The Combination of Three Techniques for Breast Reduction: A Series of Ten Consecutive Cases

There is continuing controversy regarding the most effective and safest technique for breast reduction surgery. This case series describes our experience with a breast reduction approach that combines three techniques aimed at addressing three different aspects of breast reduction: skin reduction, shaping, and nipple areolar complex shaping. We assessed the perioperative course and postoperative outcomes (for a mean of 19 months) of 10 consecutive women who underwent breast reduction surgery involving a combination of three techniques: “inverted T” skin reduction, modified Hall-Findley supero-medial pedicle for glandular reduction, and inferior de-epithelialized flap (modified “Foustanos” flap) for molding and improved shaping of the breast. The final bra cup size was C or D in all patients. The overall results were graded as excellent in four patients and very good in six patients. Each patient was completely satisfied with her surgery. Six patients developed venous congestion of the nipple areolar complex, which resolved within 24 - 48 hours after surgery. Two patients had uneventful delayed wound healing in the vertical scar of the inverted T pattern. There was a 100% nipple areolar complex survival rate. No patient had a major adverse event, permanently altered nipple areolar complex sensitivity, or bottoming out of the lower pole. None required revision surgery. This case series confirms our expectations that the solution to questions about breast reduction methods may depend on melding different techniques into a single procedure. The combination of techniques herein described was both effective and safe. Level of Evidence: Level IV, therapeutic study.

Experimental assessment of regenerative properties of platelet rich plasma on the human skin-a review

Several studies demonstrated the favorable effects of platelet rich plasma(PRP)on the skin and promoted its wide use in clinical practice.The growth factors stored in platelet alfa-granules allow for the tissue regeneration and the main fields of application of PRP in current clinical practice are the cartilage and musculoskeletal defects,osteoarthritis and other bone disorders,chronic and difficult to heal wounds,and aesthetic procedures.The relevant number of different PRP preparation protocols may explain the inconsistency of the different clinical outcomes reported in the literature.Despite the technological advances in PRP preparation,the objective assessment of the clinical efficacy of PRP from the literature reports still is difficult due to the low homogeneity of the samples in terms of both inclusion criteria and size.Therefore,it might be useful to establish standardized and reproducible experimental models to confirm and objectively measure the effectiveness of the available clinical results.Many experimental investigations have been carried out to objectively assess the effectiveness of PRP and platelet gel on several tissues.As far as the skin is concerned,the studies carried out to date are limited to fibroblasts in in-vitro culture models or to collagen,vascular supply,epithelium,and hair follicle in in-vivo models.The skin,however,is a very complex organ,where different cell lines coexist and feature complex mutual interaction.A model that combines the advantages of both in-vitro and in-vivo cultures is the ex-vivo model.The demonstration of the platelet derived growth factors effects through the ex-vivo human full-thickness skin culture model is a keystone to support the evidence of the PRP effectiveness,as it represents an objective,fast,reproducible,and ethical investigational method.