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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.

Background Mechanosensitivity changes and trigger points in the infraspinatus muscle are associated with several painful conditions of the upper limb. The aim of this study was to assess the effect of different postures of the upper quadrant on the pressure pain threshold (PPT) of the infraspinatus muscle. Methods This was an observational, cross-sectional study. Fifty-four subjects with and without shoulder pain (Asymptomatic subjects = 27, mean age 26.9 ± 4.92 years, BMI 23.73 ± 3.87), (symptomatic subjects = 27, mean age 27.6 ± 3.68 years, BMI 24.35 ± 3.86) were evaluated with a pressure algometer on the infraspinatus muscle belly, in four different positions of the upper quadrant: rest position (P1), passive scapular retraction position (P2), cervical contralateral inclination position (P3), and suprascapular nerve provocation position (P4). The assessed side was randomly chosen and all measurements were taken in sitting position. Results No differences were observed between groups. The within-group analysis showed differences for both factors: “Positions” (F = 69.91; p = 0.001) and the interaction “Positions^Group” (F = 3.36; p = 0.02). The pairwise post-hoc analysis showed differences for the retracted position (P2) compared to others P1 (p = 0.001), P3 (p = 0.001), and P4 (p = 0.001), with higher PPT results achieved on the retracted position. Differences between P4 vs. P1 (p = 0.03) were also observed, with higher values for P4. Conclusion Placing the scapular girdle in a passive scapular retraction position significantly reduces the pressure sensitivity at the infraspinatus muscle. Physiotherapists can take into account these results when assessing and treating patients with upper quadrant pain syndromes.

Rhythmic joint mobilizations (RJM) of the temporomandibular joint (TMJ) are employed to relieve pain and improve function in patients with temporomandibular disorders (TMD). However, the evidence on the immediate effects of RJM in patients with TMD is scarce. The aim of this study was to assess the immediate clinical and functional effects of RJM in patients with TMD.This was a one-group quasi-experimental before and after study. Thirty-eight patients with TMD were assessed by means of pain intensity (visual analogue score, VAS), pressure pain threshold (PPT, measured through pressure algometry on the masseter and temporal muscles), mouth opening (MO, measured with a ruler), and surface electromyographic activity of the masseter and temporal muscles (asymmetry index, AI). Measurements were performed before and after a single, 1-min session of RJM of each TMJ. All statistical analyses were performed using the SPSS version 20.0 statistical package.A statistical significant difference was found in pain intensity, PPT and MO after the intervention (p 0.05). No difference was found in the AI. A large effect size was observed for pain intensity, PPT of the left and right masseter muscles and MO (d = 0.85-1.13), whereas for the left and right temporal muscles the effect size was moderate (d = 0.62) and small, respectively (d = 0.49).In this sample of patients with TMD, a single session of RJM of the TMJ seemed to be effective in reducing pain intensity, increasing PPT and improving MO immediately after the intervention, without differences in the AI.

Breast remodeling following breast-conserving surgery (BCS) and radiation therapy (RT) is challenging and often burdened by complications due to irradiated tissue atrophy. The authors present a case–control study to compare the central mound mastopexy (CMM) to more conventional techniques, applying it to different patterns of skin excision. A variation of the original central mound technique is presented separately addressing glandular and cutaneous deformities. Between 2012 and 2018, 17 consecutive patients presenting defects following unilateral BCS and RT underwent breast remodeling with CMM technique. Immediate and long-term complications together with patient-reported outcomes were evaluated and compared to a matched control group of sixteen patients who underwent superior pedicle mammoplasty. Two independent plastic surgeons reviewed pre- and postoperative photographs and rated the cosmetic outcomes on a visual analog scale from 1 to 5. In the study group, different patterns of skin excision, i.e., inverted-T pattern (41.2%), circumareolar (23.5%), skin-sparing type V (17.65%), omega (11.77%), and J (5.88%), were used to correct various breast deformities, and a decisional algorithm was developed. No major complications were registered. Retraction recurrence rate was higher in the control group (p = 0.037). Cosmetic results were considered more satisfying in the CMM group by both patients (4.18 vs 3.00, p

