Plastic Surgery: Volume 5: Breast (Plastic Surgery, 5)

✍ Scribed by Maurice Y Nahabedian MD FACS, Peter C. Neligan MB FRCS(I) FRCSC FACS

• Publisher: Elsevier
• Year: 2023
• Tongue: English
• Leaves: 754
• Edition: 5
• Category: Library

✦ Synopsis

Comprehensive and fully up to date, the six-volume Plastic Surgery remains the gold standard text in this complex area of surgery. Completely revised to meet the demands of both the trainee and experienced surgeon, Breast, Volume 5 of Plastic Surgery, 5th Edition, features new, full-color clinical photos, procedural videos, lectures, and authoritative coverage of hot topics in the field. Editor-narrated video presentations offer a step-by-step audio-visual walkthrough of techniques and procedures.

• New chapters cover composite breast augmentation (fat and implants), mastopexy after massive weight loss, breast implant illness, and management options for gender affirmation surgery of the breast; coverage throughout includes new, pioneering translational work shaping the future of breast plastic surgery. 

• New digital video preface by Dr. Peter C. Neligan addresses the changes across all six volumes. 

• New treatment and decision-making algorithms added to chapters where applicable. 

• New video lectures and editor-narrated slide presentations offer a step-by-step audiovisual walkthrough of techniques and procedures.  

• Evidence-based advice from an expanded roster of international experts allows you to apply the very latest advances in breast plastic surgery and ensure optimal outcomes. 

• Purchase this volume individually or own the entire set, with the ability to search across all six volumes online! 

• An eBook version is included with purchase. The eBook allows you to access all of the text, figures and references, with the ability to search, customize your content, make notes and highlights, and have content read aloud. 

