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Book Details
Abstract
Fully updated to meet the demands of the 21st-century surgeon, Breast, Volume 5 of Plastic Surgery 3rd Edition, provides you with the most current knowledge and techniques in breast surgery, allowing you to offer every patient the best possible outcome. Access all the state-of-the-art know-how you need to overcome any challenge you may face and exceed your patients’ expectations.
- Consult this title on your favorite e-reader, conduct rapid searches, and adjust font sizes for optimal readability. Compatible with Kindle®, nook®, and other popular devices.
- Apply the very latest advances in breast plastic surgery and ensure optimal outcomes with evidence-based advice from a diverse collection of world-leading authorities.
- Purchase this volume individually or own the entire set, with the ability to search across all six volumes online!
- Make optimal use of the latest practices in aesthetic breast surgery, including imaging for breast augmentation and short scar mastopexy; autologous lipofilling of the breast; the use and challenges of silicone gel devices; and new techniques for developmental and congenital deformities of the breast.
- Know what to look for and what results you can expect with 1,300 photographs and illustrations.
- See how to perform key techniques with 25 surgical videos online.
- Access the complete, fully searchable contents online, download all the tables and figures, and take advantage of additional content and images at www.expertconsult.com!
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| Plastic Surgery | i | ||
| Copyright page | iv | ||
| Table of Contents | v | ||
| Video Contents | xi | ||
| Foreword | xvi | ||
| Preface | xvii | ||
| List of Contributors | xviii | ||
| Acknowledgments | xl | ||
| Dedication | xli | ||
| 1 Anatomy for plastic surgery of the breast | 1 | ||
| Introduction | 1 | ||
| Ideal breast architecture | 1 | ||
| Development of the breast | 2 | ||
| Parenchyma | 3 | ||
| Nipple areola complex | 5 | ||
| Skeletal support | 5 | ||
| Vascularity | 6 | ||
| Lymphatics | 8 | ||
| Innervation | 9 | ||
| Musculature | 9 | ||
| Pectoralis major | 9 | ||
| Serratus anterior | 10 | ||
| Rectus abdominis | 11 | ||
| External oblique | 11 | ||
| Surgical indications | 11 | ||
| Conclusion | 11 | ||
| References | 12 | ||
| References | 12.e1 | ||
| I Cosmetic Surgery of the Breast | 13 | ||
| 2 Breast augmentation | 13 | ||
| Introduction | 13 | ||
| History | 13.e1 | ||
| Basic science/disease process | 13 | ||
| Evolution of saline implants | 13 | ||
| Silicone chemistry | 14 | ||
| Evolution of silicone implants | 14 | ||
| Diagnosis and patient presentation | 15 | ||
| Patient selection | 16 | ||
| Informed consent | 17 | ||
| Operative planning | 19 | ||
| Incision length and placement | 19 | ||
| Pocket position | 20 | ||
| Implant selection | 24 | ||
| Filling material | 24 | ||
| Implant size | 25 | ||
| Implant surface texture | 25 | ||
| Implant shape | 25 | ||
| Treatment and surgical technique | 27 | ||
| Inframammary incision | 27 | ||
| Periareolar incision | 30 | ||
| Transaxillary incision | 31 | ||
| Transumbilical | 32 | ||
| Postoperative care | 32 | ||
| Perioperative complications | 32 | ||
| Delayed complications of augmentation mammaplasty | 36 | ||
| Periprosthetic capsular contracture | 36 | ||
| Implant rupture and deflation | 37 | ||
| Secondary procedures | 37 | ||
