Innovations in Plastic Surgery and Regenerative Medicine

Topic Information

Dear Colleagues,

We are pleased to announce a Topic on new insights and recent advancements in Plastic Surgery and Regenerative Medicine. The topic will cover innovations in plastic reconstructive aesthetic and maxillofacial surgery. We encourage all potential authors to contribute with papers demonstrating new applications and new findings concerning flaps and autologous grafts, liposuction and body contouring, breast surgery, new facial and body reconstructive and cosmetic procedures and new strategies based on autologous and/or mini-invasive procedures, as well as regenerative strategies such as platelet-rich plasma (PRP), human follicle stem cells (HFSCs), human adipose tissue-derived follicle stem cells (H-AT-d-FSCs), adipose-derived mesenchymal stem cells (AD-MSCs), micro-needling technique (MN-T) fat grafting, and biomaterials. We also encourage to submit new research on oncoplasty, breast reconstruction, microsurgery, composite tissue allotransplantation (face transplantation) lymphatic surgery, genital restoration and tissue decellularization. Original articles or comprehensive review papers are welcome. Case reports and case series involving the above topics will also be considered. With the collaboration of all of us, this volume is bound to strengthen the field and stimulate further research.

Dr. Simone La Padula
Prof. Dr. Barbara Hersant
Prof. Dr. Jean Paul Meningaud
Prof. Dr. Francesco D’Andrea
Topic Editors

Keywords

Participating Journals

Journal Name	Impact Factor	CiteScore	Launched Year	First Decision (median)	APC
Applied Sciences applsci	2.7	4.5	2011	16.9 Days	CHF 2400
Biomedicines biomedicines	4.7	3.7	2013	15.4 Days	CHF 2600
Dermato dermato	-	-	2021	15.0 days *	CHF 1000
Journal of Clinical Medicine jcm	3.9	5.4	2012	17.9 Days	CHF 2600
Medicina medicina	2.6	3.6	1920	19.6 Days	CHF 1800

* Median value for all MDPI journals in the second half of 2023.

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Published Papers (10 papers)

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15 pages, 6818 KiB  

Open AccessArticle

Diagnosis of Local Recurrence of Malignant Soft Tissue Tumors after Reconstructive Surgery on MRI

by Eun-Hee Song, So-Yeon Lee, Seungeun Lee, Joon-Yong Jung, Seung-Han Shin, Yang-Guk Chung and Chan-Kwon Jung

J. Clin. Med. 2023, 12(13), 4369; https://doi.org/10.3390/jcm12134369 - 29 Jun 2023

Viewed by 1403

Abstract

Purpose: Magnetic resonance imaging (MRI) is useful in the diagnosis of local recurrence, but few studies have explored recurrence in MRI in patients after reconstructive surgery. The purpose of this study was to analyze MRI findings of locoregional recurrence following reconstructive surgery after [...] Read more.

Purpose: Magnetic resonance imaging (MRI) is useful in the diagnosis of local recurrence, but few studies have explored recurrence in MRI in patients after reconstructive surgery. The purpose of this study was to analyze MRI findings of locoregional recurrence following reconstructive surgery after malignant soft tissue tumor resection. Method: Fifty-three postoperative MRIs from 37 patients who underwent reconstructive surgery after malignant soft tissue tumor resection were retrospectively reviewed. A total of 76 enhancing lesions, including 40 locoregional recurrences and 36 postoperative changes, were analyzed regarding morphology (location on the transplanted tissue, border, and shape) and the signals on T1- and T2-weighted imaging (T1WI, T2WI), fat-suppressed (FS) T2WI, and contrast-enhanced FS T1WI. Diffusion-weighted imaging with an apparent diffusion coefficient was assessed. A chi-squared test and Fisher’s exact test were used for statistical analysis. Results: The most common site of recurrent tumors and postoperative changes was the peripheral margin on transplanted tissue (63% and 61%, respectively p = 0.907). Recurrent tumors commonly appeared with well-defined borders (75%) as well as nodular appearance (98%), hyperintensity on T2WI (85%) and FS-T2WI (95%), isointensity on T1WI (65%), impeded water diffusion (55%), and intense (50%) or moderate (45%) enhancement. Postoperative changes showed ill-defined borders (75%), nodular appearance (56%), facilitated water diffusion (69%), and moderate (86%) enhancement, which were significantly different from those of recurrent tumors (p ≤ 0.020). Conclusions: Common and partitioning MRI features of locoregional recurrence were well-defined borders, nodular shape, impeded water diffusion, and intense enhancement. Peripheral margins on transplanted tissue were common sites in both recurrent tumors and postoperative changes. Full article

