Background: Nipple-sparing mastectomy is gaining widespread popularity, as it could allow improved aesthetic outcome without increasing oncologic risk. To investigate the reconstructive issues experienced with immediate implant reconstruction, the authors reviewed the cosmetic outcomes of their series. Methods: The authors retrospectively analyzed the data on 33 cases of nipple-sparing mastectomy for both cancer and prophylaxis with immediate implant reconstruction using the submusculo-subfascial pocket. Cosmetic evaluation methods were clinical and photography-based assessments and a patient-satisfaction survey. Results: The average follow-up period was 26.8 months. No nipple-areola complex cancer involvement was registered. The reconstructive outcomes ranged from good to excellent in 83 percent of the cases. Patients' satisfaction was high to very high, except in one patient who experienced total nipple-areola complex loss (one breast, 2.4 percent). Overall, early minor complications were registered in four breasts (9.5 percent) and late minor complications in five cases (12 percent). Conclusions: The authors' series suggest that nipple-sparing mastectomy is an option for carefully selected and screened patients. Larger studies with longer follow-up are needed, however. On the whole, the immediate one-stage implant reconstruction with hyperprojected anatomical gel implants represents a valid option. The skin incision algorithm proposed, which is based on the breast size, shape, and previous scars, might aid in the decision-making process to achieve satisfying results using this procedure. The radial approaches represent a good compromise between the oncologic and reconstructive procedures.

The role of platelet-rich plasma in enhancing fat graft take is attracting the scientific community. There is, however, a lack of clinical studies on the matter. The aim of this article is to report the authors' experience in breast fat grafting with and without platelet-rich plasma and to investigate the state of the art on adipose tissue platelet-rich plasma enrichment. The authors retrospectively reviewed 42 women who underwent breast fat grafting between September of 2007 and September of 2009. Seventeen of these patients (40 percent) were grafted with fat (according to Coleman) enriched with platelet-rich plasma at 10 percent (group A), and 25 patients (60 percent) received only fat grafts according to Coleman (group B). All patients underwent preoperative breast ultrasound and mammography and were regularly followed up with breast ultrasound 3 months later and then at 6-month intervals. The reconstructive and aesthetic outcomes were evaluated using the following parameters: (1) clinical outcomes according to the surgeons and the patient, (2) the rate of liponecrosis at breast ultrasound, and (3) the need of further fat grafting to achieve the planned result. The clinical outcomes, the rate of liponecrosis at breast ultrasound, and the need for further fat grafting reveal that fat grafting plus platelet-rich plasma at 10 percent is not superior to Coleman fat grafting alone. In the authors' retrospective analysis, no effect of platelet-rich plasma was seen in enhancing fat graft take when compared with the Coleman fat graft. Further research and prospective clinical studies are needed to understand the role of platelet-rich plasma, if any, in fat grafting.