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Vaccari S, Ragaini EM, Bucci F, Klinger F, Vinci V. Analyzing the Ingredients Available and Choosing the Appropriate Tools: Our Algorithm for a Winning Recipe to Treat Tuberous Breasts. Aesthet Surg J 2024; 44:NP354-NP355. [PMID: 38114079 DOI: 10.1093/asj/sjad373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/02/2023] [Accepted: 12/12/2023] [Indexed: 12/21/2023] Open
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Donnenfield JI, Nuzzi LC, McNamara CT, White AG, Labow BI. The Impact of Tuberous Breast on Adolescents: A Cross-sectional Study. Plast Reconstr Surg Glob Open 2024; 12:e5530. [PMID: 38268714 PMCID: PMC10807874 DOI: 10.1097/gox.0000000000005530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 10/23/2023] [Indexed: 01/26/2024]
Abstract
Background Tuberous breast deformity is a nondiagnostic, descriptive term for a congenital breast difference that becomes apparent at puberty. Although the negative physical and psychosocial effects of macromastia and breast asymmetry are established, no studies to date have explored the impact of tuberous breasts on health-related quality of life (HRQoL) outcomes using a robust sample size. Methods In this cross-sectional study, HRQoL surveys were administered to adolescent women with tuberous breasts and healthy female controls, aged 12-21 years. Surveys included the Short-Form 36v2, Rosenberg Self-Esteem Scale, and Eating Attitudes Test-26. Demographics were compared, and linear regressions were fit to determine the effect of tuberous breast deformity on survey scores, with body mass index (BMI) category as a covariate. Results Thirty-four patients with tuberous breasts and 264 controls participated. Patients with tuberous breasts had higher mean BMI than controls (P < 0.05). After adjusting for differences in BMI category, patients with tuberous breasts scored lower than controls on the Rosenberg Self-Esteem Scale and in Short-Form 36v2 domains related to physical and psychological health (P < 0.05, all). Compared with controls, patients with tuberous breasts had a higher mean score on the Eating Attitudes Test-26 (P < 0.05). Conclusions Tuberous breast deformity may negatively impact patients' physical and psychosocial HRQoL and increase their risk for disordered eating and higher BMIs. It is imperative that healthcare providers and third-party payors understand tuberous breast deformity is not just a cosmetic issue and tailor care and coverage policies accordingly.
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Affiliation(s)
- Jonah I. Donnenfield
- From the Adolescent Breast Center, Boston Children’s Hospital and Harvard Medical School, Boston, Mass
- Department of Plastic and Oral Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, Mass
| | - Laura C. Nuzzi
- From the Adolescent Breast Center, Boston Children’s Hospital and Harvard Medical School, Boston, Mass
- Department of Plastic and Oral Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, Mass
| | - Catherine T. McNamara
- From the Adolescent Breast Center, Boston Children’s Hospital and Harvard Medical School, Boston, Mass
- Department of Plastic and Oral Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, Mass
| | - Ava G. White
- From the Adolescent Breast Center, Boston Children’s Hospital and Harvard Medical School, Boston, Mass
- Department of Plastic and Oral Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, Mass
| | - Brian I. Labow
- From the Adolescent Breast Center, Boston Children’s Hospital and Harvard Medical School, Boston, Mass
- Department of Plastic and Oral Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, Mass
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Alvaro AI, Willet JW, Dounas GD, Jeeves A, Lodge M, Javed MU. A Systematic Review of Outcomes and Complications of Tuberous Breast Surgery. Aesthet Surg J 2023; 43:NP1001-NP1009. [PMID: 37439225 DOI: 10.1093/asj/sjad229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 07/04/2023] [Accepted: 07/11/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Tuberous breast is a complex congenital breast anomaly that can be challenging to correct surgically. OBJECTIVES The authors conducted a systematic review with pooled analysis of data, with the aim of determining the effectiveness and complications related to operative management of the deformity. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were adopted in performing this systematic review. A simplified classification system for tuberous breast deformity was developed to accurately compare data and guide analysis. RESULTS The review identified 38 studies, reporting a total of 897 patients undergoing tuberous breast surgery. The mean age of patients was 24 years (range 13-53 years). Mean follow-up was 39 months. A combination of tissue rearrangement and implant augmentation was the most common technique (73% of patients) followed by fat transfer alone (9%). Breast implants were employed in 83% of patients. The mean implanted volume per breast was 263 cc. Fat grafting was performed in 13% of patients and mean volume of fat grafted per breast was 185 cc. An overall complication rate of 20% was reported. Subjective assessment of patient satisfaction was 99%, and the mean score on BREAST-Q for satisfaction with clinical outcome was 86.7. Future studies should focus on robust study designs including randomized and cohort studies, use of patient-reported outcome measures, and long-term follow-up. CONCLUSIONS The surgical techniques to correct tuberous breast deformity are safe, effective, and have a high satisfaction rate. Fat transfer has the capacity to provide promising results in treating tuberous breast deformity. LEVEL OF EVIDENCE: 4