In conducting this study, it was our presumption that lipofilling is a necessary and simultaneous adjunct to lifting the middle third of the face in patients with negative lower eyelid vectors, enabling satisfactory and enduring aesthetic results. Eligible patients met the following criteria: (1) primary midface lift in subperiosteal plane; (2) negative inferior eyelid vectors at preoperative baseline; (3) postoperative monitoring for ~ 2 years; (4) standard pre- and postoperative photo-documentation; (5) proficiency in Italian language; and (6) signed consent for study participation. Informed consent pertaining to photography allowed for subsequent publication. Pertinent patient data were also collected as follows: age, sex, duration of follow-up, type of surgical procedure, related secondary procedures, quantity of fat injected, nature of incision, and patient satisfaction level. Complete randomness was thus conferred during computer-assisted patient assignment to one of two study arms: midface lift only (group 1) or midface lift plus facial lipofilling as a concurrent operation (group 2). All patients completed Italian versions of the FACE-Q module, which were issued by e-mail approximately 2 years postoperatively. Two plastic surgeons reviewed all postoperative photographs of treated patients and rated outcomes on a scale of 1–5. Statistical analysis was powered by standard software expressing categorical data as numbers and percentages and quantitative data as means ± standard deviations. Between January 2016 and March 2018, a total of 56 patients (women 48; men 8) subjected to primary midface lifts in subperiosteal plane at our Plastic Surgery Department met all criteria for study enrollment. Mean patient age was 56.5 years (range 40–70 years), and the mean follow-up period was 2.1 years (range 2–5 years). Differences in postoperative FACE-Q scoring by the two groups were significant (p

In this review, we examine the use of DAS59 and DAS24 in the scientific literature and in particular how the use of these questionnaires has improved the understanding and practice of plastic and reconstructive surgery. A systematic review protocol was developed in accordance with the Preferred Reporting for Items for Systematic Review and Meta-Analys-Protocol (PRISMA-P) guide. A multi-step search of the PubMed, MEDLINE, Embase, Premedeline, Ebase, CINAHL, PsychINFO and Cochrane databases was performed to identify studies on body image using DAS59 and DAS24. The literature review yielded 28 articles with DAS59 and 32 articles with DAS24 from peer-reviewed journals met our inclusion criteria and were included in the analysis. Since its inception in 2001, the number of publications incorporating the DAS has increased each year with a total of 3.483 patients for DAS59 and 6.012 patients for DAS24. The prospective study design was the most prevalent, being used in 50% of publications (n = 30), 57% for DAS59, 43% for DAS24. The DAS59 was administered in a cross-sectional design in 21% of studies (n = 6) and DAS24 41% (n = 13). The DAS59 was administered in a retrospective design in 18% of studies (n = 5) and DAS24 9% (n = 3). We reported only one case series for DAS59 and 2 for DAS24. The DAS59 and DAS24 are versatile self-assessment tools that can be used in different medical and surgical environments. Level of evidence: not ratable.

The idea of this study stemmed to understand if sexuality can be a factor that affects the perception of one’s body and can be a feature that makes the subject more inclined to undergo esthetic surgery. A total of 51 male subjects participated in this study by filling out the Italian version of the DAS59 consisting of 59 items, which took approximately 35 min, under the supervision of a research assistant who did not interfere with the privacy of the patient. The data was entered in SAS version 8.4 (SAS Institute, Cary, NC, USA). The reliability of the scale was tested by Cronbach’s alpha coefficient and the correlation coefficient. Retest reliability was also tested using Spearman’s correlation coefficient between items and the total scale score. Analysis of variance was performed between the two groups. Differences between the homosexual and heterosexual subjects were assessed using the Mann–Whitney test of discriminant validity. Adult homosexual male patients without a personal history of esthetic procedures were recruited. We enrolled 26 adult homosexual male patients aged 18–42 years old and 25 male heterosexual adults aged 18–43 years. Any subject had personal history of esthetic procedures. We analyzed direct and indirect indicators of “esthetic concern,” the number of answers given by each subject accuracy, the attention to the questionnaire, and the effect on age on accuracy between the two groups. We confirmed that there are many differences between the two groups. Nevertheless, the greater attention to esthetics and concern for appearance is much more present in the homosexual group than in the heterosexual group, and its relationship with age in the homosexual group is a strong indication of an important and essential phenomenon in development. The absence of such a relationship in the heterosexual group leads instead to think that the esthetic concern is in this group a phenomenon of local type and much less fundamental than the personality. The DAS59, used in a homogeneous study group, has shown that esthetic sensibility may depend on emotional and psychological factors within a homogeneous social dimension that does not create a difference. This pilot study is the first to introduce the importance of the role of sexuality in the perception of the esthetics of one’s body. Level of evidence: Not ratable.

