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

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Any screen. Any time. Anywhere.\nPlastic\rSurgery\nCopyright\nContents\nVideo Contents\nLecture Video Contents\nPreface to the Fifth Edition\nList of Editors\nList of Contributors\nAcknowledgments\nDedication\n1\n 1 Preoperative assessment and planning of the aesthetic breast patient\n Introduction\n Patient factors\n Medical history\n Patient motivation\n Body dysmorphic disorder\n Body characteristics\n Implant characteristics\n Patient expectations and requests\n Patient information and education\n Implant factors\n Pocket control\n Physical exam\n Implant selection\n Pocket selection\n Implant surface selection\n Surgical factors\n Superficial fascial system of the breast\n Preoperative planning\n Incision site\n Marking\n Conclusion\n References\n2\n 2 Current status of breast implants\n Introduction\n History of breast implants\n Implant shape\n Round vs. anatomical implants\n Surface\n Gel\n Dimensionality\n Projection point and volume distribution\n Why are we told there is no difference between the devices?\n Indications for anatomical implants\n Natural look\n Poor soft tissue envelope\n Thoracic shape\n Complex asymmetries\n Pseudoptosis\n Tight inframammary fold (IMF)/constricted breast\n Secondary surgery\n Indications for round implants: when anatomical implants are not necessary\n Fuller look\n Basic breast shape is good\n Sportswomen\n Secondary surgery\n Complications of anatomical implants\n BIA-ALCL\n Late seroma\n Implant rotation\n Feel\n Device fill in the modern era: the implant gel\n The monobloc\n Dual gel concept\n Latest gel developments\n Sixth generation device\n Saline implants\n The ideal implant\n The implant surface\n Summary\n References\n3\n 3 Primary breast augmentation with implants\n Introduction\n Indication\n Patient selection\n Patient consultation\n Medical history\n Patient motivation\n Patient information and education\n Patient expectations and requests\n Patient examination and implant selection\n Pre- and postoperative planning, implant selection and follow-up protocol (Fig. 3.1)\n Patients’ satisfaction self-assessment of her breast, 1–10, prior to surgery\n Breast tissue assessment and characteristics\n Patient measurements\n Implant choice\n Implant selection\n Operative technique\n Preoperative planning and marking\n In the OR\n Anesthesia\n Scrubbing and draping\n Double-check of preoperative markings, local anesthetics\n Surgical instruments\n Surgery\n 1. Skin incision\n 2. Dissection through the deep dermis and subcutaneous fat\n 3. Identification of the major pectoral muscle\n 4. Entrance into the subpectoral space\n 5. Creation of the implant pocket\n Subglandular implant placement\n Dissection technique\n 6. Implant insertion\n 7. Wound closure\n 8. Bandaging\n Pitfalls and how to address\n Breast aplasia\n Asymmetries\n The lower constricted pole\n Postoperative care\n Summary\n References\n4\n 4 Autologous fat transfer: fundamental principles and application for breast augmentation\n History\n Principles of 3D tissue grafting\n Blood supply\n Recipient capacity\n The fibrovascular recipient scaffold\n The rate-limiting step\n Percentage graft survival vs. percentage recipient site augmentation\n Breast augmentation technique that abides by the recognized principles\n Preparing the recipient\n Factors improving the recipient\n External volume expansion (EVE)\n Internal expansion\n Harvesting the graft\n Preparing the graft\n Grafting\n Adjunctive procedures to improve breast augmentation\n Incision-free flaps\n Graft immobilization and passive expansion\n Totally autologous breast augmentation case examples\n Conclusion\n References\n5\n 5 Augmentation mastopexy\n Introduction: a historical perspective\n Pertinent Anatomy\n Definition and classification of ptosis\n Diagnosis, patient presentation, and counseling\n Anatomic factors in augmentation mastopexy\n Selecting the appropriate mastopexy incision\n Pseudoptosis\n Grade 1 Ptosis\n Grade 2 Ptosis\n Grade 3 Ptosis\n Implant selection\n One- versus two-stage augmentation mastopexy\n Preoperative preparation\n Treatment/surgical technique\n Patient Markings\n Setting the Stage\n Step-By-Step Technique (Video 5.2)\n Special considerations\n Borderline Ptosis\n Pseudoptosis\n The Constricted Breast\n Breast Asymmetry\n Postoperative care\n Complications and secondary procedures\n Immediate Complications\n Hematoma\n Infection\n Soft Tissue Concerns\n Delayed Complications\n Implant-Related\n Tissue-Related\n Outcomes\n References\n6\n 6 Mastopexy after massive weight loss\n Introduction\n Diagnosis/patient