✦ Table of Contents

Any screen. Any time. Anywhere.
Plastic
Surgery
Copyright
Contents
Video Contents
Lecture Video Contents
Preface to the Fifth Edition
List of Editors
List of Contributors
Acknowledgments
Dedication
1
1 Preoperative assessment and planning of the aesthetic breast patient
Introduction
Patient factors
Medical history
Patient motivation
Body dysmorphic disorder
Body characteristics
Implant characteristics
Patient expectations and requests
Patient information and education
Implant factors
Pocket control
Physical exam
Implant selection
Pocket selection
Implant surface selection
Surgical factors
Superficial fascial system of the breast
Preoperative planning
Incision site
Marking
Conclusion
References
2
2 Current status of breast implants
Introduction
History of breast implants
Implant shape
Round vs. anatomical implants
Surface
Gel
Dimensionality
Projection point and volume distribution
Why are we told there is no difference between the devices?
Indications for anatomical implants
Natural look
Poor soft tissue envelope
Thoracic shape
Complex asymmetries
Pseudoptosis
Tight inframammary fold (IMF)/constricted breast
Secondary surgery
Indications for round implants: when anatomical implants are not necessary
Fuller look
Basic breast shape is good
Sportswomen
Secondary surgery
Complications of anatomical implants
BIA-ALCL
Late seroma
Implant rotation
Feel
Device fill in the modern era: the implant gel
The monobloc
Dual gel concept
Latest gel developments
Sixth generation device
Saline implants
The ideal implant
The implant surface
Summary
References
3
3 Primary breast augmentation with implants
Introduction
Indication
Patient selection
Patient consultation
Medical history
Patient motivation
Patient information and education
Patient expectations and requests
Patient examination and implant selection
Pre- and postoperative planning, implant selection and follow-up protocol (Fig. 3.1)
Patients’ satisfaction self-assessment of her breast, 1–10, prior to surgery
Breast tissue assessment and characteristics
Patient measurements
Implant choice
Implant selection
Operative technique
Preoperative planning and marking
In the OR
Anesthesia
Scrubbing and draping
Double-check of preoperative markings, local anesthetics
Surgical instruments
Surgery
1. Skin incision
2. Dissection through the deep dermis and subcutaneous fat
3. Identification of the major pectoral muscle
4. Entrance into the subpectoral space
5. Creation of the implant pocket
Subglandular implant placement
Dissection technique
6. Implant insertion
7. Wound closure
8. Bandaging
Pitfalls and how to address
Breast aplasia
Asymmetries
The lower constricted pole
Postoperative care
Summary
References
4
4 Autologous fat transfer: fundamental principles and application for breast augmentation
History
Principles of 3D tissue grafting
Blood supply
Recipient capacity
The fibrovascular recipient scaffold
The rate-limiting step
Percentage graft survival vs. percentage recipient site augmentation
Breast augmentation technique that abides by the recognized principles
Preparing the recipient
Factors improving the recipient
External volume expansion (EVE)
Internal expansion
Harvesting the graft
Preparing the graft
Grafting
Adjunctive procedures to improve breast augmentation
Incision-free flaps
Graft immobilization and passive expansion
Totally autologous breast augmentation case examples
Conclusion
References
5
5 Augmentation mastopexy
Introduction: a historical perspective
Pertinent Anatomy
Definition and classification of ptosis
Diagnosis, patient presentation, and counseling
Anatomic factors in augmentation mastopexy
Selecting the appropriate mastopexy incision
Pseudoptosis
Grade 1 Ptosis
Grade 2 Ptosis
Grade 3 Ptosis
Implant selection
One- versus two-stage augmentation mastopexy
Preoperative preparation
Treatment/surgical technique
Patient Markings
Setting the Stage
Step-By-Step Technique (Video 5.2)
Special considerations
Borderline Ptosis
Pseudoptosis
The Constricted Breast
Breast Asymmetry
Postoperative care
Complications and secondary procedures
Immediate Complications
Hematoma
Infection
Soft Tissue Concerns
Delayed Complications
Implant-Related
Tissue-Related
Outcomes
References
6
6 Mastopexy after massive weight loss
Introduction
Diagnosis/patient presentation
Patient selection
Surgical technique
Relevant anatomy
Preoperative markings
Surgical technique
Postoperative care
Outcomes, prognosis, and complications
Special considerations
Combined procedures
Secondary procedures
Conclusion
References
7
7 Prevention and management of complications following breast augmentation and mastopexy
Introduction
Breast augmentation – complications and revisional approach
Hematoma
Infection
Sensation changes
