Spear's Surgery of the Breast: Principles and Art

Title Page
Copyright
Contributing Authors
Foreword
Preface
Contents
SECTION I: Breast Surgery and oncology
	CHAPTER 1 Epidemiology of Breast Cancer: Incidence and Risk Factor
		Incidence, Mortality, and Survival
			Changing Trends and Migration
		Risk Factors
			Gender, Age, and Race
			Early Life Events
			Nutritional Factors
		Alcohol
		Smoking
		Body Mass Index and Total Body Fat
		Physical Activity
		Benign Breast Disease
		Breast Density
		Growth Factors and Adult Height
		Exogenous Hormones
			Hormonal Contraceptives
			Hormone Replacement Therapy
		Family History And Genetics
			Family History
			Genetics
	CHAPTER 2 Breast Cancer Screening and Diagnosis, Including the Surgically Altered Breast
		History
		Imaging in Women 40 to 70
		The Argument Against Imaging
		Policy Implications for Women 40 to 70
		Breast Imaging After 70
		High-Risk Screening
		Imaging the Surgically Altered Breast
		Conclusions and Current Imaging Guidelines Per Society (Tables 2-2 to 2-4)
	CHAPTER 3 Molecular Pathology of the Breast
		Molecular Diagnostics
		Polymerase Chain Reaction
		Gene Expression Profiling
		Intrinsic Breast Cancer Subtypes
		Clinical Applications
		Oncotype Dx
		Mammaprint
		PAM50 (Prosigna)
		Endopredict
		Breast Cancer Index
		Conclusions
	CHAPTER 4 Defining and Managing the High-Risk Patient
		History
		Risk Stratification
		Risk Assessment Models
		Genetic Counseling And Testing
		Approach to Managing the High-Risk Patient
			Genetic Testing
			Healthy Lifestyle
			Risk-Reducing Agents
			Risk-Reducing Surgery
		Conclusion
	CHAPTER 5 Heredity and Breast Cancer: Risk Assessment, Genetic Testing, and Management Options
		Risk Factors for Breast Cancer
		Breast Cancer Risk Assessment
		Considerations When Conducting Genetic Testing
		Genes Associated With Breast Cancer Susceptibility
			High-Penetrance Genes
			Moderate-Penetrance Genes
			Low-Penetrance Genes
		Clinical Management of BRCA Pathogenic Variants
			Screening and Prevention
			Risk-Reducing Strategies: Surgeries and Chemoprevention
			Screening of Male BRCA Carriers
			Reproductive Considerations
			Treatment Strategies in BRCA1/ 2-Related Cancers
			Prognosis
		Clinical Management of Other (Non-BRCA–Related) Hereditary Breast Syndromes
		Psychosocial Issues in Inherited Breast and Ovarian Cancer Syndromes
	CHAPTER 6 Patient Selection for Breast-Conservation Therapy
		Patient Selection For Bct
		History And Physical
		Radiologic Evaluation
		Patient Preferences Regarding Breast Conservation Versus Mastectomy
		Contraindications For Bct
		Pathologic Features of Breast Cancer
		Post Bct Surveillance
		Conclusion
	CHAPTER 7 Axillary Nodal Recurrence
		Rates of Axillary Nodal Recurrence
		Risk Factors for Axillary Recurrence
		Time to Axillary Nodal Recurrence
		Diagnosis
		Treatment And Prognosis
		Summary
	CHAPTER 8 Role of Nonsurgical Management of Breast Cancer: Endocrine Therapy and Tumor Ablation
		Primary Endocrine Therapy
		In Situ Ablation
			Patient Selection
			In Situ Ablation Techniques
			Radiofrequency Ablation
			LASER Thermotherapy
			Microwave Ablation
		Conclusion
			Limitations
	CHAPTER 9 Oncoplastic Approach to Maximizing the Lumpectomy-Level I
		Goals and Benefits of Oncoplastic Breast Surgery
		Level I Versus Level II Oncoplastic Techniques
		Performing Level I Oncoplastic Surgery
			Preoperative Evaluation
			Operative Markings for Surgical Planning
			Intraoperative Surgical Steps for Performing General Level I Procedures
		Level I Oncoplastic Incisions/Techniques
			Basic Incisions
			Circumareolar Incision
			Inframammary Incision
			Incisions That Include Resection of Skin
			Incision With Skin Deepithelialization
		Postoperative Complications of Level I Oncoplastic Surgery
		Conclusion
	CHAPTER 10 Oncoplastic Approach to Maximizing the Lumpectomy-Level II
		Literature Review
			Benefits of Oncoplastic Surgery
			Safety
		Patient Evaluation
			History
			Physical Examination
			Imaging
		Ideal Candidates for Level II Oncoplastic Surgery
			Patients With Multifocal Tumors
			Patients Who Desire Breast Reduction/Mastopexy
			Patients With Large Tumors
			Patients Who Desire Nipple-Sparing Mastectomy
		Timing Of Operative Intervention
		Technique
			Volume Displacement Approaches
			Volume Replacement Approaches
		Management Of Central Tumors
		Conclusion
	CHAPTER 11 Breast Conservation Failure: When to Do a Completion Mastectomy
		Declining Rate Of Events
		Immediate Indications for Mastectomy
		Diagnosis and Workup of IBTR
		Treatment Of Ibtr
			The Ipsilateral Breast: Mastectomy
			The Ipsilateral Breast: Reconservation
			The Axilla
			The Contralateral Breast
		Prognosis Following Ibtr
		Follow Up Post Ibtr
		Conclusions
	CHAPTER 12 Radiation Therapy Following Breast-Conserving Surgery
		Invasive Disease
		Ductal Carcinoma In Situ
		Omission of Radiation Therapy in Select Populations
		Radiation Target Volume, Dose, and Fractionation
		Regional Nodal Radiation Therapy
		Conclusion
	CHAPTER 13 The Surgical Management of Locally Advanced and Stage IV Breast Cancer
		Locally Advanced Breast Cancer
			Epidemiology
			Diagnosis
			Systemic Treatment
			Surgical Treatment
		Stage Iv Breast Cancer
		Inflammatory Breast Cancer
			Epidemiology
			Diagnosis
			Neoadjuvant Systemic Treatment
			Surgery
			Adjuvant Treatment
			Stage IV Inflammatory Breast Cancer
	CHAPTER 14 Neoadjuvant and Adjuvant Systemic Therapy
		Prognostic Factors in Early Breast Cancer
			Overview
			Pathologic Factors
			Genomic Profiles/Intrinsic Molecular Subtypes
			Gene Expression Profiling for Early-Stage Breast Cancer
			Circulating Tumor Cells
			Summary
		Neoadjuvant Therapy
			Overview
			Neoadjuvant Chemotherapy in TNBC
			Neoadjuvant HER-2 Targeted Therapy
			Neoadjuvant Endocrine Therapy
		Treatment of Residual Disease Post Neoadjuvant Therapy
			Treating Residual Disease in TNBC
			Treating Residual Disease in HER-2–Positive Breast Cancer
			Treating Residual Disease in HR-Positive Breast Cancer
		Adjuvant Therapy
			Adjuvant Chemotherapy
			Chemotherapy-Related Side Effects
			Adjuvant HER-2 Targeted Therapy
			Principles of Adjuvant Endocrine Therapy
		Bone-Modifying Therapy
		Conclusion
	CHAPTER 15 Breast Cancer Diagnosis, Prognosis, and Treatment in Augmented Women
		History
		Implants And Cancer Risk
		Physical Examination of the Augmented Breast
		Radiologic Imaging of the Augmented Breast
