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Cranioplasty

Cranioplasty is performed to restore the integrity and appearance of the skull. This most often involves the reconstruction of full-thickness skeletal defects. Cranioplasty may also be performed to normalize or to improve the contours of the intact cranium, usually the frontal area, and hence the appearance of the upper third of the face. Acquired cranial bone deformities are usually full-thickness defects of the skull. In these…

Principles and operative technique for facial skeletal augmentation

This chapter presents the principles and basic steps of the senior author’s operative technique for implant augmentation of the facial skeleton. Preparation In anticipation of implant surgery, steps to minimize the likelihood of infection are taken. To facilitate intraoperative hemostasis, patients are instructed to discontinue any medications or foods that compromise the blood clotting system. To optimize intraoral hygiene, a professional dental examination and cleaning may…

Implant materials

The craniofacial skeleton can be reconstructed with both autogenous bone and alloplastic implants. Alloplastic implants are used only as onlay grafts to the native skeleton to improve facial contour and to replace missing portions of the non-load-bearing cranial vault and internal orbit. Autogenous bone may be used for these purposes, but is more suited to replace segmental, load-bearing defects of the facial skeleton. Virtually all aesthetic…

Evaluation and planning for facial implant surgery

Physical examination is the most important element of preoperative assessment and planning for both reconstructive and cosmetic procedures. Reviewing photographic images with the patient can be helpful when discussing aesthetic concerns and goals. All faces are asymmetric. Asymmetries are usually subtle but, with sufficient scrutiny, detectable ( Fig. 2.1 ). Open full size image Fig. 2.1 To demonstrate the asymmetry in a “normal” face, a photograph…

Indications for facial implants

The shape of the human face is composed of a skeletal bony framework that is covered by a soft tissue envelope. Overall, skeletal proportions are probably the most important component of facial attractiveness. Fritz E. Barton Jr., 2009 Since the skeletal infrastructure of the human face is fundamental to its appearance, its surgical change can be powerful. Conceptually, autogenous bone would be the best material to…

Transgender Breast Surgery (Male-to-Female and Female-to-Male)

Introduction Gender dysphoria, quite often referred to as gender identity disorder, is defined by an individual’s persistent discomfort with his or her own assigned sex. Individuals with gender identity disorder have a desire to live as members of the opposite sex and therefore often modify their primary and secondary sexual characteristics. Today there are many surgical and medical options for transsexual patients to transition into their…

Correction of Congenital Breast Asymmetry

Introduction Congenital breast asymmetry can be relatively common among young women. , Although tuberous breast deformity, Poland syndrome, and structural chest wall deformities can be considered reconstructive, less extensive congenital breast asymmetry is typically corrected as a cosmetic breast procedure. This chapter will focus only on correction of congenital breast asymmetry for young women who are seeking correction of their breast asymmetry for aesthetic reasons. Often,…

Correction of Gynecomastia

Introduction Gynecomastia is defined as benign glandular enlargement of the male breast, its hallmark location being a concentric mass directly beneath the nipple. , It can consist of various proportions of excess subareolar fibrous breast and adipose tissue peripherally, and its extent depends on the individual’s body habitus. By contrast, pseudogynecomastia is enlargement of adipose tissue of the male breast. Gynecomastia is by far the most…

Breast Reshaping With an Inferior Parenchymal Flap

Introduction Breast reduction and breast lift are widely performed procedures, with over 100,969 surgeries reported by American Society of Plastic Surgeons members in 2016. Patients seek surgery not only for the improvement of symptoms associated with macromastia but also because of concerns over the role of the breasts in body harmony and overall aesthetics. After surgery, patients report an improvement in the quality of their life,…

Breast Reshaping After Massive Weight Loss

Introduction With the ongoing rise of obesity in the United States a greater emphasis is placed on the importance of weight loss, diet, and exercise. A weight loss of more than 50 lb is classified as massive weight loss, and it can cause significant disfigurement and irregularities. Breasts are significantly affected by these changes. The loss of parenchymal volume combined with skin redundancy and loss of…

