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Immediate single stage breast reconstruction is a challenging procedure with the goal of improving the quality of life of patients with breast cancer. The aim of this study is to evaluate using the BREAST-Q patient satisfaction, body perception and quality of life after direct-to-implant breast reconstruction comparing unilateral and bilateral reconstructions.In this study we enrolled 56 women who underwent mastectomy and immediate single-stage direct-to-implant (DTI) breast reconstruction at Campus Bio-Medico University of Rome between 2013 and 2020. One year after surgery they were administered electronically the BREAST-Q post-operative module.Our two cohorts of patients consisted in 34 women who received unilateral nipple-sparing mastectomy and DTI breast reconstruction and 22 women who underwent bilateral nipple-sparing mastectomy and DTI breast reconstruction. Twenty-four of the 34 patients belonging to the unilateral group responded to the questionnaire (70.5%), while in the bilateral group responders were 16 out of 22 (72.7%). The BREAST-Q scores were compared between the two groups: patients undergoing bilateral mastectomy and breast reconstruction showed higher scores in every BREAST-Q domain compared to patients undergoing unilateral mastectomy and breast reconstruction with a statistically significant difference in the Satisfaction with breast (P = 0.01), Sexual well-being (P = 0.03), and Satisfaction with implants (P = 0.01) domains.Patients undergoing bilateral DTI breast reconstruction have a favorable postoperative surgical cosmetic outcome with a better patient's body image perception and a higher post-operative level of satisfaction compared to unilateral DTI reconstruction after nipple-sparing mastectomy.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.

Resumen Antecedentes La asociacion entre el posicionamiento craneocervical (PCC) y los trastornos temporomandibulares (TTM) ha sido intensamente investigada, pero todavia hay controversias entre clinicos e investigadores. Objetivo Analizar los cambios en el dolor y el PCC en pacientes con TTM de origen miofascial tratados con terapia miofuncional. Metodo Estudio experimental, longitudinal y prospectivo. Se evaluaron 16 pacientes de ambos sexos, edad promedio 31,62 ± 10,61 anos, con diagnostico de TTM de origen miofascial (segun los criterios diagnosticos para la investigacion de los TTM), que habian recibido 10 sesiones de MAR grado iv de Maitland de la articulacion temporomandibular combinadas con el uso de un dispositivo interoclusal de descompresion articular. Antes y despues de esa intervencion se evaluo: el PCC por fotografia analizada a traves del programa SAPO; dolor espontaneo y dolor a la presion. Se analizo la normalidad de las variables mediante la prueba de Shapiro-Wilks. Para las comparaciones antes-despues se aplico la prueba t de Student para muestras pareadas. Se considero significativo un valor p Resultado Se observo una disminucion estadisticamente significativa del dolor espontaneo y a la presion. No se encontraron diferencias en las variables del PCC (p Conclusion Luego del tratamiento con MAR grado iv de Maitland de la articulacion temporomandibular y el dispositivo interoclusal de descompresion articular, se observo una disminucion estadistica y clinicamente significativa del dolor espontaneo y a la presion. No se encontraron diferencias en las variables del PCC.

Morphing is one of the first digital effects developed by the film industry and consists of the fluid, gradual and seamless transformation between two images of different shapes, which can be objects, people, faces, landscapes. In plastic surgery, morphing has been used to show the patient a possible outcome of an operation, such as what the face might look like after a rhinoplasty operation. To undergo a cosmetic surgery the two most important things are the awareness that the patient acquires before the surgery and the motivation to perform the surgery. Awareness is reached with the preliminary visits and it is the surgeon's obligation to inform the patient about the risks, benefits and possible complications of the surgery but above all about the possible realistic results that can be obtained so that the patient has realistic expectations. Motivation is the right key to achieving the final goal, which is the result of the intervention. Moreover, if complications arise, he will be ready and aware to deal with them. Using morphing during the first visit can be disadvantageous for a correct motivation for the surgery and for a correct awareness of the possible result.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 .