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 .

Basal cell carcinoma (BCC) is the most common skin cancer, and it can be easily treated by surgery or by various other physical modalities and topical chemotherapy. For metastatic, locally advanced BCC and for cancers that cannot be removed by surgery, systemic drugs known as hedgehog pathway blocker are used. High-frequency ultrasound (HFUS) is a non- invasive technique used in diagnosis of some skin cancers. It has proven potentially useful for BCC management. In this study we used high frequency ultrasounds to evaluate BCCs' thickness and the correlation with dermoscopic features.We examined 86 basal cell carcinomas with dermoscopy and with high-frequency ultrasound. The main patterns identified by ultrasound were linear, ellipsoid and non-specific or undefined. Patients were divided by sex and age. The BCCs were grouped by anatomic location. Finally, we recorded specific dermoscopic features of BCCs noting their presence/absence in lesions overall and in each of four quadrants. Then the lesions were excised, and histological examination was made with definition of tumor thickness (in mm).In our study, two main echographic patterns were described: linear, associated with superficial BCC, and ellipsoid, found primarily in nodular variants. However, a small percentage of lesions have otherwise non-specific patterns. We observed a significant correlation between echographic tumor thickness and histotype. We observed high concordance between histological tumor thickness and ultrasounds. Also, dermoscopic criteria as large branching and blue ovoid nests were significantly associated with heightened histologic and echographic assessments of tumor thickness.Our study confirmed the utility of ultrasound in the diagnosis of BCCs and for the first time we have correlated ultrasounds' patterns with dermoscopy and tumor thickness.

Introduction The purpose of this study is to determine if there is a better quality of life with one of the two techniques and if the results are in line with those already present in the literature. The hypothesis from which we started is to demonstrate that cancer patients who undergo a deep inferior epigastric perforator flap (DIEP) breast reconstruction surgery are more satisfied and have a higher level of quality of life compared to those subjected to an intervention of reconstruction with prosthesis. Materials and Methods All patients undergoing reconstruction from January 2010 to July 2018 were eligible for inclusion. This is a retrospective cohort study carried out using the patients of two plastic surgery departments who have undergone monolateral or bilateral implant-based or DIEP flap breast reconstruction. We administered BREAST-Q questionnaire electronically almost 2 year after surgery. Patients were divided into two groups: implant-based and autologous breast reconstruction with DIEP flaps. Baseline demographics and patient characteristics were analyzed using a Students t-test (continuous variables) or Chi-square/Fisher’s exact test (categorical variables). Mean standard deviation BREAST-Q scores were reported for the overall cohort and by modality for the postoperative period. The linear regression model was applied to all BREAST-Q score with all predictor factors. Results Of the 1125 patients involved, only 325 met the inclusion criteria and were enrolled in this study; specifically, 133 (41%) DIEP and 192 (59%) prosthetic reconstructions. We summarized the results of the principal scales of BREAST-Q module: satisfaction with breast, psychosocial well-being, satisfaction with outcome, and sexual well-being in which the autologous group was always more satisfied. We reported results of all linear regression models with higher values for the DIEP group independently from predictors. Conclusion This is the first study performed on the Italian population that compares autologous surgical techniques with the implantation of breast implants. In this population, DIEP is considered the technique that leads to the highest satisfaction in all BREAST-Q scores. 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.