			Mammography
			Digital Mammography
			Magnetic Resonance Imaging
			Ultrasound
		Effects of Implants on Disease Stage and Prognosis
		Treatment of Breast Cancer in Augmented Patients
		Conclusion
		Acknowledgments
	CHAPTER 16 Guidelines and Patient Selection Criteria for Nipple and Skin-Sparing Mastectomy
		History
		Indications
		Contraindications
		Preoperative Planning
		OPERATIVE TECHNIQUE
			Patient Selection
		Outcomes
		Conclusions
	CHAPTER 17 Invasive Carcinoma: Radiation Therapy After Mastectomy
		History
		Original Trials Supporting Use of Postmastectomy Radiation Therapy
		Postmastectomy Radiation Therapy in Select Node-Negative Populations
		Postmastectomy Radiation Therapy in Patients Receiving Neoadjuvant Chemotherapy
		Radiation Target Volume, Dose, and Fractionation
		Side Effects of Postmastectomy Radiation Therapy
		Conclusion
	CHAPTER 18 Optimizing Mastectomy Flaps Based on Breast Anatomy
		History
		Indications/Contraindications
		Preoperative Planning
		OPERATIVE TECHNIQUE
		Intraoperative Care
		Postoperative Care
		Generic Risks
		Outcomes
		Conclusion
	CHAPTER 19 Male Breast Cancer: Surgery of the Breast
		History
		Risk Factors
		Clinical Presentation
		Radiology
		Pathology
		Surgical Management
		Medical Oncology Management
		Radiation Oncology Management
		Conclusions
	CHAPTER 20 Breast Cancer Recurrence—Strategies for Risk Reduction
		History
		Mechanism of In-Breast Recurrence
		Presentation of a Local/Regional Recurrence
		Estimation of Risk of Recurrence
			Invasive Breast Carcinoma
			Multigene Assays
			Recurrence Risk for DCIS
			Extent of Surgery
			Margins
		Reconstruction
		Role of Radiation Therapy
	CHAPTER 21 Disease of the Breast, Benign to Premalignant; Hyperplasia to DCIS
		Benign Disorders
		Nonproliferative Lesions
		Cystic Breast Mass
		Proliferative Lesions Without Atypia
		Atypical Hyperplasias
		Radial Scars and Complex Sclerosing Lesions
		Benign Neoplasms
			Fibroadenoma
			Phyllodes Tumor
			Intraductal Papilloma
			Nipple Adenoma
			Miscellaneous Lesions
		Inflammatory Conditions
			Fat Necrosis
			Mammary Duct Ectasia
			Granulomatous Mastitis
		Noninvasive Carcinoma
			Lobular Carcinoma in Situ
			Ductal Carcinoma in Situ
		Workup
		Imaging
		Biopsy
		Pathologic Classification
		Treatment
		Surgery
		Breast-Conserving Therapy
		Mastectomy
		Radiation Therapy
		Systemic Treatment
		Posttreatment Surveillance
	CHAPTER 22 Breast Cancer Screening and Management in the Transgender Patient
		History
		Indications
			Transmales
			Transfemales
		Contraindications
		Preoperative Planning
			Transfemales
		OPERATIVE TECHNIQUE
		Intraoperative Care
		Postoperative Care
			Transwomen
			Transmen
		Conclusion
	CHAPTER 23 Shared Decision Making: Patient Choice and Satisfaction
		History
		Patient Choice
			Sense of Urgency and Insufficient Time for Decision Making
			Decisions Made From a Sense of Fear
			Whose Opinion Matters?
			Older Patients
			Patient Expectations
			Reconstruction
			“No Best Option”
			Limited Information
		Satisfaction
			Role of Decision Making and Feeling Informed
			Role of Physician/Team Communication and Decisional Conflict
			Role of Body Image
			Role of Scars
			Role of Personality
			Role of Surgical Options
			Role of Radiation Therapy
			Role of Contralateral Prophylactic Mastectomy
			Role of Decision Aids
			Role of Regret Over Time
			Discussion
		Conclusion
	CHAPTER 24 Team Approach to Nipple-Sparing Mastectomy
		History
		Risk-Reduction Nsm
		Therapeutic Nsm
			Increasing Trends of NSM
			Oncologic Safety of NSM
			Oncologic Indications/Contraindications for NSM
			NSM and Breast Irradiation
			NSM and Neoadjuvant Chemotherapy
		NSM and High Body Mass Index, Large Breasts, or Ptotic Breasts
		NSM and Nipple Necrosis
		Technical Aspects of NSM
			Flap Quality
			Incision Location
			NAC Anatomy
		Conclusion
SECTION II: The Axilla and Lymphedema
	CHAPTER 25 Basic Science and Management of Postsurgical Lymphedema and Vascularized Lymph Node Transplant
		History
		Pathophysiology of Lymphedema
		Diagnosis of Lymphedema
		Indications for Lymphatic Surgery
		Contraindications
		Preoperative Planning
		OPERATIVE TECHNIQUE
		Vascularized Omentum Lymphatic Transplant Harvest
		Preparation of the Axilla and Anastomosis
		Postoperative Care
		Risks
		Outcomes
		Conclusion
	CHAPTER 26 Sentinel Node Biopsy and Axillary Dissection
		History
		Case Selection for Slnb
		Technique of Slnb
			Nuclear Medicine
			Surgery
			Pathology
		Case Selection for Alnd
			Clinically Positive Axilla
			SLN Positive Outside the Z0011 Selection Criteria
			Clinically Node Positive or SLN Positive Following Neoadjuvant Chemotherapy
			Inflammatory Breast Cancer
			Prior Inadequate ALND
			Failed SLNB
			Unavailability of SLNB
			Isolated Locoregional Recurrence
		Technique of Alnd
			Extent of Procedure
			Choice of Incision
			Beginning the Operation
			Flap Elevation
			Dissection of the Medial Pectoral Nerve
			Mobilizing Levels II and III
			Identifying the Intercostobrachial Nerve
			Identifying the Long Thoracic Nerve
			Identifying the Thoracodorsal Nerve
			Completing the Axillary Dissection
			Closing
			Postoperative Care
		Complications of Slnb and Alnd
			Lymphedema
			Axillary Web Syndrome
			Sensory Morbidity
			Shoulder Function
			Infection
		Conclusion
	CHAPTER 27 Postneoadjuvant Axillary Assessment and Management
		History
		Axillary Surgery in Clinically Node-Negative Patients
			Feasibility and Timing of Sentinel Lymph Node Biopsy After Neoadjuvant Chemotherapy
			Nodal Positivity Rates and Axillary Recurrences After NAC
			Strategies to Avoid Axillary Lymph Node Dissection
		Axillary Surgery in Clinically Node-Positive Patients
			Feasibility and Optimization of SLNB Following NAC
			Management of Residual Nodal Disease
		Current Indications for ALND After NAC
		Ongoing Studies
		Conclusion
	CHAPTER 28 Alternative Methods for Axillary Sentinel Lymph Node Dissection
		History
			Indocyanine Green (ICG)
			Superparamagnetic Iron Oxide (SPIO)
		Indications
			Indocyanine Green (ICG)
			Superparamagnetic Iron Oxide (SPIO)
		Contraindications
			Indocyanine Green (ICG)
			Superparamagnetic Iron Oxide (SPIO)
		Preoperative Planning
			Indocyanine Green (ICG)
			Superparamagnetic Iron Oxide (SPIO)
		OPERATIVE TECHNIQUE
			Indocyanine Green (ICG)
			Superparamagnetic Iron Oxide (SPIO)
		Intraoperative Care
			Indocyanine Green (ICG)
