Augmentation mastopexy generally is regarded as one of the most challenging aesthetic procedures ... more Augmentation mastopexy generally is regarded as one of the most challenging aesthetic procedures performed on the breast. Indeed, for many surgeons, the complications associated with breast augmentation and mastopexy are not just additive when these two procedures are performed together. The actually seem to compound each other.
Background Periareolar mastopexy is a well-described technique for cosmetic improvement of breast... more Background Periareolar mastopexy is a well-described technique for cosmetic improvement of breasts classified as Regnault ptosis grades 1 and 2. However, this technique is used less frequently for cases of grade 3 ptosis. Methods Grades 2 and 3 ptosis were corrected for selected patients using a combination of augmentation with Style 410 shaped, form-stable, highly cohesive, silicone gel implants and periareolar mastopexy. Results In this study, 17 patients were treated. The Style 410 implants used included four different devices: FX (full height, extra-full projection, n = 4), MX (medium height, extra-full projection, n = 1), MF (medium height, full projection, n = 8), and FF (full height, full projection, n = 4). No complications occurred immediately after surgery, and only two cases of capsular contracture Baker grade 2 cases with implant palpability occurred during a mean follow-up period of 18 months. All 17 women were very satisfied with
Conservative mastectomy (CM) has become an established alternative in the treatment of breast can... more Conservative mastectomy (CM) has become an established alternative in the treatment of breast cancer, offering by different techniques a good cosmetic outcome, as well as oncologic control. The different options to achieve these goals are presented. Oncoplastic treatment of breast cancer needs planning and knowledge of well-established plastic surgery techniques.
Preoperative vascular mapping has been demonstrated to be an excellent adjunct to perforator flap... more Preoperative vascular mapping has been demonstrated to be an excellent adjunct to perforator flap surgery by reducing operative times and enhancing surgical precision. The purpose of this study was to evaluate the benefit of preoperative vascular mapping using magnetic resonance imaging and Doppler ultrasonography to identify the different perforators to the breast and compare it postoperative mapping. Specifically, the intent was to determine whether preoperative knowledge of the various vascular sources to the nipple areolar complex affected the outcome and vitality of the NAC.
Abstract: Surgical treatment of breast cancer has changed during the last few decades. Long-term
... more Abstract: Surgical treatment of breast cancer has changed during the last few decades. Long-term
evaluation of several studies performed worldwide have confirmed that conservative surgery (CS) and radical
mastectomy have similar survival rates. Due to CS being the gold standard for treatment for most women
with breast cancer, advances in materials, mastectomy and reconstructive surgery techniques, now give us the
possibility to perform on our patients a great outcome with oncological security. Both advances, in plastic
and oncologic surgery, created a new discipline, called oncoplastic breast surgery, that allow surgeons to
resect large breast specimens preventing subsequent deformities with the correct previous planning. This
is particularly important when more than 30% of the breast volume will be resected because it allows for
planning CS depending on the site of the lesion and for establishing the limits between CS and mastectomy.
Level of Evidence V This journal requires that authors assign a level of evidence to each submiss... more Level of Evidence V This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of
At this time in medical history, we often see the complications of industrial silicone injections... more At this time in medical history, we often see the complications of industrial silicone injections in patients who have undergone this procedure to augment the size of their breasts. This practice, long considered outside the ethical standards of good medical practice, commonly leads to adverse health effects and the physical and psychological trauma associated with them.
Introduction: The traditional design for truncal perforator flaps are ipsilateral without midline... more Introduction: The traditional design for truncal perforator flaps are ipsilateral without midline decussation. The presumed rational is to minimize the risk of distal flap necrosis. In this paper we present our experience and results ipsilateral truncal perforator flaps designed and raised crossing the midline. Methods: This retrospective analysis included 43 patients (25 men and 18 women) who underwent reconstructive surgery from 1984 to 2021 using a contralateral flap design crossing the midline in the anterior trunk and upper back. Considerations included: pathology, location, as well as the dimensions of the defect and flap. An arithmetic and weighted mean with their 95% CI was estimated to compare ipsilateral and contralateral techniques. Results: Contralateral flaps utilized included the internal mammary perforator flap (n=28) superficial superior epigastric artery (n=8), superior epigastric perforator (n=2), and the 2 nd or 9 th dorsal intercostal artery perforator flaps (n=5). All of these flaps excluding the superficial superior epigastric artery demonstrated length and coverage surface averages that were significantly greater than those traditional ipsilateral flaps. However, with the contralateral superficial superior epigastric artery, both measures were statistically similar to those traditional ipsilateral flaps. Conclusions: The anatomic variation design suggests that trunk midline is not a barrier and that perforator flaps in these two regions may be raised on different longitudinal axes without compromising vitality.
