Mastoplasty after Massive Weight Loss: Redefinition and Stabilization of the Breast Mound with Submuscular Autoprosthesis.

CONTEXT: After massive weight loss, breast changes dramatically becoming ptotic, flat in the upper pole, with significant skin excess. After mastoplasty, often ptosis can recur and the upper pole can lose its fullness again. The technique described in this study treats breast deformities ensuring stable results and avoiding ptosis recurrence. AIM: To analyze a new modality of breast reshaping after massive weight loss, evaluating outcomes and complications as well as patient satisfaction. SETTINGS AND DESIGN: This was a case series. MATERIALS AND METHODS: Fifteen patients (all women, average age, 43.1 years) with bilateral breast ptosis after massive weight loss underwent mastoplasty: the technique included the creation of an inferior pedicle flap that was placed as a prosthesis under the pectoralis muscle and a superomedial pedicle flap containing the nipple-areola complex (NAC). Patients were followed up for at least 6 months, reporting any complications, and measuring the jugulum-NAC distance. Patients' satisfaction was also reported. STATISTICAL ANALYSIS USED: Nil. RESULTS: All patients were extremely satisfied with the breast volume, shape, symmetry, and ptosis correction. The new mammary contour and the distance between the jugular fossa and the nipple were stable during the follow-up and the upper pole maintained its fullness. No major complications were reported. CONCLUSION: Mastoplasty with submuscular autoprosthesis proved to be a safe and effective technique to treat breast deformities after massive weight loss because removed redundant tissue repositioned the NAC and filled the upper pole with stable results over time. A similar technique has not been described yet.

Arm Contouring After Massive Weight Loss: Liposuction-Assisted Brachioplasty Versus Standard Technique.

Massive weight loss (MWL) brachioplasty is frequently requested for the improvement of the appearance and function of arms. Despite its diffusion, this procedure can be associated with significant complications. Liposuction-assisted brachioplasty (LAB) preserves the vascular, nervous, and lymphatic network and reduces the incidence of postoperative complications. This retrospective cohort study is aimed at analyzing two different modalities of arm contouring after MWL by evaluating the outcomes and complications. Of 31 patients (all females, average age 43.5 years), 20 were managed with standard brachioplasty represented by a swallowtail scar and monobloc resection and 11 with brachioplasty combined with aggressive liposuction. Evaluated parameters included age, body mass index, method of weight loss, and complications rate. No statistical analysis was used. Major postoperative complications (reoperation, bleeding, or thromboembolism) were not reported in both groups. The incidence of minor complications (wound separation, wound infection, and seroma) was globally 42%; the incidence of complications was significantly lower in the LAB group (9% vs. 60%). The incidence of hypertrophic scarring or keloid was higher in the control group (55% vs. 18%). Most patients were satisfied after surgery: in the LAB group, 81.8% of the patients expressed a high degree of satisfaction and 18.2% a good degree of satisfaction after 4 months of follow-up. In our experience, the LAB should be preferred in MWL patients because it has a lower rate of complications and a faster recovery than the standard technique. Proper execution requires considerable technical skill and experience.

Inhalation therapy in the next decade: Determinants of adherence to treatment in asthma and COPD.

Proceedings of the European Seminars in Respiratory Medicine course, Inhalation therapy in the next decade: Determinants of adherence to treatment in asthma and COPD, held in Taormina, Italy, on 3-4 March, 2017.

The preventive effect on respiratory tract infections of Oscillococcinum®. A cost-effectiveness analysis.

BACKGROUND: Anas barbariae hepatis et cordis extractum 200K (Oscillococcinum®) is used to treat and prevent seasonal colds and airway inflammatory affections, improve symptom control, and reduce the frequency of respiratory tract infection (RTI) episodes. The objective of this controlled observational study is to investigate, from the Italian National Health Service (NHS) point of view, the role of Anas barbariae hepatis et cordis extractum 200K in preventing RTIs and estimate the annual average cost per patient due to visits and medicines in a real-world setting, investigating whether this method of treatment can bring savings for the NHS. METHODS: Data from a single center from 2002 to 2011 were used. The analysis examined 455 patients who suffered from respiratory diseases. Of the total number of patients, 246 were treated with Anas barbariae hepatis et cordis extractum 200K while 209 were not treated (Control group). All the data concerning RTI episodes, pharmacological treatments, and pneumological visits were extracted from the database. RESULTS: It was found that, regardless of the diagnosis, the frequency of RTI episodes was always lower in patients treated with Anas barbariae hepatis et cordis extractum 200K; the difference between the numbers of events occurring was statistically significant in every class of patients (p<0.001). The costs that the NHS had to incur were significantly lower in the classes of patients treated (p<0.001). DISCUSSION: The results indicate that Anas barbariae hepatis et cordis extractum 200K has a preventive effect on the onset of RTI episodes. The analysis shows that treating patients with Anas barbariae hepatis et cordis extractum 200K lowers costs for the NHS; this is primarily due to the fact that the medication causes fewer episodes of RTI to develop. This study suggests that the treatment with Anas barbariae hepatis et cordis extractum 200K could be helpful in preventing RTIs and improving the health status of patients who suffer from respiratory diseases, and it could lead to savings to the Italian NHS.

Burns: bone-anchored, extra-oral implantology.

Extra-oral implants represent a valid alternative technique in aesthetic reconstruction of the craniofacial district in oncology surgery. Two female patients were selected; they were treated from December 2001 to June 2007 by implanting auricular epithesis. The age range was 27 years. They shared the same diagnosis: burns of the auricle-temporal region. The deformity in the auricle region and the complete absence of the pinna convinced the authors to choose this reconstructive method. Most patients showed a good stability of fixtures, epithesis and perimplants soft tissue, in some cases there has been a delay in the time to healing soft tissue perimplant and only one patient has removed the plant after 5 years cancer recurrence. No complications were observed, including bleeding and infections, in the postsurgery period. No report was made in any case of lesion of the facial nerve having the fixtures being positioned in the back and above the point of emergency.