| References | 38 | ||
| References | 38.e1 | ||
| 3 Secondary breast augmentation | 39 | ||
| Introduction | 39 | ||
| Basic science/disease process | 40 | ||
| Diagnosis/patient presentation | 40 | ||
| Classification | 41 | ||
| Patient selection/indications | 42 | ||
| Treatment/surgical technique | 44 | ||
| Contracture | 46 | ||
| Malposition | 53 | ||
| Etiology | 53 | ||
| Treatment | 55 | ||
| Implant failure | 58 | ||
| Rippling and palpability | 59 | ||
| Breast asymmetry | 61 | ||
| Soft tissue changes | 63 | ||
| Size change | 64 | ||
| Postoperative care | 65 | ||
| Outcomes, prognosis, and complications | 65 | ||
| References | 66 | ||
| References | 66.e1 | ||
| 4 Current concepts in revisionary breast surgery | 67 | ||
| Introduction | 67 | ||
| History | 68.e1 | ||
| Basic science and disease process | 68 | ||
| Acellular dermal matrix | 68 | ||
| Published literature | 69 | ||
| Regeneration | 69 | ||
| Resorption | 69 | ||
| Encapsulation | 71 | ||
| Diagnosis and patient presentation | 71 | ||
| Patient selection | 71 | ||
| Treatment and surgical technique | 71 | ||
| Coverage of the lower pole | 73 | ||
| Implant stabilizer | 75 | ||
| Tissue thickener | 76 | ||
| Treatment of capsular contracture | 77 | ||
| Outcomes, prognosis and complications | 78 | ||
| References | 79 | ||
| References | 80.e1 | ||
| 5 Endoscopic approaches to the breast | 81 | ||
| Introduction | 81 | ||
| The optical cavity | 81 | ||
| Support systems | 82 | ||
| Illumination and imaging | 82 | ||
| History | 82.e1 | ||
| Use of the surgical endoscope in cosmetic breast surgery | 82.e1 | ||
| Use of the surgical endoscope in reconstructive breast surgery | 82.e1 | ||
| Endoscopic augmentation mammaplasty | 83 | ||
| Basic science/disease process | 83 | ||
| Diagnosis/patient presentation | 83 | ||
| Patient selection | 83 | ||
| Treatment/surgical technique | 84 | ||
| Postoperative care | 87 | ||
| Outcomes, prognosis, and complications | 87 | ||
| Endoscopic breast reconstruction | 88 | ||
| Basic science/disease process | 88 | ||
| Diagnosis/patient presentation | 88 | ||
| Patient selection | 89 | ||
| Treatment/surgical technique | 89 | ||
| Postoperative care | 93 | ||
| Outcomes, prognosis, and complications | 93 | ||
| References | 96 | ||
| 6 Iatrogenic disorders following breast surgery | 97 | ||
| Introduction | 97 | ||
| Injection materials | 97 | ||
| Paraffin (1899–1914) | 97 | ||
| Liquid silicone injections (1944–1991) | 98 | ||
| Polyacrylamide hydrogel (1988–2010) | 100 | ||
| Breast implants | 101 | ||
| The sponges (1951–1962, the early years) | 101 | ||
| Silicone gel implants | 102 | ||
| Implant disruption: silicone gel implants | 103 | ||
| Hematoma | 104 | ||
| Infection | 105 | ||
| Capsular contracture | 106 | ||
| Closed capsulotomy | 107 | ||
| Capsular calcification: silicone gel implants | 107 | ||
| Calcified capsules with saline implants | 110 | ||
| Steroid atrophy | 110 | ||
| Complications specific to saline implants | 110 | ||
| Deflation | 110 | ||
| Ripples and folds | 111 | ||
| Autoinflation | 111 | ||
| Implant malposition | 112 | ||
| Plane of insertion | 112 | ||
| Inadequate muscle release | 113 | ||
| Submusculofascial plane | 114 | ||
| Transaxillary dissection | 115 | ||
| Symmastia | 115 | ||
| Double-bubble deformity | 116 | ||
| Ptosis of the augmented breast | 116 | ||
| Secondary ptosis after pregnancy | 117 | ||
| References | 118.e1 | ||
