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Qi F, Zhang F, Zhang Y, Torres-Guzman R, Chaker SC, Lineaweaver W, Liu J. Surgical Management of Postoperative Nipple Necrosis After Inverted Nipple Correction: Experiences From a Series of 25 Cases. Ann Plast Surg 2024; 93:S43-S46. [PMID: 38775260 DOI: 10.1097/sap.0000000000003966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Abstract
INTRODUCTION The inverted nipple is a condition that affects approximately 10% of women and can have negative cosmetic and psychological implications. Surgical correction is a common approach to address this concern; however, this method can lead to complications, such as nipple necrosis. As comprehensive guidelines are currently lacking for postoperative nipple necrosis management, this study reports our experience in the management of postoperative nipple necrosis following initial attempt at surgical management. METHODS A retrospective chart review was conducted and included female patients who experienced postoperative nipple necrosis after inverted nipple correction between 2018 and 2021. Cases of recurrent nipple retraction following partial necrosis and cases of complete nipple necrosis were evaluated. Recurrent nipple retraction was managed using various inverted nipple correction techniques, while complete necrosis required a modified C-V flap for nipple reconstruction. RESULTS A total of 25 patients with a total of 42 affected nipples were included. Thirteen cases (26 nipples) experienced recurrent nipple retraction following partial necrosis, while 12 cases (16 nipples) exhibited complete necrosis. No significant predictive variables for these complications were found. Notably, all patients achieved successful healing following single-stage surgical repair. At 6 months postoperation, the treated nipples exhibited satisfactory healing and appearance and an absence of infection or papillary necrosis. Seven reconstructed nipples showed a mean loss of projection (2.7 ± 0.98) compared with only 2 nipples in the inverted nipple correction group. CONCLUSIONS Distinguishing between recurrent nipple retraction after partial necrosis and complete nipple necrosis is crucial and should be taken into consideration when managing patients following inverted nipple correction.
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Affiliation(s)
- Fazhi Qi
- From the Plastic and reconstructive surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Feng Zhang
- From the Plastic and reconstructive surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yong Zhang
- From the Plastic and reconstructive surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ricardo Torres-Guzman
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sara C Chaker
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - William Lineaweaver
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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Adebagbo OD, Rahmani B, Park JB, Chen A, Garvey SR, Lee D, Saxena N, Lee BT, Boustany A, Lin SJ, Cauley RP. Effect of pedicle type on breast reduction: Clinical and patient-reported outcomes. J Plast Reconstr Aesthet Surg 2024; 95:7-14. [PMID: 38865843 DOI: 10.1016/j.bjps.2024.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 04/03/2024] [Accepted: 04/05/2024] [Indexed: 06/14/2024]
Abstract
PURPOSE The choice of pedicle in reduction mammaplasty is highly variable with prior studies demonstrating high patient satisfaction in most cases. This study aimed to examine the impact of pedicle type on clinical and patient-reported outcomes in patients undergoing reduction mammaplasty. METHODS A total of 588 patients underwent bilateral reduction mammaplasty with Wise pattern or modified Robertson incision by 13 surgeons at a single institution. Clinical outcomes were compared according to the pedicle type in all patients and BREAST-Q responders (32% response rate). Survey respondents were sub-grouped by resection volume, and the BREAST-Q satisfaction scores were compared. RESULTS Among all included reduction mammoplasties, 439 (75%) were performed using inferior pedicles, and 149 (25%) using superior or superomedial pedicles. Responders and non-responders were similar in preoperative characteristics including age, body measurements, and comorbidities. Although a higher incidence of infection occurred among the responders, clinical outcomes were comparable across all pedicle types. A total of 187 patients completed the BREAST-Q. Compared to the superior pedicle group, respondents in the inferior pedicle group reported higher nipple satisfaction, even when adjusted for resection weight over 500 g. In contrast, the superior pedicle group had better sexual well-being scores, which persisted in resection weight less than 500 g (all p values <0.05). CONCLUSION Inferior pedicles were associated with greater nipple satisfaction and superior pedicles were associated with greater sexual satisfaction. Our findings suggest that those with resections less than 500 g were more satisfied with superior pedicles whereas those with greater resections were more satisfied with inferior pedicles.
