Septum-Enhanced Mammaplasty in Inferocentral Pedicled Breast Reduction for Macromastia and Gigantomastia Patients.

BACKGROUND: Inferior pedicle and free nipple grafting are commonly used as breast reduction techniques for patients with breast hypertrophy and gigantomastia. Limitations of these techniques are, respectively, possible vascular compromise and total/partial necrosis of the nipple-areola complex (NAC). The authors describe the innovative inferocentral pedicled reduction mammaplasty (ICPBR) enhanced by preservation of Würinger's septum for severe hypertrophic breasts. MATERIALS AND METHODS: Among 287 breast reductions performed between January 2001 and 2015, 83 (28.9%) macromastia and gigantomastia patients met the inclusion criteria (breast volume resection ≥400 g-sternal notch-to-nipple distance ≥33 cm) and were included in the study. Patients were stratified according to pedicle type: Group A (51 patients) underwent ICPBR with Würinger's septum preservation; group B (32 patients) underwent IPBR. Groups were compared for NAC vascular complications, surgical revisions, wound-healing period and patient satisfaction at a minimum 6-month follow-up assessed by a five-category questionnaire (breast size, shape, symmetry, texture and scars appearance), with five Likert subscales (1 = poor to 5 = excellent). Descriptive statistics were reported, and comparisons of performance endpoints between groups were performed using Chi-squared, Fisher's exact and Mann-Whitney U tests, with p value <0.05 considered significant. RESULTS: Group A and group B had, respectively, a mean age of 48.3 ± 12.4 and 50.1 ± 11.7 years, mean BMI of 23.8 and 24.6, mean weight resected of 560 ± 232 g and 590 ± 195 g, mean sternal notch-to-nipple distance of 35.1 and 34.3 cm, average nipple elevation of 9.7 and 9.5 cm. Among group A and group B, NAC complication rates were, respectively, 6.2 and 24.2% (p = 0.03), surgical revision rates were 33.3 and 60% (p = 1.00), healing time was 15.90 ± 3.2 and 19.03 ± 5.9 days (p = 0.002), and mean patient satisfaction scores were 19.9 ± 2.6 and 18.7 ± 3.4 (p = 0.07). CONCLUSIONS: The ICPBR technique enhanced by Würinger's septum preservation was found to be a reproducible and effective procedure for hypertrophic breasted and gigantomastia patients, improving the reliability of the vascular supply to the inferior-central pedicle. The authors do believe this procedure should be regarded as an innovative and safe option giving optimal aesthetic outcomes in this demanding group of patients. 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 .

Borderline Case in Reconstructive Plastic Surgery of the Lower Limb Treated with Bone Drilling and Use of Dermal Regeneration Template.

The traumatic pathology of the lower limb represents a very complex branch of medicine, which, despite the wide presence of guidelines, aimed at regulating the various therapeutic procedures, and is still greatly influenced by random variables and by the multiple responses to treatments. In this report, we present our experience with a borderline case, where the timing of the trauma and the patient's characteristics made it difficult to use the most recommended procedures in trauma management.

Neoadjuvant treatment by ECT in cutaneous malignant neoplastic lesions.

Electrochemotherapy (ECT) is a local treatment and its use has been standardised for cutaneous nodules of any histological origin. In this study, we use ECT as a neoadjuvant therapy to reduce the size of neoplastic lesions to obtain an ideal cleavage plane where vital or very important vascular and/or nervous structures are separated from the tumour, thus allowing a radical surgical excision, which is otherwise unfeasible. In their retrospective study, the authors identified 41 patients who were treated at our institution with neoadjuvant intent. ECT was performed under general (30 patients, 73%), regional (9 patients, 22%) or local anaesthesia with sedation (2 patients, 5%). At a median time of 2 months (range, 0.3-9) after neoadjuvant ECT, all patients underwent surgical intervention to resect the residual tumour. Median reduction of tumour volume after ECT was 55% (range, 10%-65%). After ECT plus surgery, 25 patients (61%) had complete response (CR), 16 patients (39%) partial response (PR). The percentage of CR in patients with larger lesions (>100 mm) was 27%, in patients with smaller lesions (≤100 mm) was 73% (p = 0.0119). Major side effects after ECT were: bleeding and/or ulceration (54%) and pain (59%) naturally resolved within 1-2 months. Side effects observed after surgery were: necrosis of the flap (N = 3), a case of diastasis of the donor site. Median survival time in CR patients was 53 months (range, 4-108), whereas in PR survival was 23 months (range, 5-126), p = 0.0400. ECT represents a safe and effective therapeutic approach that could be effectively used for neoadjuvant purposes.

Skin-reducing mastectomy and direct-to-implant reconstruction in giant phyllodes tumour of breast: case report.

BACKGROUND: The phyllodes tumour of the breast comprises about 0.5% of all neoplasms of the breast. CASE REPORT: we present the case of a female patient (55 years old) suffering from giant phyllodes tumour (>10cm) of the left breast, who underwent Skin Reducing Mastectomy (SRM) and reconstruction with silicone breast implant (Bostwick Technique). DISCUSSION AND CONCLUSION: In selected patients with large sized breasts (C-D cup) and poor surface area of skin involved, a valid technique in the treatment of this pathology is the Skin-Reducing Mastectomy and immediate reconstruction with implants (DTI=direct to implant).

Hemangioma of the oral and perioral region: Nd:YAG vs surgery.

INTRODUCTION: Hemangiomas are very commonly diagnosticated in childhood. The area most affected by this disease is the head and neck. In recent decades, the laser therapy has changed the treatment of hemangiomas through special techniques with advantages in bleeding risk management. MATERIALS AND METHODS: Object of this study is comparing Nd:YAG laser and surgical excision, in terms of aesthetic outcomes, in the treatment of hemangiomas of oral and perioral region. The aim is the comparison between the two techniques in terms of aesthetic outcomes through photographic reportage and clinical supervision by three expert plastic surgeons (observers), unrelated to treatment, through the use of Patient and Observer Scar Assessment Scale. RESULTS: The results of the investigation with POSAS show a better aesthetic result with the use of the Nd:YAG laser compared with excisional treatment with cold blade, both for the patient and for the external examiners. CONCLUSIONS: Nd:YAG laser treatment for hemangiomas of the perioral region is a safe, fast and low complications choice. The lower risk of bleeding allows to use the laser technique even in the clinics not equipped for surgeries offering an important advantage to the operator. The main indication is represented by hemangiomas that cause a psychological and functional discomfort to the patient, such as frequent possibility of ulcerations and bleeding, in which it is clear the benign nature of the lesion. KEY WORDS: Hemangiomas, Laser Therapy, Nd:YAG, Vascular lesions.