Background Estrogens play a key role in the skin. They are associated with an increased production of melanin, proliferation of melanocytes, increased skin thickness and increased cutaneous vascularization. Spitz and Reed nevi are acquired melanocytic lesions that generally develop during childhood or adolescence, a period of changes in sex hormones background. Our study project aimed at investigating, through immunohistochemical analysis, the expression levels of ERs receptors and their expression patterns (cytoplasmic or nuclear) in Spitz and Reed nevi. Methods In our study, we collected a total of 86 melanocytic lesions of patients: of these, 16 were common nevi, 23 were Spitz nevi, 18 were Reed nevi and 29 were melanomas. Expression curves for estrogen receptors were constructed using the Kaplan-Meier method and compared using a log-rank test. Statistical analysis was performed using MedCalc® (MedCalc Software, Ostend, Belgium). Immunohistochemical analysis on all histological sections of nevi and melanomas was performed to evaluate the expression levels of of ERs and their expression patterns (cytoplasmic or nuclear). The agreement between the operators was calculated using Fleiss κ values. Results The correlation between immunoreactivity for the β-estrogen receptor and the sex of patients with Spitz and Reed nevi showed that immunoreactivity was higher in male patients. The correlation between β-estrogen receptor immunoreactivity and patient age for Spitz and Reed nevi showed no statistically significant correlation. Correlation between immunoreactivity for the β-estrogen receptor and histotype: Spitz and Reed nevi showed a high intensity, while in common nevi and in melanomas the immunoreactive was low. The correlation between receptor immunoreactivity for β estrogens and Breslow thickness in melanomas indicated that Breslow thickness of non-immunoreactive melanomas for ERβ was much higher than those showing high immunoreactivity for this receptor. Conclusions Spitz and Reed nevi express a higher immunoreactivity for estrogens than common nevi and melanomas, especially those with a high Breslow thickness; and immunoreactivity is higher in younger age groups.

Introduction: Postherpetic neuralgia (PHN) is a complex neuropathic painful condition in which pain is a direct consequence of the response to peripheral nerve damage experienced during herpes zoster attack. PHN is the most common chronic complication of herpes zoster and it causes considerable suffering, affecting the physical functioning and psychological well-being of patients. Objective: To describe the effect of a conservative treatment using pain neuroscience education (PNE) and transcutaneous electrical nerve stimulation (TENS) in a patient with trigeminal PHN. Case Description: A 67-year-old woman sought care for pain, dysfunction, and sensory loss in the left jaw. The assessment included: 1) pain, using the numerical pain rating scale (NPRS), pressure pain threshold (PPT), Douleur Neuropathique 4 (DN4), McGill Pain Questionnaire (MPQ), Graded Chronic Pain Scale (GCPS), and classic body charts of the cranial region; 2) somatosensory function, by means of mechanical detection threshold (MDT) and pressure pain threshold (PPT); 3) jaw function, using the Jaw Functional Limitation Scale-20 (JFLS-20); and 4) psychosocial features, by means of the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorders Questionnaire-7 (GAD-7). Treatment consisted of 12 sessions of PNE and TENS. Outcomes: After treatment, a clinically significant improvement in NPRS, DN4, MDT, GCPS, and PHQ-9 was observed. Conclusion: In this case report, a treatment based on the combination of PNE and TENS seemed to have contributed to improving pain, sensory abnormalities, and jaw function. Psychosocial factors also showed a trend to improve after the treatment.