| 7 Mastopexy | 119 | ||
| Introduction | 119 | ||
| Basic science/disease process | 120 | ||
| History | 120.e1 | ||
| Diagnosis and patient presentation | 124 | ||
| Patient evaluation | 124 | ||
| Patient selection | 125 | ||
| Treatment/surgical technique | 125 | ||
| Periareolar techniques | 126 | ||
| Concentric mastopexy without parenchymal reshaping | 126 | ||
| Periareolar Benelli mastopexy | 127 | ||
| Technique | 128 | ||
| Góes periareolar technique with mesh support | 132 | ||
| Technique | 132 | ||
| Vertical/short scar techniques | 133 | ||
| Lassus vertical scar technique | 134 | ||
| Lejour vertical scar technique | 135 | ||
| Grotting sculpted vertical pillar mastopexy | 136 | ||
| Technique | 138 | ||
| Authors’ preferred technique for augmentation mastopexy | 139 | ||
| Technique | 142 | ||
| Mastopexy post-explantation | 143 | ||
| Technique | 145 | ||
| Inverted-T technique | 146 | ||
| Technique | 146 | ||
| Postoperative care | 147 | ||
| Outcomes, prognosis, complications | 148 | ||
| Nipple loss | 148 | ||
| Scars | 149 | ||
| Flap necrosis | 149 | ||
| Nipple malposition | 149 | ||
| Cosmetic disappointments | 149 | ||
| Other complications | 150 | ||
| Secondary procedures | 150 | ||
| References | 150 | ||
| References | 151.e1 | ||
| 8.1 Reduction mammaplasty | 152 | ||
| Introduction | 152 | ||
| History | 153 | ||
| Basic science | 161 | ||
| Mammary hypertrophy | 161 | ||
| Diagnosis/patient presentation | 162 | ||
| Patient evaluation | 162 | ||
| References | 164 | ||
| References | 164.e1 | ||
| 8.2 Inferior pedicle breast reduction | 165 | ||
| Evolution of the technique | 165 | ||
| Patient selection | 166 | ||
| Details of planning and marking | 166 | ||
| Details of planning | 166 | ||
| Creating an equilateral triangle | 166 | ||
| Marking of the transverse incisions at the base of the triangle | 167 | ||
| Marking of the inframammary fold | 167 | ||
| Assessing symmetry of markings | 168 | ||
| Visualizing or examining the asymmetric patient | 168 | ||
| Detailed description of technical procedure | 168 | ||
| Case examples | 172 | ||
| Complications and how to handle them | 175 | ||
| Summary | 175 | ||
| References | 175 | ||
| References | 176.e1 | ||
| 8.3 Superior or medial pedicle | 177 | ||
| Evolution of the technique | 177 | ||
| Patient selection | 180 | ||
| Symptoms | 180 | ||
| Patient characteristics | 180 | ||
| Details of planning and marking | 181 | ||
| General perioperative care | 181 | ||
| Skin marking | 181 | ||
| Detailed description of the technical procedure | 182 | ||
| Anesthesia and positioning | 182 | ||
| Selection of the pedicle | 182 | ||
| Infiltration | 182 | ||
| Deepithelialization | 184 | ||
| Surgical excision | 184 | ||
| Liposuction | 185 | ||
| Breast shaping | 186 | ||
| Wound closure | 187 | ||
| Dressings and wound care | 188 | ||
| General postoperative instructions and follow-up | 188 | ||
| Examples of superior and medial pedicle breast reductions | 188 | ||
| Superior pedicle breast reduction | 188 | ||
| Medial pedicle breast reduction | 189 | ||
| Complications and how to handle them | 189 | ||
| Healing of the vertical scar | 190 | ||
| Wound dehiscence | 191 | ||
| Under-resection | 192 | ||
| Summary | 192 | ||
| References | 193.e1 | ||
| 8.4 Short scar periareolar inferior pedicle reduction (SPAIR) mammaplasty | 194 | ||
| Evolution of technique | 194 | ||
| Patient selection | 195 | ||
| Surgical planning and marking | 196 | ||