Augmentation mastopexy generally is regarded as one of the most challenging aesthetic procedures ... more Augmentation mastopexy generally is regarded as one of the most challenging aesthetic procedures performed on the breast. Indeed, for many surgeons, the complications associated with breast augmentation and mastopexy are not just additive when these two procedures are performed together. The actually seem to compound each other.
Background Periareolar mastopexy is a well-described technique for cosmetic improvement of breast... more Background Periareolar mastopexy is a well-described technique for cosmetic improvement of breasts classified as Regnault ptosis grades 1 and 2. However, this technique is used less frequently for cases of grade 3 ptosis. Methods Grades 2 and 3 ptosis were corrected for selected patients using a combination of augmentation with Style 410 shaped, form-stable, highly cohesive, silicone gel implants and periareolar mastopexy. Results In this study, 17 patients were treated. The Style 410 implants used included four different devices: FX (full height, extra-full projection, n = 4), MX (medium height, extra-full projection, n = 1), MF (medium height, full projection, n = 8), and FF (full height, full projection, n = 4). No complications occurred immediately after surgery, and only two cases of capsular contracture Baker grade 2 cases with implant palpability occurred during a mean follow-up period of 18 months. All 17 women were very satisfied with
Conservative mastectomy (CM) has become an established alternative in the treatment of breast can... more Conservative mastectomy (CM) has become an established alternative in the treatment of breast cancer, offering by different techniques a good cosmetic outcome, as well as oncologic control. The different options to achieve these goals are presented. Oncoplastic treatment of breast cancer needs planning and knowledge of well-established plastic surgery techniques.
Preoperative vascular mapping has been demonstrated to be an excellent adjunct to perforator flap... more Preoperative vascular mapping has been demonstrated to be an excellent adjunct to perforator flap surgery by reducing operative times and enhancing surgical precision. The purpose of this study was to evaluate the benefit of preoperative vascular mapping using magnetic resonance imaging and Doppler ultrasonography to identify the different perforators to the breast and compare it postoperative mapping. Specifically, the intent was to determine whether preoperative knowledge of the various vascular sources to the nipple areolar complex affected the outcome and vitality of the NAC.
Abstract: Surgical treatment of breast cancer has changed during the last few decades. Long-term
... more Abstract: Surgical treatment of breast cancer has changed during the last few decades. Long-term
evaluation of several studies performed worldwide have confirmed that conservative surgery (CS) and radical
mastectomy have similar survival rates. Due to CS being the gold standard for treatment for most women
with breast cancer, advances in materials, mastectomy and reconstructive surgery techniques, now give us the
possibility to perform on our patients a great outcome with oncological security. Both advances, in plastic
and oncologic surgery, created a new discipline, called oncoplastic breast surgery, that allow surgeons to
resect large breast specimens preventing subsequent deformities with the correct previous planning. This
is particularly important when more than 30% of the breast volume will be resected because it allows for
planning CS depending on the site of the lesion and for establishing the limits between CS and mastectomy.
Level of Evidence V This journal requires that authors assign a level of evidence to each submiss... more Level of Evidence V This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of
At this time in medical history, we often see the complications of industrial silicone injections... more At this time in medical history, we often see the complications of industrial silicone injections in patients who have undergone this procedure to augment the size of their breasts. This practice, long considered outside the ethical standards of good medical practice, commonly leads to adverse health effects and the physical and psychological trauma associated with them.
Introduction: The traditional design for truncal perforator flaps are ipsilateral without midline... more Introduction: The traditional design for truncal perforator flaps are ipsilateral without midline decussation. The presumed rational is to minimize the risk of distal flap necrosis. In this paper we present our experience and results ipsilateral truncal perforator flaps designed and raised crossing the midline. Methods: This retrospective analysis included 43 patients (25 men and 18 women) who underwent reconstructive surgery from 1984 to 2021 using a contralateral flap design crossing the midline in the anterior trunk and upper back. Considerations included: pathology, location, as well as the dimensions of the defect and flap. An arithmetic and weighted mean with their 95% CI was estimated to compare ipsilateral and contralateral techniques. Results: Contralateral flaps utilized included the internal mammary perforator flap (n=28) superficial superior epigastric artery (n=8), superior epigastric perforator (n=2), and the 2 nd or 9 th dorsal intercostal artery perforator flaps (n=5). All of these flaps excluding the superficial superior epigastric artery demonstrated length and coverage surface averages that were significantly greater than those traditional ipsilateral flaps. However, with the contralateral superficial superior epigastric artery, both measures were statistically similar to those traditional ipsilateral flaps. Conclusions: The anatomic variation design suggests that trunk midline is not a barrier and that perforator flaps in these two regions may be raised on different longitudinal axes without compromising vitality.