Introduction This study aims to analyze whether there is any patient- or treatment-related factor that can influence patients' body perception after mastectomy and autologous or implant-based breast reconstruction. Materials and methods This retrospective cohort study included patients who underwent immediate implant-based or DIEP flap breast reconstruction. Predictive factors analyzed included chemotherapy, radiotherapy, hormone therapy, body mass index, age, type of mastectomy, and follow-up length. The BREAST-Q was administered postoperatively almost 2 years from the last surgical procedure. Mean BREAST-Q scores were reported for the overall cohort and by modality for the postoperative period. A linear regression model was applied to all BREAST-Q scores with all predictor factors. Results In total, 325 patients were enrolled in this study (133 DIEP flap and 192 implant-based reconstructions). The DIEP flap reconstruction group with a previous nipple sparing mastectomy showed the highest scores. Patients with a longer follow-up were less satisfied than the ones with a shorter follow-up, which could be considered as an assessment of the outcome. No significant difference was reported between patients who underwent radiotherapy, chemotherapy or hormone therapy and those who did not. Furthermore, age and BMI had no influence on patient satisfaction. Conclusion This study is the first that groups a large number of patients and analyzes predictive factors of long-term satisfaction of patients undergoing breast reconstruction. This can be regarded as a pilot study to raise the awareness of everyone's clinical practice to predict the attitude that patients have after surgery and to prepare them in the best possible way. 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 .

Autologous fat grafting (AFG), defined as the re-implant to the breast of fat tissue from different body areas, has been firstly applied to esthetic plastic surgery and then has moved to reconstructive surgery, mainly used for scar correction and opposite breast altering. Nevertheless, due to the potentially unsafe stem-like properties of adipocytes at the tumoral bed level, no clear evidence of the procedure’s oncological safety has been clearly documented at present. We retrospectively collected data of early breast cancer (BC) patients from 17 Italian Breast Units and assessed differences in terms of locoregional recurrence rate (LRR) and locoregional recurrence-free survival (LRFS) between patients who underwent AFG and patients who did not. Differences were analyzed in the entire cohort of invasive tumors and in different subgroups, according to prognostic biological subtypes. With a median follow-up time of 60 months, LRR was 5.3% (n = 71) in the matched population, 3.9% (n = 18) in the AFG group, and 6.1% (n = 53) in the non-AFG group, suggesting non-inferiority of AFG (p = 0.084). Building Kaplan–Meier curves confirmed non-inferiority of the AFG procedure for LRFS (aHR 0.73, 95% CI 0.41–1.30, p = 0.291). The same effect, in terms of LRFS, was also documented among different biological subtypes (luminal-like group, aHR 0.76, 95% CI 0.34–1.68, p = 0.493; HER2 enriched-like, aHR 0.89, 95% CI 0.19–4.22, p = 0.882; and TNBC, aHR 0.61, 95% CI 0.12–2.98, p = 0.543). Our study confirms in a very large, multicenter cohort of early BC patients that, aside the well-known benefits on the esthetic result, AFG do not interfere negatively with cancer prognosis.

Background Recent studies indicate that the assessment of conditioned pain modulation (CPM) responses and emotional factors can provide important information regarding chronification mechanisms, choices for more efficient therapeutic strategies, and clinical variables supporting a therapeutic prognosis. Aims To investigate the impact of nonspecific chronic low back pain (NSCLBP) on CPM and psychosocial factors in individuals with NSCLBP compared with healthy controls. Design Case-control study. Methods Eighteen patients with NSCLBP and 18 healthy controls were recruited for this study. Pain intensity and affective-emotional aspects of pain, functional disability, kinesiophobia, depression, anxiety, and catastrophizing pain were obtained using a questionnaire. A CPM protocol was established to assess the functioning of the descending inhibitory system, with a cold pressor test as a conditioning stimulus and pressure pain threshold as a test stimulus. The maximal isometric strength of the trunk extensors also was evaluated. Results Healthy participants demonstrated a greater CPM response than those with NSCLBP. Patients with NSCLBP exhibited significantly lower pressure pain threshold than healthy subjects. Moreover, patients with NSCLBP presented with a considerable exacerbation of cognitive-behavioral changes. NSCLBP patients showed diminished maximal isometric strength of the trunk extensor compared to healthy subjects. Conclusions The endogenous pain inhibition system is reduced in patients with NSCLBP, with significant cognitive-behavioral changes indicated by high levels of anxiety and moderate pain intensity. Setting Clinical School of Physical Therapy of the Federal University of Delta of Parnaiba, Piaui - Brazil. Participants/Subjects 36 subjects with and without NSCLBP.