Deflation and implant rupture
Capsular contracture
Treatment of capsular contracture
Implant malposition
Treatment of malpositions
Wrinkling/rippling
Animation deformity
Anaplastic large cell lymphoma
Mastopexy – complications and revisions
Augmentation mastopexy – complications and revisions
Pseudoptosis, or bottoming-out
Re-lifting the breast with low breast and NAC
Waterfall deformity (Snoopy deformity)
Conclusion
References
8
8 Short scar breast reduction
Introduction
Breast reduction principles
Superomedial pedicle vertical breast reduction
Applied anatomy
Indications and contraindications
Preoperative Assessment
Preoperative planning (Video 8.2 )
Determination of new nipple position
Marking the upper breast border
Marking the level of the IMF
Marking the breast meridian
Marking the new nipple position
Design of the skin resection pattern
Areolar opening
Skin resection opening
Design of a superomedially based pedicle
Operative technique (see Video 8.2)
Positioning
Parenchymal resection
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
Complications
Scarring
Sensation
Breastfeeding
Puckers
Scar contracture
Nipple and areolar necrosis
Hematoma
Seroma
Infection
Wound-healing problems
Under-resection and bottoming out
Asymmetry
Summary
References
9
9 Reduction mammaplasty with inverted-T techniques
Introduction
Historical Perspective
Breast anatomy
The inverted-T skin pattern
Patient Selection
Markings
Treatment/surgical technique
The Bipedicle Techniques
Inferior Pedicle Technique
Markings
Surgical Technique
Outcomes
The Medial Pedicle
Markings
Surgical Technique
Outcomes
Superomedial Pedicle Technique
Markings
Surgical Technique
Outcomes
Central Mound Technique
Markings
Surgical Technique
Outcomes
Special circumstances
Reduction Mammaplasty and Radiation Therapy
Reduction Mammaplasty and Breast Asymmetry
Secondary Reduction Mammaplasty
Postoperative care
Complications
Conclusion
References
10
10 Breast implant illness: diagnosis and management
Introduction
ASIA syndrome and other silicone incompatibility syndromes
Science on trial: changing sources of medical information
Self-described symptoms in women with breast implants-BII
Current BII literature
Social media and BII
Current theories on the potential etiology of BII
Particle theories: silicones and heavy metals
Immunological theories
Bacterial theory
Illness anxiety disorders: somatization disorders
Treatment
Conclusion
References
11
11 Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL): diagnosis and management
Introduction
Lymphoma background
BIA-ALCL pathogenesis
Mechanical friction
Silicone implant shell particulate
Leachables
Bacteria/biofilms
Genetic predisposition
Epidemiology
Diagnosis and treatment
Staging
Clinical characteristics and outcomes
Setting research priorities
Medico-legal considerations
Reporting of cases
Conclusions
References
12
12 A critical analysis of irrigation solutions in breast surgery
Introduction
The breast is a clean-contaminated site
Biofilms and breast implants
History of breast pocket irrigation
Antibacterial solutions
Povidone-iodine
Triple-antibiotic solution
Hypochlorous acid
Chlorhexidine
In vitro analyses
Capsular contracture
In breast augmentation
In breast reconstruction
Skin and soft tissue infection
In breast augmentation
In breast reconstruction
Breast implant-associated ALCL
Conclusion
References
13
13 Imaging and surveillance in patients with breast implants
Introduction
Integrating HRUS into your plastic surgery practice
Selecting equipment that suits your needs: breast, body, face, and OR
The learning curve: recording your images, comparing to radiological reports and intra-operative findings
Informed consent
Adapting a practice to HRUS- timing: who and when, charging the patient or free?
Clinical studies of HRUS and breast implant evaluation
Conclusions
References
14
14 Breast implant explantation: indications and strategies to optimize aesthetic outcomes
Indications for breast explantation
Capsular contracture
Implant rupture
Implant exposure and infection
BIA-ALCL
Breast implant illness
Patient preference
Explantation techniques: capsule management
Capsulotomy
Partial capsulectomy
Total capsulectomy
Neopectoral pocket
En bloc capsulectomy
Explantation techniques: adjunctive aesthetic procedures
Mastopexy
Fat grafting
Autoaugmentation with flaps
Conclusion
References
15
15 Management strategies for gynecomastia
Introduction
Presentation
Etiology and diagnostic evaluation
Histopathological variations
Treatment
Surgical Tips And Tricks
Treatment Algorithms
Example Algorithm A: Bailey et al.8,29
Example Algorithm B: Waltho et al.6
Example Algorithm C: Holzmer et al.19
Outcomes
Pitfalls
Conclusions
References
16
16 Management options for gender affirmation surgery of the breast