| Technique | 196 | ||
| Results | 201 | ||
| Complications | 203 | ||
| Fat necrosis | 203 | ||
| Shape distortion | 204 | ||
| Areolar spreading | 204 | ||
| PTFE infection/exposure | 204 | ||
| Recurrence of hypertrophy | 204 | ||
| Summary | 205 | ||
| References | 205.e1 | ||
| 8.5 The L short-scar mammaplasty | 206 | ||
| Evolution of the technique and patient selection | 206 | ||
| Planning and marking | 207 | ||
| Technical procedure | 207 | ||
| Examples of large, medium, and small reductions | 210 | ||
| Complications | 213 | ||
| Summary | 214 | ||
| References | 215 | ||
| 8.6 Periareolar technique with mesh support | 216 | ||
| Evolution of the technique | 216 | ||
| Patient selection | 217 | ||
| Technique | 217 | ||
| Marking | 217 | ||
| Surgical technique | 218 | ||
| Mesh application | 219 | ||
| Complications | 226 | ||
| Summary | 226 | ||
| References | 226 | ||
| References | 227.e1 | ||
| 8.7 Sculpted pillar vertical reduction mammaplasty | 228 | ||
| Evolution of technique | 228 | ||
| Patient selection | 228 | ||
| Planning and markings | 229 | ||
| Technique | 229 | ||
| Closure | 231 | ||
| Patient examples: small, medium, and large reductions | 235 | ||
| Case 1: small breast reduction | 235 | ||
| Case 2: moderate breast reduction | 236 | ||
| Case 3: large breast reduction | 236 | ||
| Complications | 236 | ||
| Summary | 239 | ||
| References | 241 | ||
| 9 Revision surgery following breast reduction and mastopexy | 242 | ||
| Introduction | 242 | ||
| Patient history | 242 | ||
| Preoperative patient evaluation | 244 | ||
| Diagnosis/patient presentation | 244 | ||
| Basic science | 244 | ||
| Postoperative management | 244 | ||
| Outcomes/prognosis/complications | 245 | ||
| Surgical re-intervention for acute problems | 245 | ||
| Hematoma | 245 | ||
| Skin flap necrosis | 246 | ||
| Postoperative care | 246 | ||
| Wound excision and re-closure | 246 | ||
| Contour abnormalities at the end of incisions | 247 | ||
| Nipple areola ischemia | 247 | ||
| Areola deformities | 248 | ||
| Areola hypopigmentation | 249 | ||
| Fat necrosis | 251 | ||
| Asymmetry(ies) | 251 | ||
| Nipple retraction | 252 | ||
| Nipple malposition | 252 | ||
| Nipple loss | 253 | ||
| Re-do breast reduction | 254 | ||
| Revision of mastopexy | 254 | ||
| Revision mastopexy | 262 | ||
| II Reconstructive Surgery of the Breast | 266 | ||
| 10 Breast cancer: | 266 | ||
| Introduction | 266 | ||
| Basic science | 266 | ||
| History | 266.e1 | ||
| Diagnosis | 267 | ||
| Clinical breast examination | 267 | ||
| Diagnostic imaging modalities | 268 | ||
| Mammography | 268 | ||
| Ultrasonography | 268 | ||
| Magnetic resonance imaging | 268 | ||
| Diagnostic imaging in patients with breast implants | 270 | ||
| Histologic diagnostic modalities | 271 | ||
| Image-guided core biopsy | 271 | ||
| Fine-needle aspiration | 272 | ||
| Core needle biopsy | 272 | ||
| Excisional biopsy | 273 | ||
| Patient selection | 273 | ||
| Treatment/surgical technique | 274 | ||
| Breast conserving surgery | 274 | ||
| Technique | 276 | ||
| Oncoplastic surgery | 277 | ||
| Mastectomy: terminology and techniques | 280 | ||
| Total mastectomy | 281 | ||
| Skin-sparing mastectomy | 282 | ||
| Nipple sparing mastectomy | 282 | ||
| Prophylactic mastectomy | 284 | ||
| Modified radical mastectomy | 285 | ||
| Nodal evaluation | 286 | ||
| Outcomes, prognosis, complications | 286 | ||
