Mission Dr Cippini Erri

- The office of Dr Cippini Erri (for consultation and outpatient surgery) has been operational since November 8, 2006 and is located in Via Spalto San Marco  1/A (25121) Brescia. - Tel: 0303758502 - Mobile: 3395496222.
I consider a privilege the opportunity to explain the philosophy of my behavior as a Medical Doctor and as a Plastic Surgeon, behavior  which I think is the basis of my profession. This is also how I see my profession, how to achieve my mission.
Attached there are a curriculum vitae with my qualifications, and a list of cosmetic/antiaging procedures and outpatient surgical interventions  that I perform in my office, but I have to start with a brief introduction on the mandatory path that led me to this point.
I have dedicated my life to Surgery, with the last University issued Master  in Breast Oncoplastic Surgery concluded in July of 2011 (at my 56 years of age in December of that year) only to make an example.
My career begins with having attended, free of salary (incredible to say!),  the Department of Gynecology at the University of Milan(based at theUniversity  Hospital "Spedali Civili" of Brescia) acquiring the first Residency degree in "Obstetrics and Gynecology", for eleven years (one yr as an Intern, four yrs as a Resident and six yrs as a Fellow) and , for making a living, having been working during nights as an Emergency Doctor on call, because in those years that was the usual life for Residents in Italy, if a young doctor would like to be in the list for a job.
In those years, owing to a political crisis, there were no availability of hospital jobs and young doctors were compelled to attend University Departments free of salary: this situation lasted for ten years and  I had to make the best of my bad luck after not having won the first interview held on 19th December  1990 (in fact  I didn't have any support from politics or other) and change the course of my life.
At that time I was interested particularly in "Gynecologic Oncology" and in all the reconstructive procedures of female genitalia after demolition for cancer.  
The knowledge of Dr. Piero Candiani (son of Prof Candiani, Director of Ob/Gyn Dept at Mangiagalli Clinic of the University of Milan), who, that time,  was a young but well renowned plastic surgeon who attended, like me, the University Hospital "Spedali Civili" of Brescia,  took me to Plastic and Reconstructive Surgery.
              By Piero Candiani, I had later the occasion to meet Prof Luigi Donati (Director of Plastic Surgery Department of the University of Milan at the Niguarda Hospital and then at San Donato Hospital) with whom I acquired the second Residency degree, now in "Plastic and Reconstructive Surgery".
             I followed and respected deeply Prof. Luigi Donati, who in every occasion expressed satisfactory feedback on me, but  He passed away on February 17, 2003, and left me unable to continue the projects started with him.
Personally I was already well known as good and skilled surgeon (I won, as a student, also a cash prize from the University of Milan because I got the highest average rating of all the students of the university) but, then, I found myself (having missed my mentor Prof. Donati) unable to enter public hospitals because, even also for the absence of any political recommendation on me, a leader chair in a Dept has the fear of  having another one in the same Department.
So I chose the private practice as a professional man, with the obvious need to practice what everyone asked for... I mean that cosmetic surgery in which I have become an expert in all districts of the organism, but always with the heart turned to the reconstructive surgery.
To learn from leading surgeons I travelled extensively, aware of teaching of my Prof. Donati who was used to tell me that... a monkey (if well trained) can learn to work better than a great surgeon ... because not is the  pure and simple "surgical technique" the first real  skill for a surgeon, but instead the "indication" (i.e. knowing what is the best surgical procedure for that individual patient rather than for another one), and that the second real skill for a surgeon is certainly the "option" (i.e. knowing how to perform the same thing in different ways in different patients, depending on the "indication" as said before) ...and also He said that stupid is to say that a surgeon should perform all surgical procedures in  the same way  in different patients...because a nose is different in a person from another, a facelift in a round face is different from a face-lift in a bony "squared" face.
The specialty in Plastic Surgery (which deals with reconstruction after trauma, tumors or malformations) is in fact very different from all the other specialties for this reason ...
Not is enough (in the words of Prof. Luigi Donati) knowing those twenty operations , or little more, that a heart surgeon or a gynecologist are used to performing in the same way for all over their life and in the whole of their patients...... because their kind of Surgery is an "organ-targeted" surgery and their technical ability is acquired through repeating the same operation in the day after day practice in the hospital ....