			Superparamagnetic Iron Oxide (SPIO)
		Postoperative Care
			Indocyanine Green (ICG)
			Superparamagnetic Iron Oxide (SPIO)
		Risks of the Procedure
			Indocyanine Green (ICG)
			Superparamagnetic Iron Oxide (SPIO)
		Conclusion
			Indocyanine Green (ICG)
			Superparamagnetic Iron Oxide (SPIO)
	CHAPTER 29 Axillary Surgery Versus Radiation as Treatment of Regional Nodes: AMAROS Trial and Beyond
		History
			Impact of Extensive Surgery on Clinical Outcome
			Trials of Sentinel Lymph Node Biopsy Versus Axillary Dissection in Node-Positive Patients
			Trials of Sentinel Lymph Node Biopsy and Targeted Radiation Versus Axillary Dissection in Node-Positive Patients
		Indications for Axillary Dissection Versus Targeted Radiation to the Axilla
			Surgery First
			Surgery After Neoadjuvant Chemotherapy
		Contraindications
		Preoperative Planning
		Intraoperative Technique
		Postoperative Care
			Radiation Guidelines in Patients With pN1 Disease Not Undergoing ALND
		Risks of Axillary Dissection Versus Radiation
		Beyond Amaros
		Conclusion
	CHAPTER 30 Conservative Management of Postsurgical Lymphedema
		History
		Risk Reduction Education
		Traditional Therapy
			Complete Decongestive Therapy
			Phases of Care (Fig. 30-7)
		Alternative Therapies
			Low-Level Laser Therapy
			Taping
			Intermittent Pneumatic Compression Device
		Prehabilitation
	CHAPTER 31 Selection of Vascularized Lymph Node Donor Sites for Upper Extremity Lymphedema Surgery and Strategies to Minimizing Complications
		Lymphatic System and Lymphedema
		Treatment of Lymphedema
		Mechanism of Action of VLNT
		Donor Site Options
			Groin Flap
			Supraclavicular Flap
			Submental Flap
			Gastroepiploic Flap
			Jejunal Mesenteric Lymph Node Flap
			Lateral Thoracic Lymph Node Flap
		Reverse Lymphatic Mapping
		Discussion
	CHAPTER 32 Liposuction as a Viable Treatment for End-Stage Upper Extremity Lymphedema
		History
		Indications
		Preoperative Care
		Surgical Technique
		Postoperative Care
		Treatment Outcomes
		Contraindications
		Conclusion
SECTION III: Oncoplastic Techniques and Breast Reduction
	CHAPTER 33 Oncoplastic Breast Surgery and Shared Decision Making
		History
		Shared Decisions and Breast Cancer
		General Concepts of SDM Applied to Oncoplastic Breast Surgery
		Preliminary Phase
			Patient’s Personal History and Morphologic Characteristics
			Assessment of Disease Characteristics
		Shared Decision Making Before Oncoplastic Procedures
			Team Talk
			Option Talk
		Therapeutic Mammoplasties and Uncertainties
		Breast Reconstruction Techniques and Information to Patients
		Conclusion
			Messaging to Patients
			Assessment of Patients’ Values
			Possible Techniques
	CHAPTER 34 Oncoplastic Techniques in Breast Conservation Therapy—The Plastic Surgeon’s Perspective
		History
			The Plastic Surgeon’s Perspective
		Indications
		Contraindications
		Preoperative Planning
		OPERATIVE TECHNIQUE
			Volume Displacement Techniques
			Volume Replacement Techniques
		Postoperative Care
		Outcomes
			Complications
			Margins
			Patient-Reported Outcomes
			Recurrence
		Conclusion
	CHAPTER 35 Local Flaps for Partial Mastectomy Defects
		History
		Indications
		Contraindications
		Preoperative Planning
		Relevant Surgical Anatomy
			The Latissimus Dorsi Flap
			The TDAP Flap
			The ICAP Flap
		OPERATIVE TECHNIQUE
		Preoperative Markings
		Surgical Exposure and Details of Procedure
		Intraoperative Care
		Postoperative Care
		Complications
		Outcomes
		Conclusion
	CHAPTER 36 Local Flaps for Breast-Conserving Surgery Defects
		History
		Locating The Perforators
		Planning A Local Perforator Flap
		OPERATIVE TECHNIQUE
		Licap/ltap Flaps
		Tdap Flap
		Conclusion
	CHAPTER 37 Avoiding Pitfalls in Symmetry Procedures Following Unilateral Autologous Versus Implant-Based Reconstruction
		History
		Indications
			Implants
			Breast Lift
			Breast Reduction
			Fat Transfer
		Contraindications
		Preoperative Planning
		OPERATIVE TECHNIQUE
			Implant Reconstruction
			Breast Lift/Breast Reduction
			Fat Transfer
		Intraoperative care
		Postoperative care
		Outcomes
		Conclusion
	CHAPTER 38 Breast Reduction and Mastopexy After Massive Weight Loss
		History
		Indications
			Inadequate Breast Volume
			Excessive Breast Volume
			Adequate Breast Volume
		Contraindications
		Preoperative Planning
		OPERATIVE TECHNIQUE
		Intraoperative Care
			Markings
			Technique
		Postoperative Care
		Outcomes
		Conclusion
	CHAPTER 39 Vertical Breast Reduction and Rereduction
		History
		Principles
		Anatomy
		Indications and Contraindications
		Preoperative Assessment
		Preoperative Planning
			Determination of New Nipple Position
			Design of the Skin Resection Pattern
		Design of a medially and superomedially based pedicle
			Design of a Medially Based Pedicle
			Design of a Superomedially Based Pedicle
		OPERATIVE TECHNIQUE
		Positioning
		Infiltration
		Pedicle Creation
		Insetting of the Pedicle
		Closure of the Pillars
		Closure of the Dermis
		Liposuction
		Closure of the Skin
		Intraoperative and Postoperative Care
			Drains
			Bandaging and Taping
			Recovery
		Risks
			Scarring
			Sensation
			Breastfeeding
		Complications
			Nipple and Areolar Necrosis
			Hematoma
			Seroma
			Infection
			Wound Healing Problems
			Puckers
			Underresection and Bottoming Out
			Asymmetry
		Breast Rereduction
	CHAPTER 40 Reduction Mammoplasty With Inverted-T Incision
		Introduction
		Anatomy
		History of the Inferior Pedicle
		Indications
		Preoperative Considerations
		Patient Markings: Inverted-T Technique
		OPERATIVE TECHNIQUE
		Inferior Pedicle
		Conclusion
	CHAPTER 41 Secondary Breast Reduction
		History
		Indications
		Contraindications
		Preoperative Planning
			When the NAC Is Already in the Correct/Ideal Position
			Previous Operation Was Free Nipple Graft Technique
			Previous Pedicle of the NAC Is Known
			Previous Pedicle of the NAC Is Unknown
		OPERATIVE TECHNIQUE
			When the NAC Is Already in the Correct/Ideal Position
			When the Initial Breast Reduction Used a Free Nipple Graft
			Initial NAC Pedicle Is Unknown and the NAC Needs to Be Repositioned
		Outcomes
		Conclusion
	CHAPTER 42 Management of Complications in Breast Reduction: The Displaced NAC
		History
		NAC Placement in Breast Reduction
		Indications and Contraindications
		Preoperative Planning
		Intraoperative care
			Superiorly Displaced NAC
			Inferiorly Displaced NAC
			Medially and Laterally Displaced NAC
		Postoperative Care
