Augmentation Mastopexy: Mastering the Art in the Management of the Ptotic Breast

Foreword
Contents
Contributors
1: Anatomy of the Breast
	Introduction
	Surface Anatomy
	Breast Tissue
	Nipple-Areolar Complex
	Vasculature
	Lymphatic System
	Innervation
	Musculature
	Thoracic Wall
	Conclusion
	References
2: Principles of Breast Augmentation: The Process of Augmentation Mastopexy and Criteria for Staging
	Introduction
	The Process of Augmentation Mastopexy
	The Tissue Based Triad
	Pre-operative Evaluation
		The Markings
	Surgical Approach
		Intraoperative Steps
		Adjunctive Procedures
	Conclusion
	References
3: Principles of Mastopexy
	General Principles of Mastopexy
	Key Principles
	Breast Anatomy
	How to Decide if a Mastopexy Is the Best Surgical Approach
	Nipple Ptosis
	Glandular Ptosis
	Pseudoptosis
	Types of Mastopexy
	Key Elements to the Pre-operative Workup
	Pre-operative Breast Markings for Vertical Mastopexy (Figs. 3.13 and 3.14)
	Intra-operative Details and Clinical Pearls
	Postoperative Care
	Complications
		Preoperative Planning
		Preoperative Markings
		Intraoperative Execution
	References
4: Breast Augmentation for Early Ptosis
	Introduction
	Pre-operative Evaluation
	Perioperative Decision Making
	Patient Expectations
	Operative Approach: Breast Augmentation for Early Ptosis
	Post-operative Management
	Conclusion
	Case Examples Are Given in Figs. 4.19, 4.20, 4.21, and 4.22
	References
5: Preoperative Assessment in Augmentation Mastopexy
	Introduction
	Pre-operative Evaluation
	Blood Supply as Impacts Decisions in Mastopexy and Pocket Selection
	Patient Expectations
	Selection of Procedure
	Mastopexy Selection
	Implant Selection
	Pocket Selection
	Conclusion
	Case Examples
		Case 1 (Fig. 5.12)
		Case 2 (Fig. 5.13)
		Case 3 (Fig. 5.14)
		Case 4 (Fig. 5.15)
		Case 5 (Fig. 5.16)
	References
6: Technique in Simultaneous Augmentation Mastopexy
	Introduction
	Preoperative Evaluation
	Blood Supply
	Pre-operative Markings
	Surgical Technique
	Pocket Development
	Implant Placement
	Tailor-Tacking
	Breast Flap and Pedicle Dissection
	Deep Fascial Sling
	Closure
	Post-operative Care and Expected Outcomes
	Complications
	Secondary Procedures
	Conclusion
	Case Examples
	References
7: Two-Stage Augmentation Mastopexy
	Introduction
	Pre-operative Evaluation
	Managing Patient Expectations
	One-stage vs Two-stage
	Surgical Planning
		Mastopexy
		Augmentation
			Implant Selection
			Implant Placement
			Augmentation Incision
	Operative Technique
		Mastopexy
		Second Stage Augmentation
	Post-Operative Care
	Conclusion
	References
8: Secondary Mastopexy
	Introduction
	Indications and Preoperative Preparation
		Mastopexy Selection
		Cresent or Circumareolar
		Circumvertical
		Lower Pole Mastopexy
		Symmetry
		Patient Assessment Subpectoral vs. Subfascial
	Operative Approach
		Markings
		Surgical Technique
	Conclusion
	References
9: Simultaneous Short-Scar Mastopexy Augmentation
	Introduction
	Preoperative Planning
	Markings
	Intraoperative Technique (Mastopexy First Technique)
	Anatomic Challenges
	Our Experience
	Discussion and Literature Review
	Conclusion
	References
10: Circumareolar Augmentation Mastopexy
	Introduction
	Physics of the Circumareolar Mastopexy Technique
	Blood Supply
	Uses for Circumareolar Mastopexy Part 1 – Areolar Reduction
	Uses for Circumareolar Mastopexy Part 2 – Areolar Repositioning
	Uses for Circumareolar Mastopexy Part 3 – Lax Breast Skin/Mild Ptosis
	Uses for Circumareolar Mastopexy Part 4 – Tuberous Breasts
	Markings for Circumareolar Mastopexy
	Circumareolar Mastopexy Technique
	Postoperative Management
	Complications
	Conclusion
	References
11: Tuberous Breast Correction
	Introduction
	Anatomy and Classification
	Pre-operative Evaluation
	Blood Supply as It Impacts Decision Making in Tuberous Deformity Correction
	Patient Expectations
	Treatment Goals
	Surgical Approach
	Implant-Based Correction of the Tuberous Breast
	Fat-based Correction
		Fat Grafting to the Tuberous Breast
		Composite Augmentation with Breast Implants and Fat Grafting
		Lipofilling for Volume Augmentation Combined with Needle Band Release
		Fat Grafting Requiring the Use of an External Pre-expansion Device
		Complications
	Conclusion
	References
12: Augmentation Mastopexy with Breast Asymmetry
	Introduction
	Anatomy and Evaluation
	Breast
	Nipple
	Chest Wall
	Treatment Modalities
	Case Examples
	Bibliography
