Italian Plastic Surgeon, Dr. Egidio Riggio's "Zenith System" For Breast Augmentation

Dr. Egidio Riggio focuses on innovation and research related to plastic surgery, both aesthetic and reconstructive. 

Name: Egidio Riggio, M.D.
Location: Milan, Italy

That's interesting: Dr. Egidio Riggio is the creator of an innovative philosophy and aesthetics of an original surgical approach to breast augmentation he calls the "Zenith System" which he claims lead to more natural breast augmentation results. He has performed mor than 100 cases and published this proceedure in the international journal of cosmetic surgery most authoritative, Aesthetic Plastic Surgery August 2012.

Could you tell us a little about your practice?

My practice is organized in two branches: the institutional hospital activity covered by our public Health System in Milano and the private activity dedicated to cosmetic surgery and medicine. The private office is located in Milano downtown. Here I mostly perform medical consultations, dermal fillers and Botox injections. All surgical procedures of mine are located in day-surgery units and in clinics for prolonged recovery where I don’t have financial interests. In such a way I am free not to have fixed and great expenses, especially when periods of economical crisis occur. 

How does practicig cosmetic surgery in Italy compare with what you see in other countries in Europe? 

The commercial availability and surveillance of the medical device market follow the same rules in EU. However, the recent PolyImplants prostheses “affair” raised many doubts concerning security and transparency of the controls by the overseeing authorities. 

In Italy, people are still modestly influenced by commercial cosmetic inputs in comparison with what you can see in Spain or UK. Also the commercial, i.e. not medical, societies interested in the cosmetic surgery market, are much less developed in Italy, as well  in France. A large number of people still demonstrate interest in the skills and peculiarities of an individual local surgeon rather than travel for the low-cost of the surgical tourism abroad.

Who are your typical patients? Is there any move towards nonsurgical technologies?

My typical patient is the woman in her 30 and 40 years of age, mostly seeking for soft corrections of the face, augmentation and rejuvenation of the breast, lipo-sculpturing, repair of the abdominal wall after pregnancy. 

My aim is research for a natural result, less showy but less obvious at the same time, This does not mean minimal corrections but “sustainable” surgery. It does not matter if surgery is heavy or mini-invasive. That’s important is adapting my surgery to body perception of the patient without destroying the anatomical frames. 

My point  is that we are moving towards nonsurgical procedures in the field of facial aesthetics but as surgeons we can maintain the surgery leadership in breast and all the body contouring  if we are able to change our mindset and embrace what is going to be the new dynamics of modern plastic surgery.

You are an active author of several publications and journals. Can you tell us more about your research background?

I spent twenty years both operating and researching in the fields of breast and face surgery, either reconstructive or cosmetic. My research background started from the facial malformations, carried on with head & neck cancer reconstructions, and ends with the oncoplastic surgery of the breast. I am a plastic surgeon in a big cancer institute and I am still working there. 

In Italy it is possible to use high-cohesive silicone implants without any suspension, hence I have used nearly 1,000 breast anatomical implants. I have recently published about: one-stage breast reconstruction after mastectomy with anatomical implants without use of ADM; all mastopexy variants to shape the breast immediately after lumpectomy/quadrantectomy. The last study was published in the August issue of Aesthetic Plast Surgery. It concerns a cosmetic issue about an original breast-augmentation concept based on a measurement system for pocket preparation related to the nipple/implant-vertex ratio, on the biomechanical synergism among high-cohesive silicone, extra-projected shape, and partial submuscular coverage of the anatomical implants. I called this breast concept the “Zenith system”.

How competitive is cosmetic medicine in Italy? How do you market your services?

Cosmetic medicine is really competitive with the new hi-tech devices and the unlimited market of cosmeceutical products and injectable materials. Too many products receive the EU certification to be sold in Europe compared with FDA restrictions. Too many medical practitioners coming from different fields of interest and experience have filled the market. 

My own practice of nonsurgical cosmetic medicine is small (no laser, radiofrequency, or other devices) in comparison with my surgery and I am recently trying to market these nonsurgical services using promotions of dermal fillers or botulinum injections. I consistently try to maintain average prices emphasizing my peculiar expertise against the mixture low-cost/poor-professionality/higher-risk.

