In morbidly obese patients, the incidence of histological liver damage is very high, despite acceptable liver function tests. In addition to steatosis, however, a "second hit" to induce necrosis and inflammation, favoring the development of significant fibrosis, is not essential. Being obese is an independent risk factor for liver damage and could contribute to liver fibrosis either alone or in association with other insulting factors. The identification of obese patients with septal fibrosis/cirrhosis, at surgery, is of considerable interest in clinical practice, mainly under the aspect of prognosis and liability.

Breast reconstruction is fully justified only from an aesthetic perspective. A reconstructed breast, therefore, should be as aesthetically natural and similar to the contralateral one as possible, even if this means reproducing some little defects. The breast's profile (projection, ptosis, sulcus location, and superficial unevenness), symmetry, areola, and nipple are the characterizing aesthetic factors. The authors present their experience in prosthetic breast reconstruction seen with an aesthetic eye and an artistic touch, illustrating personal tips and technical adjustments: use of anatomical prostheses, pectoralis muscle treatment, sulcus stabilization or reconstruction, superficial irregularities correction, and nipple-areola complex reconstruction. Results are evaluated by both the surgeon and the patient using a score system, validating the method.

Background. Virilizing adrenocortical tumors are uncommon in adult women. These lesions generally secrete dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEAS), but not testosterone, which usually is produced by ovarian tumors. Exceptionally, adrenal growths may give off testosterone and no other assessable androgen. The detection of the site of excess testosterone yield is paramount for proper surgery. The true nature of the growth often is unpredictable, even at the time the pathologist examines the surgical specimen. Methods. The workup in a virilized adult woman relies on biochemical tests such as 24‐hour urinary 17‐KS and 17‐OHCS levels and plasma corticosteroid levels (testosterone, DHEA, DHEAS, and androstenedione), and on modern imaging studies such as ultrasonography, computed tomography, and digital angiography. Results. Among a series of 190 adrenal tumors collected in the last 30‐year period, only 10 virilizing growths (5.3%) were detected. Two cases of virilization mixed with cushingoid features were observed. In two other cases, reported in detail, the tumor secreted testosterone only, without other assessable androgens. Seven of the 10 tumors were malignant. Conclusions. In cases of tumors secreting testosterone only, high‐resolution imaging has contributed significantly in pinpointing the site of the growth, whereas dynamic hormone testing, using selective stimulation or suppression studies, has been misleading. The malignant nature of the growth may be revealed only by the presence of metastases, because pleomorphism and capsular and vascular invasion have been detected histologically in clinically benign tumors. The prognosis for large tumors usually is dismal.

The tuberous breast syndrome is the result of a complex series of defects with various degrees of expression. However, much confusion has been generated in the literature by the use of often inadequate terminology, which is partly the cause of multiplicity of managements being proposed that mainly aim to correct the major defect and not the entire syndrome. The surgical approach adopted by our group stems from the improvement of classic techniques, consisting essentially of a combination of periareolar mastopexis, additive mastoplasty, and gland base enlargement by cross incision. Our results were fully satisfying both aesthetically and functionally. We achieved a correct shape, resolved ptosys and reduced areolas with no double-fold effect, and attained good symmetry in more complex unilateral cases.

Cartilage weakening techniques can lead to better aesthetic results, primarily because of a softer and more natural ear curvature.