"The Chignon Mastopexy": A Double Glandular Suspended Flaps for an Auto-Augmentation Effect

Comparison of Classic Mastopexy Method with Double-Pedicled Auto-augmentation Mastopexy with Conic-Shaped Modified Inferior Butterfly Flap

BACKGROUND

In mastopexy surgery, extra skin and a specific amount of breast tissue are resected. Resected breast tissue is not in a large amount as in reduction surgery. In this study, we have investigated the results of an auto-augmentation mastopexy technique involving use of a superior pedicled mastopexy with conic-shaped inferior butterfly flap for augmentation without implant or fat injection.

METHODS

A total of 80 patients, 40 patients in each group, were included in the study. In the first group, double-pedicled auto-augmentation mastopexy with conic-shaped modified inferior butterfly flap technique was used. In the second group, conventional superior pedicled wise-pattern mastopexy was utilized. The results were evaluated from photographic measurements performed from standardized preoperative and postoperative lateral photographs.

RESULTS

No major complications were seen such as partial or total areola necrosis or breast volume loss. None of our patients has made a return with request for revision surgery. Minor complication seen in several patients was resolved with early intervention. The preoperative and postoperative photographic measurements of breast projection, upper pole projection, nipple position and lower pole level from preoperative and postoperative standardized lateral photographs revealed no significant difference between the groups.

CONCLUSION

We obtained highly satisfactory results for our patients. Following the surgery, our patients protected the cup sizes of their bra. In spite of the fact that there was no real augmentation performed in this procedure, effective straightening and the compact breast structure patients that achieved were highly successful in creating an augmented breast image.

LEVEL OF EVIDENCE III

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Parallel Rap1>RalGEF>Ral and Ras signals sculpt the C. elegans nervous system

Ras is the most commonly mutated oncogene in humans and uses three oncogenic effectors: Raf, PI3K, and RalGEF activation of Ral. Understanding the importance of RalGEF>Ral signaling in cancer is hampered by the paucity of knowledge about their function in animal development, particularly in cell movements. We found that mutations that disrupt function of RalGEF or Ral enhance migration phenotypes of mutants for genes with established roles in cell migration. We used as a model the migration of the canal associated neurons (CANs), and validated our results in HSN cell migration, neurite guidance, and general animal locomotion. These functions of RalGEF and Ral are specific to their control of Ral signaling output rather than other published functions of these proteins. In this capacity Ral functions cell autonomously as a permissive developmental signal. In contrast, we observed Ras, the canonical activator of RalGEF>Ral signaling in cancer, to function as an instructive signal. Furthermore, we unexpectedly identified a function for the close Ras relative, Rap1, consistent with activation of RalGEF>Ral. These studies define functions of RalGEF>Ral, Rap1 and Ras signaling in morphogenetic processes that fashion the nervous system. We have also defined a model for studying how small GTPases partner with downstream effectors. Taken together, this analysis defines novel molecules and relationships in signaling networks that control cell movements during development of the nervous system.