		Generic Risks
		Outcomes
		Conclusion
	CHAPTER 43 Male Breast Reduction: Liposuction Versus Excision
		Indications and Decision Making
		Treatment
		OPERATIVE TECHNIQUES
		Liposuction
			History
			General Considerations and Conventional Liposuction
			Power-Assisted Conventional Liposuction
			Liposuction With New Devices (Nonconventional Liposuction)
			Outcomes in Liposuction for Gynecomastia
		Minimally Invasive Excisional Techniques (Table 43-3)
			Pull-Through Technique
			Arthroscopic Shavers
			Endoscopic Techniques
			VAB Techniques
			Microdebrider Excision
			Summary: Liposuction and Minimally-Invasive Techniques
		Excision
			Indications
			Techniques for Excision
			Complications and Limitations of Open Excision
		Complications and Outcomes in Male Breast Reduction (Tables 43-9 and 43-10)
		Postoperative Care
			Combining Liposuction and Open Excision
			Comparing and Contrasting Liposuction and Open Excision
		Conclusion
SECTION IV: Implant Based Reconstruction
	CHAPTER 44 Evolution of Breast Surgery and the Bioengineered Concept
		History
		Evolution of Prosthetic Breast Reconstruction
			Subcutaneous Reconstruction
			Submuscular Reconstruction
			Partial-Muscle or Dual Plane Reconstruction
			Prepectoral Reconstruction
		Bioengineered Breast Concept
		Conclusion
	CHAPTER 45 Overview of Indications and Consideration for Prepectoral Versus Subpectoral Reconstruction
		History
		Subpectoral Breast Reconstruction
		Prepectoral Breast Reconstruction
		Indications
		Contraindications
		Preoperative Planning
		OPERATIVE TECHNIQUE
		Intraoperative Care
		Postoperative Care
		Outcomes
		Conclusion
	CHAPTER 46 Patient Selection for One-Stage Subpectoral Reconstruction
		History
		Indications
		Contraindications
		Preoperative Planning
		OPERATIVE TECHNIQUE
		Postoperative Care
		Complications
		Outcomes
		Conclusion
	CHAPTER 47 Patient Selection for One-Stage Reconstruction Prepectoral
		History
		Patient Selection
		BRAND4P Procedure
		OPERATIVE TECHNIQUE
		BRAND4P
		Postoperative Care
		Conclusion
	CHAPTER 48 Breast Reconstruction With Form-Stable Implants
		History
		The Evolution of Breast Reconstructive Surgery
		Breast Reconstruction: A Shared Decision
		Form-Stable Implant-Based Breast Reconstruction: A Complex Choice
		An Evolution of Our Decisional Algorithm
			Type 1 Breasts
			Type 2 Breasts
			Type 3 Breasts
		Future Directions
			Hybrid Breast Reconstruction
	CHAPTER 49 Management of Ptotic Patient Desiring Nipple-Sparing Mastectomy With Implant-Based Reconstruction
		History
			Oncologic Parameters
		Patient Consultation
		Indications
		Contraindications
		Incision Location
			IMF
			Lateral Incision
			Vertical Incision
			Reduction Pattern Incision
		Marking the Patient
		Device Selection
		OPERATIVE TECHNIQUE
		Dual Plane
		Prepectoral Plane
		Reduction Pattern
			Reduction for NAC Perfusion Delay
		Conclusion
	CHAPTER 50 Two-Staged Nipple-Sparing Mastectomy for Preservation of the Nipple Areolar Complex in the Large or Ptotic Breast: Reconstructive Algorithm and Approach
		History
		Indications and Contraindications
		Preoperative Planning
		OPERATIVE TECHNIQUE
		Stage One: Making the Breast Envelope Smaller: Lumpectomy, Lymph Node Sampling, and ONcoplasty and/or MAstopexy/REduction
		Stage Two: NSM and Reconstruction
		Postoperative Care
		Outcomes
		Conclusion
	CHAPTER 51 Can We Identify Risky Patients for NSM?
		History
		Oncoplastic Surgery
		Conclusion
	CHAPTER 52 Implant-Based Reconstruction in High-BMI Patients
		History
			Key Points
		Prepectoral Reconstruction in High-Bmi Patients
			Operative Planning
			Reconstructive Considerations
		Benefits of Prepectoral Reconstruction in High-Bmi Patients
		Improving Outcomes in Obese Patients
		Conclusion
	CHAPTER 53 When Is Delayed Breast Reconstruction Indicated?
		History
		Immediate versus Delayed Breast Reconstruction
		Implant-Based versus Autologous Delayed Breast Reconstruction
		Delayed-Immediate Breast Reconstruction
		Conclusion
	CHAPTER 54 Immediate Two-Stage Breast Reconstruction Using a Tissue Expander and Implant
		History
		Indications
		Contraindications
		Preoperative Planning
		OPERATIVE TECHNIQUE
		Subpectoral
		Dual Plane
		Prepectoral
		Postoperative Care
		Second Stage
		Emerging Technologies
		Conclusion
	CHAPTER 55 Delayed Expander/Implant Sequenced Breast Reconstruction
		History
		Indications and Timing
		Contraindications
		Preoperative Planning
		OPERATIVE TECHNIQUE
		First Stage: Delayed Expander Insertion
			Implant Selection
		Stage Two: Final Implant Placement
		Surgical Risks
		Conclusion
		Disclosure and Addendum
	CHAPTER 56 Prepectoral Direct-to-Implant Reconstruction: What Is the Role for Dermal Substitutes?
		History
		Modern-Day Prepectoral Reconstruction
		Indications
			Usage of Dermal Matrices in Prepectoral Reconstruction
		OPERATIVE TECHNIQUE
		Prepectoral Implant-Based Reconstruction Without Dermal Substitutes: Our Technique
			Clinical Scenarios
		Revision Procedures
			Results and Literature
		Conclusion
	CHAPTER 57 Role of Acellular Dermal Matrix in Breast Reconstruction
		History
		What Is ADM
		Handling Of ADM
		Adm Technique
			Dual Plane Reconstruction and ADM
			Prepectoral Reconstruction and ADM
		Adm And Capsular Contracture
		Adm And Radiation Therapy
		ADM and Revision of Breast Reconstruction
			Rippling and Wrinkling
			Implant Displacement/Malposition
		Conclusion
	CHAPTER 58 Use of Meshed Acellular Dermal Matrix in Breast Reconstruction
		History
		Indications
		Preoperative Considerations
		OPERATIVE TECHNIQUE
		Caveat 1: Treat Matrices Like an Implant
		Caveat 2: ADM May be Premeshed by Manufacturer or Meshed With a Mesher
		Caveat 3: Use Gaps Within the ADM to Suture the Mesh to the Pocket
		Postoperative Care
		Risks And Complications
		Conclusion
	CHAPTER 59 Role of Implant Reconstruction in Previously Radiated Patients
		History
		USE OF IMPLANTS FOLLOWING MASTECTOMY
		Indications
		Contraindications
		Preoperative Planning
		OPERATIVE TECHNIQUE
		Intraoperative Care
		Postoperative Care
		Generic Risks
		Outcomes
		Conclusion
		USE OF IMPLANTS TO CORRECT THE BCT DEFORMITY
		Preoperative Planning
		OPERATIVE TECHNIQUE
		Outcomes
		Conclusion
	CHAPTER 60 Management and Prevention of Nipple and Mastectomy Skin Necrosis
		History
		Skin Ischemia and Necrosis Score
		Patient Risk Factors
			Smoking
			Obesity
			Prior Breast Radiotherapy
			Specimen Weight/Breast Cup Size/Ptosis