Aesthetic breast augmentation revision surgery, 2022
Rupture is an important complication of breast implants. Before cohesive gel silicone implants, ... more Rupture is an important complication of breast implants. Before cohesive gel silicone implants, rupture rates of both saline and silicone breast implants were over 10%. Through an analysis of ruptured implants, we can determine the various factors related to ruptured implants. Breast implant rupture is one of the most serious complications and concerns of patients. Both manufacturers and physicians commonly explain that breast implants are semi-permanent. However, according to the United States Food and Drug Administration (US FDA) classification, breast implants have a limited product-life. In practice, a breast implant device can maintain its mechanical integrity for decades in a woman’s body, but the incidence of rupture increases with time. Upon saline breast implant rupturing or leaking, it quickly deflates, which is noticed by the patient. By contrast, rupture of a silicone breast implant does not usually produce a change in volume, and the patient generally cannot realize what has happened in her body.
Rupture is an important complication of breast implants. Before cohesive gel silicone implants, r... more Rupture is an important complication of breast implants. Before cohesive gel silicone implants, rupture rates of both saline and silicone breast implants were over 10%. Through an analysis of ruptured implants, we can determine the various factors related to ruptured implants. Breast implant rupture is one of the most serious complications and concerns of patients. Both manufacturers and physicians commonly explain that breast implants are semi-permanent. However, according to the United States Food and Drug Administration (US FDA) classification, breast implants have a limited product life. In practice, a breast implant device can maintain its mechanical integrity for decades in a woman's body, but the incidence of rupture increases with time. Upon saline breast implant rupturing or leaking, it quickly deflates, which is noticed by the patient. By contrast, rupture of a silicone breast implant does not usually produce a change in volume, and the patient generally cannot realize what has happened in her body.
Oncoplastic and Reconstructive Management of the Breast: A Multidisciplinary Approach, Third Edit... more Oncoplastic and Reconstructive Management of the Breast: A Multidisciplinary Approach, Third Edition S. Kronowicz
Hypoplasia and ptosis of the mammary glands in a single patient are frequent occurrences, especia... more Hypoplasia and ptosis of the mammary glands in a single patient are frequent occurrences, especially after multiple pregnancies, breastfeeding, or significant weight loss. Inadequate breast volume may induce a negative body image and low self-esteem, affecting a patient’sn quality of life. A mastopexy survey of 487 members belonging to the American Society for Aesthetic Plastic Surgery published in 2006 concluded that the inverted T is the most popular mastopexy approach (46%) despite the varying nature of mammary ptosis and its treatment. Short-scar mastopexy techniques were used by 18% of respondents, and the periareolar approach was used in 6.2% of the surgeries performed by respondents using only a single technique of mastopexy [1]. Over the years, breast augmentation with periareolar mastopexy has remained a challenging and controversial procedure [2–5]. The aesthetic results of combining breast augmentation and mastopexy are less predictable than those associated with augmentation mammoplasty or mastopexy alone [3].
Implant –based breast reconstruction with implants is the most widely used form of immediate bre... more Implant –based breast reconstruction with implants is the most widely used form of immediate breast reconstruction today. It provides a satisfactory result in most cases, and is the optimal choice for women wishing breast reconstruction and are not undergoing radiotherapy. Two stages allows symmetrization of the contralateral breast in the second stage, resulting in a more predictable outcome. It is usually accepted that the best patients for a suitable staged implant-based breast reconstruction with implants are those small or medium-breasted women with well-defined body shape, minimal breast ptosis and minimal or none skin resection with symmetric breasts. Large-breasted women treatment, usually involves skin resections that must be planned previous to mastectomy. We have observed that breast volume evaluation alone s not enough as an indicator for patient and technique selection. Mastectomy flaps thickness is also an important factor in immediate breast reconstruction planning, and breast volume and flap thickness are not in direct relationship.
