Background: Capsular contracture remains one of the most challenging complications of implant-based breast reconstruction, particularly in patients undergoing postmastectomy radiotherapy (PMRT). Autologous fat grafting has been proposed as a regenerative strategy to mitigate radiation-induced damage, but long-term data are limited. Methods: We retrospectively reviewed women who underwent two-stage implant-based breast reconstruction followed by PMRT (50 Gy in 25 fractions) between 2010 and 2021 at Ospedale Sant’Anna, Como. Eligible patients subsequently received at least one session of autologous fat grafting after radiotherapy. Primary outcome was the incidence and severity of capsular contracture; secondary outcomes included the need for salvage autologous reconstruction, oncologic safety, and patient-reported satisfaction. Results: Thirty-two patients met inclusion criteria. The mean age was 56.1 years, and mean BMI was 23.8 kg/m². All underwent submuscular two-stage reconstruction with anatomically shaped implants (mean volume 336 cc). Patients received an average of 1.7 fat grafting sessions (mean cumulative volume 180 cc). At a mean follow-up of 7.7 years, capsular contracture occurred in 6 patients (18.8%): 4 with Baker grade III and 2 with Baker grade II. No cases of severe (grade IV) contracture were observed. Importantly, no patient required salvage autologous reconstruction, and no local recurrences were recorded. Minor donor-site complications (transient edema or ecchymosis) occurred in 18.7% of patients. Subjective satisfaction was uniformly high, with reported improvements in breast softness and contour. Conclusions: Fat grafting appears to be a safe and effective adjunct in maintaining implant-based breast reconstruction after radiotherapy. In this long-term series, lipofilling was associated with a lower incidence of capsular contracture compared with historical rates, absence of severe contracture, and no oncologic events. For selected patients who are not candidates for autologous reconstruction, fat grafting may represent a valuable strategy to preserve implant viability, improve tissue quality, and reduce the need for salvage procedures.

This article describes the senior author's (M.S.) approach to nasal tip management in primary rhinoplasty, integrating preservation concepts with selective structural reinforcement to enhance long-term stability and refined definition. Over 15 years, the technique transitioned from routine columellar strut grafting, effective early but prone to late ptosis, to a septal-based philosophy centered on the Teostrut and the septal extension graft (SEG), providing more predictable projection control. Clinical decision-making relies on assessment of skin thickness, lower lateral cartilage strength, and inherent tip support, which together determine the degree of preservation or reinforcement required. The operative approach combines preservation of native support when feasible, controlled strengthening through Teostrut or SEG when indicated, conservative cephalic adjustments, and precise dome–suture modulation. This sequence balances structural stability with aesthetic subtlety while respecting tissue dynamics. Refinements continue to evolve through improved mapping of cartilage responsiveness, integration of regenerative strategies, and advancements in suture-based modulation. This experience-based approach offers reproducible, stable, and naturally refined results in primary rhinoplasty, emphasizing durable tip support and patient-specific aesthetic goals.

Prepectoral breast reconstruction without acellular dermal matrix (ADM) is gaining attention as a potentially safe and effective approach, particularly in non-irradiated patients. This study aimed to evaluate the safety and efficacy of immediate one-stage prepectoral breast reconstruction without ADM and assess the impact of radiation therapy (RT) on postoperative outcomes. A retrospective review of 198 patients (239 breasts) who underwent mastectomy followed by direct-to-implant prepectoral reconstruction without ADM between 2018 and 2023 was performed. Patients were divided into RT and non-RT groups. Demographics, complications, and secondary procedures were analyzed. Fisher’s exact tests were used for statistical correlation. In the non-RT group, complication rates were low, with capsular contracture observed in 6 patients (3.5%). In the RT group, capsular contracture was significantly higher (p < 0.0001). Other complications were comparable between groups. Secondary procedures were more frequent in the RT group. Immediate prepectoral breast reconstruction without ADM is a safe and effective option, especially in non-irradiated patients, with acceptable complication rates and favorable surgical outcomes.