This book fills the gap for lack of a precise roadmap to approach the fundamentals of implant-based breast surgery to achieve optimal results. Despite the vast number of publications on breast surgery, there is a deficit in easy to process yet detailed source of information which brings all of the concepts together. With observation, surgical experience, and better devices the approach to implant-based breast surgery must evolve from “volumizing” the breast to “shaping” the breast.
In a concise and accessible fashion, Shaping the Breast covers the best practices in breast surgery covering topics of primary augmentation, augmentation mastopexy, composite augmentation, revision breast surgery and breast reconstruction. In a methodical and logical approach, it provides the successful pillars for reproducible outcomes which includes patient assessment, biodimensional planning, surgical techniques and patient care along with pearls and pitfalls. It includes dozens of before and after images alongside case studies to illustrate the management of variety of complex issues.
Author(s): Kiya Movassaghi
Publisher: Springer
Year: 2021
Language: English
Pages: 131
City: Cham
Preface
Acknowledgments
Contents
Contributors
1: Shaping the Breast: Optimizing Outcomes in Breast Augmentation
Introduction
Patient Factors
Medical History
Patient Motivation
Body Dysmorphic Disorder
Body Characteristics
Patient Expectations and Requests
Patient Information and Education
Implant Factors
Pocket Control
Physical Exam
Implant Selection
Pocket Selection
Implant Surface Selection
Surgical Factors
Superficial Fascial System of the Breast
Preoperative Planning
Incision Site
Marking
Surgery
Skin Incision
Identification of the Major Pectoral Muscle
Creation of the Implant Pocket
Implant Insertion
Wound Closure
Dressing
Prepectoral Implant Placement
Postoperative Care
Case Presentations
Case 1
Case 2
Case 3
Case 4
Case 5
Case 6
Conclusion
References
2: Shaping the Breast: Augmentation Mastopexy
Introduction
Preoperative Evaluation
Blood Supply
Patient Expectations
Operative Decision-Making
To Stage or Not to Stage
Mastopexy
Augmentation Mastopexy
Implant Selection
Implant Profile and Size
Smooth Versus Textured Implants
Shaped Implants
Additional Implant Characteristics
Pocket Selection
Mastopexy Technique
Circumareolar
Circumvertical
Circumvertical with Inverted-T Skin Excision
Lower Pole Mastopexy
Operative Technique
Preoperative Markings
Vertical Mastopexy Technique
Surgical Technique
Pocket Development
Submuscular Dual-Plane Pocket
Subfascial Pocket (Fig. 2.26)
Subglandular Pocket (Fig. 2.27)
Implant Placement
Tailor-Tacking (Figs. 2.30, 2.31, and 2.32)
Breast Flap and Pedicle Dissection
Lower Pole De-bulking
Deep Fascial Sling
Closure
Postoperative Care and Expected Outcomes
Complications
Secondary Procedures
Conclusion
Case Examples
References
3: Shaping the Breast: Composite Breast Augmentation
Introduction
Composite Breast Augmentation
Surgical Technique
Fat Harvest/Liposuction
Breast Implant Placement
Fat Grafting in Primary Breast Augmentation
Fat Grafting in Secondary Breast Augmentation
Needle Band Release
Patient Examples
Primary Composite Breast Augmentation
Surgical Technique
Revision Composite Breast Augmentation
Surgical Technique
Conclusion
References
4: Shaping the Breast: Optimizing Aesthetics with Reconstructive Breast Surgery
Introduction
Prosthetic Reconstruction
Patient Selection
Device Selection
Immediate Versus Delayed Reconstruction
Acellular Dermal Matrix
Partial Subpectoral Prosthetic Breast Reconstruction and ADM
Prepectoral Prosthetic Breast Reconstruction
Autologous Fat Grafting and Prosthetic Breast Reconstruction
Radiation Therapy and Prosthetic Breast Reconstruction
Autologous Reconstruction
Patient Selection
Flap Selection
Abdominal Flaps
TRAM Flap
Free TRAM Flap
DIEP Flap
SIEA Flap
Shaping the Abdominal Flap
Flap Insetting
Latissimus Dorsi Reconstruction
Gluteal Flaps
SGAP Flap
IGAP Flap
Shaping Gluteal Flaps
Thigh Flaps
TUG and TMG Flaps
PAP Flap
Secondary Revisions
The Reconstructed Breast
The Non-reconstructed Breast
Conclusion
References
5: Shaping the Breast: Managing Complex Breast Issues
Introduction
The Constricted Lower Pole
Case Analysis
Asymmetries
Case Analysis
Case Analysis
Secondary Cases with a Large Implant Pocket/Implant Malposition
Case Analysis
Correction of Malposition in One Operation: An Algorithmic Approach
Operative Techniques
For Lateral Malposition
For Inferior Malposition
For Correction of Recurrent Lateral and Inferior Malposition
Case Analysis
Case Analysis
Correction of Pectoralis Disruption
Case Analysis
Double-Bubble Deformity
Case Analysis
Unilateral Breast Reconstruction with Contralateral Breast Post Mastopexy/Reduction Bottoming Out
Case Summary
Symmastia
Case Analysis
Conclusion
References
Index