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Lonie S, Tavakoli K. An Algorithm for Correction of Mild Tuberous Breast Deformity in Augmentation Mammaplasty: Camouflage or Correct? Aesthet Surg J 2023; 43:NP878-NP887. [PMID: 37556836 DOI: 10.1093/asj/sjad255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Tuberous breast deformity (TBD) is a common abnormality, particularly in patients presenting for breast augmentation. Failure to correct each regional abnormality, including the inframammary fold, lower pole deficiency, nipple-areola complex widening or herniation, or any degree of ptosis, will result in exaggeration of the deformity and a poor aesthetic outcome. OBJECTIVES To describe an algorithm, including novel techniques, to address each region of mild TBD in patients undergoing breast augmentation. METHODS This is a retrospective review and description of the senior author's (K.T.) techniques for correction of early-stage TBD from 2016 to 2021. RESULTS One hundred forty-two patients underwent a stepwise approach to correct milder TBD features when undergoing breast augmentation. CONCLUSIONS The authors propose a regional algorithm for management of TBD, to allow mostly single-stage correction, except in cases with marked ptosis, severe asymmetry, or marked macroareola. LEVEL OF EVIDENCE: 4
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Vaccari S, Bucci F, Di Giuli R. Comment on: ''Tuberous Breast, Deformities, and Asymmetries: A Retrospective Analysis Comparing Fat Grafting Versus Mastopexy and Breast Implants''. Aesthetic Plast Surg 2023; 47:207-208. [PMID: 36547686 DOI: 10.1007/s00266-022-03233-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022]
Abstract
We read with great interest the article titled "Tuberous breast, deformities, and asymmetries: a retrospective analysis comparing fat grafting versus mastopexy and breast implants" by Gentile. In this interesting paper, the author compares results obtained in patients suffering from tuberous breast, deformities, and asymmetries treated with fat grafting (FG) with those of patients who underwent mastopexy and breast implant (M-SI). The TB reconstructive procedures aims to release the constricted base both vertically and horizontally, restore the correct nipple-inframammary fold distance, avoid the double bubble, correct ptosis and hypertrophy, and restore both volume and asymmetry. In most cases, it poses a real challenge to surgical correction through the exclusive use of only one of the surgical techniques described in the paper. We think the type of surgical procedure is determined by specific factors which must be considered by both the surgeon and the patient. We propose a classification that analyzes 3 characteristics (type of stenosis, hypoplasia, and ptosis) and identifies 8 classes of TB: this classification allows to guide the surgeon in choosing the most appropriate surgical maneuvers for each type of TB. In conclusion, we think that each case of TB, deformities, and asymmetries should be carefully studied and classified, opting for the most appropriate surgical method "tailored made" to ensure the best result for the patient. Among these techniques, M-SI and FG are two important weapons in the hands of the surgeon, who must use them wisely, knowing each indication and limits.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 .
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Affiliation(s)
- Stefano Vaccari
- Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Humanitas Clinical and Research Hospital, Reconstructive and Aesthetic Plastic Surgery School, University of Milan, Via Manzoni 56, 20090, Rozzano, Milan, Italy.
| | - Flavio Bucci
- Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Humanitas Clinical and Research Hospital, Reconstructive and Aesthetic Plastic Surgery School, University of Milan, Via Manzoni 56, 20090, Rozzano, Milan, Italy
| | - Riccardo Di Giuli
- Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Humanitas Clinical and Research Hospital, Reconstructive and Aesthetic Plastic Surgery School, University of Milan, Via Manzoni 56, 20090, Rozzano, Milan, Italy
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Eisenberg T. The Underappreciated Saline Breast Implant. Aesthetic Plast Surg 2022; 47:897-900. [PMID: 36131136 DOI: 10.1007/s00266-022-03106-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 09/11/2022] [Indexed: 11/01/2022]
Affiliation(s)
- Ted Eisenberg
- Nazareth Hospital, 2375 Woodward Street, Suite 102, Philadelphia, PA, 19115, USA.