| Breast reconstruction after mastectomy | 287 | ||
| Immediate reconstruction | 287 | ||
| Delayed reconstruction | 291 | ||
| Secondary procedures | 292 | ||
| References | 294 | ||
| References | 295.e1 | ||
| 11 The oncoplastic approach to partial breast reconstruction | 296 | ||
| Introduction | 296 | ||
| Disease process | 296 | ||
| The history behind partial breast reconstruction | 296.e1 | ||
| Patient presentation and selection | 297 | ||
| Timing of partial breast reconstruction | 297 | ||
| Management of margins | 298 | ||
| Surgical planning | 301 | ||
| Oncoplastic resection | 301 | ||
| Treatment algorithm for partial reconstruction | 301 | ||
| Volume displacement techniques | 302 | ||
| Volume replacement techniques | 306 | ||
| Oncologic safety | 310 | ||
| Postoperative care | 310 | ||
| Outcomes and secondary procedures | 310 | ||
| Conclusion | 312 | ||
| References | 312 | ||
| References | 313.e1 | ||
| 12 Patient-centered health communication | 314 | ||
| Healthcare decisions | 314 | ||
| Unwarranted variation in medical practice | 315 | ||
| Categories of variation and preference-sensitive decisions | 315 | ||
| Variation in surgical decisions | 315 | ||
| What about evidence? | 316 | ||
| Risk communication | 317 | ||
| Risk language | 317 | ||
| Absolute versus relative risk | 318 | ||
| Better data presentation | 319 | ||
| Visual aids | 319 | ||
| Balanced framing | 319 | ||
| Teach-back method | 320 | ||
| Creating a high quality decision | 320 | ||
| Decision aids that are evidence-based | 321 | ||
| Shared decision-making | 321 | ||
| A shared decision-making process | 321 | ||
| Decision quality reports | 322 | ||
| The value proposition for shared decision-making | 323 | ||
| Patients’ perception of SDM | 323 | ||
| Surgeons’ acceptance of shared decision-making | 323 | ||
| Looking forward: informed consent versus informed choice | 324 | ||
| Summary | 324 | ||
| References | 324 | ||
| References | 325.e1 | ||
| 13 Imaging in reconstructive breast surgery | 326 | ||
| Introduction | 326 | ||
| Defining the ideal perforator vessel | 327 | ||
| History | 326.e1 | ||
| Conventional preoperative mapping methods in perforator flaps | 327 | ||
| Hand-held Doppler ultrasound | 327 | ||
| Color Doppler imaging | 328 | ||
| Imaging techniques in breast reconstruction | 328 | ||
| Radiological protocol of the acquisition sequence | 329 | ||
| MDCT | 329 | ||
| Noncontrast MRI | 329 | ||
| How to select the most suitable perforator | 330 | ||
| Conclusion | 331 | ||
| References | 335.e1 | ||
| 14 Expander-implants breast reconstructions | 336 | ||
| Introduction | 336 | ||
| History | 336.e1 | ||
| Development of breast implants | 336.e1 | ||
| The controversy regarding silicone implants | 336.e1 | ||
| Basic science | 336 | ||
| Breast reconstruction with tissue expansion and permanent implants | 338 | ||
| Reconstructive paradigms and surgical strategy | 340 | ||
| Diagnosis and patient presentation | 344 | ||
| Exclusion criteria | 345 | ||
| Inclusion criteria according to dimensional considerations | 346 | ||
| Patients with small breasts | 346 | ||
| Patients with medium-sizes breasts | 346 | ||
| Patients with large breasts | 346 | ||
| Surgical technique | 346 | ||
| The comprehensive preoperative project | 346 | ||
| Evolution of prosthetic implants | 352 | ||
| Shape (Fig. 14.15) | 352 | ||
| Shell (Fig. 14.16) | 352 | ||
| Filler materials (Fig. 14.17) | 352 | ||
| Dimensions | 352 | ||
