Augmentation Rhinoplasty and Centrofacial Lipofilling: Our Experience (ARCL).

Introduction: Augmentation rhinoplasty traditionally represents a serious challenge for plastic surgeons. The association with centrofacial lipofilling is a great approach to achieve harmonious, aesthetic results. The aim of this article is to describe our personal association between Augmentation Rhinoplasty and Centrofacial Lipofilling (ARCL) in non-Caucasian patients. Materials and Methods: In this study, we retrospectively reviewed patients treated with ARCL at our institution between January 2019 and December 2023. We described our personal approach and technique. At a minimum follow-up time of one year, post-operative pictures were taken, and patients were reassessed, evaluating aspects such as global symmetry, shape and contour of the nose, and facial harmony and rejuvenation; finally, patients' satisfaction was investigated according to the ROE questionnaire and the modified S-GAIS. Results: A total of 307 patients were included in the study. They reported a significant satisfactory aesthetic result in nasal image and facial harmony, as the mean postoperative ROE and S-GAIS score show. None of the grafts extruded or collapsed. Wounds healed without reported major infection. Conclusions: This study has demonstrated that ARCL is a safe approach that contributes to improve functional and aesthetic outcomes, has a high patient satisfaction rate, and limited post-operative complications.

Selective Capsulotomies and Partial Capsulectomy in Implant-Based Breast Reconstruction Revision Surgery.

Background: Breast cancer with about 2.3 million diagnoses and 685,000 deaths globally is the most frequent malignancy in the female population. Continuous research has led to oncological and reconstructive advances in the management of breast cancer, thus improving outcomes and decreasing patient morbidity. Nowadays, the submuscular expander and prosthesis (E/P) implant-based breast reconstruction (IBR) accounts for 73% of all reconstructions. Despite its widely accepted efficacy, the technique is not free from complications and up to 28% of cases require revision surgery for mechanical complications such as capsular contracture, implant displacement/rotation, and implant rupture. With this study, the authors report their experience in the management of E/P IBR revision surgery through the technique of Selective Capsulotomies (SCs) and Partial Capsulectomy (PC). Methods: A retrospective study was conducted on patients who had previously undergone E/P IBR and presented for revision reconstruction between January 2013 and May 2023 at the Department of Plastic Surgery of the University of Siena, Italy. Reasons for revision included capsular contracture, implant displacement/rotation, and implant rupture. Revision reconstructions involved SC and PC with implant replacement. Fat grafting was also considered. The complication rate was evaluated by analysis of patients' medical records. Patients' satisfaction with the treatment was assessed through a specific questionnaire. Results: 32 patients underwent revision surgeries. No early complication occurred. Recurrence rate was assessed at 19% with average follow-up of 59 months (range: 13-114 months). The average time between revision surgery and recurrence was 3 years (range: 1-6 years). 23 patients answered the questionnaire and were overall satisfied with the treatments (8.29/10). Conclusions: SC possibly associated to PC is a valuable option for E/P IBR revision surgery with minimal complications, reduced surgical trauma, short operating time, and relatively low recurrence risk. In addition, treated patients are overall satisfied with the results over time.

Periocular sebaceous carcinoma: updates in the diagnosis, treatment, staging, and management.

Periocular sebaceous carcinoma (PSC) is a rare, aggressive, and potentially metastatic adnexal malignancy. Due to the ability of PSC to resemble several benign and malignant conditions, diagnosis is often delayed or mistaken. In addition, even with a known diagnosis, choosing the right treatment is still an open debate. For this reason, we decided to review the most up-to-date literature on PSC and propose a dedicated procedural protocol to help clinicians when dealing with PSC. A PubMed search was carried out using the terms "Sebaceous Carcinoma", "Adnexal Periocular Cancer", "Sebaceous Carcinoma AND eyelid", "Periocular Sebaceous Carcinoma", and "Ocular Adnexa". Pertinent studies published in English from 1997 up to December 2022 were compared to the selection criteria and if suitable, included in this review. Through the initial search, 84 articles were selected. Of these, 36 were included in the final study. Several papers explored different diagnostic and therapeutic strategies regarding PSC diagnosis and management. In light of the current literature review and the multidisciplinary experience of three clinical centers, a dedicated procedural protocol is proposed. PSC diagnosis may be achieved through accurate clinical evaluation, but it requires histopathologic confirmation, which can be challenging. Dermoscopy, in vivo reflectance confocal microscopy, and optical coherence tomography may facilitate PSC clinical examination, while immunohistochemistry stains may support histological diagnosis. Appropriate disease staging is necessary before choosing the treatment, as local disease requires radically different treatment compared to advanced disease. In addition, recent innovations in nonsurgical treatments, including radio-chemotherapy, immunotherapy, and targeted therapy, may be a viable option in the most challenging cases.