On the contrary, Plastic surgery is a surgery "targeted to the body", which is different from patient to patient, and you have to learn it by travelling and travelling, and staying at the side of good surgeons often abroad (..what I have done many times and always at my expenses) ... like young Scholars did in the Middle Ages ... ...and like the young painters did in the Renaissance.
This is why I have gained great experience and acquired a great culture in the matter, which also I express in a huge personal bulk  of "decision trees for each intervention" and "specific informed consent" that I have gradually improved over the years,  making me achieve balanced and wise protocols of management in all kind of patients and in difficult clinical cases too, in order not to have any trouble or problem.  However, the passion for oncology and reconstruction after demolition for cancer disease has driven me to the last master in Oncoplastic Breast Surgery that I concluded in July 2011. In addition, and unfortunately, the increase in so-called aesthetic surgeon "nothing else than Cosmetic Cowboys" convinced me to dedicate myself more and more to the reconstructive oncology: from my point of view,  I preferred to devote myself to the issues I knew better and I chose to target my skill to the reconstruction and care of soft tissues of the face and of breast and female external genitalia, together with abdomen for bariatric surgery.
My passion is still breast surgery, where I can deal with reconstruction but also with demolition in its various options.
Making a virtue of necessity, I dedicated also to aesthetic-antiaging medicine and in this regard I enclose the list of what I usually perform in my office as outpatient's procedures.
(1) MESOTHERAPY (against cellulite and localized adiposity and lymphatic pathology).
(2) PEELINGS (exfoliating-regenerative procedures which stimulate dermal reaction).
(3) BIOSTIMULATION (amino acids, vitamins, non-cross-linked hyaluronic ac) for skin rejuvenation.
(4) Carboxytherapy (for revitalizing purposes and for the reactivation of the lymphatic circulation and against localized fat  and the "the so-called cellulite").
(5) FILLERS (fillers for wrinkles) with collagen, but mainly with jaluronic acid (cross-linked).
(6) Treatment with botulinum toxin (Botulin Toxin Type A) of both Vistabex brand and Azzalure brand ( I prefer Azzalure): for wrinkles in the upper third of the face.
I must underline the importance of referring procedures of  reconstructive plastic surgery and aesthetic/cosmetic plastic surgery  to dedicated facilities (in every clinical case which cannot be ruled by local anesthesia on an outpatient basis), for inveterate habit to look first of all at patient safety.
I run the wound dressings and the follow-up of scars after surgery, following the process of wound healing, even in cases of revision of previous scars or outcomes of dystrophic scars (also secondary to action taken by other).
I run too, if necessary (1) the excision of nevi  which then are delivered to histological examination, writing on my refer  the specific histology question together with the specific description of the landmarks of the excised tissue (patients often have already passed through a Dermatologist) and (2) I run directly revision of scars, even with secondary outcomes of  shrinking .
I also want to explain that the whole  minor surgery outpatient procedures, even cosmetic, that I run under local anesthesia follows the guidelines  suggested by SICPRE (Società Italiana di Chirurgia Plastica Ricostruttiva ed Estetica: Italian Society of Plastic Reconstructive and Aesthetic Surgery) and AICPE (Associazione Italiana di Chirurgia Plastica Estetica: Association of Italian Aesthetic Plastic Surgery) of both of which I am an active member.
In addition to the above procedures of (1) excision of nevi's skin  and (2) revision of scars and keloids including (2a) "Z-plasty" or "VY-plasty" (performed either on previous "aged" scars to debride adhesions and soften the tissue, but also to restore symmetry in  wounded areas after  trauma or burn),  I wish to underline that I perform, always referring to small areas to be addressed in an outpatient basis,  all the procedures which involve only superficial tissue and under local anesthesia.  Among them  we can consider the (3) blepharoplasty when you remove only a small strip of skin, or a (4) otoplasty  when you remove a lozenge of skin behind the ear and give you some points on the cartilage, or a (5) miniliposuction which means a removal of a not excessive amount of subcutaneous fat, or also the (6) autologous fat transplant , as well as a (7) cheiloplasty (VY-plasty for lip advancement), and also a (8) mini facelift of the skin contouring the ear , and also (9) intervention on nipple retraction (extraction of inverted nipple).
This is what I do in my office. The whole bulk of more important  Cosmetic Surgery procedures are of course performed in private Clinics and in dedicated facilities.