This randomized controlled study aimed to analyse the long-term results of thin-skinned patients who underwent rhinoplasty. All the included study patients had the following characteristics: underwent primary rhinoplasty for functional and/or cosmetic problems, were thin-skinned, had been followed for almost 2 years, underwent both standard pre- and post-operative photography, had a good understanding of the Italian language, and had signed a consent form for inclusion in the study. The patients were randomly divided into 4 groups as follows: group 1, camouflage of the dorsum by diced cartilage; group 2, camouflage of the dorsum with lipofilling; group 3, camouflage of the dorsum by a temporal fascia graft; and group 4 (control group), without camouflage of the dorsum. Patients answered the Italian version of the FACE-Q rhinoplasty module. The Obagi skin pinch test was used to measure nasal skin thickness. We compared pre- and post-operative patient satisfaction with the appearance of their nose between the 4 patient groups by the Chi-squared test for unpaired data. Two plastic surgeons reviewed all the post-operative photographs of the study patients and rated the photographs on a scale of 1 to 5. A total of 101 patients who underwent primary rhinoplasty between January 2016 and March 2018 in our department of plastic surgery and satisfied the inclusion criteria were enrolled in this study. The mean patient age was 38.5 years. The mean follow-up time was 2.5 years. The differences between the preoperative and post-operative FACE-Q values for group 1 were significant (P

The objectives of this study are: (1) comparison of long-term outcomes after correction of severe gynecomastia using different techniques; (2) apply the Italian version of the BODY-Q; (3) present the role of intercostal perforator flap (ICAP) after massive weight loss for correction of severe gynecomastia. Between January 2008 and March 2016, we performed surgical correction of bilateral severe gynecomastia in 80 men (160 breasts) following massive weight loss. Patients answered the Italian version of BODY-Q postoperative module. All patients had experienced substantial weight loss (> 30 kg), presented with bilateral severe tissue ptosis of the breast, follow-up of almost 2 years and had a good understanding of the Italian language, and signed consents were included in the study. The sample was studied about age, BMI, comorbidity, bariatric surgical procedure, follow-up, type of post-bariatric surgical procedure, complications and secondary procedures. We performed 487 severe gynecomastia corrections from 2008 to 2016; 80 patients adhered to the inclusion criteria and formed our study group. This cross-sectional study compared three cohorts: 52 access using a circumareolar scar, 18 with an inframammary fold scar, 10 with an inframammary fold scar using intercostal perforator flaps. There were 16 secondary procedures in group one, 2 in group two and 1 in group three. We compared the secondary procedures of group 1 with the other groups, and we obtained a significant difference with a P = 0.04. The mean patient age was 36.5 years, and the average body mass index was 27.5 kg/m2 at the time of surgical correction of gynecomastia. From the BODY-Q analysis, the group of patients undergoing adenomammectomy with inframammary fold scar using intercostal perforator flaps has achieved significantly better results regarding the satisfaction with chest, psychosocial function, satisfaction with outcome and better body image. This is the first study that used the BODY-Q to analyze the correction of severe gynecomastia following massive weight loss with long-term results. The use of this patient-reported outcome measure underlined that the intercostal artery perforator flap, used in the correction of severe gynecomastia following massive weight loss, is a safe and effective technique with good outcomes and high patient satisfaction. 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 .

Introduction Many techniques have been described to treat full thickness nasal defects. The authors introduce the bipaddle chimaeric forehead flap (BCFF), a new alternative technique to achieve simultaneous lining and cutaneous reconstruction in case of full thickness hemi-nasal defects, presenting surgical details and applications for its clinical use. Patients and methods From June 2015 to April 2017, 10 patients presenting with oncological full thickness defects involving nasal sidewall and/or nasal ala were reconstructed with the BCFF technique. Mean age was 69.4 years. The chimaeric flap was composed of 2 paddles (cutaneous and periosteal), nourished by a single supratrochlear pedicle, which were used to independently reconstruct the deficient cutaneous and mucosal layers of the nose. Cartilage grafts were used in 8/10 patients. Results Mean surgical time was 114 minutes. An intermediate thinning operation was performed in 3 out of 10 patients. All the flaps survived with no partial necrosis or cartilage exposure observed. Viability and mucosalization of the periosteal paddle was documented both intra-operatively (during the 2nd stage of the operation) and postoperatively (with fiberoptic rhinoscopy performed 3 months after the procedure). Clinical follow-up period ranged from 4 to 24 months postoperatively. The final result was judged sufficient, good and excellent in 1, 5, and 4 cases, respectively. Conclusions The BCFF technique may be a new alternative approach to address full thickness hemi-nasal defects with no extra donor site morbidity, allowing primary placement of structural cartilage grafts and immediate definition of the nasal subunits to be reconstructed.