Flowchart in Post-Bariatric Surgery: A Research for the Appropriate Type and Timing of Plasties Reshaping the Body.

INTRODUCTION: Obesity is a chronic disease with significant health implications. Bariatric surgery is an effective treatment for obesity-related conditions. However, the timing of post-bariatric body contouring surgery remains uncertain. MATERIALS AND METHODS: We conducted a retrospective study of 1336 patients who underwent bariatric surgery. We analyzed weight trends and variations after different types of bariatric procedures. The Pittsburgh Index was used to evaluate body contouring outcomes. RESULTS: The majority of patients were women, and sleeve gastrectomy was the most common procedure. Weight loss varied depending on the surgery type, with different outcomes for male and female patients. The Pittsburgh Index remained stable in most cases. CONCLUSION: Our findings suggest that the timing of body contouring surgery should be tailored to the type of bariatric procedure performed. Abdominoplasty is recommended as a last procedure for sleeve gastrectomy patients, while gastric bypass patients are suitable candidates for early abdominoplasty. Biliopancreatic diversion patients should stabilize their weight before abdominoplasty. The Pittsburgh Index is a valuable tool for assessing the timing of post-bariatric plastic surgery. Further research is needed to optimize surgical planning and outcomes. LEVEL OF EVIDENCE V: 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 .

Advances on Capsular Contracture-Prevention and Management Strategies: A Narrative Review of the Literature.

Capsular contracture (CC) is the most relevant complication of both aesthetic and reconstructive breast implant surgery. For many years, experimental and clinical trials have attempted to analyze CC risk factors, clinical features, and appropriate management strategies. It is commonly accepted that a multifactorial etiology promotes CC development. However, the heterogeneity in patients, implants and surgical techniques make it difficult to suitably compare or analyze specific factors. As a consequence, discordant data are present in literature, and a true systematic review is often limited in its conclusions. Hence, we decided to present a comprehensive review of current theories on prevention and management strategies, rather than a specific "solution" to this complication. Methods: The PubMed database was searched for literature regarding CC prevention and management strategies. Pertinent articles in English, published before December 1, 2022, were compared with selection criteria and eventually included in this review. Results: Through the initial search, 97 articles were identified, of which 38 were included in the final study. Several articles explored different medical and surgical preventive and therapeutic strategies, showing numerous controversies on appropriate CC management. Conclusions: This review provides a clear overview of the complexity of CC. The wide variety of clinical situations in term of patients, implants, and surgical techniques prevent the standardization of CC management strategies. By contrast, a patient-customized approach should be preferred, and different strategies should be considered depending on the specific case. Further research is desirable to better ascertain evidence-based protocols with regard to CC prevention and treatment.

Erdheim-Chester Disease of the Breast: First Review and First Case of Isolated Severe Gynecomastia.

(1) Introduction: Erdheim-Chester disease (ECD) is a life-threatening condition and often a diagnostic challenge. It has recently been classified as a hematopoietic tumour, and the cases of ECD reported in the literature has dramatically increased during the last 15 years. (2) Methods: We describe the case of a 57-year-old male patient with severe gynecomastia, with a detailed description of his diagnostic iter and consequent surgical operation. We provide the first systematic review of the literature of breast involvement in ECD, following PRISMA guidelines, including 13 studies and 16 patients. (3) Results: Our report resulted to be the first case of gynecomastia as a single clinical and imaging feature of ECD described in English literature. A total of 81.3% of patients included were female. Among them, 76.9% had unilateral and nodular presentation, while male patients presented bilateral heterogeneous breast enlargement. Globally, 87.5% expressed breast alterations as their first manifestations of ECD. Only 50% presented skeletal involvement. (4) Conclusion: The reported case represents a unique addition to the literature. We found two different patterns in ECD-related breast involvement between male and female patients, an unusual M/F ratio, and a lower rate of bone involvement. Breast involvement is frequently the first clinical feature; therefore, breast caregivers should be aware of this dangerous and most likely underestimated condition.

Breast cancer in pregnancy: concurrent cesarean section, nipple-sparing mastectomy, and immediate breast reconstruction-case report.