| A good reconstruction always starts with a good mastectomy (Figs 14.18, 14.19) | 353 | ||
| Immediate breast reconstruction after mastectomy (first stage) | 353 | ||
| Surgical steps for insertion of expander | 353 | ||
| Skin reducing mastectomy | 354 | ||
| Immediate breast reconstruction in one stage for large and ptotic glands | 354 | ||
| Second stage of immediate two stage reconstructions | 356 | ||
| Surgical steps for prosthesis insertion | 356 | ||
| Contralateral adjustment | 356 | ||
| Patients with small breasts | 356 | ||
| Patients with medium size breasts | 357 | ||
| Patients with large breasts | 358 | ||
| Delayed reconstruction | 358 | ||
| Postoperative care | 358 | ||
| Outcomes and complications | 359 | ||
| Hematoma | 359 | ||
| Erythema and cellulitis | 359 | ||
| Persistent serous drainage through suction catheter | 359 | ||
| Partial or complete skin necrosis | 360 | ||
| Expander failure or malfunction | 360 | ||
| Infection | 361 | ||
| Outcomes of breast reconstruction with implants | 363 | ||
| Experience of the authors | 365 | ||
| Secondary procedures | 365 | ||
| Revision for cosmetic purposes | 365 | ||
| Fat injection | 365 | ||
| Nipple reconstruction | 365 | ||
| Other reconstructive techniques involving implants and/or tissue expansions | 366 | ||
| Adjustable, permanent expander-implant (Fig. 14.41) | 366 | ||
| Expander-implant use in association with flaps | 367 | ||
| Breast envelope preservation for staged flap reconstruction | 367 | ||
| Developments | 368 | ||
| References | 369 | ||
| References | 369.e1 | ||
| 15 Latissimus dorsi flap breast reconstruction | 370 | ||
| Introduction | 370 | ||
| Anatomy | 370 | ||
| Patient presentation | 372 | ||
| Patient selection/indications | 372 | ||
| History | 370.e1 | ||
| Specific indications | 374 | ||
| Patients who are not candidates for a TRAM flap | 374 | ||
| Previous irradiation during breast conservative therapy | 376 | ||
| Partial mastectomy defects | 380 | ||
| Excessively thin or unreliable skin flaps over an implant | 380 | ||
| After a previous mastopexy or reduction | 380 | ||
| Augmented breasts | 380 | ||
| Large ptotic breasts | 380 | ||
| Prophylactic mastectomy | 381 | ||
| Contraindications | 381 | ||
| Techniques | 381 | ||
| Main surgical variants | 387 | ||
| Secondary procedures | 389 | ||
| Exchange of expander to implant | 389 | ||
| Secondary thoracodorsal nerve ligation | 389 | ||
| Postoperative care | 389 | ||
| Outcomes and complications | 389 | ||
| Flap necrosis | 390 | ||
| Donor site morbidity | 390 | ||
| Conclusion | 390 | ||
| Financial disclosure | 390 | ||
| References | 391 | ||
| References | 392.e1 | ||
| 16 The bilateral pedicled TRAM flap | 393 | ||
| Introduction | 393 | ||
| Basic science/anatomy | 394 | ||
| Patient selection | 395 | ||
| History | 393.e1 | ||
| Treatment/surgical technique | 396 | ||
| Preoperative considerations | 396 | ||
| Operative procedure | 396 | ||
| Shaping of the TRAM flap breast reconstruction | 405 | ||
| Postoperative care | 406 | ||
| Outcomes, prognosis, complications | 407 | ||
| Secondary procedures | 410 | ||
| References | 410 | ||
| References | 410.e1 | ||
| 17 Free TRAM breast reconstruction | 411 | ||
| Introduction | 411 | ||
| History | 411.e1 | ||
| Basic science/disease process | 411 | ||
| Anatomy and physiology | 412 | ||
| Diagnosis/patient presentation | 414 | ||
| Timing: delayed versus immediate reconstruction | 414 | ||