Background
Gender identity and terminology
History
Gender-affirming mastectomy
Gender-affirming breast augmentation
Gender-affirming care
Standards of care
Best practices
General preoperative considerations
Gender-affirming mastectomy
Preoperative evaluation
General considerations
History and physical exam
Preoperative planning
Surgical technique
Periareolar mastectomy
Double-incision mastectomy with free nipple grafts
Postoperative care
Perioperative period
Complications
Long-term considerations
Gender-affirming breast augmentation
Preoperative evaluation
General considerations
History and physical exam
Preoperative planning
Surgical technique
Postoperative care
Perioperative period
Complications
Long-term considerations
Conclusions
References
17
17 Preoperative evaluation and planning for breast reconstruction following mastectomy
Introduction
Breast cancer history and considerations
Stage
Nipple-sparing mastectomy
Contralateral prophylactic mastectomy
Reconstructive options
Implant-based reconstruction
Autologous reconstruction
Radiation
Chemotherapy
Hormone and biologic therapies
Host factors
Health and nutrition status
Surgical history
Medications
Physical exam, photography, and preoperative imaging
Conclusions
References
18
18 Perfusion assessment techniques following mastectomy and reconstruction
Introduction
Perfusion imaging in implant-based breast reconstruction
History
Intra-operative use
Imaging in autologous tissue transfer
Verifying essential anatomy
Perforator mapping and selection
Assessing boundaries of perfusion
Conclusion
References
19
19 Introduction to prosthetic breast reconstruction
Introduction
Anaplastic large cell lymphoma
Breast implant illness
Acellular dermal matrix
Subpectoral placement of prosthetic devices
Prepectoral placement of prosthetic devices
Two-stage versus one-stage reconstruction
Conclusions
References
20
20 One- and two-stage prepectoral reconstruction with prosthetic devices
One-stage prepectoral reconstruction
Introduction
Indications for prepectoral DTI
Patient selection
Surgical technique
Incision location
Use of meshes
Complete wrap with a pre-shaped mesh
Complete wrap with flat sheet mesh
Anterior wrap with flat sheet mesh
Conclusions
Two-stage prepectoral reconstruction
History of prepectoral reconstruction
Indications and contraindications
Reconstructive contraindications
Oncologic contraindications
Multidisciplinary approach
Delayed reconstruction
Preoperative evaluations
Surgical technique
Prepectoral pocket management
Acellular dermal matrix insetting
Tissue expander insertion
Drain placement
Skin flap management
Implant selection
Expander to implant exchange
Aseptic conditions
Postoperative care
Management of complications
Fat grafting
Conclusions
References
21
21 One-stage dual-plane reconstruction with prosthetic devices
Introduction
Background
Direct-to-implant breast reconstruction
Preoperative considerations
Patient Selection
Patient Goals and Evaluation
Medical and Surgical History
Chemotherapy/Radiotherapy
Surgical planning (Table 21.1)
Ablative Technique
Oncologic Plan – Mastectomy Type and Incision
Plane for Reconstruction
Internal Support Matrices
Biologic
Synthetic
Implant Selection
Intraoperative technique: immediate subpectoral DTI reconstruction with ADM
Preoperative
Initial Inspection and Prosthesis Selection
Pocket Creation
Pectoralis Muscle Release
Pocket Creation and Adm Inset
Troubleshooting
Implant Placement and Closure
Implant Placement
Closure
Postoperative considerations
Postoperative Care
Outcomes
Complications
Skin Necrosis
Infection
Other Complications
Revisions and Refinements
Fat Grafting
Malposition
Capsular Contracture
Nipple-Specific Refinements
References
22
22 Two-stage dual-plane reconstruction with prosthetic devices
History
Current state of alloplastic breast reconstruction
The evolution of implant planes
Preoperative evaluation
General considerations
Patient history
Physical exam
Preoperative planning
One-stage versus two-stage reconstruction
Implant plane
Mastectomy technique
Tissue-expander selection
Support material
Dual-plane tissue-expander reconstruction
Preoperative markings and patient preparation
Surgical technique
Mastectomy
Pocket dissection
Expander and ADM insertion
Closure
Postoperative management
Immediate postoperative period
Expansion
Implant exchange
Preoperative planning
Timing
Implant choice
Expander evaluation
Surgical technique
Postoperative management
Complications
First-stage complications
Second-stage complications
Conclusions
References
23
23 Two-stage prosthetic reconstruction with total muscle coverage
Introduction
Preoperative counseling
Procedure selection
Surgical technique: two-stage reconstruction