Background: Pregnancy-associated breast cancer (PABC), with an incidence rate from 1:3,000 to 1:10,000 deliveries, is the most frequent cancer during pregnancy. PABC appropriate management must take into consideration both the maternal oncological safety and the fetal health, thus posing a challenge for the mother, the baby, and the clinicians. The treatment should adhere as closely as possible to the breast cancer (BC) guidelines. Therefore, surgery is a mainstay, and, when mastectomy is required, breast reconstruction (BR) is a topic of debate. To minimize the risks to the baby, most surgeons postpone BR to delivery. However, a delayed breast reconstruction (DBR) could affect the outcome. In the present case, we report cesarean section concurrent with mastectomy and immediate breast reconstruction (IBR). Methods: A 37-year-old patient, at the 36th week of pregnancy with PABC, underwent simultaneous cesarean delivery, nipple-sparing mastectomy, and IBR. To minimize risks for the newborn, cesarean was firstly performed under spinal anesthesia. Immediately after, breast surgery, including mastectomy and IBR, was performed under general anesthesia. Partial submuscular IBR with an acellular porcine dermal matrix concluded the surgical procedure. Lactation was inhibited, and adjuvant chemotherapy and hormone therapy were administered to the patient. Results: In a single surgical session, cesarean delivery, subcutaneous mastectomy, axillary dissection, and IBR were successfully carried out. No early or late postoperative complications were reported for both the patient and the newborn. Histopathological investigation reported a multifocal and multicentric infiltrating ductal carcinoma. After a 6-year follow-up, the patient is alive and well. Conclusion: To the best of our knowledge, this is the first reported case of concomitant cesarean delivery, PABC mastectomy, axillary dissection, and IBR. This surgical strategy allowed PABC treatment by the BC guideline, minimizing the newborn's disadvantage and permitting, at the same time, the best final BR outcome.

Target volume size effect on comparison of dynamic arc treatment plans computed using flattened and unflattened 6MV beams.

INTRODUCTION/BACKGROUND: In conventional linear accelerators, to obtain flat profiles leading to uniform dose distribution in homogeneous medium, the flattening filter is usually applied on the beam path. In recent years, to obtain higher dose rates, there have been the options of flattening filter free (FFF) beams and it has been noticed that these have many advantages. The aim of this study was to clearly underline the advantages and the drawbacks of flattened filter free (FFF) beams in comparison with the flattening filter (FF) beams for different clinical contexts (planning target volumes locations). METHODS: Two groups (planned with auto-planning VMAT, full and partial arcs) of eight patients each were analyzed: Group I (small planning target volume PTV, with average volume 48.9 ±44.4 cm3), Group II (large PTV, with average volume 532.4 ±368.8 cm3). Both beam modalities 6MV and 6MVFFF were compared in terms of Dmax, D95%, D1cc, D2cc, homogeneity index (HI), number of monitor units (MU), treatment delivery time. RESULTS: Using the 6MVFFF, the treatment delivery time was significantly reduced (p<0.05). For larger PTVs, the number of MU increased by more than twice, and the p-value shown a significant difference (p= 0.008). The value of Dmax increased by 4%. On the contrary, for small volumes, the results were quite similar from 6MVFFF to 6MV except some differences in terms of MU. CONCLUSION: It is recommended to use 6MVFFF beam with small PTV volumes. Dose distributions are almost the same as with 6MV and there is a significant reduction of the treatment delivery time up to 57%. Due to the dose profile shape in FFF mode, the dose is lowered beyond the central axis for the FFF beams, and the additional MU allows the dose to be delivered away from the beam axis.

The Jaws Brachioplasty: An Original Technique: Improving Aesthetic Outcomes in Arm Lift Procedures.

(1) Background: The increase in the number of bariatric surgery procedures has led plastic surgeons to look for new approaches to improve outcomes of body-contouring surgeries. A major concern in brachioplasty is the scarring process. Here, we propose a novel technique to minimize the incidence of pathological or unsatisfactory scars from brachioplasty. A video of the entire procedure is provided. (2) Methods: From January 2016 to August 2020, we performed the "Jaws" brachioplasty on 16 post-bariatric patients. We evaluated the effectiveness of the technique through pre- and postoperative assessments by patients and surgeons, the Vancouver Scar Scale, and the detection of major and minor complications within 12 months of follow-up. (3) Results: Thirteen patients were female and three were male, with a mean age of 32.5 ± 6.8 years (range: 22-47 years). The BODY-Q© Arms Section scores improved significantly, with no incidence of major or minor complications over 1 year of follow-up, and favorable aesthetic outcomes. (4) Conclusions: We believe that the "Jaws" technique is a valid contribution to post-bariatric surgery, as it aims to solve specific aesthetic problems of scarring from brachioplasty. The small number of patients does not allow the comparison of our original technique to others previously described in the literature.