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Lozito A, Vinci V, Talerico E, Asselta R, Di Tommaso L, Agnelli B, Klinger M, Klinger F. Review of Tuberous Breast Deformity: Developments over the Last 20 Years. Plast Reconstr Surg Glob Open 2022; 10:e4355. [PMID: 35702542 PMCID: PMC9187173 DOI: 10.1097/gox.0000000000004355] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/12/2022] [Indexed: 02/05/2023]
Abstract
Tuberous breast (TB) deformity is a condition characterized by alterations in breast morphology and tissue structure with high prevalence in the general population. The literature provides sparse descriptions of TB, as not many investigations on the condition have been conducted. The aim of this review was to analyze and provide a holistic overview on the morphological characteristics of the TB. Methods A review of current literature was performed using the PubMed database from 2001 to 2021. The key words used for the review included "tuberous breast," "constricted breast," and "stenotic breast." We included articles that analyzed the anatomic and histologic characteristics of TB. Results From 213 articles, only 42 met the inclusion criteria. A total of 171 articles were excluded, as they were letters, not related to the condition, or were written in a foreign language. The studies in this review drew on hypothesis on the embryological origin of TB and analyzed the composition of TB tissues, consisting in a constricting fibrous ring, made of longitudinally arranged collagen and elastic fibers. Furthermore, the review reports the different anatomical and surgical classifications, as well as the various surgical corrective procedures developed throughout history up to 2021. Conclusion The review describes all etiological, epidemiologic, anatomical, histological, and surgical characteristics of tuberous breast.
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Affiliation(s)
- Alessia Lozito
- From the Humanitas Clinical and Research Center – IRCCS, Rozzano – Milan, Italy
| | - Valeriano Vinci
- From the Humanitas Clinical and Research Center – IRCCS, Rozzano – Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Eleonora Talerico
- From the Humanitas Clinical and Research Center – IRCCS, Rozzano – Milan, Italy
| | - Rosanna Asselta
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Luca Di Tommaso
- From the Humanitas Clinical and Research Center – IRCCS, Rozzano – Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Benedetta Agnelli
- From the Humanitas Clinical and Research Center – IRCCS, Rozzano – Milan, Italy
| | - Marco Klinger
- Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Reconstructive and Aesthetic Plastic Surgery School, Humanitas Clinical and Research Hospital, University of Milan, Milan, Italy
| | - Francesco Klinger
- University of Milan, Department of Health Sciences, Ospedale San Paolo, Milan, Italy
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Klinger M, Vinci V, Battistini A, Klinger F. Reply to "The Limitations of Periareolar Mammaplasty". Plast Reconstr Surg Glob Open 2022; 10:e4067. [PMID: 35083107 PMCID: PMC8785921 DOI: 10.1097/gox.0000000000004067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Marco Klinger
- From the Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Humanitas Clinical and Research Hospital, Reconstructive and Aesthetic Plastic Surgery School, University of Milan, Milan, Italy
| | - Valeriano Vinci
- Humanitas University Department of Biomedical Sciences, Milan, Italy
| | - Andrea Battistini
- From the Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Humanitas Clinical and Research Hospital, Reconstructive and Aesthetic Plastic Surgery School, University of Milan, Milan, Italy
| | - Francesco Klinger
- From the Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Humanitas Clinical and Research Hospital, Reconstructive and Aesthetic Plastic Surgery School, University of Milan, Milan, Italy
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Papadopoulos S, Colpaert SDM, Goulis DG, Nigdelis MP, Grimbizis GF, Tio J, Abdallah A. Treating Anisomastia and Tuberous Breast with Fat Grafting: Technique and Evaluation of Outcomes Using BREAST-Q Surveys. Aesthetic Plast Surg 2021; 45:2729-2741. [PMID: 33864117 DOI: 10.1007/s00266-021-02273-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 03/28/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND In the surgical correction of tuberous breast deformity, implants and regional flaps play a prominent role. Lately, fat grafting has been used as an alternative, but there is evidence that patient satisfaction is higher after correction with implants compared with lipofilling. METHODS We report a tuberous breasts correction series of ten cases, enrolled between 2015 and 2018. Percutaneous fasciotomies and fat grafting were performed by the Body-Jet technique. Analysis of outcomes was undertaken with BREAST-Q surveys. RESULTS The breast satisfaction scores increased from 0 to 75 (p < 0.01), the psychological well-being scores from 20 to 70 (p < 0.01) and the sexual well-being scores from 18.5 to 58 (p = 0.02), while the physical well-being scores remained stable (from 68 to 63, p = 0.2). The median outcome satisfaction score was 86. CONCLUSION Scores of patient-reported outcomes after lipofilling can reach and even exceed those of patients corrected with implants, at the cost of more interventions. Fat grafting is beginning to establish itself as a true alternative in the treatment of tuberous breast deformity in patients with the appropriate fat deposits. 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 Table of Contents or online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Sarantos Papadopoulos
- Department of Senology, Evangelische Kliniken Gelsenkirchen, Munckelstrasse 27, 45879, Gelsenkirchen, Germany.