Tissue-expander placement
Expansion Phase
Second Stage/Exchange Surgery
Implant Selection
Advantages/disadvantages
References
24
24 Skin reduction using “smile mastopexy” technique in breast reconstruction
Introduction
Surgical technique
Preoperative markings
Surgery
Postsurgical care
Second stage reconstruction
Results
Limitations
Conclusion
References
25
25 Management of complications of prosthetic breast reconstruction
Introduction
Predicting the risk of complications
Timing of complications
Managing complications
Hematoma
Risk factors and prevention
Presentation and management
Seroma
Risk factors
Prevention
Presentation and management
Mastectomy flap necrosis
Risk factors
Management and prevention
Infection
Microbiology
Risk factors and prevention
Presentation and management
Implant exposure
Implant rupture
Presentation and management
Aesthetic complications
Implant rippling and animation deformity
Animation deformity
Thin soft-tissue envelope
Implant-related issues
Implant malposition
Nipple malposition
Inadequate size or projection
Conclusion
References
26
26 Secondary refinement procedures following prosthetic breast reconstruction
Introduction
Autologous fat grafting
NAC repositioning
Animation deformity correction
Contralateral breast symmetrization in unilateral prosthetic breast reconstruction
Breast augmentation mammaplasty
Breast reduction mammaplasty
Reduction/augmentation-mastopexy
References
27
27 Introduction to autologous breast reconstruction with abdominal free flaps
Introduction
References
28
28 Breast reconstruction with the pedicle TRAM flap
Introduction
History
Anatomy
Initial markings
Surgical timing/preoperative planning
Patient selection
Surgical procedure
The “Bikini Inset” in delayed TRAM flaps in irradiated breasts (Video 28.4 )
TRAM flap modifications
Double-pedicled folded TRAM flap for a single mastectomy site
Bilateral pedicled stacked TRAM flaps (Fig. 28.9)
Prior abdominal surgeries and scars
TRAM flap delay
Additional flap modifications
Postoperative care
Outcomes, prognosis, risk factors, complications
Risk factors
Complications
Recipient site
Donor site
Secondary procedures
References
29
29 Breast reconstruction with the latissimus dorsi flap
Introduction
Operative strategy
Historical perspective
Anatomy
Patient marking
Delayed breast reconstruction: marking
Immediate breast reconstruction: marking
Surgical technique
Patient positioning
Defect preparation
Flap elevation
Pedicle identification
Flap inset
Device placement
Skin island inset
Delayed breast reconstruction
Immediate breast reconstruction
Final closure: postoperative care
Second stage reconstruction
Immediate breast reconstruction
Delayed breast reconstruction
Autologous reconstruction
Lumpectomy reconstruction
Revision reconstruction
Complications
Persistent seroma
Flap necrosis
Capsular contracture
Persistent breast animation
Contour irregularity
Summary
References
30
30 Autologous breast reconstruction with the DIEP flap
Introduction
History
Patient selection
Choosing the recipient vessels
Anatomy of internal mammary vessels
Vascular anatomy and relevance to lower abdominal tissue transfer
Perfusion zones
Perforator mapping
Ultrasonography
Angiography
Thermal imaging
Perforator selection
Strategies to maximize flap volume
Enhanced recovery after surgery
Preoperative preparation
Preoperative marking
Operative setup
Preparation and draping
Surgical technique
Flap elevation
Suprafascial dissection
Intramuscular dissection
Submuscular dissection
Recipient vessel dissection
Microvascular flap transfer (see Videos 30.4 & 30.5 )
Closure of the donor site and fashioning of the umbilicus
Flap orientation, inset, and shaping
Flap orientation
Flap inset and shaping
Footprint
Conus shaping
Skin envelope
Advances in DIEP breast reconstruction
Sensory restoration
Vascularized lymph node transfer
Minimally invasive approaches to flap harvest
Postoperative care
Complications
Secondary surgical procedures
Conclusion
References
31
31 Autologous breast reconstruction with the free TRAM flap
Introduction
Basic science/anatomy
Fat layer, muscle and vessels of the lower abdomen
Structure of the free TRAM flap
Superficial inferior epigastric vein and dominance of the venous drainage system
Midline cross-over vessels
Recipient vessels in breast reconstruction
Patient selection
Preoperative planning using angiography
Surgical technique
Preoperative marking
Flap elevation
Donor closure
Microanastomosis
Inset of the flap
Delayed breast reconstruction
Utility of indocyanine green infrared fluorescence angiography
Postoperative care
Complications
Recipient site
Donor site
Conclusion
References
32
32 Autologous breast reconstruction with the superficial inferior epigastric artery (SIEA) flap