A case of necrotizing fasciitis from a pedicure: when beauty centers become life-threatening.

INTRODUCTION: in a historical moment where there is an increasing use of beauty center, we report a case of necrotizing fasciitis occurred after a pedicure, with the aim of clarifying the safety of these aesthetic treatments. CASE REPORT: we discuss a case of left foot necrotizing fasciitis as consequence of removing a plantar callus. The patient is a 49 years old man; he is hypertensive, and diabetic not controlled. We report our experience showing the clinical manifestation and the tricky profile of the patient; then we reflect on the safety profiles of these aesthetic treatments. DISCUSSION: some bacterial infections of soft tissue after pedicure and manicure are reported in Literature. Mycobacteria seems to play a prevalent role, mostly after a peculiar practice of "fish pedicure". Our experience shows how the combination between a patient with complicated profile and poor hygienic measures can have catastrophic consequences. CONCLUSION: the aim of this article is to raise awareness on the serious consequences that can arise from banal aesthetic procedures. Furthermore, we want to recommend more control over these treatments performed in Beauty Salon, considering the large turnout of people, even clinically sensitive.

Recurrence of breast ptosis after mastopexy - a prospective pilot study.

BACKGROUND: Breast ptosis is characterized by severe volumetric deficiency of the upper pole, excess of skin in the lower pole and descent of the nipple-areola complex (NAC). Mastopexy, also known as breast lifting, is the surgical operation aimed to reshape the ptotic breast. Recurrence of breast ptosis after mastopexy is common but to the best of our knowledge no study before has measured it. PURPOSE: The aim of this study was to measure the recurrence of breast ptosis after mastopexy in a prospective study. MATERIALS AND METHODS: Female patients affected by unilateral or bilateral moderate or severe breast ptosis were enrolled in the study. All the patients underwent mastopexy performed only with the removal of skin excess following a Wise pattern. The jugular notch-nipple distance was measured before surgery, immediately after surgery and after 1, 3, 6 and 12 months. RESULTS: Ten patients were included in the study, four underwent unilateral mastopexy and six underwent bilateral mastopexy. The lifting of the NAC, measured in the immediate post-operative period, ranged from 3 to 8.5 cm, with an average value of 6.3 cm. This lifting, one year after surgery, ranged from 2 to 7 cm, with an average value of 4.6 cm. The percentage loss of the NAC lifting one year after surgery compared to the immediate post-operative time ranged from 12.5 to 41.7%, with an average value of 27.5%. CONCLUSION: In our case series, the lifting of the NAC obtained immediately after surgery showed an average loss of 27.5% one year after surgery. Even if limited by the low number of patients included, this pilot study is eye-opening on a very common phenomenon that occurs after mastopexy. The patients should be informed about the possible recurrence of the breast ptosis.

The Regenerative Effects of Botulinum Toxin A: New Perspectives.

Background: Botulinum Toxin A (BTX-A) has been found to improve blood flow perfusion. This study aimed to find in literature the use of BTX-A in Plastic Surgery and in particular its use to improve blood flow perfusion.Methods: We read the article "Effects of Botulinum Toxin A on the blood flow in expanded rat skin" and starting from this article we searched in the literature all the articles talking about the use of BTX-A to improve blood flow perfusion.Results: BTX-A increase the expression of VEGF, CD-31 and INOS. Moreover BTX-A selective suppress sympathetic neurons of the cutaneous microcirculation. We found 13 studies that confirm the effects of Botulinum Toxin A in improving blood flow perfusion of cutaneous and myocutaneous flaps.Conclusion: We think that in the future we could start to use BTX-A in these fields of plastic surgery, but we really need to understand good dosages and standardize them, see which are the effects on long-term outcomes, and put on randomized trials providing high-level evidence about the range of dosages in which we are safe to use BTX-A and asses the risk-benefit ratio in humans and the cost-benefit ratio.

Ligasure™ Impact and Ligasure™ Small Jaw in Body Contouring after Massive Weight Loss: A New Perspective.

