Biological Morphogenetic Surgery: A Minimally Invasive Procedure to Address Different Biological Mechanisms.

We present a methodology called biological morphogenetic surgery (BMS) that can recover (enlarge or reduce) the shape/volume of anatomic structures/tissues affected by congenital or acquired malformations based on a minimally invasive procedure. This emerges as a new concept in which the main task of surgery is the biological modulation of different remodeling and repair mechanisms. When applied, for example, to a tuberous breast deformity, the "enlarging BMS" expands the retracted tissue surrounding the gland through a cutting tip of a needle being inserted through small incisions percutaneously, accounting for the biological activity of the grafted fat. The obtained spaces might be spontaneously occupied and later filled with autologous grafted fat, which promotes tissue expansion by eliciting adipogenesis and preventing fibrosis. The "reducing BMS" creates an interruption of the contact between the derma and the hypoderma of the abnormally large areola and then promotes adipocytes to induce a fibrotic reaction, leading to areola reduction. Current evidence suggests that BMS might induce a bivalent mesenchymalization of the adipocyte, which promotes either new adipogenesis and angiogenesis of local fat (expanding BMS) or the granulation tissue/fibrotic response (reducing BMS), thus leading to the physiological recovery of the affected structures/tissues to normality. Level of Evidence: 4.