			Patient Age
			Hypertension
			Previous Breast Surgery
		Operative Risk Factors
			Breast Vascular Anatomy
			Mastectomy Types and Skin Incision Patterns
			Mastectomy Flap Thickness
			Tumescent Technique Mastectomy
			Reconstruction Timing and Type
			Miscellaneous
		Operative Assessment
			Fluorescein Angiography
			Indocyanine Green Angiography
		Postoperative Management
			Nonoperative Management
			Operative Management
		Conclusion
	CHAPTER 61 Management of the Exposed Implant
		History
		Implant Exposure: Incidence and Risk Factors
		Radiation Therapy: An Etiologic Contributor to Implant Exposure
		Prediction Modeling for Exposure: Progression to Reconstructive Failure
		Management of the Exposed Implant
		Conclusion
	CHAPTER 62 Management of Animation Deformity in Implant-Based Reconstruction
		History
		Rationale For Prepectoral Conversion
		OPERATIVE TECHNIQUE
		Prepectoral Conversion
			Incision
			Prepectoral Plane Change
			Implant Exchange
		Clinical Experience
		Elements Of Successful Outcomes
			The Appropriate Patient
			The Appropriate Implant
			The Use of ADM
			Autologous Fat Grafting
		Conclusion
	CHAPTER 63 Symmetry Procedures Following Unilateral Implant Breast Reconstruction
		History
		Timing of the Symmetry Procedure
		Symmetry Factors
		Breast Characteristics
			Size
			Shape
		Implant
			Type
			Plane
			Stages
		Secondary Operations on the Reconstructed Breast
			Capsule Management
			Change of Plane
			Change of Implant
			Fat Injection
		Primary Symmetry Procedures on the Contralateral Breast
			Breast Reduction
			Reduction and Augmentation
			Mastopexy With or Without Augmentation
			Fat Injection
		Timing of the Symmetry Procedure
			Size and Shape
			Postmastectomy Radiation Therapy
		Conclusion
	CHAPTER 64 Implant-Based Breast Reconstruction After Unilateral Mastectomy
		History
		Indications
		Contraindications
		Preoperative Planning
		OPERATIVE TECHNIQUE
			Second Stage
		Postoperative Care
			Drains
			Follow-Up
			Chemotherapy Considerations
			Radiation Considerations
		Outcomes
		Conclusion
	CHAPTER 65 Patient Satisfaction in Unilateral Versus Bilateral Mastectomy With Reconstruction
		History
		Effect of Reconstruction Option on Patient Satisfaction
		Scale for Assessing Patient-Reported Outcomes
		Patient Satisfaction Data
		Effects of Patient Satisfaction on Clinical Choice
		Future Trends in Patient Satisfaction Following Breast Reconstruction
	CHAPTER 66 Surgical Treatment of Nipple Malposition in Nipple-Sparing Mastectomy
		Nipple-Sparing Mastectomy Malposition: History
		NSM Malposition: Risk Factors and Patient Selection
		NSM Malposition: Intraoperative Maneuvers to Avoid Malposition
		NSM Malposition: Correction—Indications
		NSM Malposition: Correction—Contraindications
		NSM Malposition: Correction
			Crescent Mastopexy
			Pocket Revision
			Free Nipple Graft
			Pedicled Nipple Transposition
		NSM Malposition: Correction Postoperative Care
		NSM Malposition: Outcomes
		NSM Malposition: Conclusion
	CHAPTER 67 Salvage of the Contracted Radiated Implant: Radiation Sequelae and Evolving Strategies in Prevention and Reconstruction
		History
		Effects of Radiation on Breast Tissue
		Effects of Radiation Therapy on Implant-Based Reconstruction
			Complications Associated With Irradiated Prostheses
			Subpectoral Reconstruction and Radiation
			Prepectoral Reconstruction (With Acellular Dermal Matrix) and Radiation
			Direct-to-Implant Reconstruction
			Nonoperative Adjunct Therapies
		Reconstructive Surgery Strategies for the Radiated Breast
			Latissimus Dorsi Flap
			Abdominal-Based Free Tissue Transfer Options
			Delayed-Immediate Reconstruction
			Delayed Secondary Free Tissue Transfer for Salvage
			Mastectomy Reconstruction Outcomes Consortium (MROC) Study
		Autologous Fat Grafting
			Implant-Based Salvage Techniques
		Conclusion
	CHAPTER 68 Reconstruction of Previously Augmented Patients Undergoing Mastectomy: Options for Implant-Based Reconstruction
		History
		Mastectomy in Patients With Breast Implants
			Mastectomy in Patients With Implants Previously Placed in the Dual Plane Position
			Mastectomy in Patients With Implants Previously Placed in the Subglandular Position
		The Reconstruction in Patients With Previous Breast Implants
			Tissue Quality
			Tumor
			Complete or Partial Capsulectomy
			Need for Radiation
			Reconstruction in Patients With Previous Subpectoral Augmentation
			Reconstruction in Patients With Previous Subglandular Augmentation
		The Contralateral Augmented Breast
		Special Considerations
			Skin-Reducing Mastectomy
		Conclusion
	CHAPTER 69 Latissimus Dorsi Musculocutaneous Flap Breast Reconstruction
		History
		Anatomy
		Indications
		OPERATIVE TECHNIQUE
			Tissue Expander Versus Implant?
			Management of the Opposite Breast
			Delayed Breast Reconstruction
			Immediate Breast Reconstruction
			Autogenous Latissimus Reconstruction
			Reconstruction of the Partial Mastectomy Defect
			Revision Reconstruction
		Complications
		Conclusion
	CHAPTER 70 Radiating Implants Versus Expanders: Plastic Surgeon’s Perspective and Experience
		History
		Indications
		Contraindications
		Preoperative Planning
		OPERATIVE TECHNIQUE
		Outcomes
			Risk of Reconstructive Failure
			Aesthetic Outcomes and Capsular Contracture
			Effect of Timing of Surgical Intervention Following Irradiation
			Effect of ADM Use
			Prepectoral Breast Reconstructions
			Single-Stage DTI Reconstructions
		Conclusion
	CHAPTER 71 Perioperative Pain Management: ERAS Protocols, Blocks, and the Role of Pharmacogenomics
		History
		Current Understanding of Perioperative Pain After Breast Surgery
		Enhanced Recovery After Surgery: Historical Perspective
		Breast Eras
		Breast Eras Components
			Preadmission Interventions
		Preoperative Holding Interventions
		Intraoperative Interventions
		Perioperative Multimodal Pain
		Regional Pain Control for Patients Undergoing Breast Surgery
			Local Infiltration
			Regional Neuronal Blocks
			Paravertebral Blocks
			Pectoral Nerve Blocks
			Transversus Abdominis Plan Block
			Postoperative Interventions
		Early Mobilization
		Conclusion
SECTION V: Autologous Based Reconstruction
	CHAPTER 72 Tips and Tricks to Achieve Best Result in Autologous-Based Reconstruction: Shaping Flaps in Delayed Versus Immediate Reconstruction
		History
		Preoperative Planning
		OPERATIVE TECHNIQUE
		Footprint
		Flap Shaping and Insetting
			Shaping
