Gynecomastia is a common deformity encountered by plastic surgeons. The appropriate location of the nipple-areola complex is a major determinant of the aesthetic success of the procedure. To study the natural location of the nipple-areola complex in the normally built male, 50 nonobese men with no evidence of gynecomastia and an average age of 27.9 years were examined. Three ratios were calculated and found to be relatively constant; they were the ratio between the height of the nipple and the height of the patient, the ratio between the distance between the nipples and chest circumference, and the ratio between the suprasternal notch-to-nipple distance and the height of the patient. Using these three parameters, a method of locating the nipple-areola complex on the male chest wall was devised. The method is advocated as a reliable, simple, and useful technique.
The motivational factors were divided into three categories: (1) independent decision, (2) observation of previous patients, and (3) external influences. The results of the percentage breakdown of the patients in our present study are compared with previous results are presented in 1983 in this journal. Once again, the independent decision of the patient was the most important factor in deciding to have cosmetic rhinoplasty, followed by their observation of results in other patients. These two factors have been the motivation in approximately 80% of all the patients in all three studies. The age breakdown of cosmetic rhinoplasty patients shows that after the age of 21, as patients get older, a smaller and smaller percentage of patients was motivated for surgery by independent decision alone. These older patients need external influences to motivate them to have surgery. In most cases, the desire for surgery had smoldered in them since adolescence, and they needed an external "OK" to have it done.
Basal cell carcinoma (BCC) is the most common skin tumor in Caucasians. Loss of heterozygosity (LOH) of chromosome 9 (9q22.3) is common in BCCs, and indirectly implies their monoclonal origin. Although BCCs are considered monoclonal tumors, the clonal origin of anatomically distinct tumors in the same patient was rarely investigated. Forty-one anatomically distinct BCCs from 15 female patients were genotyped for LOH at chromosome 9q22.3, and the inactivation pattern of X-chromosome using the androgen receptor polymorphic site. Overall, 11 women with 30 tumors were heterozygous (informative) with either one of the two 9q markers or the androgen receptor polymorphism. LOH of 9q was detected in 20 tumors from seven patients, and in all tumors derived from the same patient, the same allele was lost. An identical X-chromosome inactivation pattern was noted in all four tumors taken from one patient, and in another informative patient, one tumor demonstrated LOH and the other retained it. In five tumors from two patients, there was no evidence of monoclonality using either technique. We conclude that the majority of anatomically distinct BCCs are monoclonal neoplasms and may represent expansion of the same clone.
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