(This article belongs to the Topic Innovations in Plastic Surgery and Regenerative Medicine)

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6 pages, 4270 KiB  

Open AccessCase Report

Simultaneous Free Fibula and Anterolateral Thigh Flap in Lower Extremity Reconstruction Following Osteomyelitis in a Trauma Patient: A Case Report

by Tadej Voljc, Michael Schintler, Anna Vasilyeva, Lars-Peter Kamolz and Heinz Buerger

Medicina 2023, 59(7), 1206; https://doi.org/10.3390/medicina59071206 - 27 Jun 2023

Viewed by 1312

Abstract

This case report focuses on a 17-year-old polytrauma patient who suffered a septic wound infection after an open reduction and internal fixation (ORIF) and soft tissue reconstruction with a pedicled flap, which led to a substantial bone and soft tissue defect of the [...] Read more.

This case report focuses on a 17-year-old polytrauma patient who suffered a septic wound infection after an open reduction and internal fixation (ORIF) and soft tissue reconstruction with a pedicled flap, which led to a substantial bone and soft tissue defect of the lower leg. After thorough antibiotic treatment and after ensuring a non-septic wound, the defect was reconstructed using a contralateral free fibula flap designed as a flow through flap in a double loop manner to accommodate two fibular fragments and an ipsilateral ALT flap. Early weight bearing was initiated 11 days after the free flap transfer under external fixation, with full weight bearing achieved in 36 days with external fixation. After the removal of external fixation, full weight bearing was able to be reinitiated after 13 days, leading to the patient’s return to normal activity 6 months after the bony reconstruction. This case presents an innovative approach to treating a complex defect, with the final decision on using two separate free flaps instead of a single osteofasciocutaneous free flap resulting in a good bony reconstruction and soft tissue coverage, and with the use of external fixation enabling early rehabilitation. Full article

(This article belongs to the Topic Innovations in Plastic Surgery and Regenerative Medicine)

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11 pages, 1185 KiB  

Open AccessArticle

Influence of Adipose-Derived Stromal Vascular Fraction on Resorption of a Large-Volume Free-Fat Transplant Evaluated Using T3D Optical Scanning

by Matic Koren, Simona Kranjc Brezar, Tadej Dovšak, Gregor Sersa, Andrej Kansky and Nataša Ihan Hren

Appl. Sci. 2023, 13(12), 7100; https://doi.org/10.3390/app13127100 - 14 Jun 2023

Viewed by 806

Abstract

Background and Objectives: The main drawback of lipofilling is fat transplant volume loss, which makes long-term results unreliable. This study’s aim was to assess the influence of an adipose-derived stromal vascular fraction (SVF) on volume retention in large-volume fat grafts. Materials and Methods: [...] Read more.

Background and Objectives: The main drawback of lipofilling is fat transplant volume loss, which makes long-term results unreliable. This study’s aim was to assess the influence of an adipose-derived stromal vascular fraction (SVF) on volume retention in large-volume fat grafts. Materials and Methods: A murine model was used for the in vivo evaluation of fat-graft volume changes over 6 months. We used 28 immunocompromised nude NU(NCr)-Foxn1nu mice and human fat tissue as a liposuction by-product. Part of the fat tissue was used for SVF preparation. We created a fat transplant without SVF (SVF-) and with SVF (SVF+) groups. Large-volume grafts were injected above the sacrum and scapula in the same animal. Volume loss was evaluated using three-dimensional optical scanning at 14 days (T1), 3 months (T2), and 6 months (T3) after transplantation. Scans were processed with Artec Studio software to obtain stereolithography files. The volumes were calculated in RapidForm software 2006. Results: The highest volume loss was observed above the scapula at T3 (SVF- 85%; SVF+ 75%). There was a significant difference in volume between SVF-/SVF+ for grafts above the sacrum at T2, with lower loss in SVF+, and the significance became stronger at T3. The difference in volume loss was also significant above the scapula between SVF-/SVF+ at T3. Conclusions: Although we found a beneficial effect of SVF on the long-term survival of large-volume fat tissue transplants, volume loss due to other contributing factors was high. Full article

