Italian plastic surgery was the protagonist of the international congress organized by the American Society of Aesthetic Surgery (ASPS), from 28 September to 1 October in Chicago: Professor Marco Klinger, Head of the Humanitas Plastic Surgery Operational Unit, gave a plenary session of the Maliniac Lecture – one of the most important scientific awards in the world – presenting to over 9,000 colleagues and experts the ‘sum’ of his studies on breast surgery.


The Maliniac Lecture

The prestigious ‘lectio magistralis’ is awarded every year to a surgeon for high merits and scientific awards; those who keep it are included in the Roll of Gold, a list in which “sacred monsters” such as Ivo Pitanguy, Fernando Ortiz Monasterio and Daniel Marchac stand out.

“It is a great recognition for Italy and for our plastic surgery, – said Klinger – a tribute to the very high scientific and clinical level achieved by the specialty in our country”, which in this last edition of the international congress was the ‘guest nation’.


From breast reconstruction to malformation surgery

Mammary plastic surgery is the theme on which Professor Klinger focused during his lecture, “Fat and Periareolar Approach: Science and Skills in Breast Surgery”, with which, in about 30 minutes of surgery, Klinger illustrated his most important studies, the result of over 15 years of research and application, dedicated to breast reconstruction and the use of autologous fat, that is, derived from the patient himself.

“The use of fat and the periareolar technique, which involves small scars that are not visible because they are positioned around the areola, have revolutionized breast surgery – explained Klinger. The combination of these two elements allows us to address many cases of post-onocological reconstruction in a new way and to address an increasingly widespread problem of breast abnormalities with extraordinary results, on which I focused with the publication of two studies.


Breast abnormalities

The luminary also presented some evidence that emerged in 6 years of research and observation of patients, conducted together with the staff of Humanitas: “about half of the women who from 2009 to 2014 presented for an intervention to increase (48.5%, to be exact) and almost half of those who wanted to reduce the volume of their breasts (exactly 47.3%) actually had a stenotic breast, a breast abnormality,” explained Klinger. “Without identifying it and planning the operation accordingly, it is not possible to obtain a truly pleasing and correct aesthetic result. In the next study, published the following year – continued the professor – we have developed a classification tool, just to help surgeons to deal with these cases, that are becoming more and more widespread probably due to aspects related to food and pollution. “This means that often, even behind the request for surgery, there is a dissatisfaction not always recognized by patients for a form that is not considered correct and is even abnormal.

The correction of these anomalies requires a “complete technical eclecticism” because they are not solved simply by the insertion of prosthesis. It is a complex task, in which it is necessary to reshape the entire gland, which very often has a different volume from the other. Finally, the use of autogenous fat makes the result more natural.


Italian plastic surgery: a comparison with the USA and Brazil

The United States and Brazil are countries that have always been recognized as being at the forefront of aesthetic and reconstructive plastic surgery. For some time now, Italy has also been an excellent country for research and application in the field of surgery. Proof of this is the assignment of the Maliniac Lecture to Professor Klinger and the invitation to the Società Italia Chirurgia Platica Ricostruttiva as a ‘guest nation’ at the Chicago Congress.


But how has plastic surgery changed in Italy? And how does it differ from American and Brazilian surgery?

“Three things have certainly influenced breast reconstruction in recent years: biotechnology, new techniques and imagination,” explained Professor Kilinger. In particular, “breast reconstruction has undergone a great evolution in recent years thanks to increasingly early diagnoses and the increasingly widespread use of fat as a “filler” to restore volume after cancer surgery and as a regenerative biological principle, thanks to the presence of adult stem cells that can greatly improve the quality of irradiated tissues,” explained the professor. “Post-onocological reconstruction aside, fat is a real passe-partout in plastic surgery, also and above all in the correction of breast abnormalities”.

In the treatment of breast abnormalities through plastic surgery, in the United States we have always focused on the maximum standardization of interventions with protocols, “an approach that shows great limitations in the face of events that are, by definition, different from each other as in the case of breast abnormalities,” Klinger clarified. “A standard protocol in these cases, therefore, the same for everyone, will never give me a good result. It is necessary to have the ability to customize the interventions tailored to the patient. There is no possibility of standardizing the operation, because each case is different from the other and often the best solution combines the use of prostheses, fat and very refined techniques, such as the periareolar approach.

Brazilian surgery, on the other hand, unlike Italian surgery, pays great attention to the shape and outcome of the surgery – a harmonious shape of the breast, a flat and well pulled belly – but does not pay sufficient attention to the final ‘post-operative’ result, in particular the scars.

In an operation that does not follow a disease, the aesthetic aspect is more important than ever and the possibility of having scars that are practically invisible is very precious. “For years now, and more and more in Italy, we have also been using the periareolar technique in mastopexy surgeries, the so-called breast lift that is performed on patients who have ptosic breasts following breastfeeding or the passage of time. Incisions only around the areola allow to correct slight ‘sagginess’, practically without surgical signs”, concluded Klinger, clarifying that even the patients’ approach to plastic surgery, in general, is different today. “While years ago plastic surgery was considered almost a jet set, now there are people of all kinds, even very young girls who do not feel good about themselves”.