This year, in April, you are invited speaker in the XVIth Congress of the Romanian Association of Plastic Surgeons – ACPR. Please share with us your thoughts regarding this event.
It is the first time I participate at the National Plastic Surgery Congress in Romania. I am very curious and happy because I think it is an opportunity for discussion and exchange with Romanian colleagues. I had the opportunity to appreciate their work in many international congresses, where they brought significant experiences and innovative techniques. The National Congress of each country is an important moment, not only professionally, but also to establish personal relationships and friendships that are often maintained over time.
We know it is not your first time in Romania.What are your impressions and what do you know about Plastic and Reconstructive Surgery in our country ?
This is the third time I come to Romania. The first time to coordinate a microsurgery course for my graduates. Romania has microsurgery laboratories and courses dedicated to microsurgical techniques extremely well organized that attract participants from all over Europe and especially from Italy, where we have bureaucratic difficulties in organizing microsurgical courses „in vivo”. The second time, I was in Jasi for a congress of aesthetic medicine and aesthetic surgery. It was a wonderful human and professional experience. Romanian plastic surgery has a high professional level comparable with other European countries. The mobility of surgeons, internships abroad, the ease of obtaining the most recent articles from the most prestigious journals, has made the quality of the different European plastic surgery schools very homogeneous. But every nation has different philosophies and aesthetics and therefore, even in a common groove, each country interprets cosmetic surgery according to its own feelings.
One of your most popular procedures is the Breast Reconstruction with ADM. Can you tell us more about this procedure?
The first applications of acellular dermal matrices in the breast were on reconstruction/augmentation revision cases to reduce rippling. With better products and improved technologies, now breast reconstruction has become a standard use for ADM: either sub-pectoral or pre-pectoral. The crucial part of these procedures is its consideration of every aspect of regenerative medicine: the ADM, modulating the inflammatory response, integrates and provides mechanical support to the implant while re-establishing the lost suspensory ligaments of the mammary gland, in the pre-pectoral reconstruction. In particular, the implant is masked by the ADM, a biological substance, avoiding all the complications caused by the direct contact of synthetic materials with body tissues that may compromise the aesthetic and functional result. As plastic surgery is the surgery of details, we should treat ADM the same way we take care of the skin of our patients; that is the way to a successful surgery.
Immediate breast reconstruction is the most common procedure in Europe, but in Romania is a big challenge. What kind of programmes are in place in Italy regarding this procedure and what are the advantages ?
IBR is one of the revolutions in breast surgery and it stems from the improvement of oncological treatments and diagnostic techniques. These have given surgeons the tools to perform more conservative mastectomies with a high degree of oncological safety. Programmes involve both the scientific community and the national health service. On one side, congresses and live-surgery events are now the common occasions to gather reconstructive surgeons and senologists, share knowledge and improve competences, and the institution of the breast unit as the virtual path to go with the patient in order to treat her in a multidisciplinary manner, under every aspect of her health and well-being. On the other side, mass screening and consulting are offered to the target population in order to have a diagnosis at the earliest stages of the neoplasia.
In suitable cases, performing mastectomy and reconstruction within the same OR is a win-win. Patients do not have to cope with the major sense of loss caused by a radical mastectomy, the need for fewer theatre admissions means less distress for the patient and also lower costs for the health trust.
What is your advice for the Romanian Plastic Surgeons?
Breast reconstructive surgery is a complex field where there are no standardized guidelines and much is left to the choices and preferences of the individual surgeon. For this reason, if you want to tackle this issue in the best way, you need to know all the breast reconstruction techniques, from microsurgical to prosthesis reconstruction, in order to individualize the treatment in the search for the best possible solution for the patient. We also have to take into account also the costs of our choices, because the maintenance of a high quality within a public system like the Italian one, imposes a careful management of the costs.
Since 2007 you are Managing Director at the Reconstructive Plastic Surgery Clinic at the Faculty of Medicine and Surgery in University of Udine and visiting doctor in USA, France, Scotland, Slovenia and Egipt. Why did you decide to pursue a career in plastic surgery?
When I was a student at the medical faculty I had the occasion to do my graduation thesis with who became my teacher later. I had the fortune to work in various centers in Italy and abroad, studying different fields of the plastic surgery and then I landed in Udine, where I completed my academic career. In Udine I am so lucky to work with young people who are doing their training and this also represents a motivation for me to update and change.
Can you describe your philosophy on beauty regarding plastic surgery?
The definition of beauty has engaged philosophers for thousands of years and it is impossible to give a definition. Artistic sensitivity is not taught and is formed during the life of each person, thanks to the cultural and artistic motivation that we received. In this, we Italians are lucky, because we grow up in a real outdoor museum, which many our cities are. In aesthetic surgery I think that beauty should be natural, improving the individual’s characteristics without distorting its characteristics and trying to improve its points of strength.
How do you think breast reconstruction will evolve over the next decade and how will this change patient care? How involved are plastic surgeons in these developments?
The future of plastic surgery is certainly represented by regenerative surgery in its various forms. At the same time, the technological improvements are offering us more and more sophisticated and effective devices. This is why plastic surgery is constantly evolving, and a constant updating is imperative in order to offer high quality results to our patients. This technological improvement must not make us forget the basics of our specialty; I believe for many years traditional surgery will play an important role in relation to new technologies, making it necessary to be trained and informed for both.