After the surgical operation performed on an outpatient basis in my office, the patient must be kept under observation for a variable period of time depending on the complexity of the procedure performed but never for a time less than 30 minutes. The patient is then referred to his/her General Practitioner and is given a letter  which provides the "general" description of the surgical procedure, the prescription of drugs that the patient has to take in the days following the operation, and the date of further controls and medications at my office. This letter contains my telephone number for emergencies.
It's my habit, for good clinical sense, to recall and personally contact the patient by phone within 12 hours after discharge to assess his/her  state of health and the absence of any postoperative complication.
All sensitive data (patients' histories, informed consents and a description of the procedure performed) are contained in folders collected in a specific and reserved part of my library and are not accessible to other than myself .
There is, of course, an  <EMERGENCY KIT > made of: ambu balloon, with mask and connecting tube, screw opener and tongue forceps, three Guedell / Mayo cannulas of varying degrees, three saliva suction tubes (12G, 14G, 16G), and oxygen tank of 2 liter (for the current regulations, the OXYGEN TANK currently in use is provided by SIAD , a certified company). There are emergency medications: Adrenaline 1: 1000 (ampoules 1mg), atropine sulfate (1 mg / 1 ml),  Solumedrol 1g,  Bentelan 4 mg, Saline (sodium chloride 0.9%) and infusion sets and infusion systems ( Venflon type) 18G and 20G, and needles (butterfly type) 21G
PROTOCOL of EMERGENCY.Owing to the small kind of the outpatient procedures  that I perform in my surgery  (major ones are performed in private Clinic), I am used to putting a lot of attention to the medical history of the patients with a particular focus on blood coagulation problems and cardiac and infectious diseases (for which I require special instrumental tests, and hematological tests) and on the history of allergies. The only emergency that happened to me (twice in ten years) was due to a fainting owing to vasovagal reflex that I simply solved with keeping the patient in Trendelenburg position and an infusion of 1 gram of cortisone (never I had to use atropine).
Never happened nor will be supponed to happen any other kind of emergency ,in fact no emergency for  bleeding could happen because in office I work on superficial layer's tissues , never with access to any important caliber blood vessels (anyway  is  available an electrosurgical coagulation device),
I have an experience of five years (last five years) as medical director of an A&E (emergency dept) where I worked as Consultant Plastic Surgeon for trauma accidents, and I have multiple certifications of courses on  BLS and BLS-D, with the latest pediatric BLS also performed in London on 8 October 2015.
I would like to say a few words on the relationship with patients.
I have already mentioned my constant effort on renewal and up-to-date of protocols for any surgical intervention that I run in the operating room in the Clinics and surgical facilities I work with (but also for outpatient basis performed procedures in my office), so as on the constant upgrading of  flow charts (decision making trees) for each procedure that I perform, but I would like also to underline the great bulk of specifically set up informed consent (also be applied to the minimal outpatient procedures that I perform in an outpatient basis in my office, and that I mentioned before) that are increasingly sophisticated, passing from a mere list of risks and contraindications to a full and well explained disclosure of the matter  to the patient, who is now involved  in the decision-making procedure.
 For the guidelines in my profession, I make reference to the guidelines of SICPRE (Italian Society of Plastic Reconstructive and Aesthetic Surgery) and AICPE (Association of Italian Aesthetic Plastic Surgery), of  which I am full certified member.
And now a few words about the so-called Aesthetic (antiaging) Medicine and Aesthetic Surgery.
"The Aesthetic Medicine is a medical discipline that deals with the construction or reconstruction of psycho-physical individuality , and caters mainly to those persons  who live their life uncomfortable for a  blemish and a defect poorly accepted. As J.Cocteau said, a defect of the soul cannot be mended, but a defect of the body (if corrected) can make the soul recover.  
It 'a medicine for the quality of life, for health as an expression of the physical and mental wellbeing, for enhancing self-esteem.
It is fundamentally a form of preventive medicine and , then,  also a corrective medicine".
My training in Aesthetic Medicine (see CV) began in 1991 at the International School of Aesthetic Medicine "Fatebenefratelli" Foundation in Rome after four years of classes,  with a diploma degree obtained in 1995 which bears the number 112, which means that I am the 112th doctor in Italy to have been trained since the beginnings  in the matter (today there are thousands). It also means that I saw  a lot of "water flowing under the bridge" and that I can really say that I have known the "History" of this profession since its beginnings.