| The pedicled versus free TRAM | 414 | ||
| Radiation therapy | 415 | ||
| Patient selection | 416 | ||
| Risk factors | 416 | ||
| Procedure selection | 417 | ||
| Treatment/surgical technique | 418 | ||
| Mastectomy planning | 419 | ||
| Flap dissection | 419 | ||
| Recipient vessel | 422 | ||
| Flap insetting | 426 | ||
| Abdominal closure | 426 | ||
| Postoperative care | 428 | ||
| Complications | 430 | ||
| Revision | 430 | ||
| Conclusion | 432 | ||
| References | 433 | ||
| References | 434.e1 | ||
| 18 The deep inferior epigastric artery perforator (DIEAP) flap | 435 | ||
| Introduction | 435 | ||
| History | 435.e1 | ||
| Basic science: anatomy | 436 | ||
| The deep inferior epigastric artery perforator (DIEAP) flap | 436 | ||
| Recipient vessels | 439 | ||
| Diagnosis/patient presentation | 439 | ||
| Ultrasound evaluation of perforator vessels | 440 | ||
| CT imaging | 440 | ||
| Patient selection | 440 | ||
| Surgical technique | 442 | ||
| Preoperative marking | 442 | ||
| Operative procedure | 443 | ||
| Suprafascial dissection | 443 | ||
| Intramuscular dissection | 446 | ||
| Submuscular dissection | 446 | ||
| Closure of the donor site and fashioning of the umbilicus | 447 | ||
| Shaping of the DIEAP flap in secondary autologous breast reconstruction | 447 | ||
| The breast footprint | 447 | ||
| The breast conus | 449 | ||
| The breast envelope | 451 | ||
| Postoperative care | 451 | ||
| Outcomes, prognosis, and complications | 452 | ||
| Secondary procedures | 453 | ||
| References | 455 | ||
| References | 456.e1 | ||
| 19 Alternative flaps for breast reconstruction | 457 | ||
| Introduction | 457 | ||
| History | 457.e1 | ||
| Transverse upper gracilis free flap (TUG) | 457.e1 | ||
| Superior/inferior gluteal artery perforator free flap (SGAP/IGAP) | 457.e1 | ||
| Basic science/disease process | 458 | ||
| Diagnosis/patient presentation | 458 | ||
| Transverse upper gracilis free flap (TUG) | 458 | ||
| Patient selection | 458 | ||
| Anatomy | 458 | ||
| Treatment/surgical technique | 459 | ||
| Complications | 459 | ||
| Superior/inferior gluteal artery perforator free flap (SGAP/IGAP) | 459 | ||
| Patient selection | 460 | ||
| Anatomy | 461 | ||
| Surgical technique | 463 | ||
| Postoperative care | 464 | ||
| Complications | 464 | ||
| The deep femoral artery perforator flap (DFAP) | 464 | ||
| Lumbar artery perforator flap (LAP) | 467 | ||
| Secondary procedures | 470 | ||
| References | 471 | ||
| References | 471.e1 | ||
| 20 Omentum reconstruction of the breast | 472 | ||
| Introduction | 472 | ||
| Basic science/disease process | 472 | ||
| Patient selection | 473 | ||
| History | 472.e1 | ||
| Treatment/surgical technique | 473 | ||
| Laparoscopic harvesting of the omental flap | 473 | ||
| Omentum reconstruction | 473 | ||
| Omentum reconstruction and implant | 474 | ||
| Use of implants, pectoralis major muscle, mixed-mesh, and omental flap | 474 | ||
| Complementing with lipofilling | 476 | ||
| Bilateral reconstruction | 476 | ||
| Closing the epigastric region | 477 | ||
| Symmetry and reconstruction of the nipple-areola complex | 480 | ||
| Symmetry | 480 | ||
| Reconstruction of the nipple-areola complex | 480 | ||
| Postoperative care | 480 | ||
| Outcomes, prognosis, and complications | 480 | ||
| Secondary procedures | 481 | ||
| References | 481 | ||
| References | 481.e1 | ||
| 21 Local flaps in partial breast reconstruction | 482 | ||
| Introduction | 482 | ||