Background There has been an increase in body contouring procedures following massive weight loss (MWL), including male breast reduction procedures. Treating male chest deformity after MWL using standard mastopexy techniques often leads to suboptimal results. Objectives The authors describe a technique to treat pseudogynecomastia using a modified elliptical excision and nipple-areola complex (NAC) transposition on a thinned inferior dermal pedicle as an alternative to conventional techniques. Methods A retrospective chart review from January 2011 to January 2019 identified a total of 14 male patients who underwent excision of pseudogynecomastia using the described technique. Results Patients were characterized by age, method of weight loss, pre-weight loss body mass index (BMI), post-weight loss BMI, total weight loss, grade of pseudogynecomastia, and concurrent procedures performed. Patients were followed for a period ranging from 3 months to 1.5 years (average, 8.1 months). Pre-weight loss BMI and post-weight loss BMI averaged 52.0 kg/m2 and 29.6 kg/m2, respectively. The average weight lost was 79.72 kg and the average total amount of tissue removed was 2615 g. All patients had concurrent procedures with an average operative time of 274 minutes. Four out of 14 patients (28.6%) experienced minor complications, which included asymmetry, delayed wound healing, seroma, and hyperpigmentation. There were no wound infections, hematomas, flap necrosis, or dysesthesia. Conclusions Due to several cosmetic advantages and low complication profile, our technique using a modified elliptical excision and NAC transfer on an inferior dermal pedicle is an attractive option for treating male chest deformity after MWL. Level of Evidence: 4

Dysmorphophobia is the phobia that arises from the distorted view that one has of one's external appearance, caused by the excessive concern for one's body image, in most cases not justified. The role of the plastic surgeon is to recognize the dysmorphophobic patient, make him aware of the non-existence of the defect and direct him towards a path that can help him. The body is a living organism that has its own characteristics and with its own uniqueness. Performing a cosmetic surgery means improving an imperfection by enhancing the positive traits of each patient. For this reason, the ultimate goal of surgery is to seek a positive aesthetic improvement and never a transformation. A dysmorphophobic patient is a dissatisfied person who is constantly looking for a mutation by entering a loop from which he will not be able to get out easily. When the patient suffers from dysmorphophobia, he generally complains of a blemish that cannot be objectified and must be an alarm bell for the specialist who is visiting him. The visit serves to analyze the patient as a whole. Relying on a specialist in plastic, reconstructive and aesthetic surgery means that you are faced with a professional trained in this branch of medicine, who can guide the patient towards the most suitable path and with the safest and most predictable results, or is a capable professional. To recognize a psychological weakness of the patient, blocking from the beginning a process that would not be indicated.

We live in a world where each of us is constantly surrounded by the influence of social networks that represent daily points of reference with which we interact. The perception of our body is determined by three main views: the view we ourselves have of our body, the view we have of our body when looking in the mirror and the perception of how others see our body. The combination of these three points of view manages to establish the relationship that each of us has with our body. Plastic surgery and aesthetic medicine are means that in recent decades have made it possible to resolve bodily discomforts. During this pandemic period, social networks have been a resource that has allowed us to stay as close as possible. We must always keep in mind that each of us has their own characteristics and external beauty is never perfection, but represents harmony of proportions and the interaction between the external and internal spheres. The "beauty effects" linked to the filters of social networks represent only an ideal world that deviates from the reality we live and therefore represent unattainable circumstances. 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 .