- Private Practice, Vasillisis Olgas 158, 54645, Thessaloniki, Greece.
| | | | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Meletios P Nigdelis
- 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Grigorios F Grimbizis
- 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Joke Tio
- Department of Obstetrics and Gynecology, Breast Center, Muenster University, Muenster, Germany
| | - Abdallah Abdallah
- Department of Senology, Evangelische Kliniken Gelsenkirchen, Munckelstrasse 27, 45879, Gelsenkirchen, Germany
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Rimondo A, Battistini A, Bandi V, Vinci V, Klinger F. Comment on: Simultaneous Mastopexy via Areola Excision to Correct Mild and Moderate Breast Ptosis. Aesthetic Plast Surg 2021; 45:2531-2. [PMID: 33733333 DOI: 10.1007/s00266-021-02214-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 03/01/2021] [Indexed: 10/21/2022]
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Faure A, Mosca MV, Régas I, Pluvy I. [Tuberous breast deformity correction: Long-term satisfaction assessment with BREAST-Q questionnaire]. ANN CHIR PLAST ESTH 2021; 66:466-475. [PMID: 34563409 DOI: 10.1016/j.anplas.2021.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 08/23/2021] [Accepted: 08/29/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Tuberous Breast Deformity (TBD) is a complex breast malformation: shape, size and symmetry of breast can be affected. It causes physical and mental suffering with significant effect on life quality. The purpose of this study is to assess patients satisfaction and patients quality of life after TBD surgery over time. METHODS All TBD patients operated between January 2007 and December 2018 were retrospectively identified for the study and those treated whith implant and/or mammoplasty were included. Different parameters have been recorded: age, malformation severity, breast symmetry, BMI, pregnancies, breast-feeding, type of primary surgery, complications and number of re-operations. Long-term satisfaction was assessed thanks to a BREAST-Q questionnaire (with a special « augmentation » or « reduction/mastopexy » module according to the primary surgery). RESULTS Eighty-two patients were included: 35 patients had recieved bilateral breast implants, 14 patients had received unilateral breast implant with or without collateral mammoplasty, and 33 patients had undergone breast reduction surgery. The total average for the medical follow-up was 7.4 years. The number of intervention was significantly higher for patients who had undergone breast augmentation surgery (P=0.001) and for patients with severe TBD (P=0.01). Forty patients replied to the BREAST-Q questionnaire. Patients satisfaction scores were not significantly different between the different groups. Regarding life quality scores, patients undergoing a breast augmentation surgery with bilateral implants seemed to have a better "sexual well-being" score (P=0.03). "Physical well-being" score was lower for patients who had a breast reduction compared to the other groups (P=0.01). Patients with breast implants had significant better quality of life scores, especially for the following parameters: "psychosocial well-being" (P=0.02), "sexual well-being" (P<0.001), "physical well-being" (P<0.001) and "satisfaction with breast" (P=0.03). CONCLUSIONS TBD surgery basically provides long-term satisfaction for most of the patients. The number of re-operations does not seem to deteriorate satisfaction over time.
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Affiliation(s)
- A Faure
- Service de chirurgie plastique, reconstructrice et esthétique, CHU de Besançon, 25000 Besançon, France.
| | - M V Mosca
- Service de chirurgie plastique, reconstructrice et esthétique, CHU de Besançon, 25000 Besançon, France
| | - I Régas
- Service de chirurgie plastique, reconstructrice et esthétique, CHU de Besançon, 25000 Besançon, France
| | - I Pluvy
- Service de chirurgie plastique, reconstructrice et esthétique, CHU de Besançon, 25000 Besançon, France
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Klinger M, Vinci V, Giannasi S, Bandi V, Veronesi A, Maione L, Catania B, Lisa A, Cornegliani G, Giaccone M, Siliprandi M, Battistini A, Barbera F, Tinterri C, Testori A, Caviggioli F, Klinger F. The Periareolar Approach: All Seasons Technique for Multiple Breast Conditions. Plast Reconstr Surg Glob Open 2021; 9:e3693. [PMID: 34422516 DOI: 10.1097/GOX.0000000000003693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/13/2021] [Indexed: 11/27/2022]
Abstract
The periareolar approach was first introduced by Hollander in 1924 and, since then, numerous contributions have been reported by different authors. Despite all the strengths associated with this versatile technique, the periareolar approach still poses three main problems: large areolar diameter with poor quality scar, flattening of the breast cone, and poor stability of the results. The purpose of this article is to show how this surgical technique, with a good patient selection, can be applied to different situations and obtain excellent results.