			Insetting
			Key Sutures
		Skin Envelope
		Immediate Reconstruction
		Delayed Reconstruction
		Secondary Reconstruction
		Conclusion
	CHAPTER 73 Efficiency in Autologous Breast Reconstruction
		Introduction
		Concepts for Surgical Efficiency
		Process Mapping
			Operative Process Mapping and Standardization
			Operative Technique
			Reliable Near-Equivalent Backup
			Recipient Vessel and Flap Selection
			Shaping
			Anastomosis
			Postoperative Care
			Reevaluation of the Process
			Outcomes
		Conclusion
	CHAPTER 74 Management of the Unilateral Reconstruction and Timing of Matching
		History
		Oncologic Considerations
		Type of Reconstruction
		Timing of A Matching Procedure
		Long-Term Outcome
		Conclusion
			Tips and Tricks
	CHAPTER 75 Pedicle TRAM and Free TRAM
		History
		Tram Flap Breast Reconstruction Indications and Contraindications
		OPERATIVE TECHNIQUE
		The Operation
		Complication
		Conclusion
	CHAPTER 76 Superior Gluteal Artery Perforator Flap (SGAP)
		History
		Indications
		Contraindications
		Preoperative Planning
		OPERATIVE TECHNIQUE
		Intraoperative Care
		Postoperative Care
		Generic Risks
		Donor-Site Complications
		Outcomes
		Conclusion
	CHAPTER 77 DIEP Flap Breast Reconstruction With Sensory Neurotization
		History
		Indications and Patient Selection
		Contraindications
		PREOPERATIVE PLANNING AND OPERATIVE TECHNIQUE
		Intraoperative and Postoperative Care
		Risks of the Procedure
		Conclusion
	CHAPTER 78 Profunda Artery Perforator Flaps
		History
		Indications
		Contraindications
		Preoperative Planning
		OPERATIVE TECHNIQUE
		Intraoperative Care
		Postoperative Care
		Outcomes
		Conclusion
	CHAPTER 79 Transverse Upper Gracilis Flaps
		History
		Indications
		Contraindications
		Preoperative Planning
		OPERATIVE TECHNIQUE
			Intraoperative Care
			Postoperative Care
		Outcomes
		Conclusion
	CHAPTER 80 The Lumbar Artery Perforator Flap: An Alternative to DIEAP Flap for Breast Reconstruction
		History
		Anatomy
		Indication
		Contraindication
		Preoperative Planning
		OPERATIVE TECHNIQUE
		Intraoperative Care
		Postoperative Care
		Generic Risks
		Outcomes
		Conclusions
	CHAPTER 81 Goldilocks Mastectomy for Immediate Reconstruction Without Implants
		History
		Indications
		Preoperative Evaluation and Planning
			Counseling and Patient Selection
			Preoperative and Perioperative Considerations
		OPERATIVE TECHNIQUE
		Marking
		Deepithelialization Before Versus After Mastectomy
		Flap Creation
		Assembly of the Mound With Nipple Excision
		Nipple Preservation With Local Flap
		Licap Addition
		Multiple Flap Insets/Creation of Breast Mound
			Nipple Preservation With Free Graft
		After Care
			Follow-Up
			Adjunctive Procedures
		Results
		Conclusion
	CHAPTER 82 Neurotization of the Autologous Flap
		History
		Neurotization Techniques
		Neurotization Outcomes
		Conclusion
	CHAPTER 83 Management of the Failed Free Flap
		History
		Factors Associated With Microvascular Anastomotic Failure
		Preventative Maneuvers to Minimize Flap Failure
		RECONSTRUCTIVE OPTIONS
		Prosthetic Reconstruction
		Pedicle Flap Reconstruction
		Microvascular Flap Reconstruction
		Conclusion
	CHAPTER 84 Management of Donor-Site Complications
		History
			Relevant Anatomy
		Existing Scars
		Preoperative Imaging
		Hernia Rates and Prevention Techniques
		Surgical Site Occurrences of DIEP Flap Donor Sites
			Surgical Site Infection
			Seroma and Hematoma
			Dissection and Cautery
			Fibrin Sealants
			Drains
			Progressive Tension Sutures
			Dehiscence and Necrosis
		Barbed Sutures
		Negative Pressure Incision Management
	CHAPTER 85 Secondary Procedures for the Autologous Reconstructed Breast
		History
		Planning a Secondary Procedure
		Breast Mound Revision
			Contour Remodeling by Adding Volume
			Contour Remodeling by Removing Volume
			Contour Remodeling by Flap Rearrangement
		Inframammary Fold Correction
		Nipple–Areola Reconstruction
		Postoperative Care
		Outcomes Assessment
		Conclusion
	CHAPTER 86 Radiation and Autologous Breast Reconstruction: The Role of Delayed-Immediate Reconstruction
		History
		Clinical Complications Associated With Patients Undergoing Breast Reconstruction and Pmrt
		Timing of Pmrt
		PMRT and Its Effects on Breast Reconstruction
			Implant-Based Reconstruction and PMRT
			Autologous Tissue-Based Reconstruction and PMRT
			Immediate Breast Reconstruction and PMRT
			Immediate Versus Delayed Breast Reconstruction
			Delayed-Immediate Breast Reconstruction
		Conclusion
	CHAPTER 87 Abdominal-Based Breast Reconstruction—Optimizing Aesthetic Results
		History
		Aesthetic Considerations
		Indications/Contraindications and Patient Selection
		Marking
		OPERATIVE TECHNIQUE
		Abdominal Closure
		Umbilicus
		Postoperative Considerations
	CHAPTER 88 Autologous Tissue Breast Reconstruction in the Thin Patient
		History
		Indications
		Contraindications
		Preoperative Planning
		OPERATIVE TECHNIQUE
		Abdominally Based Reconstruction
		Latissimus Dorsi
		Superior Gluteal Artery Perforator
		Inferior Gluteal Artery Perforator
		Anterolateral Thigh and Tensor Fascia Lata
		Lateral Thigh
		Transverse Myocutaneous Gracilis
		Medial Circumflex Femoral Artery Perforator
		Posterior Medial Thigh
		Profunda Artery Perforator
		Lumbar Artery Perforator
		Ruben Fat Pad
		Adjunctive Procedures
		Intraoperative/Postoperative Care
		Generic Risks
		Outcomes
		Conclusion
	CHAPTER 89 Enhancing Volume in Autologous Reconstruction
		History
		Timing
		OPERATIVE TECHNIQUES
		Increasing Volume and Projection
			Breast Implants (Fig. 89-1)
			Fat Injections (Fig. 89-2)
			Autologous Flap Combination
			Autologous Reconstruction and Radiotherapy
		Breast Reductions
			Fat Removal—Mastopexy
			Liposuction
		Conclusion
SECTION VI: Fat Grafting
	CHAPTER 90 Does Fat Grafting Increase the Risk of Breast Cancer?
		History
		Does Fat Grafting Interfere With Breast Cancer Detection?
		Preclinical Studies: Does Fat Graft Increase Breast Cancer Recurrence?
			Composition of Lipoaspirate
			AFG and ASCs on Growth Factor and the Tumor Microenvironment
			Limitations of Preclinical Studies
		Clinical Evidence: Does Fat Graft Increase Breast Cancer Recurrence?
			Observational Studies
			Case-Controlled Studies
			Does Immediate Versus Staged Reconstruction Affect Outcome?
			Does the Type of Primary Breast Cancer Surgery (BCT vs. MST) Affect Outcome?
			Does Cancer Type Affect Outcome?
			Does Cell-Enriched AFG Affect Outcome?