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Affiliation(s)
- Oluwaseun D Adebagbo
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; Tufts University School of Medicine, Boston, MA, USA
| | - Benjamin Rahmani
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - John B Park
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Amy Chen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Shannon R Garvey
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Daniela Lee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Nimish Saxena
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; Tufts University School of Medicine, Boston, MA, USA
| | - Bernard T Lee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Ashley Boustany
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Samuel J Lin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Ryan P Cauley
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
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Yiltok SJ, Akintayo AJ, Karago CY, Choji JD, Sankey B, Agada E, Dafong AA, Ezekiel AS, Orkar KS. Reduction Mammoplasty for Macromastia: Our Experience Using the Inferior Pedicle with Inverted-T Skin Resection. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2023; 13:77-83. [PMID: 37538218 PMCID: PMC10395857 DOI: 10.4103/jwas.jwas_30_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/16/2023] [Indexed: 08/05/2023]
Abstract
Introduction Macromastia is a major reason why women seek for breast reduction especially when there are symptoms. Breast reduction is an uncommon procedure in our environment and this is a report of our experience with inferior pedicle with an inverted-T skin resection. Materials and Methods This is a report of breast reductions using the inferior pedicle with an inverted-T skin resection approach that were carried out between 2004 and 2022. The information that was retrieved from the case notes were age, marital status, parity, last child birth, family history of breast enlargement, presenting features, height, weight, the weight of tissue excised, and complications. The data obtained were then entered into the SPSS version 25 (IBM Corp.) software and analysed. Results Seventeen women were managed with an age range of 16-50 years and a mean of 31.06 ± 9.66 years. The most common features at presentation were heavy weight around the chest, backache, shoulder pain, no appropriate brassiere with low self-esteem and self-confidence. Ten had skin changes and recurrent rashes over the breast, whereas four complained of grooves with skin changes. The weight of excised breast tissue ranged from 0.2 to 5.5 kg with an average of 2.18 ± 1.28 kg for the right and 2.05 ± 1.00 kg for the left breast. All except one patient had blood transfusion. The common complications were delayed wound healing (47%) followed by partial wound dehiscence (17.6%), and flap necrosis (11.8%). Except for those with flap necrosis the wounds healed with some having broad scars. Conclusions Patients for breast reduction are mainly due to the symptoms and signs with the associated large breast. The inferior pedicle with inverted-T skin resection is a valuable technique with a very good outcome. To improve access to breast reduction, there is the need to enhance awareness through advocacy using women groups and health education.
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Affiliation(s)
- Simon Jekat Yiltok
- Department of Surgery, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | | | - Christopher Y. Karago
- Department of Plastic Surgery, Prince Mishari bin Saud Hospital, Baljurashi, Bahah Region, Kingdom of Saudi Arabia
| | - Joshua D. Choji
- Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
| | - Babangida Sankey
- Department of Plastic Surgery, Skin 101 Hospital, Maitama, Abuja, Nigeria
| | - Enye Agada
- Department of Surgery, Federal Medical Centre, Makurdi, Nigeria
| | - Atarang A. Dafong
- Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
| | - Anthony S. Ezekiel
- Department of Surgery, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
| | - Kusu Samuel Orkar
- Department of Plastic Surgery, Queen Victoria Hospital, West Sussex, UK
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Sipos K, Kämäräinen S, Kauhanen S. Topical tranexamic acid reduces postoperative hematomas in reduction mammaplasties. J Plast Reconstr Aesthet Surg 2023; 83:172-179. [PMID: 37276736 DOI: 10.1016/j.bjps.2023.04.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 04/12/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Postoperative bleeding requiring reoperation is an untoward event in breast surgery. Topical tranexamic acid (TXA) has been routinely used to reduce the risk of postoperative bleeding in some surgical fields. In breast surgery, it is not routinely used owing to scarce information. We investigated whether the intraoperatively applied topical TXA reduces the incidence of postoperative hematoma in reduction mammaplasty surgeries. METHODS This retrospective, single-center cohort study comprises of 415 consecutive patients who underwent reduction mammaplasty between 2019 and 2021. The prophylactic use of topically applied TXA (20 mg/ml) was implemented as a part of the hospital protocol in November 2020. The patients who were rinsed with TXA before the wound closure were compared with those who were not rinsed. The results were analyzed using statistical tests, two-sided Pearson's Chi-Square and Fisher's exact tests. RESULTS Topical TXA significantly reduced the number of postoperative hematomas requiring evacuation (p = 0.008). In the non-TXA control group, 12 (5.8%) hematomas were observed out of 208 patients. In the topical TXA group, only one (0.6%) hematoma occurred among the 168 patients. A tendency towards fewer wound infections, seromas, and other minor wound-healing problems can also be seen in the topical TXA group (ns). No adverse events of topical TXA were detected. CONCLUSIONS The incidence of postoperative hematomas decreased to a tenth after the introduction of topical TXA in reduction mammaplasty surgeries. This simple procedure may save patients from reoperations owing to bleeding. Randomized controlled trials are warranted.