Introduction
Preoperative evaluation and indications
Pre-surgical preparation
SIEA flap elevation
Recipient vessel preparation
Flap inset
Flap monitoring
Postoperative care
References
33
33 Introduction to autologous reconstruction with alternative free flaps
Introduction
Gluteal perforator flaps
Medial thigh flaps
Posterior thigh flaps
Lumbar artery perforator flap
Clinical review
References
34
34 Gluteal free flaps for breast reconstruction
Introduction
History
Patient selection and considerations
Preoperative perforator mapping
Operative approach (Videos 34.1 & 34.2 )
Patient markings and flap harvest
Anastomosis and flap inset
Postoperative care
Immediate
Revision surgery
Complications and management
Early (0–3 months)
Late (>3 months)
Conclusion
References
35
35 Autologous breast reconstruction with medial thigh flaps
Introduction
History
Basic science/disease process
Diagnosis/patient presentation
Patient selection
Treatment/surgical technique
Patient positioning
Flap harvest
Step 1: caudal incision with fat recruitment
Step 2: anterior flap elevation (see Videos 35.1 & 35.2 )
Step 3: division of distal gracilis
Step 4: elevation of posterior flap
Step 5: division of proximal gracilis
Step 6: pedicle dissection and flap detachment
Step 7: flap molding and inset
Step 8: Microsurgery
Postoperative care
Outcomes, prognosis, complications
Double TUG flaps for one breast
Flap orientation
Anastomotic sites
Secondary procedures: TUG plus…
Lipofilling
Implant
DIEP and TUG flaps for one breast
References
36
36 Autologous breast reconstruction with the profunda artery perforator (PAP) flap
Introduction
Historical perspective
Basic science/anatomy
Patient selection
Surgical technique
Postoperative care
Outcomes and complications
Secondary procedures
Trends/alterations
Conclusion
References
37
37 Autologous reconstruction with the lumbar artery perforator (LAP) free flap
Introduction
Historical perspective
The lumbar artery perforator (LAP) flap anatomy
Recipient vessels
Interposition graft
Patient selection
Donor site
CT imaging
Surgical technique
Preoperative marking
Operative procedure
Shaping of the lumbar flap
Postoperative care
Outcome, prognosis and complications
Conclusion
References
38
38 Hybrid breast reconstruction: combining flaps and implants
Introduction
Hybrid breast reconstruction
Plane of implant placement
Timing of implant placement
Radiation therapy
Surgical technique: immediate hybrid breast reconstruction
Summary
References
39
39 Innervation of autologous flaps
Introduction
Breast sensation anatomy
Understanding nerve anatomy and physiology
Neurotization techniques
Innervated implant-based reconstruction
Outcomes
Future directions
References
40
40 Stacked and conjoined flaps
Introduction
Patient selection and preoperative assessment
Surgical technique
Flap harvest
DIEP flap
LAP flap
PAP flap
Recipient site preparation
Microsurgery
Inset
Postoperative care
Outcomes
Conclusions
References
41
41 Management of complications following autologous breast reconstruction
Introduction
Systemic complications
Breast complications
Mastectomy flap necrosis
Total flap failure
Partial flap failure
Fat necrosis
Donor site complications
Early complications
Late complications
Preventing complications
DIEP flap perforator selection
DIEP flap zone selection
Venous outflow enhancement
Conclusion
References
42
42 Enhanced recovery after surgery (ERAS) protocols in breast surgery: techniques and outcomes
Introduction
What is pain?
Opioids
ERAS
Components of an ERAS protocol
Preoperative optimization
Multimodal analgesia
Local anesthesia
Liposomes and other adjuvants
Surgical-site infiltration
Regional blocks
Transversus abdominis plane blocks
Technique
Outcomes
Complications
Breast blocks (PECS I, PECS II, SAP, intercostal nerve)
Pectoralis (PECS I) block technique
Modified pectoralis (PECS II) block technique
Serratus anterior plane (SAP) block technique
Intercostal nerve block technique
Outcomes
Complications
Paravertebral blocks and epidural analgesia
Technique
Outcomes
Complications
Anesthesia ERAS considerations
Summary
References
43
43 Secondary procedures following autologous reconstruction
Introduction
Timing of secondary procedures
Treatment algorithm for secondary procedures
Procedure planning
Procedures
Correction of volume discrepancies and shaping of the flap
Correction of contour and structural irregularities
Surgical tools for refining volume and contour abnormalities
Autologous fat grafting (AFG)
Liposuction
Direct tissue excision
Implant augmentation
NAC (nipple–areolar complex) reconstruction
Symmetrization of the contralateral breast
Mastopexy
Reduction mammoplasty
Breast augmentation
Augmentation/mastopexy
Corrections to donor site