The TDAP flap was originally described in 1992 (1) as a method of harvesting the skin and subcuta... more The TDAP flap was originally described in 1992 (1) as a method of harvesting the skin and subcutaneous island of the traditional latissimus dorsi musculocutaneous (LD-MC) flap without the muscle. It was initially reported as a complementary technique for breast reconstruction (2-3) and recently reported for complete autologous breast reconstruction (4). Several studies have demonstrated that the TDAP flap is a reliable and safe technique (4-6). The TDAP flap is irrigated by the proximal perforator of the descending branch of the thoracodorsal artery which is consistently present(7-8). The superior (scapular) and inferior (lumbar) fat compartments can be partially captured and irrigated by this proximal muscle perforator when additional volume is needed without the muscle as an Extended TDAP flap (9) With this method, sufficient volume to reconstruct a B-cup sized breast can be obtained using a totally or partially deepithelialized flap.
la mamografia analogica no permite la correcta identificacion y medicion del tejido de cobertura... more la mamografia analogica no permite la correcta identificacion y medicion del tejido de cobertura no glandular. La mamografia digital en cambio diferencia claramente la densidad del tejido glandular del tegumento y de la grasa, revelando el espesor de la cobertura. la planificacion quirurgica y el procedimiento reconstructivo, estan relacionados con la evaluacion de la cobertura mas que con el volumen mamario.
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Papers by alberto rancati
evaluation of several studies performed worldwide have confirmed that conservative surgery (CS) and radical
mastectomy have similar survival rates. Due to CS being the gold standard for treatment for most women
with breast cancer, advances in materials, mastectomy and reconstructive surgery techniques, now give us the
possibility to perform on our patients a great outcome with oncological security. Both advances, in plastic
and oncologic surgery, created a new discipline, called oncoplastic breast surgery, that allow surgeons to
resect large breast specimens preventing subsequent deformities with the correct previous planning. This
is particularly important when more than 30% of the breast volume will be resected because it allows for
planning CS depending on the site of the lesion and for establishing the limits between CS and mastectomy.
evaluation of several studies performed worldwide have confirmed that conservative surgery (CS) and radical
mastectomy have similar survival rates. Due to CS being the gold standard for treatment for most women
with breast cancer, advances in materials, mastectomy and reconstructive surgery techniques, now give us the
possibility to perform on our patients a great outcome with oncological security. Both advances, in plastic
and oncologic surgery, created a new discipline, called oncoplastic breast surgery, that allow surgeons to
resect large breast specimens preventing subsequent deformities with the correct previous planning. This
is particularly important when more than 30% of the breast volume will be resected because it allows for
planning CS depending on the site of the lesion and for establishing the limits between CS and mastectomy.
Breast implant rupture is one of the most serious complications and concerns of patients. Both manufacturers and physicians commonly explain that breast implants are semi-permanent. However, according to the United States Food and Drug Administration (US FDA) classification, breast implants have a limited product-life. In practice, a breast implant device can maintain its mechanical integrity for decades in a woman’s body, but the incidence of rupture increases with time. Upon saline breast implant rupturing or leaking, it quickly deflates, which is noticed by the patient. By contrast, rupture of a silicone breast implant does not usually produce a change in volume, and the patient generally cannot realize what has happened in her body.
Breast implant rupture is one of the most serious complications and concerns of patients. Both manufacturers and physicians commonly explain that breast implants are semi-permanent. However, according to the United States Food and Drug Administration (US FDA) classification, breast implants have a limited product life. In practice, a breast implant device can maintain its mechanical integrity for decades in a woman's body, but the incidence of rupture increases with time. Upon saline breast implant rupturing or leaking, it quickly deflates, which is noticed by the patient. By contrast, rupture of a silicone breast implant does not usually produce a change in volume, and the patient generally cannot realize what has happened in her body.
S. Kronowicz
Two stages allows symmetrization of the contralateral breast in the second stage, resulting in a more predictable outcome.
It is usually accepted that the best patients for a suitable staged implant-based breast reconstruction with implants are those small or medium-breasted women with well-defined body shape, minimal breast ptosis and minimal or none skin resection with symmetric breasts. Large-breasted women treatment, usually involves skin resections that must be planned previous to mastectomy.
We have observed that breast volume evaluation alone s not enough as an indicator for patient and technique selection.
Mastectomy flaps thickness is also an important factor in immediate breast reconstruction planning, and breast volume and flap thickness are not in direct relationship.
Several studies have demonstrated that the TDAP flap is a reliable and safe technique (4-6).
The TDAP flap is irrigated by the proximal perforator of the descending branch of the thoracodorsal artery which is consistently present(7-8). The superior (scapular) and inferior (lumbar) fat compartments can be partially captured and irrigated by this proximal muscle perforator when additional volume is needed without the muscle as an Extended TDAP flap (9)
With this method, sufficient volume to reconstruct a B-cup sized breast can be obtained using a totally or partially deepithelialized flap.