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The rising number of female patients after massive weight loss has led to an increased demand for breast surgery. Autoaugmentation and implant-based augmentation mastopexy represent well-established procedures in this unique patient population. However, there is a notable lack of direct comparison of these two surgical approaches. Currently, a multicenter study is being conducted to further evaluate comparative outcomes of epi- versus subpectoral augmentation mastopexy, as comparative data regarding these surgical techniques in this population are lacking.

This retrospective study included 100 consecutive massive weight loss patients over the past 7.6 years (64 autoaugmentation vs. 36 implant-based). Complication and surgical revision rates were collected retrospectively. During a follow-up examination postoperative BREAST-Q Scores, SF-36, and aesthetic outcomes were evaluated.

Patients were identified with a mean age of 39 ± 10.6 years and a median follow-up time of 2.8 years range, 0.3-7.6 years. In the autoaugmentation group most aesthetic evaluation criteria and postoperative BREAST-Q scores for “Satisfaction with Breasts” (p < 0.001) and “Satisfaction with Outcome” (p < 0.001) were significantly higher. According to the Clavien-Dindo-Classification, autoaugmentation group complications were mainly managed conservatively, while most in the implant group required surgical revision (p = 0.009). Recurrent ptosis occurred more frequent in the implant group. SF-36 indicated no significant group differences.

A tendency towards increased use of autoaugmentation techniques amongst these 100 patients was observed, achieving significantly higher outcome scores and lower complication rates. If sufficient breast tissue is available, implant use should be avoided in this patient population. If an implant is required, patients should be thoroughly informed about the higher complication rates and potential need for revisional surgery.

Numerous procedures have been described to lift the breast tissue in order to improve aesthetic
appearance of the upper pole through auto-augmentation mastopexy procedures with a wide range of
techniques. This study introduces a novel mastopexy procedure designed to optimize volume in the
central and upper breast pole using a mushroom-shaped flap.

This paper presents a modified approach to fill the breast’s upper pole, with a median and deep based
pedicule flap. This is a retrospective, multicentered study, based on a series of cases conducted by the
author. The perioperative management and the surgical technique are described. A systematic approach
was employed to identify acute and subacute complications during the postoperative follow-up period.

From January 2018 to Decembre 2023, 198 women were included in the study and underwent mushroom
mastopexy with or without implant or/and lipofilling. The mean age was 44,3 (18 to 74 years). General
complication rate was 13%, and we observed 1 hematoma which required a reintervention. In 17
patients, local surgical revision due to hypertrophic scarring and nipple asymmetry was necessary. There
was no NAC-necrosis in this report.

Mushroom mastopexy lifts the breast while restoring maximum volume to the upper pole and can be
combined with breast augmentation using implants or lipofilling. This technique is simple, reliable, and
produces excellent aesthetic results with a low complication rate.

Infectious bacterial symphysitis (IBS) is a rare, debilitating complication, usually arising from hematogenous spread or per continuitatem from chronic urogenital or intestinal infections with fistulas to the symphysis, commonly after pelvic radiotherapy. Management is not standardized, but aggressive debridement and prolonged antibiotics are typically required. We report our multidisciplinary strategy combining symphysectomy, resection of fistulas, flap-based dead space management, and targeted antimicrobial therapy.

A retrospective analysis was conducted on 8 patients managed at our hospital between 2023 and 2026. All patients were preoperatively discussed in an interdisciplinary board involving orthopedic, plastic surgery, urology, and infectious disease specialists. The findings were compared to pertinent literature.

Prostate cancer with prior pelvic radiotherapy was the underlying diagnosis in 6 patients, the remaining two had squamous cell carcinoma of the vulva and ulcerative colitis. All patients underwent symphysectomy, some received cystectomy with ileal conduit (n=4), abdominal wall mesh reinforcement (n=7), and pedicled flap reconstruction (VRAM n=2, gracilis muscle flap n=6). No partial or total flap necrosis was observed. Complications were seroma (n=4), soft tissue infection (n=3), and abdominal wall hernia (n=5), all requiring re‑intervention (overall Clavien–Dindo IIIa or b). All patients received culture‑guided antibiotics, started intravenously and switched to oral therapy after wound stabilization, for 6–12 weeks depending on the presence of implants. At last follow‑up, no re‑operations for persistent bone infection and no pelvic ring instability were observed.

IBS is associated with considerable morbidity in patients with pelvic malignancies, often previously irradiated. Interdisciplinary planning is crucial to define the extent of symphysectomy and achieve complete removal of infected bone. Flap-based reconstruction reliably filled the defect with vascularized tissue, promoted healing, protected intra‑abdominal organs, and supported antimicrobial efficacy. In this context, gracilis flap is a valuable alternative to VRAM flap, limiting abdominal donor‑site morbidity and preserving the abdominal wall for potential future stoma or abdominal surgery. A tailored, multidisciplinary approach is key to durable source control and reconstruction.