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Klinger M, Bandi V, Giannasi S, Caviggioli F, Veronesi A, Maione L, Catania B, Lisa A, Battistini A, Tinterri C, Testori A, Vinci V, Klinger F. Gynecomastia: Ultrasound-Confirmed Classification Pertainent to Surgical Correction. Aesthetic Plast Surg 2021; 45:1397-403. [PMID: 33625529 DOI: 10.1007/s00266-021-02187-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 02/08/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Gynecomastia is the most common form of breast alteration in men, due to proliferation of the gland ducts and stromal components, including fat. In addition to the most obvious indications (weight loss, pharmacotherapy, and drugs suspension), the surgical treatment is needed for long-standing gynecomastia, combining liposuction, adenectomy, partial mammary adenectomy, periareolar skin resection, and round-block suture. MATERIALS AND METHODS A retrospective study was conducted on 148 patients undergoing gynecomastia correction from May 2012 to April 2018. Follow-up ranged from 9 to 14 months. The authors propose a new ultrasound-confirmed classification system, dividing patients into six categories. The authors analyzed immediate complications, revision, recurrence, and minor aesthetic problems (retracted/depressed areas) and introduced a way to correct the irregularities with fat grafting and needles. RESULTS The total complication rate was 11.5% (17/148). Most of the complications (11) were observed in patients who underwent glandular resection and 3 after liposuction only. Retrospective surveys about patients' and surgeons' satisfaction were performed, showing excellent feedbacks regarding the results accomplished. CONCLUSIONS The simple classification helps surgeons choose the most suitable approach, avoiding insufficient or invasive treatments and undesirable scars. Moreover, the analysis of the type of sequelae and their correction allow high patients' satisfaction. 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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Battistini A, Lisa A, Maione L, Klinger M, Klinger F. Comment on: "Autologous Fat Grafting with Percutaneous Fasciotomy and Reduction of the Nipple-Areolar Complex for the Correction of Tuberous Breast Deformity in Teenagers". Aesthetic Plast Surg 2021; 45:806-807. [PMID: 33543345 DOI: 10.1007/s00266-021-02143-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Andrea Battistini
- Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Humanitas Clinical and Research Hospital, Reconstructive and Aesthetic Plastic Surgery School, University of Milan, Via Manzoni 56, 20090, Rozzano, Milan, Italy.
| | - Andrea Lisa
- Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Humanitas Clinical and Research Hospital, Reconstructive and Aesthetic Plastic Surgery School, University of Milan, Via Manzoni 56, 20090, Rozzano, Milan, Italy
| | - Luca Maione
- Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Humanitas Clinical and Research Hospital, Reconstructive and Aesthetic Plastic Surgery School, University of Milan, Via Manzoni 56, 20090, Rozzano, Milan, Italy
| | - Marco Klinger
- Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Humanitas Clinical and Research Hospital, Reconstructive and Aesthetic Plastic Surgery School, University of Milan, Via Manzoni 56, 20090, Rozzano, Milan, Italy
| | - Francesco Klinger
- Plastic Surgery Unit, MultiMedica Holding S.p.A., Reconstructive and Aesthetic Plastic Surgery School, University of Milan, Sesto San Giovanni, Milan, Italy
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Naidu NS. Invited Response on: "Autologous Fat Grafting with Percutaneous Fasciotomy and Reduction of the Nipple-Areolar Complex for the Correction of Tuberous Breast Deformity in Teenagers". Aesthetic Plast Surg 2021; 45:808. [PMID: 33559093 DOI: 10.1007/s00266-021-02160-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 01/24/2021] [Indexed: 10/22/2022]
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Battistini A, Vaccari S, Maione L, Andreoletti S, Klinger F. Comment on: Evaluation of the Sensitivity of the Nipple-Areola Complex in Patients Undergoing Breast Ptosis Correction with Periareolar Dermis Release-A Randomized Controlled Trial. Aesthetic Plast Surg 2021. [PMID: 33758976 DOI: 10.1007/s00266-021-02215-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 03/01/2021] [Indexed: 10/21/2022]
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Lisa A, Battistini A, Vinci V, Klinger M, Caviggioli F. Comment on: "Circumlateral Vertical Augmentation Mastopexy for the Correction of Ptosis and Hypoplasia of the Lower Medial Quadrant in Tuberous Breast Deformity". Aesthetic Plast Surg 2021. [PMID: 33537849 DOI: 10.1007/s00266-021-02144-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 10/22/2022]
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Vinci V, Maione L, Tinterri C, Lozito A, Klinger M. Letter to the Editor on: "Tuberous Breast Deformity Correction: 12-Year Experience". Aesthetic Plast Surg 2021; 45:357-8. [PMID: 31218379 DOI: 10.1007/s00266-019-01411-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 05/23/2019] [Indexed: 10/26/2022]
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Retrouvey H, Hanna SA, Bengtson BP, Brown M. The Nomenclature, Terminology and Lexicon of Breast Surgery: Are We Really Saying the Same Thing? Clin Plast Surg 2021; 48:109-21. [PMID: 33220898 DOI: 10.1016/j.cps.2020.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study investigated inconsistencies in the use of descriptors in breast surgery and recommends a novel nomenclature that will be adopted and standardized among plastic surgeons. The study used a modified Delphi methodology to first identify redundant descriptors or those with multiple interpretations, and then achieve consensus on ideal recommended nomenclature in breast surgery. The Delphi panel agreed that there was misuse of and lack of a clear definition for several terms, and recommended removal of these subjective terms. Replacement with more anatomic nomenclature was suggested. Stretch deformity, pectoral banding, and implant-gland mismatch were introduced as new terms.