(This article belongs to the Topic Innovations in Plastic Surgery and Regenerative Medicine)

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10 pages, 1705 KiB  

Open AccessArticle

Local Gentamicin Fixation with Sprayed Fibrin—An In Vivo Animal Study Reveals New Options to Treat Soft Tissue Infections

by Meike B. Kejwal, René D. Verboket, Katharina Sommer, Fabian Dust, Dominique Thomas, Philipp Störmann, Johannes Frank, Dirk Henrich, Ingo Marzi and Maren C. Janko

J. Clin. Med. 2023, 12(10), 3390; https://doi.org/10.3390/jcm12103390 - 10 May 2023

Cited by 2 | Viewed by 1363

Abstract

For acute and chronic soft tissue infections, radical surgical debridement is required and is considered the gold standard, along with its immediate systemic antibiotic therapy. Treatment with local antibiotics and/or antibiotic-containing materials is commonly used as an additional tool in clinical practice. Spraying [...] Read more.

For acute and chronic soft tissue infections, radical surgical debridement is required and is considered the gold standard, along with its immediate systemic antibiotic therapy. Treatment with local antibiotics and/or antibiotic-containing materials is commonly used as an additional tool in clinical practice. Spraying with fibrin and antibiotics is a newer technique that has been studied for some antibiotics. However, for gentamicin, data are not yet available on absorption, optimal application, antibiotic fate at the site and transfer of antibiotic into the blood. In an animal study involving 29 Sprague Dawley rats, 116 back wounds were sprayed with gentamicin using either gentamicin alone or one of two possible spray combinations of gentamicin and fibrin. Simultaneous application of gentamicin and fibrin via a spray system to soft tissue wounds resulted in significant antibiotic concentration over a long period of time. The technique is easy and cost-effective. The systemic crossover was significantly minimized in our study, which may have led to fewer side effects in patients. These results could lead to an improvement in local antibiotic therapy. Full article

(This article belongs to the Topic Innovations in Plastic Surgery and Regenerative Medicine)

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12 pages, 1496 KiB  

Open AccessArticle

A Comparison of Tissue Adhesive Material and Suture as Wound-Closure Techniques following Carpal Tunnel Decompression: A Single-Center Randomized Control Trial

by Veridijana Sunjic Roguljic, Luka Roguljic, Vedran Kovacic and Ivana Jukic

J. Clin. Med. 2023, 12(8), 2864; https://doi.org/10.3390/jcm12082864 - 14 Apr 2023

Cited by 2 | Viewed by 2033

Abstract

Background: Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy caused by compression of the median nerve in the carpal tunnel. The presented study aimed to evaluate clinical outcomes by comparing two techniques of wound closure following carpal tunnel surgery in subjects [...] Read more.

Background: Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy caused by compression of the median nerve in the carpal tunnel. The presented study aimed to evaluate clinical outcomes by comparing two techniques of wound closure following carpal tunnel surgery in subjects randomized to the application of tissue adhesive or sutures. Methods: From April 2022 to December 2022, a single-center randomized prospective trial was conducted at the University Hospital of Split in Croatia. The study participants consisted of 100 patients (70 females) aged 61.56 ± 12.03 years, randomly assigned to suture-based wound closure (n = 50) or tissue adhesive-based wound closure (n = 50) with two-component skin adhesive Glubran Tiss 2^®. The outcomes were assessed postoperatively during the follow-up period at intervals of 2, 6, and 12 weeks. A scar assessment was performed using the POSAS (Patient and Observer Scar Assessment Scale) and cosmetic VAS (Visual Analog Scale). The VNRS (Verbal Number Rating Scale) was used to assess pain. Results: There were significant differences between glue-based wound closure and suture-based wound closure at 2-week and 6-week intervals after the surgery on the POSAS and cosmetic-VAS scales (better aesthetic effect with glue-based wound closure technique where noticed), with less postoperative pain at the same intervals. With the 12-week interval, differences in outcomes were insignificant. Conclusions: This trial demonstrated that cyanoacrylate-based adhesion mixtures might be possibly superior in the short term in terms of cosmetic appearance and discomfort compared to conventional skin suturing techniques for the closing of surgical wounds following open CTS decompression, but there was no difference between both procedures in the long term. Full article