Traumatic penile amputation is a rare urological emergency that requires surgical strategy. Published clinical replantation cases (2015-2023) are few, numbering only 46 over 7 years. Reconstruction using local flaps following major traumatic corporal amputation is exceptionally rare and remains largely unquantified in systematic reviews. When replantation is impossible, reconstruction using local tissues must be considered. We present a case of penile amputation management using a two-stage local flap reconstruction to restore both function and aesthetics.

A 33-year-old male with chronic alcohol use, presented disoriented and anemic with severe, delayed genital trauma. Examination showed a deep, contaminated cut-laceration with bilateral testicular loss and a 4-5 cm corporal remnant. Amputated parts were unrecovered. Stage 1 involved meticulous debridement, securing urinary drainage and targeted antibiotic adjustment after multi-pathogen growth. Once inflammation subsided, the reconstructive second stage was performed. Longitudinal incision lines were made along the palpable remnants of the corpora cavernosa. Scar tissue was dissected and the suspensory ligament of the penis was released. The remaining cavernous bodies were then elevated together with the overlying skin flap, resulting in an observed penile lengthening. The ventral tissue defect formed beneath the penis was covered by advancement and elevation of adjacent scrotal tissues and overlying skin to construct a neophallus.

In this case, the patient presented with severe contamination, delayed trauma, severely limited definitive treatment options. The unsuitability of replantation and the high complication risk associated with complex microsurgical free flap procedures in this setting required a staged, local reconstruction approach. The use of a scrotal advancement flap was crucial, as it provided well-vascularized and elastic tissue ideally suited for covering the remaining corporal stump. This tailored two-stage management optimized the functional and aesthetic outcome using only native local tissue.

Reconstruction after penile amputation is a complex challenge. Our case demonstrates that meticulous debridement and planned local flap reconstruction provide a strong foundation for success, restoring urinary function and achieving an acceptable aesthetic outcome, even when replantation is precluded.

Perineal reconstruction after oncologic abdominoperineal resection (APR) or pelvic exenteration in irradiated patients remains challenging. Regional flaps or the vertical rectus abdominis myocutaneous flap (VRAM) may be unavailable or unreliable in severely scarred abdomens and irradiated fields. The chimeric free latissimus dorsi (LD) flap with a thoracodorsal artery perforator (TDAP) skin island represents a versatile alternative capable of addressing large three-dimensional defects in selected patients.

We present three cases of patients with extensive perineal defects following surgical resection and pelvic radiotherapy, reconstructed using a chimeric LD–TDAP free flap anastomosed to gluteal vessels.

All flaps survived and provided stable coverage. Healing occurred in all three patients. Complications included wound dehiscence and flap congestion, without flap loss.

The chimeric LD–TDAP flap is a robust and versatile option for extensive irradiated perineal defects and should be considered in patients who are not good candidates for VRAM or local flap reconstruction.

Fournier’s gangrene can cause extensive scrotal soft-tissue loss, severely impacting function and quality of life. Conventional reconstruction options, including skin grafts and local or regional flaps, often result in bulkiness, reduced pliability, donor-site morbidity, and suboptimal aesthetic outcomes.

A 54-year-old male underwent scrotal reconstruction using a superthin transverse Profunda Artery Perforator (tPAP) flap after serial debridements and wound optimization. The flap (7 × 16 cm) was elevated above the superficial fascia and transposed on a single perforator. Donor site was closed primarily. Flap perfusion was confirmed intraoperatively with handheld Doppler. Functional outcomes and patient-reported quality of life were assessed postoperatively.

The flap provided stable coverage, excellent contour, and minimal bulk. At three months, the reconstructed scrotum demonstrated natural appearance, preserved testicular protection, and satisfactory functional outcomes. The patient reported relief from pain, comfortable mobility, and high satisfaction with aesthetic results. Donor site healed without complications, and overall quality of life improved.

The superthin tPAP flap is a safe, reliable, and highly pliable option for scrotal reconstruction after Fournier’s gangrene. Beyond structural repair, it contributes to functional restoration and enhanced patient quality of life, highlighting its relevance in reconstructive surgery.

Although male intimate surgery has experienced significant development over the past decades, scrotal lifting remains relatively underexplored, as evidenced by the limited number of scientific publications on the subject.
To date, no « ideal model » of the scrotum has been defined, and the few techniques described in the literature often appear inadequate as they are not based on precise anatomical considerations and may result in visible scarring, particularly in the erect state.

We present an original three-dimensional analysis of the scrotum, based on careful examination both at rest and during erection.
This anatomical approach enables the identification of the key parameters requiring correction across the three spatial dimensions.
We then detail specific surgical strategies for addressing each parameter, prioritizing concealed scars, and propose a decision-making algorithm to guide technique selection.
Finally, we introduce a novel technique HSP, H-scrotoplasty.

Due to its highly modular design, this approach achieves consistently satisfactory outcomes, including in complex cases, as illustrated by our clinical examples.
Scrotal lifting can thus be considered a sophisticated procedure, comparable in its principles to breast lifting.

The concepts presented here contribute to optimized surgical management of scrotal lifting, a highly rewarding intimate procedure that enhances sexual quality of life and improves patient self- confidence.