| Basic science | 482 | ||
| History | 482.e1 | ||
| Diagnosis/patient presentation | 483 | ||
| Patient selection | 483 | ||
| Type of reconstruction | 483 | ||
| Timing of reconstruction | 484 | ||
| Treatment/surgical technique | 485 | ||
| Classification and vascular anatomy of flaps | 485 | ||
| The TDAP flap | 486 | ||
| The ICAP flap | 487 | ||
| The SAAP flap | 488 | ||
| The SEAP flap | 489 | ||
| Indications for pedicled flaps | 489 | ||
| Contraindications to pedicled flaps | 489 | ||
| Flap design | 489 | ||
| Flap choice | 489 | ||
| Preoperative perforator mapping | 489 | ||
| Markings | 492 | ||
| Surgical technique | 493 | ||
| Postoperative care | 493 | ||
| Outcomes, prognosis, and complications | 495 | ||
| Secondary procedures | 495 | ||
| References | 498 | ||
| References | 498.e1 | ||
| 22 Reconstruction of the nipple-areola complex | 499 | ||
| Introduction | 499 | ||
| Diagnosis and patient presentation | 499 | ||
| Patient selection | 500 | ||
| History | 499.e1 | ||
| Surgical techniques | 500 | ||
| Composite nipple graft | 500 | ||
| Traditional flaps | 502 | ||
| Skate flap | 502 | ||
| Star flap | 504 | ||
| C–V flap | 506 | ||
| Arrow flap | 507 | ||
| Pull-out/purse-string flap techniques | 507 | ||
| Bell flap | 508 | ||
| Double opposing peri-areolar/purse-string flap | 508 | ||
| Top-hat flap | 510 | ||
| Flap designs adjacent to scars | 511 | ||
| S-flap | 511 | ||
| Double-opposing tab flap | 512 | ||
| Spiral flap | 513 | ||
| Flaps with autologous graft augmentation | 514 | ||
| Cartilage grafts | 514 | ||
| Fat grafts | 514 | ||
| Flaps with alloplastic augmentation | 515 | ||
| Flaps with allograft augmentation | 515 | ||
| Areola reconstruction | 516 | ||
| Postoperative care | 518 | ||
| Outcomes and satisfaction | 519 | ||
| Complications | 519 | ||
| Secondary and revisional reconstruction | 519 | ||
| References | 520 | ||
| References | 520.e1 | ||
| 23.1 Congenital anomalies of the breast | 521 | ||
| Introduction | 521 | ||
| Basic science/disease process | 522 | ||
| Diagnosis/patient presentation | 522 | ||
| Examination of the patient | 526 | ||
| Classification of the different types of tuberous breast deformity | 526 | ||
| Type I: tuberous breast | 526 | ||
| Type II: tuberous breast | 526 | ||
| Type III: tuberous breast | 529 | ||
| Treatment/surgical technique | 529 | ||
| General considerations | 529 | ||
| Surgical technique | 529 | ||
| Glandular correction flaps | 529 | ||
| Glandular flap type I | 530 | ||
| Glandular flap type II | 530 | ||
| Glandular flap type III | 530 | ||
| Glandular flap type IV | 530 | ||
| Clinical examples | 531 | ||
| Case I | 531 | ||
| Index | i1 | ||
| A | i1 | ||
| B | i11 | ||
| C | i30 | ||
| D | i51 | ||
| E | i53 | ||
| F | i59 | ||
| G | i79 | ||
| H | i82 | ||
| I | i95 | ||
| J | i99 | ||
| K | i99 | ||
| L | i100 | ||
| M | i108 | ||
| N | i120 | ||
| O | i131 | ||
| P | i136 | ||
| Q | i149 | ||
| R | i149 | ||
| S | i158 | ||
| T | i172 | ||
| U | i187 | ||
| V | i195 | ||
| W | i199 | ||
| X | i202 | ||
| Y | i203 | ||
| Z | i203 | ||
| Online Index | e1 | ||
| A | e1 | ||
| B | e2 | ||
| C | e11 | ||
| D | e12 | ||
| E | e12 | ||
| F | e12 | ||
| G | e14 | ||
| H | e15 | ||
| I | e15 | ||
| J | e16 | ||
| K | e16 | ||
| L | e16 | ||
| M | e17 | ||
| N | e19 | ||
| O | e20 | ||
| P | e20 | ||
| R | e21 | ||
| S | e23 | ||
| T | e24 | ||
| U | e25 | ||
| V | e25 | ||
| W | e26 | ||
| Z | e26 |