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Costanzo D, Klinger M, Lisa A, Maione L, Battistini A, Vinci V. The evolution of autologous breast reconstruction. Breast J 2020; 26:2223-2225. [PMID: 32909653 DOI: 10.1111/tbj.14025] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 07/31/2020] [Indexed: 02/03/2023]
Abstract
With breast cancer (BC) becoming more treatable, breast reconstruction has become an integral part of BC treatment. Nowadays, implant-based breast reconstruction is more common. However, there is a growing interest in autologous breast reconstruction due to the increasing awareness of implant-related complications. This work provides a comprehensive overview of the evolution of autologous reconstruction techniques of the breast and the nipple-areolar complex (NAC).
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Affiliation(s)
| | - Marco Klinger
- Reconstructive and Aesthetic Plastic Surgery School, Department of Medical Biotechnology and Translational Medicine BIOMETRA - Plastic Surgery Unit, Humanitas, Clinical and Research Hospital, University of Milan, Rozzano (Milan), Italy
| | - Andrea Lisa
- Reconstructive and Aesthetic Plastic Surgery School, Department of Medical Biotechnology and Translational Medicine BIOMETRA - Plastic Surgery Unit, Humanitas, Clinical and Research Hospital, University of Milan, Rozzano (Milan), Italy
| | - Luca Maione
- Reconstructive and Aesthetic Plastic Surgery School, Department of Medical Biotechnology and Translational Medicine BIOMETRA - Plastic Surgery Unit, Humanitas, Clinical and Research Hospital, University of Milan, Rozzano (Milan), Italy
| | - Andrea Battistini
- Reconstructive and Aesthetic Plastic Surgery School, Department of Medical Biotechnology and Translational Medicine BIOMETRA - Plastic Surgery Unit, Humanitas, Clinical and Research Hospital, University of Milan, Rozzano (Milan), Italy
| | - Valeriano Vinci
- Reconstructive and Aesthetic Plastic Surgery School, Department of Medical Biotechnology and Translational Medicine BIOMETRA - Plastic Surgery Unit, Humanitas, Clinical and Research Hospital, University of Milan, Rozzano (Milan), Italy
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Klinger M, Giannasi S, Bandi V, Veronesi A, Maione L, Lisa A, Battistini A, Caviggioli F, Klinger F, Vinci V. Update on "Fat Injection for Cases of Severe Burn Outcomes: A New Perspective of Scar Remodeling and Reduction". Aesthetic Plast Surg 2020; 44:1283-1285. [PMID: 32766903 DOI: 10.1007/s00266-020-01775-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Marco Klinger
- Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Humanitas Clinical and Research Hospital, Reconstructive and Aesthetic Plastic Surgery School, University of Milan, Via Manzoni 56, 20090, Rozzano, MI, Italy.