		Conclusion
	CHAPTER 91 Indications and Controversies in Fat Grafting of the Partial Mastectomy Defect
		History
		Indications
		Contour Irregularities and Radiation Change
			Mechanisms of Action
			Technique
			Outcomes
		Controversies
			Breast Imaging
			Oncologic Safety
			Fat Retention
			Complications
	CHAPTER 92 Fat Grafting in Implant-Based Breast Reconstruction
		History
			Changes in Breast Reconstruction Expectations
		The Impact of Prepectoral Breast Reconstruction on Fat Grafting
		Fat Harvest Techniques
		Fat Preparation
		Reinjection of Fat
		Access Options
		Patient Safety
		The Impact of Fat Grafting on Breast Cancer Recurrence
		Fat Grafting as an Adjunct to Implant and Autologous Mastectomy Reconstruction
		Conclusion
	CHAPTER 93 Fat Grafting in Autologous Breast Reconstruction
		History
		Indications
		Contraindications
		OPERATIVE TECHNIQUE
		Preoperative Planning
		Fat Harvest
		Fat Processing
			Fat Transfer
		Postoperative Care
		General Outcomes
			Fat Grafting in Latissimus Dorsi Breast Reconstruction
			Fat Grafting in Abdominally Based and Other Autologous Breast Reconstructions
	CHAPTER 94 Total Breast Reconstruction With Autologous Fat Grafting and Tissue Expansion
		History
		Indications
		Contraindications
		Preoperative Planning
		OPERATIVE TECHNIQUE
			Fundamental Concepts
			Fat Harvesting: The Seeds
			Recipient Site Preparation: The Soil
			Fat Graft Delivery: The Sowing
			Postgraft Care: The Support
			Fundamental Concepts of Tissue Augmentation With Fat Grafting
			Practical Techniques That Adhere to Above Principles
		Genetic Risks
		Conclusion
SECTION VII: Augmentation & Augmentation Mastopexy & Revisionary Augmentation
	CHAPTER 95 Augmentation Mammaplasty: General Considerations
		History
		Breast Implant Evolution
			Saline-Filled Implants
			Silicone Gel–Filled Implants
		Surgical Goals and Treatment
			Patient Assessment
			Operative Planning
		OPERATIVE TECHNIQUE
		Surgical Approach
			Creating the Implant Pocket
			Postoperative Care
		Management of the Augmented Patient
			Perioperative Complications
			Delayed Complications of Augmentation Mammaplasty
		Conclusion
	CHAPTER 96 Augmentation in Patient With Congenital Breast Deformity
		History
		Anatomic Basis of the Deformity
		Classification
		Principles of Surgical Management
		Reconstruction of the Lower Pole and Base
		Constriction and Areolar Herniation
		Volume Correction
		Complications
		Poland Syndrome
		Conclusion
	CHAPTER 97 Patient Education in Breast Augmentation
		History
		Patient Education and Informed Consent
		The Initial Patient Consultation
		Patient Education in Breast Augmentation: Tools, Technology, and the Senses
		Conveying Lifelong Risk in Breast Augmentation
			The Longevity of Breast Implants
			Breast Imaging for Cancer Screening and Addition of Office-Based High-Resolution Ultrasound for Evaluation of Silicone Gel Implants
		Education and Its Role in the Management of Patient Expectations
		Conclusion
	CHAPTER 98 Inframammary Approach to Breast Augmentation
		History
		Preoperative Planning
		OPERATIVE TECHNIQUE
		Patient Positioning
		Infiltration of Local
		Surgical Prep and Sterile Draping
		Inframammary Incision
		Inframammary Fold Positioning
		Incision
		Implant Pocket
		Dual Plane Submuscular Pocket
		Subglandular/Subfascial Pocket
			Implant Placement
		Closure
		Postoperative Management
		Conclusion
	CHAPTER 99 The Periareolar Approach to Augmentation Mammaplasty
		History
		Technique
		Discussion
		Acknowledgments
	CHAPTER 100 Transaxillary Breast Augmentation
		History
		Transaxillary Endoscopic Breast Augmentation
		Markings
		Positioning
		Equipment
		Incisions
		Initial Dissection
		Pocket Creation I: Optical Cavity Creation
		Pocket Creation II: Pectoralis Major Muscle Release
		OPERATIVE TECHNIQUE
		Implant Placement
		Postoperative Care
		Nonendoscopic Approach
		Conclusion
	CHAPTER 101 Subfascial Breast Augmentation
		History
		Indications
		Anatomy
		Incision and Approach
		Implant Selection
		Postoperative Care
		Conclusion
	CHAPTER 102 The Inframammary Approach to Augmentation Mammaplasty
		History
		Incision Planning
		OPERATIVE TECHNIQUE
		Conclusion
	CHAPTER 103 Shaped Implant in Breast Augmentation
		History
		Differences Between Round and Shaped Implants
			Indications for Anatomically Shaped Implants
			Complications Related to the Use of Shaped Implants
		The Process of a Breast Augmentation Procedure
			Implant Selection
			Preoperative Markings
		OPERATIVE TECHNIQUE
		Postoperative Considerations
		Conclusion
		Addendum from January 2020
	CHAPTER 104 Light-Weight Implants in Breast Augmentation
		History
		Weight as a Central Force Acting on the Breast
		Heavier Breasts Sag More
		Weight Is the Downward Force in the Presence of Gravity
		The Force Exerted on Breast Tissue Is in Direct Proportion to Weight
		Movement Amplitude Is in Direct Proportion to Weight
		Breast Reduction
		The Breast’s Viscoelastic Response
		Long-Term Adverse Effects Associated With Higher Implant Weight
		Technologic Innovation and Preclinical Development
		Indications
		Contraindications and Precautions
		Preoperative Planning
		Intraoperative and Postoperative Care
		OPERATIVE TECHNIQUE
		Clinical Reports
			Clinical Survey Report (November 2017)
			Retrospective Study (2018)
		Additional Preliminary Benefits of the LWBI
			Less Gel Bleed Versus Traditional Implants
			Better Performance in Breast Imaging
			Favorable Breast Kinetics
		Conclusion
	CHAPTER 105 Polyurethane Implants in Aesthetic Breast Surgery
		History
		Indications
		Contraindications
		Preoperative Planning
		OPERATIVE TECHNIQUE
		Postoperative Care
		Outcomes
		Conclusion
	CHAPTER 106 Augmentation Mastopexy: General Considerations
		History
			Candidates and Noncandidates
		Preoperative Evaluation and Patient Expectation Management
		Anatomical Assessment for Augmentation Mastopexy
		Augmentation Mastopexy Surgical Planning—General Overview
		Augmentation Mastopexy Surgical Planning—Implant Selection
		Augmentation Mastopexy Surgical Planning—Incisions/Plane Selection
		Augmentation Mastopexy Surgical Planning—Choosing the Mastopexy Pattern
			Mastopexy Pattern—Crescent Lift
			Mastopexy Pattern—Circumareolar Mastopexy
			Mastopexy Pattern—Vertical Mastopexy
			Mastopexy Pattern—Inverted T Scar Mastopexy
		Augmentation Mastopexy—Universal Markings
		Augmentation Mastopexy Operative Techniques—Implant Placement
		Augmentation Mastopexy Operative Techniques—Crescent Lift
		Augmentation Mastopexy Operative Techniques—Circumareolar Mastopexy
		Augmentation Mastopexy Operative Techniques—Vertical Mastopexy
		Augmentation Mastopexy Operative Techniques—Inverted T Scar Mastopexy
		Augmentation Mastopexy—Fat Grafting
		Augmentation Mastopexy—Reinforcement Materials
		Ancillary Procedures—Nipple Reduction, inverted Nipple Correction, Liposuction
		Augmentation Mastopexy—Postoperative Care
		Outcomes and Complications
		Conclusion
	CHAPTER 107 Breast Augmentation Mastopexy—Safe and Simplified
		History
		What Is the Problem?
		Principles to Ensure Safety and Reliability
			Clear Patient Expectation, Careful Selection
			Precise Marking, Conservative Resection
			Prudent Implant Selection, Subpectoral Placement
		Outcome
		Postoperative Care
		Conclusion
	CHAPTER 108 Augmentation-Mastopexy With Shaped or Round Implants, Is There a Difference?