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Affiliation(s)
- Krisztina Sipos
- Department of Musculoskeletal and Plastic Surgery, University of Helsinki and Helsinki University Hospital, Jorvi, Finland.
| | - Satu Kämäräinen
- Department of Anesthesiology and Intensive Care Medicine, Helsinki University Hospital, Jorvi, Finland
| | - Susanna Kauhanen
- Department of Musculoskeletal and Plastic Surgery, University of Helsinki and Helsinki University Hospital, Jorvi, Finland
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Kachare SD, Kachare MD, Vivace BJ, Barrow BE, Ablavsky M, Abell S, Choo JH, Wilhelmi BJ. The 5 D's to Dunk the Dog: A Retrospective Clinical Review to Prevent Dog-Ear Contour Abnormalities in Vertical Breast Reductions and Breast Lifts. EPLASTY 2023; 23:e13. [PMID: 36919153 PMCID: PMC10008304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Background In 2020, reduction mammoplasties and mastopexies comprised 34.2% of all breast surgeries performed by plastic surgeons. Various approaches for the skin incision of these procedures have been described. The vertical pattern has become an increasingly popular option due to its lower scar burden. However, it is prone to dog-ear formation along the caudal aspect of the incision. Herein, we describe 5 technical steps to eliminate the dog-ear in patients undergoing vertical mammoplasties. Methods A retrospective chart review was performed on all patients who underwent vertical breast reduction and mastopexy between the years 2008 and 2020 performed by the senior author. The 5 steps employed in eliminating the dog-ear are delineated and depicted pictorially. Results A total of 58 patients and 89 breasts were operated upon. A majority of 66.6% were Caucasian, 33.3% were African American, and 1 patient was of Hispanic descent. The mean age was 53.2 years (19-73 years), and average BMI was 31.5 kg/m2 (21.3-42.7 kg/m2). The average resection weights for reduction and mastopexy patients were 479 grams (100-1500 grams) and 58.1 grams (18-100 grams), respectively. Mean follow-up was 10.5 months (1-35 months). Only one patient developed a dog-ear (1.7%) in bilateral breasts (2.2%); however, the patient did not request a revision. Our revision rate over 13 years remained at 0%. Conclusions Utilizing these 5 technical steps reduces the risk of dog-ear deformity and thereby diminishes the overall need for revisional surgery in patients undergoing short scar vertical mammoplasties.
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Affiliation(s)
- Swapnil D Kachare
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Milind D Kachare
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Louisville, Louisville, KY
| | - Bradley J Vivace
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO
| | - Brooke E Barrow
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University, Durham, NC
| | | | - Sara Abell
- Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville, KY
| | - Joshua H Choo
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Louisville, Louisville, KY
| | - Bradon J Wilhelmi
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Louisville, Louisville, KY
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Seswandhana R, Anzhari S, Dachlan I. A successful breastfeeding after vertical scar reduction mammaplasty with superior pedicle: A case report. Ann Med Surg (Lond) 2020; 60:600-603. [PMID: 33304571 PMCID: PMC7708693 DOI: 10.1016/j.amsu.2020.11.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/12/2020] [Accepted: 11/14/2020] [Indexed: 11/28/2022] Open
Abstract
Introduction Most of patients undergo reduction mammaplasty for aesthetic or therapeutic reasons without consider the effect on breastfeeding function. Vertical scar mammaplasty with superior pedicle is expected to be a breast reduction procedure that can keep maintain the function of breastfeeding. This is the first recorded report of breastfeeding after vertical scar reduction mammaplasty with superior pedicle in Indonesia. Presentation of case A 23 years old woman presented to the outpatient clinic with enlargement of both breast for 3 years. Physical examination showed bilateral breast enlargement. No tenderness, nodules, nor axillary lymph node enlargement were found. The patient was managed with vertical scar mammaplasty with superior pedicle. The patient was followed up with complication of skin excess and scarring on the bilateral submammary folds. We performed excision and resection procedures to eliminate the skin excess and scars without further complications. The patient was married and gave birth to her first and second child after two and five years following mammaplasty. The patient was able to provide exclusive breastfeeding for both of her children. Discussion Vertical scar mammaplasty with superior pedicle surgery is a surgical technique that combines a superior pedicle for the areola and performs a central-inferior quadrant resection for breast reduction. It only takes the tissue and glands that are located in the lower quadrant and still maintains the surrounding tissue and glands. This technique also maintains the integrity of nipple-areola complex (NAC) which also important in the lactation process Conclusion Vertical scar mammaplasty with superior pedicle can be one of the superior techniques in breast reduction which can maintain the breastfeeding function thereby increasing patient satisfaction. Breastfeeding after Vertical Scar Reduction Mammaplasty with Superior Pedicle: This procedure only takes the tissue and glands that are located in the lower quadrant. By preserving the superior pedicle it can maintains the integrity of nipple-areola complex (NAC). Keep the breastfeeding function thereby increasing patient satisfaction.
