Background: Breast reduction, also defined as reduction mammaplasty, is one of the most common procedures performed in aesthetic surgery. Multiple techniques have been proposed throughout the years and several classification systems have been adopted according to: type of incision, pedicle blood supply (cutaneous, glandular, dermoglandular), extent of undermining, excision area, simultaneous or separate tissue excision (fat/gland, skin, or both), and combination of the aforementioned. In the present article, we share our 10 years’ experience with reduction mammaplasty and we describe our personal technique, a modified superior pedicle breast reduction. Methods: We performed a retrospective analysis on 823 consecutive patients undergoing either aesthetic or functional reduction mammaplasty at Humanitas Research Hospital between 2009 and 2018. For each patient, we evaluated the mean resection volume and complication rate. We also assessed patients’ satisfaction (VAS scale) and aesthetic outcome (assessed by independent surgeons, scale from 1 to 5). Results: The average patient age was 48, ranging from 17 to 77 years. The average operative time was 77 minutes, ranging from 62 to 123 minutes. After a thorough follow-up of these patients, we can conclude that our technique has a low complication rate, patients’ satisfaction is excellent, and the result is stable over time in terms of shape and symmetry (the mean VAS score was 8.1). Postoperative surgeon’s photographs evaluation scores were 4.5 ± 0.5. Average resected volume was 860gr. Conclusion: The proposed technique is safe, fast, and simple with a relatively short learning curve, making it didactic and intuitive for young surgeons.

Obsessive-compulsive disorder (OCD) is a psychiatric condition characterised by ritualised behaviours and anxiety-stimulating thoughts. In severe cases, refractory to medical treatments, symptoms can have a substantial impact on patient's social life, with important direct and indirect costs. Radiosurgery (gamma knife surgery (GKS)) and functional neurosurgery (deep brain stimulation (DBS)) have been employed as therapeutic approaches for the more severe cases of the disorder. This systematic review aims to evaluate use of GK for OCD refractory patients. The main biomedical databases (PUBMED, EMBASE, SCOPUS and Cochrane) were investigated for English-written studies regarding the use of surgical treatments in case of medically refractory OCD. Special attention was given to the patient number, approach, outcomes and complications. A high response after the procedures was seen by the use of gamma knife (GK) treatment (48.26%). It has been noted that gamma knife radiosurgery (GKRS) anterior capsulotomy shows positive and effective responses to treating refractory OCD. Furthermore, there is low evidence of GKRS capsulotomy to be effective to decreasing depression and anxiety symptoms and improving the quality of life. The main complications after the radiosurgical treatment were mood disturbances, lethargy, insomnia, cerebral oedema, gastrointestinal symptoms, radiation necrosis, weight/appetite changes and brain cysts. Although the pharmacological advancements favoured the treatment of OCD patients, the general management is still complex and presents several difficulties. In a selected group of patients refractory to pharmacological treatments and cognitive behavioural therapy, radiosurgical intervention (GKS) is seen to be a valid solution. The review of the literature presented shows that GKRS is a valid alternative in the treatment of refractory OCD.Keywords Obsessive-compulsive disorder . Gamma knife radiosurgery . OCD . GKRS Abbreviations GKGamma knife GKS Gamma knife surgery GKC Gamma knife capsulotomy GKRS Gamma knife radiosurgery OCD Obsessive-compulsive disorder DBS Deep brain stimulation Y-BOCS Yale-Brown Obsessive-Compulsive Scale

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