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Cirurgia Plástica Volume Cinco

Cirurgia Plástica Volume Cinco

James C Grotting | Peter C. Neligan

(2012)

Additional Information

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