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Affiliation(s)
- Rosadi Seswandhana
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Sharfan Anzhari
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Ishandono Dachlan
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
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De Biasio F, Zingaretti N, De Lorenzi F, Riccio M, Vaienti L, Parodi PC. Reduction Mammaplasty for Breast Symmetrisation in Implant-Based Reconstructions. Aesthetic Plast Surg 2017; 41:773-781. [PMID: 28374302 DOI: 10.1007/s00266-017-0867-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 03/21/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Healthy breast surgery constitutes an important step to achieve symmetry in unilateral implant-based reconstructions. We analysed long-term results of breast symmetry obtained with reduction mammaplasties, and we evaluated whether different glandular pedicles may better preserve long-term stability. METHOD Between 2006 and 2012, 90 patients underwent mastectomy and immediate reconstruction with tissue expanders and simultaneous contralateral reduction mammaplasty. In 30 patients, a superior nipple-areola pedicle was harvested (GROUP A), in another 30 patients a medial pedicle was performed (GROUP B), and an inferior pedicle was used in the remaining 30 women (GROUP C). An objective evaluation of the reconstructed breast and the reduced one was performed at 1 and 24 months after surgery. One-way ANOVA and Tukey's HSD tests were used for analysis. Furthermore, three independent plastic surgeons filled out a questionnaire to assess aesthetic results. RESULTS Measurements of the reconstructed breasts showed similar variations between 1- and 24-month evaluations within the three groups with no significant difference (P value >0.05). Measurements of the reduced breast at the 1- and 24-month follow-up (Tukey's test) revealed significant differences among the three groups. Patients from GROUP C showed a significantly higher decrease in Δ nipple-lower clavicle margin distance and Δ nipple-inframammary fold compared to GROUP A and B (P value = 0.01). Surgeons' assessments revealed no statistically significant difference between the three groups. CONCLUSION Superior or medial pedicle reduction mammaplasties seem to better preserve breast shape and position, and they maintain a more similar appearance to the contralateral prosthetic breast over time. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Fabrizio De Biasio
- Department of Plastic and Reconstructive Surgery, Breast Unit, University of Udine, C/o Ospedale "S. Maria Della Misericordia", Piazzale Santa Maria Della Misericordia 15, 33100, Udine, Italy
| | - Nicola Zingaretti
- Department of Plastic and Reconstructive Surgery, Breast Unit, University of Udine, C/o Ospedale "S. Maria Della Misericordia", Piazzale Santa Maria Della Misericordia 15, 33100, Udine, Italy.
| | - Francesca De Lorenzi
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, Milan, Italy
| | - Michele Riccio
- Department of Reconstructive Plastic Surgery-Hand Surgery, Breast Unit, AOU "Ospedali Riuniti", Ancona, Italy
| | - Luca Vaienti
- Department of Plastic Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Pier Camillo Parodi
- Department of Plastic and Reconstructive Surgery, Breast Unit, University of Udine, C/o Ospedale "S. Maria Della Misericordia", Piazzale Santa Maria Della Misericordia 15, 33100, Udine, Italy
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Kumar A, Kalliainen LK. Cleft Lip Surgical Intervention in Resource Constraint Settings: A Case Report. Health (London) 2016. [DOI: 10.4236/health.2016.85050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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