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Management options for gender affirmation surgery of the breast

Access video content for this chapter online at Elsevier eBooks+ Background Gender identity and terminology One’s gender identity refers to their experienced gender, or their core sense of being a man, a woman or neither. Gender incongruence, in turn, is an International Classification of Disease (v.11) diagnosis describing persistent incongruence between a person’s experienced gender and their assigned sex, which is typically determined at birth based…

Management strategies for gynecomastia

Access video content for this chapter online at Elsevier eBooks+ Introduction Gynecomastia, a term commonly used to refer to male breast enlargement, affects roughly one-third to two-thirds of the male population at some point in their lives. The condition can negatively impact quality of life and patient satisfaction, and this has been recognized for many decades. The term itself encompasses a variety of histopathological variations, and…

Breast implant explantation: indications and strategies to optimize aesthetic outcomes

Access video content for this chapter online at Elsevier eBooks+ Indications for breast explantation The indications for breast implant removal are numerous and include both patient preference and complications from the implants themselves. Elective explantation has recently demonstrated year over year increases with growths of +15% in 2019 and +8% in 2020 making it the second fastest growing cosmetic procedure in plastic surgery today based on…

Imaging and surveillance in patients with breast implants

Introduction Following initial interest in ultrasound and breast implant evaluation in the 1980s, mainly in the UK, there has been very little research or clinical experience reported in our specialty. The final slide of the first national presentation of high resolution ultrasound (HRUS) in 2008 stated: “High Resolution Ultrasound will be in every plastic surgeons office at some point in the future …” However, integration of…

A critical analysis of irrigation solutions in breast surgery

Introduction Breast implants remain the most commonly implantable medical devices in plastic surgery operating rooms. In 2019 nearly 300,000 women and in 2020, despite the COVID-19 pandemic, 200,000 women underwent cosmetic breast augmentation in the US. Breast implants also represent the most common form of post-mastectomy reconstruction for the 1 in 8 women in the US who will be diagnosed with breast cancer during their lifetimes.…

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL): diagnosis and management

Introduction BIA-ALCL is an uncommon and emerging T-cell lymphoma caused by textured surface breast implants placed either for reconstructive or cosmetic indications. Safety communications by the US Food and Drug Administration (FDA) in 2011, and annually since 2016, have cautioned about BIA-ALCL and textured breast implants including clinical presentation, prognosis, and treatment options, and subsequently increased public and physician awareness. This warning was based upon case…

Breast implant illness: diagnosis and management

Introduction Breast implant illness (BII) is a condition that is not well understood. It is represented by a cluster of symptoms that do not fit into any other classic disease diagnosis. It is not associated with abnormal physical or laboratory findings and is therefore looked on skeptically by some individuals. Recently, the US Food and Drug Administration (FDA), the major plastic surgery societies, and other health…

Reduction mammaplasty with inverted-T techniques

Access video lecture content for this chapter online at Elsevier eBooks+ Introduction Reduction mammaplasty remains one of the most sought-fafter operations among women with mammary hypertrophy. Since its inception over 100 years ago, techniques for reduction mammaplasty have expanded and there are now dozens that have been described. Techniques can vary, based on the orientation of the pedicle for transposition of the nipple–areolar complex, as well…

Short scar breast reduction

Access video content for this chapter online at Elsevier eBooks+ Introduction There have been many descriptions of various short scar approaches to breast reduction. They all have different advantages and disadvantages. This chapter will briefly review the various techniques, but we will concentrate on the superomedial pedicle vertical approach ( Fig. 8.1 ) because we have found it to be the best way for us to…

Prevention and management of complications following breast augmentation and mastopexy

Synopsis ■ Breast augmentation is one of the most commonly performed aesthetic procedures in the US and abroad. ■ Preoperative assessment should determine the appropriate approach including choice of implant, breast pocket (submuscular, subfascial, subglandular, subpectoral with dual plane) incision location (inframammary, periareolar, transaxillary, transumbilical) and the need to lower the inframammary fold. ■ Implant selection has expanded over the past few years to include many…

Mastopexy after massive weight loss

Synopsis ■ Patient selection and planning are key for optimal outcomes. ■ Dermal suspension, parenchymal reshaping, selective autoaugmentation technique has proven to be a safe and reliable breast reshaping technique in massive weight loss patients. ■ Breast reshaping can be safely performed in combination with other body contouring procedures in massive weight loss patients, but the order should be thought carefully to avoid distortion of the…

Augmentation mastopexy

Access video and video lecture content for this chapter online at Elsevier eBooks+ Introduction: a historical perspective Single-stage augmentation mastopexy was initially described more than 50 years ago by Regnault and Gonzalez-Ulloa. In 2003, Spear published Augmentation/mastopexy: “surgeon, beware” , warning plastic surgeons of the potential risks associated with combining these procedures, namely patient dissatisfaction and unpredictable outcomes. Since then, we and others have published large…

Autologous fat transfer: fundamental principles and application for breast augmentation

Access video lecture content for this chapter online at Elsevier eBooks+ History Breast enlargement by autologous fat transfer (AFT) makes sense. We have all had patients who asked us: “Doctor, why can’t you take from there and put it here?” The procedure was attempted more than a century ago, but it was the introduction of liposuction in the early 1980s that made it practical. Bircoll, in…

Primary breast augmentation with implants

Synopsis For a breast augmentation practice to advance and improve, its surgeon must constantly strive toward minimizing complications and reoperations, achieving predictable long-term results, and providing for a better experience for the patient. The surgeon must be attentive in the communication with the patient and adhere to certain principles, both during implant selection and surgery. These can be summarized by the “Principles of the five Ps”:…

Current status of breast implants

Introduction Breast augmentation is the most performed procedure in cosmetic surgery worldwide. Approximately 300,000 breast augmentations are carried out in the US alone every year. Given the importance of the breast in terms of identity, image, fashion and sexuality, it is not surprising that it is in such demand. So strong is the desire for enlargement that historically, prior to implant development, almost anything that could…

Preoperative assessment and planning of the aesthetic breast patient

Synopsis ■ Ensure thorough valuation of each patient’s individual goals and expectations. ■ Ensure a thorough medical history is completed with focus on the breast. ■ Examination should include physical exam, 3D imaging, and implant sizing. ■ Individualized systematic preoperative planning based on each patient’s unique choices and examination including incision choice, pocket selection, and implant selection. Introduction Breast augmentation continues to be one of the…

Pediatric burns

Access video content for this chapter online at Elsevier eBooks+ Introduction Burn care is a complex endeavor that requires the coordination of a multidisciplinary team to successfully manage a patient through the phases of resuscitation, critical illness, rehabilitation, reconstruction, and ultimately re-integration into family and society. When a child is burned, there are many additional considerations that will impact how care is delivered, unique to each…

Management of the burned face and neck

Access video content for this chapter online at Elsevier eBooks+ Introduction The new age of social media presence and identity places a far greater importance on the face and its appearance than ever before. Burns involving the face interfere with identity, aesthetics, and basic functions like speech and expression of thoughts and feelings. Certain structures like the lip and eyelid are irreplaceable, and there is no…

Extremity burn reconstruction

Introduction Burns are an avoidable disaster since most of them are preventable. The post-burn sequelae in the form of unsightly scars and contractures could be functionally disabling and prevent the victims from integrating back into society. Proper primary care could reduce the morbidity. Burn care is one field where there is wide gap in service delivery in different healthcare systems. The situation is poignant since the…