(This article belongs to the Topic Innovations in Plastic Surgery and Regenerative Medicine)

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11 pages, 11148 KiB  

Open AccessArticle

The Recurrence of Ptosis after Correction Surgery Is Associated with Refractive Error

by Yu Ke, Jie Meng, Min Zhou, Pengsen Wu, Fan Zhang, Xiangqing Hei and Danping Huang

Medicina 2023, 59(3), 630; https://doi.org/10.3390/medicina59030630 - 22 Mar 2023

Viewed by 4348

Abstract

Background and objectives: Previous studies on ptosis recurrence after correction surgery have tended to focus on postoperative complications, surgical methods and suspension materials, few have mentioned refractive error. This research is to investigate the potential relation between refractive error and recurrence after [...] Read more.

Background and objectives: Previous studies on ptosis recurrence after correction surgery have tended to focus on postoperative complications, surgical methods and suspension materials, few have mentioned refractive error. This research is to investigate the potential relation between refractive error and recurrence after correction surgery in pediatric patients with simple congenital ptosis. Materials and Methods: We conducted a retrospective analysis of data from patients with simple congenital ptosis who were treated at Zhongshan Ophthalmic Center (ZOC) between 2017 and 2020. In total, 111 eyelids of 85 patients without surgery-related complications who underwent frontalis muscle flap suspension (FMFS) for simple congenital ptosis were included. Postoperative changes in eyelid height were assessed. Cycloplegic refraction was assessed before surgery and during the follow-up period (every 3 months after surgery). Recurrence in the postoperative period was defined as a marginal reflex distance 1 (MRD1) of <1 mm. Results: There were 16 recurrence and 69 non-recurrence cases, with no statistically significant differences, in terms of patient age at the time of surgery, patient sex, or preoperative MRD1, between the recurrence and non-recurrence groups. The postoperative cylindrical diopter (adjusted odds ratio [OR] = 0.432, p = 0.005), laterality (adjusted OR = 0.202, p = 0.006), and preoperative MRD1 (adjusted OR = 0.617, p = 0.019) were associated with ptosis recurrence after surgery. Differences between the recurrence and non-recurrence groups in spherical diopter and spherical equivalent (SE) before and after surgery were not statistically significant. In addition, preoperative refractive error and postoperative spherical diopter were not significantly associated with ptosis recurrence after correction surgery. Conclusions: Ptosis recurrence after FMFS in pediatric cases of congenital ptosis is associated with refractive error. Timely refractive correction and amblyopia treatment may help to reduce ptosis recurrence. Full article

(This article belongs to the Topic Innovations in Plastic Surgery and Regenerative Medicine)

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13 pages, 1648 KiB  

Open AccessArticle

Safety and Efficacy of Midface Augmentation Using Bio-Oss Bone Powder and Bio-Gide Collagen Membrane in Asians

by Jia-Yu Zhang, Ke Liu, Ruo-Xi Liu and Bao-Hua Xu

J. Clin. Med. 2023, 12(3), 959; https://doi.org/10.3390/jcm12030959 - 26 Jan 2023

Cited by 4 | Viewed by 1480

Abstract

(1) Background: Asians tend to have a regressive midface. Midface augmentation is an effective treatment, and various materials have been used as fillers for this purpose. Bio-Oss bone powder has a strong positive effect on promoting new bone regeneration, and has been used [...] Read more.