Concurrent procedures with secondary procedures
Conclusion
References
44
44 Introduction to oncoplastic breast surgery
Introduction
Safety and efficacy of oncoplastic surgery
Immediate reconstruction of the partial mastectomy deformity
Volume displacement techniques
Reduction mammaplasty
Adjacent tissue rearrangement
Volume replacement techniques
Local and remote flaps
Implantable devices
Clinical outcomes
Conclusions
References
45
45 Partial breast reconstruction using reduction and mastopexy techniques
Introduction
Patient presentation/selection
Surgical technique
Benefits
Timing
Management of positive margins
Outcomes
Surveillance postoperative care
Conclusion
References
46
46 Oncoplastic breast reconstruction: local flap techniques
Introduction
Historical perspective
Indications
Contraindications
Anatomy
Classification
Surgical technique
Evaluation of volume deficit and location
Flap design (Fig.46.3 A–C)
Flap elevation
Flap transfer
Flap insetting
Conventional TDAP flap (see Fig. 46.3 & 46.4)
Propeller TDAP (Fig. 46.5)
Secondary procedures
TDAP lipofilling
Stacked TDAP
References
47
47 Surgical and non-surgical management of breast cancer-related lymphedema
Introduction
Historical perspective
Basic science
Clinical evaluation
Non-surgical treatment
Complete decongestive therapy
Pneumatic compression therapy
Laser therapy
Diagnostic imaging
ICG-lymphography
Lymphoscintigraphy
MR-lymphography
CT-angiography
Preoperative patient selection
Surgical treatments
Immediate lymphatic reconstruction
Lymphovenous bypass (LVB) (Video 47.1 )
Vascularized lymph node transplant (Video 47.2 )
Liposuction
Conclusion
References
48
48 Breast reconstruction and radiotherapy: indications, techniques, and outcomes
Introduction
Radiotherapy in breast cancer
Radiotherapy administration methods
Radiotherapy doses and fractionation
Radiotherapy and breast-conserving surgery
Radiotherapy and mastectomy
Effects of radiotherapy on chest wall tissues
Partial breast reconstruction and radiotherapy
Techniques
Indications
Timing
Management of post-radiation deformities
Management of the contralateral breast
Breast reconstruction and postmastectomy radiotherapy
Timing
Autologous tissue-based reconstruction
Technique
Outcomes
Implant-based reconstruction
Technique
Outcomes
Hybrid reconstruction
Technique
Outcomes
Management of the contralateral breast
Nipple–areola complex reconstruction
Breast reconstruction in pre-irradiated tissue
Autologous tissue-based reconstruction
Implant-based reconstruction
Hybrid reconstruction
Fat grafting
Breast reconstruction with autologous fat graft alone
Breast reconstruction with autologous fat graft and implant
Conclusion
References
49
49 Robotic-assisted autologous breast reconstruction
Introduction
Robotic-assisted latissimus dorsi harvest (RALDH)
Surgical anatomy of the latissimus dorsi muscle flap
Patient selection
Breast reconstruction protocol
Operative procedure
Positioning and defining landmarks
Incision and port locations
Robotic docking and dissection
Undocking and extraction of the muscle
Postoperative care
Clinical cases and outcomes
The RoboDIEP: robotic-assisted deep inferior epigastric perforator flaps for breast reconstruction
Surgical anatomy of the DIEP flap
Patient selection
Operative procedure
Positioning and defining landmarks
Incision and port locations
Robotic docking and dissection
Flap extraction and closure
Postoperative care
Clinical outcomes
Limitations
Conclusion
References
50
50 Total breast reconstruction by external vacuum expansion (EVE) and autologous fat transfer (AFT)
Introduction
Indications
Contraindications
Fundamental principles and basis for the technique
Basic concepts of fat grafting
The surgery
The seeds: liposuction/fat harvest and graft preparation
Preoperative evaluation of graft volume needed
Donor site marking
The harvesting
Graft processing
The “soil”: EVE treatment protocol and recipient site preparation
The “sowing”: micrografting fat particle in 3D
Graft evenly
Graft while moving the cannula
Loosen/release the scars
The “support”: post-graft treatment
Complementary procedures: the reverse abdominoplasty and fat transfer (RAFT)
RAFT suture insertion and flap dissection technique
Complications and risks of the procedure
Case examples
Immediate reconstruction
Delayed reconstruction
Conclusion*
References
51
51 Current options for nipple reconstruction
Introduction
General principles
Anatomy
Preoperative planning
Nipple–areolar complex preservation
Surgical techniques
Areolar reconstruction
Nipple reconstruction
Nipple graft
Local flaps
Nipple projection
Tissue engineering
Autologous augmentation
Alloplastic augmentation
Allograft augmentation
3D tattooing
Conclusion
References
Confidence is ClinicalKey