BACKGROUND: The most effective dissection technique for elevating flaps in body contouring is still controversial, particularly in high-risk massive weight loss (MWL) patients. LigaSure (Medtronic, Dublin, Ireland) is an energy device commonly used among different surgical specialties to reduce morbidity and improve outcomes. The aim of this study is to investigate the effectiveness of LigaSure Impact and LigaSure Small Jaw in body contouring after MWL compared with conventional technique. MATERIAL AND METHODS: Patients who underwent abdominoplasty, mastopexy, brachioplasty and thigh lift after MWL at a single center from 1 December 2018 to 1 March 2020 were retrospectively reviewed. In each procedure patients were divided into two groups according to the dissection technique: LigaSure group and monopolar electrosurgery group. Patients characteristics, perioperative details and postoperative complications were evaluated. RESULTS: Fourty-five patients underwent abdominoplasty, twenty-six mastopexy, twenty brachioplasty and sixteen medial thigh lift. Using LigaSure, operative time was longer in abdominoplasty and thigh lift, but shorter in mastopexy and brachioplasty. Although not statistically significant, the amount of blood and serum recorded from drains in the first 36 hours was reduced in LigaSure groups. Additional analgesic intake was reduced with LigaSure as well as postoperative subjective pain. In all body contouring procedures statistically significant difference was found in days of hospital stay favoring LigaSure groups. Complications occurred most frequently in control groups compared to LigaSure groups. CONCLUSION: LigaSure Impact and LigaSure Small Jaw may be beneficial in improving outcomes because they might reduce fluids drainage, analgesics intake, hospital stay and postoperative complications.

Helix Thigh Lift. A Novel Approach to Severe Deformities in Massive Weight Loss Patients.

BACKGROUND: After massive weight loss, the severe gynoid body contour deformities are not always faceable with optimal results. The thigh is one of the most demanding area to address; therefore, the approach should be virtually individualized. The authors describe the helix thigh lift: A novel technique that combines vertical with horizontal axis of pull. The goal of this ultimate customization is to dramatically impact physical functioning and esthetics of this patient population. METHODS: Thigh lift patients from 2016 to 2019 were assessed retrospectively; fourteen patients were selected for helix thigh lift procedure. Preoperative markings, surgical technique and outcomes were described. The mean follow-up time was 14.8 ± 3.2 months. A questionnaire was administered to evaluate the results. RESULTS: Fourteen female patients (mean age, 42 ± 4.8 years) underwent helix thigh lift after massive weight loss. The overall complication rate was 36 percent. They were all minor complications and were treated in an outpatient setting. Seroma formation was the most frequent, at 29 percent. No skin necrosis was reported. Complication development was straight related to the age of the patient (p = 0.0455). The patients were very satisfied with the overall outcome. CONCLUSIONS: Helix thigh lift effectively addresses the severe gynoid body contour deformities. The high satisfaction and the reasonable complication rate suggest that this is a safe and effective technique. The age of the patient was significantly associated to complication development. A dramatic improvement of ease in performing activities of daily living along with reduction of the skin problems leads to significant improvement of the quality of life.

Safety of autologous fat grafting in breast cancer: a multicenter Italian study among 17 senonetwork breast units autologous fat grafting safety: a multicenter Italian retrospective study.

BACKGROUND: Autologous fat grafting (AFG), defined as the re-implant to the breast of fat tissue from different body areas, has been firstly applied to esthetic plastic surgery and then has moved to reconstructive surgery, mainly used for scar correction and opposite breast altering. Nevertheless, due to the potentially unsafe stem-like properties of adipocytes at the tumoral bed level, no clear evidence of the procedure's oncological safety has been clearly documented at present. PATIENTS AND METHODS: We retrospectively collected data of early breast cancer (BC) patients from 17 Italian Breast Units and assessed differences in terms of locoregional recurrence rate (LRR) and locoregional recurrence-free survival (LRFS) between patients who underwent AFG and patients who did not. Differences were analyzed in the entire cohort of invasive tumors and in different subgroups, according to prognostic biological subtypes. RESULTS: With a median follow-up time of 60 months, LRR was 5.3% (n = 71) in the matched population, 3.9% (n = 18) in the AFG group, and 6.1% (n = 53) in the non-AFG group, suggesting non-inferiority of AFG (p = 0.084). Building Kaplan-Meier curves confirmed non-inferiority of the AFG procedure for LRFS (aHR 0.73, 95% CI 0.41-1.30, p = 0.291). The same effect, in terms of LRFS, was also documented among different biological subtypes (luminal-like group, aHR 0.76, 95% CI 0.34-1.68, p = 0.493; HER2 enriched-like, aHR 0.89, 95% CI 0.19-4.22, p = 0.882; and TNBC, aHR 0.61, 95% CI 0.12-2.98, p = 0.543). CONCLUSIONS: Our study confirms in a very large, multicenter cohort of early BC patients that, aside the well-known benefits on the esthetic result, AFG do not interfere negatively with cancer prognosis.