(1) Background: Asians tend to have a regressive midface. Midface augmentation is an effective treatment, and various materials have been used as fillers for this purpose. Bio-Oss bone powder has a strong positive effect on promoting new bone regeneration, and has been used in the dental field for over 30 years. However, it has not been used and reported as a filler in midface augmentation. (2) Objective: To evaluate the safety and efficacy of midface augmentation using Bio-Oss bone powder in treating midface retrusion and resulting nasolabial folds, and to develop a predictive model for patient satisfaction. (3) Methods: 85 patients underwent midface augmentation through an intraoral approach with Bio-Oss. Treatment efficacy was assessed by blinded investigators. The data on safety were collected from patient interviews at each follow-up visit. A questionnaire was used for investigating patient satisfaction. The influencing factors of satisfaction were analyzed by univariate and multivariate analysis. A nomogram to predict the risk of dissatisfaction was built based on significant factors with R software. Results: Compared to baseline, there was a significant improvement (p < 0.001) in Wrinkle Severity (4) Rating Scale scores at week 24, with a mean decrease of 0.52 ± 0.57. The aesthetic improvement rate evaluated by the Global Aesthetic Improvement Scale was 92.9%. Four mild treatment-related adverse events were noted. The majority of patients were satisfied overall. A nomogram with good prediction performance was plotted. (5) Conclusions: This new procedure yielded safe and satisfactory aesthetic results. A nomogram with good test performance and discriminative ability was established for predicting patient satisfaction. Full article

(This article belongs to the Topic Innovations in Plastic Surgery and Regenerative Medicine)

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11 pages, 8086 KiB  

Open AccessArticle

Spontaneous Lymph Flow Restoration in Free Flaps: A Pilot Study

by Théo Sedbon, Arié Azuelos, Romain Bosc, Francesco D’Andrea, Rosita Pensato, Michele Maruccia, Jean Paul Meningaud, Barbara Hersant and Simone La Padula

J. Clin. Med. 2023, 12(1), 229; https://doi.org/10.3390/jcm12010229 - 28 Dec 2022

Cited by 8 | Viewed by 1910

Abstract

Background: Oncologic excision and trauma can be responsible for major defects and lymphedema. Free flaps are commonly used for reconstruction. We aimed to determine if lymphatic flow between flap and recipient site can be restored without lymphatic surgery. Methods: 15 free flaps were [...] Read more.

Background: Oncologic excision and trauma can be responsible for major defects and lymphedema. Free flaps are commonly used for reconstruction. We aimed to determine if lymphatic flow between flap and recipient site can be restored without lymphatic surgery. Methods: 15 free flaps were performed in different patients in our center. Infrared-based lymphography was used to plan surgery. Indocyanine green (ICG) was injected in the flap’s subdermal tissue and also at the edges of the skin defect. Circumferential lymphatic channels were marked 5 min after the ICG injection. Fluorescent images were recorded with an infrared camera system. The flap inset was obtained by putting side to side the flap markings and the recipient site markings. Infrared-based lymphography was performed on every patient one year after surgery. Spontaneous lymph flow restoration was judged positive if lymphatic connections were observed between the flap and the recipient site. Results: seven free ALT and eight DIEP flaps were performed. All ALT flaps were designed following the limb axis which is the lymphatic axiality. Spontaneous lymph flow restoration was observed for the seven ALT flaps. Eight DIEP flaps were designed upside down and one was designed following the lymph axiality. Spontaneous lymph flow restoration was only observed for the one designed following the lymph axiality. Conclusions: designing reconstructive free flap regarding lymph axiality seems to improve spontaneous lymph flow restoration between flap and recipient site without any specific lymphatic surgery. Full article

(This article belongs to the Topic Innovations in Plastic Surgery and Regenerative Medicine)

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16 pages, 1104 KiB  

Open AccessReview

Face Transplant: Indications, Outcomes, and Ethical Issues—Where Do We Stand?

by Simone La Padula, Rosita Pensato, Chiara Pizza, Edoardo Coiante, Giovanni Roccaro, Benedetto Longo, Francesco D’Andrea, Francesco Saverio Wirz, Barbara Hersant and Jean Paul Meningaud

J. Clin. Med. 2022, 11(19), 5750; https://doi.org/10.3390/jcm11195750 - 28 Sep 2022

Cited by 52 | Viewed by 2346

Abstract

Background: The addition of face allotransplantation (FT) to the head and neck reconstructive surgery arsenal has started a true revolution. This study is aimed at providing an extensive analysis of the current practice of composite tissue allotransplantation. Moreover, a thorough description of pre-procedural, [...] Read more.