13: Maintaining Upper Pole Fullness: Auto-augmentation Mastopexy with Soft Tissue Support Matrix and Lipofilling
	Introduction
	Surgical Markings for Auto-augmentation Breast Lift
	Surgical Technique for Auto-augmentation Breast Lift with Matrix Belt
		Creating the Auto-augmentation Segment
		Securing the Auto-augmentation Segment with Prosthetic Matrix
		Shaping the Breast
	Pectoralis Major Muscle Sling Versus Matrix Belt for Auto-augmentation Breast Lift
	Auto-augmentation Breast Lift Combined with Breast Reduction
	Auto-augmentation Breast Lift: A Valuable Option After Removal of Breast Implants
	Combining Auto-augmentation Breast Lift with Lipofilling
		Achieving Predictable Results with Lipofilling
	Auto-augmentation Technique for Breast Reconstruction after Lumpectomy in Irradiated Patients
	Summary
	References
14: An Algorithm for the Management of Explantation Surgery
	Introduction
	Indications for Explantation with or without Capsulectomy
	Indications for Explantation Surgery and Capsulectomy
	Surgical Management of the Capsule
	Capsulotomy
		Partial Capsulectomy
		Total Capsulectomy
		En Bloc Capsulectomy
	Aesthetic Breast Procedures After Explantation
	Conclusion
	References
15: Mastopexy with Fat Graft Augmentation
	Introduction
	Mastopexy Techniques
	Technical Details: Mastopexy with Chest Wall Based Flap for Auto Augmentation and Fat Grafting
		Case 1 (Fig. 15.2)
		Case 2: (Fig. 15.3)
	Mastopexy with Auto Augmentation, Glandular Resection and Fat Grafting
		Case 3 (Fig. 15.4)
		Case 4 (Fig. 15.5)
	Explantation Mastopexy with Auto Augmentation and Fat Grafting
		Case 5 (Fig. 15.6)
		Case 6 (Fig. 15.7)
	Conclusions
	References
16: Mastopexy with Auto-augmentation
	Introduction
	Pre-operative Evaluation
	Blood Supply
	Fat Grafting
	Patient Expectations
	Pre-operative Markings
	Intra-operative Markings
	Surgical Technique
	Post-operative Care and Expected Outcomes
	Complications
	Secondary Procedures
	Conclusion
	Case Examples
		Case 1
		Case 2
		Case 3
	References
17: Use of Soft Tissue Support in Augmentation Mastopexy
	Introduction
	History and Histology of P4HB
	Indications
	Typical Indications for Use of P4HB Scaffold Include
	Placement Options
		Implant Pocket Reinforcement
		Vertical Pillar Reinforcement
		Inferior Pole Parenchyma Reinforcement
		Combination Mesh Placement
	Technical Aspects
	Complications When Using Mesh
	Patient Acceptance
	Conclusions
	References
18: Augmentation Mastopexy in the Massive Weight Loss Patient
	Introduction
	Pre-operative Evaluation
	Pertinent Anatomy
	Perioperative Decision Making
	Patient Expectations
	Operative Approach
		Superior Pedicle Wise Pattern Augmentation Mastopexy with a Smooth Round Silicone Implant
			Markings
			Operating Room
		Auto Augmentation with Creation of Parenchymal Flaps and Dermal Suspension
		Augmentation Mastopexy with Soft Tissue Reinforcement
	Post-operative Management
	Conclusion
	Case Examples
		Case 1
		Case 2
	References
19: Pitfalls in Augmentation Mastopexy
	Introduction
	Common Pitfalls
		Waterfall Deformity (High Riding Implant and/or Tissue Ptosis)
		High Riding Implant
		Postoperative Pseudoptosis
		Overly Elevated Nipple Areolar Complex
		Excessively Long Nipple Areolar Complex to Fold Distance
		Poor Implant Selection
		Widened Mastopexy Scars
		NAC Necrosis and Pedicle Selection
		Periareolar Mastopexy for Wrong Patient
	Management and Operative Approach
		High Riding Implant
		Postoperative Tissue Ptosis
		Overly Elevated Nipple Areolar Complex
	Conclusion
	References
20: Managing Complications in Augmentation Mastopexy
	Introduction
	Operative Goals
		Addition of Volume
		Management of the Ptotic Skin Envelope
	Timing of Operative Management of Complications
	Complications and Management Strategies
		Bottoming out
			Correction of Skin Stretch: Technique
			Repair of the Inframammary Fold: Technique
		Double Bubble Deformity
			Repair of the Double Bubble Deformity: Technique
		NAC Malposition
			Interlocking Suture: Technique
		Scarring
			Scar Revision: Technique
		Capsular Contracture
			Capsulotomy:Technique
			Capsulectomy:Technique
		Breast Animation
			Further Release of the Muscle: Technique
			Conversion to a Subgandular Pocket: Technique
		Size Dissatisfaction
			Implant Upsizing After Augmentation Mastopexy
			Placing a Larger Implant: Technique
			Implant Downsizing After Augmentation Mastopexy
			Placing a Smaller Implant: Technique
	Summary
	References
Index