Breast Reduction—No Vertical Scar

Introduction Breast reduction surgery is not only about improving the quality of life of women with the symptoms of macromastia but also improving the patient’s perception of her own image. Although it is thought by surgeons that the horizontal scar is the scar that bothers most patients, when 66 prospective patients desiring reduction were asked to rate line drawings and postoperative photographs of all three reduction…

Breast Reduction—Inferior Pedicle Technique

Introduction Breast reduction can be performed for either functional or cosmetic reasons. Optimal size, shape, and symmetry and minimal scarring, as four primary goals, should be applied to any type of breast reduction; for example, the breasts after reduction should be as the patient desired and in proportion to the patient’s body habitus. The shape after breast reduction should be cosmetically pleasing and hopefully long-lasting. Symmetry…

Breast Reduction—Medial Pedicle Technique

Introduction Breast reduction can be performed for either functional or cosmetic reasons. Optimal size, shape, symmetry, and scarring, as four primary goals, should be applied to each type of breast reduction; for example, breast size after breast reduction should be as the patient desired and in proportion to the patient’s body habitus. The shape after breast reduction should be cosmetically pleasing and long-lasting. Although the exact…

Breast Reduction—Superior Pedicle Technique

Introduction Superior pedicle breast reduction is the authors’ technique of choice in patients who qualify for its use. Numerous advantages of this technique make it ideal for many patients. Advantages of the superior pedicle technique include a reliable vascular pedicle. The superior pedicle receives blood supply from the internal mammary vessels that branch at the second and/or third intercostal space and course to the nipple–areola complex…

Breast Augmentation and Mastopexy

Introduction One-stage breast augmentation combined with mastopexy is a challenging operation with numerous potential complications. Augmentation expands the breast volume, and mastopexy reduces the skin envelope; thus, these operations produce opposing forces when performed simultaneously. The combination of procedures as a single stage was initially described over 50 years ago. , However, augmentation mastopexy has been met with stark criticism in the literature by prominent plastic…

Mastopexy—Inverted T Approach

Introduction Breast ptosis is one of the most common issues seen for evaluation in a plastic surgeon’s office. It can be developmental or more commonly acquired, secondary to weight loss, hormonal changes, pregnancy, and aging. A mastopexy is reserved for a patient for whom the major concern is breast ptosis and not an issue of volume, because the procedure repositions the breast with only limited removal…

Mastopexy—Vertical Approach

Introduction Commonly, mastopexy is understood to be synonymous with “breast lift.” Among plastic surgeons, a mastopexy has been traditionally understood to mean a skin tightening procedure, certainly for a skin-only mastopexy. However, the goal of a mastopexy is improvement in the shape of the breast, not simply tightening of its elastic envelope. In ptotic breasts, the lower pole is usually reduced (i.e., parenchymal resection) to achieve…

Mastopexy—Periareolar Approach

Introduction Mastopexy is the surgical technique mostly employed for modification of volume, compaction, and repositioning of the breast mound. The harmonious combination of proportion, position, and projection requires a dermoglandular resection or, sometimes, exclusively skin resections, resulting in extensive scarring. The balance between breast shape and scarring has long posed a challenge to the plastic surgeon in search for lesser incisions that do not change the…

Revision Breast Augmentation With Posterior Capsular Flap Techniques

Introduction Complications continue to be a problem in breast implant surgery with the original prospective meta-analyses (PMAs) studies showing complications and revision rates as high as 30% ( Fig. 12.1 ). When a patient has one major complication or revision, their complication rates continue to increase to over 45% in most studies. I have written extensively about trying to establish standard terminology to classify these complications…

Revision Breast Augmentation—Capsular Contracture

Introduction Capsular contracture has for decades been the most common complication associated with aesthetic and reconstructive breast surgery. Although the exact mechanism or cause is still unclear, many causes have been implicated, the most feasible include hypertrophic scarring, the infectious theory, or potentially both. The hypertrophic theory implicates that either blood or seroma fluid surrounding a breast implant induces the capsular contracture, and the role of…