Background: The addition of face allotransplantation (FT) to the head and neck reconstructive surgery arsenal has started a true revolution. This study is aimed at providing an extensive analysis of the current practice of composite tissue allotransplantation. Moreover, a thorough description of pre-procedural, intra-operative, and post-procedural settings, indications, contraindications, outcomes, ethical considerations, and future perspectives is provided. Methods: The authors’ experience was supplemented with a literature review performed by using the PubMed, MEDLINE, and Embase databases on 21 February 2022. The search terms used were “face transplantation indications”, “face transplantation complications”, and “face transplantation ethical issues”. Results: The most recent achievements and long-term clinical sequelae of FT are classified and summarized. A large number of records (4435) were identified. Seventy-five articles were assessed for eligibility. Publications without new data and reports with a patient follow-up < 5 years were excluded. Nineteen articles met the criteria for inclusion. Conclusions: The most recent achievements in the field of FT may be combined with cutting-edge regenerative medicine procedures and innovative immunological processing. It is paramount to build strong international networks between the world FT experts in order to achieve higher-level outcomes and reduce the complication rate. Nevertheless, the utmost caution is required in patient selection, clinical assessment, strict follow-up, and rejection management. Full article

(This article belongs to the Topic Innovations in Plastic Surgery and Regenerative Medicine)

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9 pages, 1164 KiB  

Open AccessArticle

Assessment of Patient Satisfaction Using a New Augmented Reality Simulation Software for Breast Augmentation: A Prospective Study

by Simone La Padula, Rosita Pensato, Francesco D’Andrea, Ludovica de Gregorio, Concetta Errico, Umberto Rega, Luigi Canta, Chiara Pizza, Giovanni Roccaro, Raphaelle Billon, Endri Dibra, Jean Paul Meningaud and Barbara Hersant

J. Clin. Med. 2022, 11(12), 3464; https://doi.org/10.3390/jcm11123464 - 16 Jun 2022

Cited by 7 | Viewed by 2003

Abstract

Background: Breast augmentation is one of the most frequently performed plastic surgery procedures. Providing patients with realistic 3D simulations of breast augmentation outcomes is becoming increasingly common. Until recently, such programs were expensive and required significant equipment, training, and office space. New simple [...] Read more.

Background: Breast augmentation is one of the most frequently performed plastic surgery procedures. Providing patients with realistic 3D simulations of breast augmentation outcomes is becoming increasingly common. Until recently, such programs were expensive and required significant equipment, training, and office space. New simple user-friendly programs have been developed, but to date there remains a paucity of objective evidence comparing these 3D simulations with post-operative outcomes. The aim of this study is to assess the aesthetic similarity between a pre-operative 3D simulation generated using Arbrea breast simulation software and real post-operative outcomes, with a focus on patient satisfaction. Methods: The authors conducted a prospective study of patients requiring breast augmentation. Patients were asked to assess how realistic the simulation was compared to the one-year post-operative result using the authors’ grading scale for breast augmentation simulation assessment. Patient satisfaction with the simulations was assessed using a satisfaction visual analogue scale (VAS) ranging from 0 (not at all satisfied) to 10 (very satisfied). Patient satisfaction with the surgical outcome was assessed using the BREAST-Q Augmentation Module. Results: All patients were satisfied with the simulations and with the attained breast volume, with a mean VAS score of 8.2 ± 1.2. The mean simulation time took 90 s on average. The differences between the pre-operative and one-year post-operative values of the three BREAST-Q assessments were found to be statistically significant (p < 0.001). Conclusions: Three-dimensional simulation is becoming increasingly common in pre-operative planning for breast augmentation. The present study aimed to assess the degree of similarity of three-dimensional simulations generated using Arbrea Breast Software and found that the use of the software provided a very satisfying representation for patients undergoing breast augmentation. However, we recommend informing patients that only the volume simulation is extremely accurate. On the other hand, it is necessary to not guarantee an absolute correspondence regarding the breast shape between the simulation and the post-operative result. Full article

(This article belongs to the Topic Innovations in Plastic Surgery and Regenerative Medicine)

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