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BACKGROUND: Many reports have described various technical aspects of reduction mammaplasty and mastopexy procedures. The authors present their technique, which combines a number of techniques already described in the literature regarding repositioning of the nipple-areola complex, reduction of the diameter of the base of the breast, and long-term retention of mammary cone projection. This study evaluated the results for patients of various ages and phenotypes in terms of scar dimensions, breast positioning, and patient satisfaction in the short, medium, and long terms. METHODS: Mammaplasty was performed using the inverted T technique. The preoperative skin markings differed from those described in the literature in that they did not use the future position of the nipple-areola complex as the main reference point. A running circular suture was used to fix the breast to the pectoralis major fascia and to reduce the diameter of the base of the breast, resulting in a reduced horizontal scar in the inframammary fold. The skin-marking technique allowed for better postoperative breast symmetry regardless of preoperative variations in shape and volume. RESULTS: The outcomes were considered satisfactory in the majority of cases by both the patient (p = 0.78) and the physician (p = 0.58). Adequate fullness of the upper pole was maintained in 94.7 % of the breasts. CONCLUSIONS: The described technique results in a reduced diameter of the base of the breast, repair of ptosis, repositioning of the nipple-areola complex, and long-term upper pole fullness. Complications can occur with any technique, but it is important to choose a technique with good quality outcomes overall. 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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Introdução: As malformações vasculares congênitas do tipo capilar têm seus melhores resultados até o momento com o laser de corante. Nós associamos, em um único equipamento, o laser ND:Yag 1064 nm de pulso longo e a luz intensa pulsada, para o tratamento de lesões superficiais e profundas. Método: Dezessete pacientes foram tratados com a associação descrita em regime ambulatorial, com anestesia tópica, apenas em intervalos mensais, pelo mesmo cirurgião. O equipamento utilizado foi a plataforma Synchro (DEKA), com a ponteira de 4 mm de diâmetro e fluência de 110 J/cm2 para o laser ND:Yag 1064nm. Para a luz intensa pulsada foi utilizado um filtro de corte de 550 nm, a ponteira de 46 x 10 mm e 21 J/cm2 de fluência, divididos em dois disparos. Os resultados foram avaliados clinicamente e por meio de fotografias, em conjunto com os pacientes. Resultados: Dentre os dezessete pacientes tratados, quatro resultados foram considerados excelentes, nove, bons, quatro, regulares e nenhum insuficiente. Conclusão: O tratamento pode ser realizado adequadamente com anestesia tópica em regime ambulatorial. A associação das duas tecnologias possibilitou a obtenção de resultados satisfatórios e, provavelmente, é mais uma técnica no tratamento destas lesões.

Introduction: Congenital vascular malformations up to know, have their best results with dye laser. We associate, in single equipment, long pulse Nd:Yag 1064 nm laser and intense pulsed light, for simultaneous treatment of the superficial and deep lesions. Methods: Seventeen patients were treated with the association described in an office basis with topical anesthesia only at monthly intervals by the same surgeon. The equipment utilized was the Synchro Platform (DEKA) with a 4 mm diameter spot size and fluency of 110 J/cm2 for the ND:Yag 1064 nm laser. For the intense pulsed light was utilized a 550 nm cutoff filter with a 46 x 10 mm spot size and 21 J/cm2 as fluency, divided in two shots. Results were evaluated through clinical and photographical analysis together with the patient. Results: Among the seventeen patients treated, four results were considered excellent, nine, good,four, regular and none insufficient. Conclusion: The treatment can adequately be done in an office basis with topical anesthesia. Association of the two different technologies got a satisfactory result and it is probably one more technique for treating such lesions.

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INTRODUCTION: A survey of surgeons in Brazil on their experience with PERTHESE silicone breast implants was performed. MATERIALS AND METHODS: Surgeons that used PERTHESE implants between 2002 and 2008 were surveyed on the shape and volume of the implants used, surgical incision site, surgical plane of insertion, key postoperative complications, and surgeon and patient satisfaction. RESULTS: The survey had a response rate of 20%, with ten surgeons reporting data on 1447 patients. The majority of the implants used were 200-300 cc, round, and high profile. Preference for the traditional inframammary incision site (47% of patients) was favored over transaxillary (33%) and periareolar (19%), and both subglandular (55%) and submuscular (44%) planes of insertion were used. Over 97% of surgeons and patients were satisfied with the results and surgeons indicated that the implants were easy to use. CONCLUSIONS: This review demonstrates that these implants are safe, maybe easier to introduce than other implants, and result in a high level of surgeon and patient satisfaction.

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Introdução: A oftalmopatia de Graves é doença auto-imune. A cirurgia para expandir e descomprimir a órbita está reservada a apenas 5% dos casos. Foi realizada uma revisão da literatura referente a fisiopatologia da doença, indicação do tratamento cirúrgico, técnicas existentes, bem como descrição de uma paciente com lesão iatrogênica cirúrgica. Relato do caso: Paciente com grave deformidade iatrogênica pós-cirurgia, para corrigir a oftalmopatiade Graves. Apresentava, exoftalmia, proptose bilateral e abertura iatrogênica ao nível do sulco das pálpebras superiores, exposição crônica da córnea. Foi tratada cirurgicamente com:osteotomia das paredes das órbitas e ressecção de gordura periocular e síntese dos tecidos palpebrais em três diferentes planos e dispostas de forma não coincidentes. Obtidos completo restabelecimento da integridade palpebral e regressão do exoftalmo. Conclusão: Revisão da literatura mostra que a oftalmopatia de Graves deve ser tratada em 95% dos casos clinicamente. O tratamento cirúrgico está reservado para os casos graves e na fase quiescente cicatricial da doença. A indicação cirúrgica inadequada do presente caso na primeira cirurgiadeve servir a todos nós de aprendizado. A expansão de três paredes orbitárias associada à lipectomia foi importante para aliviar a pressão sobre as pálpebras e corrigir a iatrogenia.

Introduction: Graves ophthalmopathy it is an autoimmune disease. Surgical treatment for expansion and decompression of the orbits are indicated in 5% of the patients. A literature revision has been done, related to the physiopathology, surgical treatment indication, criticalreview of the existing techniques and description of an iatrogenic surgical lesion and how it was corrected. Case report: Patient with an iatrogenic severe deformity, after surgery to correct Graves ophthalmopathy disease. She had bilateral exophthalmia and proptose and the overall thickness of the superior eyelids were open, with chronic exposition of the cornea. It was treated surgically with orbital walls osteotomy and orbital fat resection and synthesisof the eyelids tissues in three different planes in a way to avoid coincident plane suture. It was possible to obtain complete reestablishment of the continuity of the eyelid and regression of the exophthalmia. Conclusion: Literature revision showed that GravesOphthalmopathy should be treated clinically in 95% of the cases. Surgical treatment is indicated only for severe cases and in the resting healing phase of the disease. Improper surgical indication of the present case, at the first operation, should be of a teachingexperience to all of us. Surgical expansion of three walls of the orbits associated to orbital lipectomy was important to reduce the pressure over the eyelids and correct the iatrogenia.

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