| | - Silvia Giannasi
- Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Humanitas Clinical and Research Hospital, Reconstructive and Aesthetic Plastic Surgery School, University of Milan, Via Manzoni 56, 20090, Rozzano, MI, Italy
| | - Valeria Bandi
- Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Humanitas Clinical and Research Hospital, Reconstructive and Aesthetic Plastic Surgery School, University of Milan, Via Manzoni 56, 20090, Rozzano, MI, Italy
| | - Alessandra Veronesi
- Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Humanitas Clinical and Research Hospital, Reconstructive and Aesthetic Plastic Surgery School, University of Milan, Via Manzoni 56, 20090, Rozzano, MI, Italy
| | - Luca Maione
- Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Humanitas Clinical and Research Hospital, Reconstructive and Aesthetic Plastic Surgery School, University of Milan, Via Manzoni 56, 20090, Rozzano, MI, Italy
| | - Andrea Lisa
- Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Humanitas Clinical and Research Hospital, Reconstructive and Aesthetic Plastic Surgery School, University of Milan, Via Manzoni 56, 20090, Rozzano, MI, Italy
| | - Andrea Battistini
- Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Humanitas Clinical and Research Hospital, Reconstructive and Aesthetic Plastic Surgery School, University of Milan, Via Manzoni 56, 20090, Rozzano, MI, Italy
| | - Fabio Caviggioli
- Plastic Surgery Unit, MultiMedica Holding S.p.A., Reconstructive and Aesthetic Plastic Surgery School, University of Milan, Sesto San Giovanni, Milan, Italy
| | - Francesco Klinger
- Plastic Surgery Unit, MultiMedica Holding S.p.A., Reconstructive and Aesthetic Plastic Surgery School, University of Milan, Sesto San Giovanni, Milan, Italy
| | - Valeriano Vinci
- Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, MI, Italy
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Rigotti G, Chirumbolo S. Biological Morphogenetic Surgery: A Minimally Invasive Procedure to Address Different Biological Mechanisms. Aesthet Surg J 2019; 39:745-755. [PMID: 30137183 DOI: 10.1093/asj/sjy198] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
We present a methodology called biological morphogenetic surgery (BMS) that can recover (enlarge or reduce) the shape/volume of anatomic structures/tissues affected by congenital or acquired malformations based on a minimally invasive procedure. This emerges as a new concept in which the main task of surgery is the biological modulation of different remodeling and repair mechanisms. When applied, for example, to a tuberous breast deformity, the "enlarging BMS" expands the retracted tissue surrounding the gland through a cutting tip of a needle being inserted through small incisions percutaneously, accounting for the biological activity of the grafted fat. The obtained spaces might be spontaneously occupied and later filled with autologous grafted fat, which promotes tissue expansion by eliciting adipogenesis and preventing fibrosis. The "reducing BMS" creates an interruption of the contact between the derma and the hypoderma of the abnormally large areola and then promotes adipocytes to induce a fibrotic reaction, leading to areola reduction. Current evidence suggests that BMS might induce a bivalent mesenchymalization of the adipocyte, which promotes either new adipogenesis and angiogenesis of local fat (expanding BMS) or the granulation tissue/fibrotic response (reducing BMS), thus leading to the physiological recovery of the affected structures/tissues to normality. Level of Evidence: 4.
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Affiliation(s)
- Gino Rigotti
- Unit Head of Reconstructive Breast and Plastic Surgery, Clinica San Francesco, Verona, Italy
| | - Salvatore Chirumbolo
- Department of Neuroscience, Biomedicine and Movement Sciences-University of Verona, Verona, Italy
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Vinci V, Maione L, Klinger F, Costanzo D, Barbera F, Battistini A, Klinger M. Comment on: ‟Efficacy of autologous fat transfer for the correction of contour deformities in the breast: A systematic review and meta-analysis". J Plast Reconstr Aesthet Surg 2019; 72:1030-48. [PMID: 30898503 DOI: 10.1016/j.bjps.2018.12.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 12/02/2018] [Indexed: 11/22/2022]
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Tenna S, Cagli B, Brunetti B, Barone M, Persichetti P. Reply to Commentaries on: Management of Tuberous Breast Deformities-Review of Long-Term Outcomes and Patient Satisfaction with Breast-Q. Aesthetic Plast Surg 2018. [PMID: 29532105 DOI: 10.1007/s00266-018-1115-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Stefania Tenna
- Unit of Plastic and Reconstructive Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy.
| | - Barbara Cagli
- Unit of Plastic and Reconstructive Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy
| | - Beniamino Brunetti
- Unit of Plastic and Reconstructive Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy
| | - Mauro Barone
- Unit of Plastic and Reconstructive Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy
| | - Paolo Persichetti
- Unit of Plastic and Reconstructive Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy
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Tenna S, Cagli B, Brunetti B, Barone M, Persichetti P. Management of Tuberous Breast Deformities: Review of Long-term Outcomes and Patient Satisfaction with BREAST-Q. Aesthetic Plast Surg 2017; 41:1249-58. [PMID: 28634700 DOI: 10.1007/s00266-017-0902-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The treatment of a tuberous breast deformity has changed over the years, with a large variety of procedures described. However, maintaining a long-lasting breast contour is an ongoing challenge. The aim of this study was to evaluate the long-term results of tuberous breast corrections, focusing on the incidence of secondary procedures and patient satisfaction. MATERIALS AND METHODS Forty-six patients who underwent correction of a tuberous breast deformity from 2000 through 2013 were considered. Age, degree of deformity, asymmetry, BMI, pregnancy, first surgical technique used, complications and further surgical procedures were evaluated. Statistical analysis was conducted to identify predicting