GROWTH FACTORS
Growth factors are a group of substances, proteins most of them, that along with hormones and neurotransmitters are crucial to cell´s communication. Growth factors are in every person’s blood. They are chemical agents that cooperate in the healing process of wounds in a healthy patient. They are also used as an auxiliary or a complementary procedure to improve cicatrisation. Until today, we know of the existence of many different growth factors. Some of them regulate skin’s remodelling and therefore, are very important to skin’s image. With time, the amount of growth factors decreases as well as their activity. Usually the preparation is done by a haematologist using a patient’s blood sample. The surgeon uses it as a post laser treatment to accelerate cicatrisation..

THE EXPERIENCE OF USING PLAQUETTE-RICH PLASMA
For several years now, we have been using growth factors obtained by the platelet-rich plasma method. The factors are applied by massotherapy (wrinkles, elastosis, dyschromias), subdermal injections (deep folds, fibrosis, scaring depressions), prepared with fat (as a graft) or as a platelet clot (in scars to accelerate healing process).

You can think of growth factors as the fertilizer we use for our plants. If we wanted to prepare a piece of land to grow corps we should follow these steps: first we would remove the stones or we would remove the weed and then we would eliminate parasites or germs. After that we would plough the area to remove and air it. Next we would water, fertilized and finally wait until it is time to harvest. Same way, when we work with an aged skin first we clean it and we eliminate the stratum corneum of the epidermis so it can renew. Then we moisturize and nourish it. Then we “scatter” growth factors to cooperate with cell regeneration, we wait and stimulate (messotherapy) and finally we harvest the results of our work: a moisturized glowing younger skin. In medicine, the platelet-rich plasma (PRP) method is used also to shape and to increase volume, especially on the facial area. Even though it has not been scientifically confirmed, it has been seen that fat grafts associated to PRP last longer. Skin also improves when infiltrated with PRP. This happens because an increased concentration of Growth Factors causes a larger and faster graft revascularization and an acceleration of stem cell’s reproduction. Its application combined to massotherapy has also proved to be very beneficial. Massotherapy is a very important procedure to treat facial aging. This technique consists in applying, locally, several micro injections of medication (minimum dosages) to the dermis. Since one of the most important aging manifestation are wrinkles, applying growth factors (alone or combined to other medications) through massotherapy, allows us to provide skin with active agents that will activate skin’s cellular regeneration and stimulate glycosaminoglycans and collagen production. These molecules are important to substitute modified structures. Summarizing, we can say that growth factors regulate epidermis and dermis remodelling. They also influence deeply skin’s looks and texture. Growth factors topic application or subcutaneous injection cause strong changes to aged skin: restores skin´s vitality and elasticity, increases its thickness, and improves its vascular affluence stimulating secretions. Aged skin treated with growth factors has never gone beyond young skin´s thickness; this proves how growth factors work perfectly as regulators. Using PRP allows us to treat our patients with their own tissues (centrifuged blood), with almost no risks at all and in an ambulatory way.

EXCESSIVE SWEATING SURGERY
Hidro Dishydrosis is the excessive sweating of hands, armpits, face and feet. These are the body areas where there are more sweat glands.

This problem can be treated medically using Botuliniun Toxin, but the procedure will have to be repeated every 4 to 6 months. Another possibility is surgery. During this treatment sweat glands are removed eliminating the reason of the problem. Classic medical treatments can improve some Hidro Dishydrosis cases but not the severe ones. Sever cases need to be treated surgically. Surgical treatment is 95% of the times totally effective when hands, face and arm pits are affected.

BENIGN TUMOURS, PRE MALIGNANT AND MALIGNANT INJURIES, MELANOMAS. FACE, NECK AND BODY
We call tumor to any kind of tissue alteration that causes volume increasing. It is an abnormal enlargement of a body part that will look swollen. More specifically, a tumour is any lump caused by an augmentation of any cell population. A malignant tumour has the capacity to invade or infiltrate to cause metastasis in other body areas, distant from where the primary tumour first appeared. This is when we talk about cancer.