		History
		Preoperative Evaluation and Planning
		OPERATIVE TECHNIQUE
		Postoperative Care
		Outcomes
		Conclusion
	CHAPTER 109 Avoiding Pitfalls With Mastopexy–Augmentation
		History
		Indications
		Contraindications
		Preoperative Planning
		OPERATIVE TECHNIQUE
		Capsular Contracture
		Implant Malposition
		Recurrent Ptosis
		Unacceptable Scarring
		Intraoperative Care
		Postoperative Care
		Generic Risks
		Outcomes
		Conclusion
	CHAPTER 110 Management of Recurrent Ptosis Following Augmentation Mastopexy
		History
		Etiology
			Etiology of Recurrent Ptosis
		Management
			Recurrent Ptosis
			Pseudoptosis (Bottoming Out)
			Waterfall Deformity (Snoopy Deformity)
		Conclusion
		Disclosure
	CHAPTER 111 Liposuction Mastopexy
		History
		Indications
		Contraindications
		Preoperative Planning
		OPERATIVE TECHNIQUE
		Intraoperative Care
		Postoperative Care
		General Risks
		Outcomes
		Conclusion
	CHAPTER 112 Neopectoral Technique for Implant Malposition
		History
		Corrective Techniques for Implant Malposition
			Revision of Existing Pocket
			Creation of a New Pocket
		OPERATIVE TECHNIQUE
		Neopectoral Technique
			Preoperative Planning
			Capsule Dissection
			Neopectoral Pocket Creation
			Acellular Dermal Matrix/Mesh Support
		Conclusion
	CHAPTER 113 Subpectoral “Dual-plane” Conversion for Treating Aesthetic Concerns After Breast Augmentation
		History
		Applications
			Rippling and Implant Palpability
			Loss of Upper Pole Fullness
			Capsular Contracture
			Implant Malposition
		Adjunct Techniques
		OPERATIVE TECHNIQUE
		Discussion
		Conclusions
	CHAPTER 114 Secondary Revision of the Augmented Breast
		History
		Indications
			Patient Assessment
		Contraindications
		Preoperative Planning
			Use of 3D Imaging
			Formulating a Surgical Plan
		OPERATIVE TECHNIQUE/INTRAOPERATIVE CARE
		Choosing a New Implant
		Treating Excess Skin
		Poor Soft Tissue Coverage
		Animation Deformity
		Capsular Contracture
		Nipple Position
			Expectation Management
		Postoperative Care
		Conclusion
	CHAPTER 115 Combining Lipofill and Small Implants for Breast Augmentation
		History
			Fat Grafting to the Breast
		Indications
		Contraindications
		Preoperative planning
		OPERATIVE TECHNIQUE
		Postoperative care
		Risks and complications
		Outcomes and secondary procedures
		Conclusion
	CHAPTER 116 Breast Revisionary Surgery and the Role of Acellular Dermal Matrix and Bioabsorbable Mesh
		History
		Indications for ADM Use
			Pocket Stabilizer
			Correction of Capsular Contracture
			Lower Pole Coverage
			Soft Tissue Thickener
		Which ADM to Use?
		Use of ADMs
		Indications for Bioabsorbable Mesh Use
		Use of Bioabsorbable Mesh
		Conclusion
SECTION VIII: General Considerations in Aesthetic and Reconstructive Surgery
	CHAPTER 117 Chest Masculinization for the Transmasculine Individual
		Background
			Gender Identity
			History
		Preoperative Considerations
			Preoperative Evaluation
			Cancer Screening
			Hormone Therapy
		Intraoperative Care
			Circumareolar Technique
			Double-Incision Free Nipple Graft Technique
		Postoperative Care
		Generic Risks
		Outcomes
		Conclusion
	CHAPTER 118 Aesthetic Breast Surgery in Transgender Patients: Feminization
		Transfeminine Mammogenesis
		Preoperative Considerations
		Transfeminine Breast Anatomy
		Surgical Considerations
			Incision
			Implant Fill
			Implant Shape and Texturization
			Implant Size
			Pocket Selection
		Special Considerations in Chest Feminization
		Postoperative Care
		Complications
		Outcomes
		Summary
	CHAPTER 119 Tuberous Breast: Correction With and Without Implants
		History
		Indications
		Contraindications
		Preoperative planning
		OPERATIVE TECHNIQUE
		Grolleau Type I or II (milD Constriction)
		Grolleau Type II or III with Hypoplasia
		Postoperative Care
		Risks
		Outcomes
		Conclusion
	CHAPTER 120 Effect of Smoking on Breast Plastic Surgery
		History
		Pathophysiology of Smoking
		Impact on Breast Surgery
			Mastopexy, Augmentation, and Combined Mastopexy-Augmentation
			Reduction Mammaplasty
			Breast Reconstruction
			Implant-Based Reconstructions
			Free Flap
		Laboratory Testing
		Perioperative Management of Smoking
		Authors’ Recommendations
		Our Strategy
		Conclusion
	CHAPTER 121 Should Elective Surgery Be Offered to High-BMI Patients?
		History
		Technical Approach
			Reconstruction
			Aesthetic
		Challenges
			Preoperative Considerations
			Perioperative and Postoperative Considerations
		Conclusion
	CHAPTER 122 Breast Implant–Associated Anaplastic Large Cell Lymphoma
		History
		Epidemiology
			Pathogenesis
		Nccn Consensus Guidelines for Diagnosis and Disease Management
		Approach to Suspected Patient
		Diagnostic Criteria
		Preoperative Oncologic Workup
		Solid Tumor Staging
		Surgical Treatment
		Indications for Adjuvant Treatments
		Follow-up and Disease Surveillance
		Treatment Outcomes
		Conclusion
	CHAPTER 123 Proactive Approach to Capsular Contracture Prevention
		History
		Background/Etiology
		Proactive Approach for Prevention
		Experimental Prevention Methods
		Conclusion
	CHAPTER 124 Diagnosing, Treating, and Preventing Biofilms in Implant-based Breast Surgery
		History
		Definition
		Growth
		Resistance
		Biofilm Pathologies
		Capsular Contracture
		Prophylactic Surgical Techniques
		Breast Implant Coatings
		Antibiotic and Antiseptic Use
		Alternative Forms of Chemoprophylaxis
		Mechanical Prophylaxis
		Intraoperative Detection
		Conclusion
	CHAPTER 125 Breast Implant Illness: What We Know Now?
		History
		What Is BII?
		Silicone Implant and Systemic Disease—Is There a Link?
			Early History
			Recent Studies
		Social Media and the Spread of Misinformation
		How to Manage Patients With BII?
			Physical Examination
			Surgery
		Moving Forward
		Conclusion
	CHAPTER 126 Avoiding and Managing Patient Dissatisfaction
		History
		Defining a “Successful” Outcome
		Breast Surgery Effect on Body Image
		Understanding the Risk Factors
			Patient Expectations
			The Impact of Social Media
			Lack of Informed Consent
			Recognizing the Psychological Factor
		Managing the Dissatisfied Patient
		Conclusion
SECTION IX: Final Considerations
	CHAPTER 127 Informed Consent: Medicolegal Considerations in Breast Surgery
		Standards for Informed Consent
		Who May Provide Informed Consent?
		Components of Learning Informed Consent
		Inclusions of Informed Consent
		Dissatisfaction With Cosmetic Results
		“The $75,000 Breast”
		Future Care
		Documentation
		Impact in a Lawsuit
		The Medicolegal Considerations of Breast Surgery
	CHAPTER 128 Social Media for the Aesthetic and Reconstructive Breast Surgeon
		History
		Social Media Platforms
			Facebook
			Instagram
			Twitter
			RealSelf
			Snapchat
			YouTube
		Patient Consent
		Professionalism
		General Guidelines for a Social Media Content Marketing Strategy
			Patient Education
			Research
			Before and After Photos
			Specials
			Events
			Practice Updates
			Personal
			Patient Testimonials
		Ethical Concerns From Social Media Content
			Patient “Ratings”
			Ethical Boundaries
			Personal Versus Professional Posting
			Risk of Unrealistic Expectations
		Conclusion
	CHAPTER 129 Integrating High-Resolution Ultrasound Into Your Practice Including Background, Ultrasound Basics, Current Studies, and Clinical Applications
		History
		Background
		Ultrasound Basics
		Case Studies
		Conclusion
	CHAPTER 130 Perioperative Principles in Breast Surgery
		History
		The Science of Postoperative Wound Healing
		Surgical Risk Reduction
		Pain Management
		Incision and Soft Tissue Management
		Drain Management and Antibiotic Protocol
		Recovery and Rehabilitation
		Conclusion
Index