In Italy, malpractice insurance is not mandated but every surgeon must absolutely find by himself an insurance for malpractice. It is not easy to find insurance guaranteeing all the aspects of the medical risk. 

Where do you think will cosmetic surgery evolve? 

The technology is already changing the anti-aging treatments at the expense of the facial cosmetic surgery, but I still believe it represents an opportunity for plastic surgeon. Less invasive treatments like the lipofilling are extending their own indications in face and body contouring but, in my opinion, its destiny is still too uncertain for breast augmentation. I also believe that handmade liposuction can remain at the top of fat-sculpting despite the recurring discover of “novel” machines.

Are you using Botox, fillers and other nonsurgical technologies? How widely available are Botox and fillers in Italy? How expensive are they?

I use Botox and fillers. Botox, i.e. 100 UI, is not marketed in Italy. Only Vistabex (50 UI) by the same Allergan Inc. and costs about 140 Euros. As for the fillers, for the last five years a cost decrease is going on, they're nearly 20-30% off from where they were. 

Have you ever had any experiences with technologies that you felt were oversold, either to the physician or to the patient? Are there any technologies that you would recommend that physicians stay away from, either for medical or business reasons? 

Technologies behind the grow-factor and stem-cell inoculation into healthy breast, at higher concentrations than the normal, are not yet controlled by long-term clinical cohort studies, it means ten years of oncological surveillance compared to either conventional lipofilling and control series. In absence of this scientific evidence, I suppose that the indiscriminate use of Grow-F and ASC will remain “off-label” and under the legal responsibility of the individual surgeon.  

What do you think that you do better than most other physicians that helps you to succeed?

I always try to permeate my reconstructive surgery with all the items and expectations present in cosmetic surgery. At the same time, I apply the anatomical and vascular details of reconstructive surgery into my cosmetic surgery and joined the private surgery practice with the scientific aspect of my work. That means new ideas, clinical studies and long-term follow-ups in some groups of patients. Of course, this takes a lot of time but it is amazing.

What's the best advice you've ever received as a physician?

From my patients? …Not to lose the capability of listening the people’s needs - all patients either unfortunate or wealthy - after surgery and for a long period.

From wiser colleagues? …do not test new materials and devices on your own patients if there are not rigorous clinical studies. Otherwise, treating and following groups of patients according to specific clinical trials. 

About: Dr. Egidio Riggio finished his Medical Degree at the University of Palermo. Afterwards, he obtained a Board certificate in Plastic Reconstructive and Aesthetic surgery from the University of   Milano. He also obtained a Board certificate in Microsurgery at the University of Milano. From 2000 to present, he is also a Staff Member of Plastic Surgery Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano. He is a member of the following societies: Italian Society of Plastic Reconstructive and Aesthetic Surgery (SICPRE); International Society of Aestethic Plastic Surgery (ISAPS); Past Member Academy of Science, New York; and Honorary  Member of the Hellenic Society for Breast Cancer Research.

Dr. Egidio Riggio is a Medical Technician Consultant at the Tribunal of Cities of Milan and Palermo. He was a Medical Officer United Nation (ONU) in Africa (Somalia). He was also a Past Researcher in Plastic surgery and Maxillo-facial surgery Units at the Istituto Nazionale Tumori, Milano, Italy. He was also a Prior Consultant Plastic surgeon in Cardiosurgery, Orthopedics, Gynecology and Breast Units for other hospitals. He is actively involved in the clinical and scientific activities dedicated to the treatment of breast and facial defects for oncologic, reconstructive and aesthetic items. Dr Riggio is an expert in breast surgery (both oncoplastic and aesthetic topics) mostly acquired in 18 years of activity in one of the most important Cancer Institute in Europe under the direction of dr A. Grisotti before and dr. M. Nava later. 

This interview is part of a series of interviews of physicians running medical spas, laser clinics and cosmetic surgery centers. If you'd like to be interviewed, just contact us.