insufficient chest wall skin remains for a satisfactory reconstruction. The author's technique for performing this flap operation is described, having evolved from cadaver dissections and eight clinical cases.