This bulk of experience in the field allows me, together with a constant updating, to recognize the validity of the drugs and products issued on the market , especially the so called "new ones" (as if being a new one product would mean to be automatically certified as the best one ever released, as in many people's thoughts),in order  to be allowed to use on my patients only the most certified and safe treatments and methods.
It  is important to teach a new culture to patients, especially to those of them who are suffering for deep psychological conditions sometime due to a real situation of intractable physical condition but mostly due to a simple non-acceptance of self and to a low self-esteem. They may be more easily prey to "vendors of potions" or to "first time" surgeons (those in the Anglo-Saxon countries called as "Cosmetic Cowboys").
And what now in Plastic Reconstructive and Aesthetic Surgery?
In Plastic Reconstructive and Aesthetic Surgery is important to discuss with patients the clinical case, in order to guarantee the full understanding of the procedure which is in planning to be performed, and its feasibility or not, especially to discourage those patients who are waiting for an easy miracle.
Precisely for this reason, the Plastic Surgery and Cosmetic Surgery are so fascinating ... and difficult.
Now I would like to present to the reader a very brief summary of my Curriculum Vitae with the most important professional accreditations.
 I think that I am not supposed to make a mistake if I end this presentation with a special reference , a sort of  "a final thought" , I would to say that....I have ever been brought up  (in my family and through sport) with a mandatory respect  to the code of honor of a true gentleman.
CIPPINI Erri,  M D  (ECFMG  GMC  FMH  certified)
Born in Brescia (Italy)  on December 11,1955.
Member (n° 3588) of the Association of Medical Doctors and Surgeons of the Province of Brescia
 CURRICULUM VITAE [DEGREE – RESIDENCY (residencies) –  FELLOWSHIP  and Career Certifications]
- Medical Qualification (DEGREE) at the University of Milano (110/110 cum Laude,  i.e. “full marks and honours”): December 18,1981
- License to Practise Medicine (Italian State Examination): Perugia, April 1982
- American Medical Examination (ECFMG certification): July 1990
- Full registered with Specialist Registration as Plastic Surgeon (General Medical Council – UK) (GMC reference number 7031966): since 10 Febr.2009
- Full registration of Medical Degree and Plastic Surgery (reconstr. and aesthetic) Residency at Public Health Federal Bureau of Helvetic Confederation (Switzerland: MEBEKO office) since 13 August 2009: it is FMH certification
- Licence to practice as Medical Doctor in the Canton Ticino (Department of Health and Social Wellness - Health Office = Dipartimento della Sanità e della Socialità - Ufficio di Sanità) since  24 January 2014
- Residency in Obsterics and Gynecology (completed at the University of Milano)
- Residency in Plastic and Reconstructive Surgery (completed at the University of   Milano) (according to New Dispositions EEC) 
- Fellowship in Plastic Surgery specifically Aesthetic Plastic Surgery at Teknon Clinic in Barcelona (Spain)
- Master in «Aesthetic and Morphodinamic Surgery »at University of Milano – it is an  Academic Title
- D.I.U. (Diplome Inter Universitaire, i.e.« French Master » developed among the Universities of Bordeaux, Marseille and Nice) « Chirurgie du Visage: de l’Anatomie aux Techniques de Chirurgie  Reconstructrice etEsthétique », granted by the Université Bordeaux 2   – it is an  Academic Title
- Master (II° level master) in «Breast Oncoplasty and Integrated Treatments» (developed among the National Cancer Institutes of Milan, Geneva and Rome for a 1500 hours course), granted by the University of Geneva  – it is an  Academic Title
-  Graduated at the International School of Aesthetic Medicine of the International Foundation “Fatebenefratelli” in Rome. (Acad.Yrs. 1992/1995, for 4 years of duration): it means to have got a recognized “Diploma of Formation in Aesthetic Medicine”.
- Former Professor at the University of Brescia, Faculty of Medicine, Master of Science in Medical Biotechnology, as appointed Chief of the teaching"Plastic Surgery" for the whole duration of the course (from Ac.Yr.  2006/2007 to Ac.Yr.  2010/ 2011).007 ad AA 2010/2011.

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