To Keep or Not to Keep? The Hamletic Umbilical Dilemma: Preservation versus Reconstruction of the Umbilicus in Vertical Abdominoplasty.

(1) Background: The role of the umbilical scar and its repositioning remains one of the most important surgical steps in the execution of any type of abdominoplasty, including those involving "inverted-t" or "fleur de lys" incisions. A consequence of this is a surgeon's Hamletic dilemma: to keep or not to keep the original umbilical scar? (2) Methods: A retrospective observational study was conducted on all patients undergoing "T-inverted" abdominoplasty at the Department of Plastic Surgery of the Santa Maria alle Scotte University Hospital, Siena, between January 2018 and December 2020. Twelve months after the surgery we submitted to all patients the U-score questionnaire about their feelings about their umbilicus's appearance. Patients could assign a score from 1 (very dissatisfied) to 4 (very satisfied) to each of the five items of the score. (3) Results: The average of the scores attributed by the nine patients in whom the navel was preserved is 13 (Range 10-17), while in patients on whom a navel reconstruction was performed, the mean score is 16.8 (Range 12-20). The mean score of patients with a reconstructed umbilicus is, therefore, statistically higher than that of the other group of patients (t-value = 3.88, p = 0.000374) with an average increase of 3.8 points. (4) Conclusions: We can state that the reconstruction of a new navel is the right answer to the Hamletic dilemma in patients having undergone vertical or anchor abdominoplasty.

Management of skin damage of health workers' face: the role of plastic surgery in the time of Pandemic.

Background The Sars-Cov-2 virus is characterized by a being highly contagiousness, and this is the reason why massive use of personal protective equipment is required by medical and paramedical staff of the COVID-19 dedicated departments. The aim of this manuscript is to describe and share our experience in the prevention and treatment of the personal protective equipment related pressure sores and other skin alterations in the medical and paramedical staff. Materials and methods All healthcare workers with PPE-related skin damages were registered at time 0. Age, sex, profession, type of skin damage, diseases and possible drugs were registered. Results Two strategies were emplyed: the first strategy was to immediately treat the skin and the second one was to prevent pressure wounds formation both in already affected healthcare workers and the recurrence in healed staff. Three weeks after the two strategies were used, the incidence rate PPE-related skin damage was reduced in a statistically significant way. Conclusions Proper management helps in reducing the incidence of pressure ulcers related to  personal protective devices in CoVid-19 Units. Skin prevention and hydration, have been obtained achieved by using products applied at home, autonomously.

Optimization of Prepectoral Breast Reconstruction.

INTRODUCTION: Acellular dermal matrix (ADM) were introduced in the early 2000s and more recently permitted new protocols for breast reconstruction allowing a short operative time with improved outcomes until the new muscle-sparing breast reconstruction proposed in 2014 using the Braxon® ADM. The aim of this research is to propose a technique to improve the aesthetic outcome using Braxon ADM with prepectoral implants. MATERIALS AND METHODS: The enrolled patients were submitted to a nipple skin-sparing mastectomy leaving 1 additional centimeter of subcutis on the proximal part of the upper pole of the breast (see Surgical Technique). Aesthetic outcomes were compared to those obtained with traditional breast reconstruction with prosthesis and the Braxon ADM placed in the prepectoral space. Mean values of aesthetic outcomes were analyzed using the Student t test, and the κ test was used to analyze interobserver variability. RESULTS: The overall aesthetic score was improved of 29.6% of the patients; in particular the most improved score was that for contour (+98.01%). Statistical significance was found for contour, upper pole definition, and total score average (p < 0.05). The κ test showed interobserver variability with a good level of agreement on contour (κ = 0.832). CONCLUSIONS: The proposed technique has allowed attainment of good results in terms of aesthetic outcomes. In a small sample we did not register any particular complications but we verified a better satisfaction on the evaluation of the aesthetic result (level of evidence: 3).