factors for multiple procedures. Patient satisfaction was evaluated with BREAST-Q. RESULTS Eighty-eight breasts were treated: 57 breasts underwent implant-based corrections, whereas 31 breasts underwent autologous procedures. A multi-step procedure was initially planned in 7 breasts only, and 41 breasts underwent secondary procedures: 33 out of 53 breasts (62.3%) were re-operated in the implant-based group, whereas 8 out of 28 breasts (28.6%) were re-operated in the autologous group. Statistical analysis showed a correlation between the number of procedures and young age (P = 0.0253) and between the number of procedures and the primary surgical technique (P = 0.0132). The BREAST-Q evaluation suggested that patient satisfaction was comparable. CONCLUSIONS The question of time is one of the main issues in breast surgery. The management of tuberous breast deformities requires a customized strategy considering all parameters to improve the longevity of the result in the long term. 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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Klinger M, Klinger F, Giannasi S, Veronesi A, Bandi V, Banzatti B, Catania B, Vinci V, Lisa A, Cornegliani G, Giaccone M, Caviggioli F, Maione L. Stenotic Breast Malformation and Its Reconstructive Surgical Correction: A New Concept From Minor Deformity to Tuberous Breast. Aesthetic Plast Surg 2017; 41:1068-1077. [PMID: 28593490 DOI: 10.1007/s00266-017-0903-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 04/25/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Several classification systems have been reported to define the spectrum of tuberous breast deformity, and a range of surgical techniques has been described. In this paper, we proposed a new classification including tuberous breast and minor deformity based on stenosis type, glandular trophism and ptosis adapting surgical planning to different breast types. METHODS A total of 246 patients meeting our definition for stenotic breasts asking for surgery were analyzed in this study. We considered eight different types of stenotic breasts analyzing anatomical presentations, and we then proposed eight key-point maneuvers, finalized to the correction of different breast deformities and their possible association according to the stenotic breast type. Results have been evaluated by a group of three surgeons and by patients. In addition, we evaluated the complication incidence in terms of re-intervention rate. RESULTS Following our classification eight different groups were distinguished. For each one we reported the prevalence and the surgical procedure adopted. Results evaluated by the surgeon group reported a mean aesthetic outcome of 8.2 (range 5-10), whereas patients reported a mean value of 7.9 (range 6-10). During a follow-up period with a mean of 16 months we observed a 4.9% re-intervention rate. CONCLUSIONS We believe this new classification to be very complete in evaluating breast shape, including most of the breast evaluable features. Our results confirmed the suitability of the approach for appropriate preoperative planning, thus improving the global surgical outcome. 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 .
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Affiliation(s)
- Marco Klinger
- Reconstructive and Aesthetic Plastic Surgery School, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Plastic Surgery Unit, Humanitas Clinical and Research Center, University of Milan, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
| | - Francesco Klinger
- Reconstructive and Aesthetic Plastic Surgery School, MultiMedica Holding S.P.A., Plastic Surgery Unit, University of Milan, Sesto San Giovanni, Milan, Italy
| | - Silvia Giannasi
- Reconstructive and Aesthetic Plastic Surgery School, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Plastic Surgery Unit, Humanitas Clinical and Research Center, University of Milan, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Alessandra Veronesi
- Reconstructive and Aesthetic Plastic Surgery School, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Plastic Surgery Unit, Humanitas Clinical and Research Center, University of Milan, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Valeria Bandi
- Reconstructive and Aesthetic Plastic Surgery School, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Plastic Surgery Unit, Humanitas Clinical and Research Center, University of Milan, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Barbara Banzatti
- Reconstructive and Aesthetic Plastic Surgery School, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Plastic Surgery Unit, Humanitas Clinical and Research Center, University of Milan, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Barbara Catania
- Reconstructive and Aesthetic Plastic Surgery School, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Plastic Surgery Unit, Humanitas Clinical and Research Center, University of Milan, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Valeriano Vinci
- Reconstructive and Aesthetic Plastic Surgery School, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Plastic Surgery Unit, Humanitas Clinical and Research Center, University of Milan, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Andrea Lisa
- Reconstructive and Aesthetic Plastic Surgery School, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Plastic Surgery Unit, Humanitas Clinical and Research Center, University of Milan, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Guido Cornegliani
- Reconstructive and Aesthetic Plastic Surgery School, MultiMedica Holding S.P.A., Plastic Surgery Unit, University of Milan, Sesto San Giovanni, Milan, Italy
| | - Micol Giaccone
- Reconstructive and Aesthetic Plastic Surgery School, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Plastic Surgery Unit, Humanitas Clinical and Research Center, University of Milan, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Fabio Caviggioli
- Reconstructive and Aesthetic Plastic Surgery School, MultiMedica Holding S.P.A., Plastic Surgery Unit, University of Milan, Sesto San Giovanni, Milan, Italy
| | - Luca Maione
- Clinica San Carlo, Plastic Surgery Unit, Via Ospedale 21, 20037, Paderno Dugnano, Milan, Italy
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