breast/aesthetic Flashcards
Indications for breast radiation
- positive surgical margins
- tumor size >5cm
- > 4 positive lymph nodes
- T4 disease
botox mechanism of action
- Binds to presynaptic cholinergic nerve terminals and inhibits the release of acetylcholine.
- In Raynauds phenomenon periarterial injection of botox inhibits Rho/Rho kinase activity as well as substance P secretion and receptor sensitivity which decreases activity of chronically upregulated C-fiber nociceptors.
- Effects potentiated by penicillamine, quinine, calcium-channel blockers and aminoglycosides.
pinch test cutoff for sub glandular implants
at least 2cm
Hormonal effects on breast
- Estrogen – ductal proliferation
2. Progesterone – glandular proliferation and periductal stromal development
Mechanism of action and effects of retinoids (topical)
Enter cells through nonreceptor-mediated endocytosis then carried to nucleus on cellular retinoic acid binding proteins (CRABP) and exert effect through binding to retinoic acid receptors and retinoid X receptors. The Retinoid-receptor complex binds to the appropriate promoter gene resulting in protein production. Also inhibit AP-1 transcription factor binding to DNA to reduce protease activity. Results in:
- Increase quantity of collagen (type I, III, VII)
- Improved collagen organization
- Improved organization of elastic tissue
- Epidermal hyperplasia
- Increased mucin deposition
- Decreased melanin
- Decrease coenocyte adhesion in the stratum corneum, reducing follicular occlusion and comedone formation.
Isotretinoin
atrophy of pilosebaceous glands and attenuation of secretion of sebum
Hydroquinone
inhibits oxidation of tyrosine to 3,4-dihydroxyphenylalanine which suppresses melanocytes
Jessner solution
- Light peel.
- Resorcinol, salicylic acid, lactic acid, ethanol
Cutis laxa
- NOT a contraindication to aesthetic surgery. Would healing not effected.
- Degeneration of elastic fibers or nonfunctioning elastase inhibitor so hypoelastic skin does not spring back.
- In AD form only skin affected. In AR or X-linked form congenital heart disease, hernias, aneurysms, emphysema and pneumothorax possible.
- appearance of premature aging
Ehlers-Danlos
- variable inheritance
- connective tissue disorder, collagen cross-linking problem
- skin laxity, hyperextensibility, thin and friable skin, joint hypermobility, aortic aneurysms, ventral hernias, redundant periocular skin (epicentral folds, wide nasal bridge)
- Wound healing is poor, hypertrophic scarring, so contraindication for elective surgery.
Werner syndrome
- AR.
- Pigmented, indurated, plaque-containing skin, osteoporosis, muscle atrophy, growth retardation, cardiovascular disease, diabetes. Small vessel angiopathy
- premature aging
- high pitched voice, baldness
- poor wound healing so contraindication for elective surgery.
Progeria
- AR.
- Premature aging.
- Lax, excess skin, loss of subcutaneous fat, growth retardation, craniosynostosis, prominent ears, micrognathia, baldness, cardiac disease.
- premature death
- Wound healing poor, contraindication for elective surgery.
Nipple innervation
Lateral branches of 3-5 intercostal course deep within pec fascia
Anterior branches of 3-5 intercostal course superficial (so maintained in NSM and superiomedial pedicle reduction).
pseudoxanthoma elasticum
- skin laxity from calcification and degenration/fragmentation of elastic fibers
- cobblestone yellowish plaques characteristic
- wound healing normal
- ocular and cardiac manifestations
