Breast cancer treatment must nowadays optimize cosmetic results. This can be accomplished in selected cases by means of a single-stage operation that the authors call "skin-reducing mastectomy." The final scars imitate those of cosmetic surgery. Careful patient selection and improvement in the learning curve may reduce the complication rate.

SUMMAR Y. We critically review 13 patients with progressive hemifacial atrophy treated with three basic surgical procedures (free flap transplantation, alloplastic implants, micro-fat injections 'lipofilling') and further ancillary techniques. In spite of the satisfactory results achieved with the procedures, with the exception of alloplasts, we feel that llpofilling may be considered an interesting solution for soft tissue augmentation of the face especially for moderate adipose defects, due to its repeatability, no donor site morbidity, no complications at the recipient site such as lesions resulting from dissection, bleeding, necrosis, etc. This technique can he performed in a day-hospital with short surgery time, at low cost and without a highly skilled team. For severe grades of adipose atrophy, because of the low blood supply to these tissues which interferes with take of any type of autograft, we think that free flaps actually represent one of the best solutions for soft tissue augmentation.

Anatomists and surgeons have underestimated the importance of understanding the anatomic connective frame of the inframammary region. The submammary fold does not originate as a self-governing unit but depends on breast mould and on a fine superficial fascial system suspension. The authors investigated the inframammary fold anatomy and subcutaneous breast territory in cadaver and live dissection with histologic analyses, without sharing the theories about superficial fascia splitting and inframammary ligament existence. The authors have understood that a reliable and fine correction of inframammary fold contour in breast reconstruction may only be achieved by an empirical surgical procedure that exclusively concerns the restoration of the superficial fascial system. The literature on this subject is reviewed. Fascial anchoring surgery, after capsulotomy and superficial fasciotomy, without lower thoracic advancement flap or deep subcutaneous undermining, was performed for 100 breast reconstructions after biodimensional device programming. Technique and results are also discussed.

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The subcutaneous fascial system of the breast was investigated. The aim was to demonstrate splitting of the superficial fascia and the existence of an inframammary ligament. The inframammary region was studied in six cadavers (12 breast dissections) and in 21 patients during breast surgery (12 surgical and nine histological investigations). The superficial fascial system is related to sex, age, breast size, weight and adiposity. In females, the inframammary fold depends on the situation of the superficial fascia which, without true splitting, becomes deeper due to an absence of fat in the deep subcutaneous space, and on more adherence to the deep fascia through thickened retinaculum; there is a connective band, the anterior breast capsule, erroneously called "superficial layer of the superficial fascia," and mistaken for "inframammary ligament", which detaches from the superficial fascia. In males, there is a zone of adherence only at the inframammary midline. The microstructure of the breast fascial system at the inframammary region is demonstrated histologically. Surgical implications are suggested.

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