There are many different kinds of skin tumors. They usually start as keratosis or spots, caused by both, photo aging and a genetic predisposition. Photo aging is very important in those places where solar radiation is increased because of weather conditions (ozone depletion) There are other types of malignant tumors located on the epidermis or some other tissues (like muscle or bone). Melanoma is a very aggressive tumor, and for a successful result, it must be treated by a team of surgeons, dermatologists and oncologists. Plastic surgeons also participate in the treatment of mammary tumors. They participate in a team with a specialist in mammary pathology. This interaction allows a better reconstruction of the area after the treatment.

Examples of benign tumors:

Skin Cancer
El cáncer de piel es una patología muy frecuente que cada día va aumentando en el número de casos reportados. Aunque puede aparecer en cualquier parte del cuerpo, el cáncer de piel tiene una frecuencia de aproximadamente un 85% a nivel de la cabeza, cara y cuello pudiendo producir grandes desfiguraciones y efectos sumamente peligrosos.

MAMMARY DISEASES
If detected on time, cancer can be treated only with radiation, even though most cases, it needs to be removed surgically. Mammary cancer surgeries are always different. The surgeon will remove different amounts of healthy tissue depending on each case .

RADICAL MASTECTOMY
Ten years ago, this was the only option for cancer treatment. Now it is rarely used, except when the tumor has spread to the surrounding muscles. Radical mastectomy removes the first layer of pectoral muscles and lymph nodules across the chest. This way the possibility of an implant is much smaller, because there is less tissue to work with, less movement capacity and bigger chances of inflammation.

MODIFIED RADICAL MASTECTOMY
The surgeon removes the entire gland as well as arm pit lymph nodles. Since chest muscles are not touched, there are less problems during the healing process. The aesthetic result is much better and it is easier to perform a reconstructive surgery.

SIMPLE MASTECTOMY
The surgeon removes only the gland and takes a sample of an arm pit lymph nodule.

SUBCUTANEOUS MASTECTOMY
Mammary tissue is removed, but skin and superficial tissue is not. This allows an implant to be place under mammary skin. A lymph nodule might be moved.

QUADRANTECTOMY
The surgeon will only remove the tumor. In other cases, he might do an in-V incision (en cuña) to remove surrounding tissue as well. In any case, nodules are removed from the arm pit. Lumpectomies are performed if the tumor is small. The area is usually radiated to kill any cancerous cell left behind. Long term treatment is always necessary if cancerous nodules are detected. Even when nodules are not cancerous, radiation, hormone therapy or chemotherapy may be used as prevented treatment .

MAMMARY RECONSTRUCTION: Implants
Today, mastectomee women can have their chest reconstructed. The plastic surgeon can reconstruct breasts using muscle and abdomen skin. These tissues are removed and replaced to reconstruct the chest.

When the new tissue comes from the back, a silicone implant is also placed. This is not necessary when the tissue comes from the abdomen.

Sometimes, skin is mechanically stretch. Later a silicone cone is placed under it or under pectoral muscles.

A surgery is considered as reconstructive surgery, when it is used to repair a functional or aesthetic defect in cases where there is an anatomical alteration caused by trauma, a tumor, surgery, etc. Normally reconstructive mammary surgery repairs defects produced by tumor removal surgery (cirugia resectiva). It can also be necessary when benign tumors had to be repeatedly removed causing asymmetrical volume or shape of the glands.

Some time ago when a mammary gland was removed, reconstruction was left far a second step because it was thought that the implant or the reconstruction itself could affect the disease’s follow up. Today we know that immediate reconstruction surgery does not affect patient’s treatment in any way. It actually cooperates, since the patient needs to go though only one surgery and she also avoids the trauma of seeing herself without her breast and her feminine shape.

The reconstruction
There are many ways to reconstruct a gland. The chosen way depends in each case particularly. Immediate reconstruction is done in patients that have a good proportion between breast and tumor size (big breasts, small tumor), so there is no need to remove the entire gland. In this type of surgery, tumor removal is planned according to the reconstruction. When the gland is completely removed reconstruction can be performed using patient’s own tissue or using regular implants and stretching the skin before the surgery.