presentation\n Patient selection\n Surgical technique\n Relevant anatomy\n Preoperative markings\n Surgical technique\n Postoperative care\n Outcomes, prognosis, and complications\n Special considerations\n Combined procedures\n Secondary procedures\n Conclusion\n References\n7\n 7 Prevention and management of complications following breast augmentation and mastopexy\n Introduction\n Breast augmentation – complications and revisional approach\n Hematoma\n Infection\n Sensation changes\n Deflation and implant rupture\n Capsular contracture\n Treatment of capsular contracture\n Implant malposition\n Treatment of malpositions\n Wrinkling/rippling\n Animation deformity\n Anaplastic large cell lymphoma\n Mastopexy – complications and revisions\n Augmentation mastopexy – complications and revisions\n Pseudoptosis, or bottoming-out\n Re-lifting the breast with low breast and NAC\n Waterfall deformity (Snoopy deformity)\n Conclusion\n References\n8\n 8 Short scar breast reduction\n Introduction\n Breast reduction principles\n Superomedial pedicle vertical breast reduction\n Applied anatomy\n Indications and contraindications\n Preoperative Assessment\n Preoperative planning (Video 8.2 )\n Determination of new nipple position\n Marking the upper breast border\n Marking the level of the IMF\n Marking the breast meridian\n Marking the new nipple position\n Design of the skin resection pattern\n Areolar opening\n Skin resection opening\n Design of a superomedially based pedicle\n Operative technique (see Video 8.2)\n Positioning\n Parenchymal resection\n Insetting of the pedicle\n Closure of the pillars\n Closure of the dermis\n Liposuction\n Closure of the skin\n Intraoperative and postoperative care\n Drains\n Bandaging and taping\n Recovery\n Complications\n Scarring\n Sensation\n Breastfeeding\n Puckers\n Scar contracture\n Nipple and areolar necrosis\n Hematoma\n Seroma\n Infection\n Wound-healing problems\n Under-resection and bottoming out\n Asymmetry\n Summary\n References\n9\n 9 Reduction mammaplasty with inverted-T techniques\n Introduction\n Historical Perspective\n Breast anatomy\n The inverted-T skin pattern\n Patient Selection\n Markings\n Treatment/surgical technique\n The Bipedicle Techniques\n Inferior Pedicle Technique\n Markings\n Surgical Technique\n Outcomes\n The Medial Pedicle\n Markings\n Surgical Technique\n Outcomes\n Superomedial Pedicle Technique\n Markings\n Surgical Technique\n Outcomes\n Central Mound Technique\n Markings\n Surgical Technique\n Outcomes\n Special circumstances\n Reduction Mammaplasty and Radiation Therapy\n Reduction Mammaplasty and Breast Asymmetry\n Secondary Reduction Mammaplasty\n Postoperative care\n Complications\n Conclusion\n References\n10\n 10 Breast implant illness: diagnosis and management\n Introduction\n ASIA syndrome and other silicone incompatibility syndromes\n Science on trial: changing sources of medical information\n Self-described symptoms in women with breast implants-BII\n Current BII literature\n Social media and BII\n Current theories on the potential etiology of BII\n Particle theories: silicones and heavy metals\n Immunological theories\n Bacterial theory\n Illness anxiety disorders: somatization disorders\n Treatment\n Conclusion\n References\n11\n 11 Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL): diagnosis and management\n Introduction\n Lymphoma background\n BIA-ALCL pathogenesis\n Mechanical friction\n Silicone implant shell particulate\n Leachables\n Bacteria/biofilms\n Genetic predisposition\n Epidemiology\n Diagnosis and treatment\n Staging\n Clinical characteristics and outcomes\n Setting research priorities\n Medico-legal considerations\n Reporting of cases\n Conclusions\n References\n12\n 12 A critical analysis of irrigation solutions in breast surgery\n Introduction\n The breast is a clean-contaminated site\n Biofilms and breast implants\n History of breast pocket irrigation\n Antibacterial solutions\n Povidone-iodine\n Triple-antibiotic solution\n Hypochlorous acid\n Chlorhexidine\n In vitro analyses\n Capsular contracture\n In breast augmentation\n In breast reconstruction\n Skin and soft tissue infection\n In breast augmentation\n In breast reconstruction\n Breast implant-associated ALCL\n Conclusion\n References\n13\n 13 Imaging and surveillance in patients with breast implants\n Introduction\n Integrating HRUS into your plastic surgery practice\n Selecting equipment that suits your needs: breast, body, face, and OR\n The learning curve: recording your images, comparing to radiological reports and intra-operative findings\n Informed consent\n Adapting a practice to HRUS- timing: who and when, charging the patient or free?\n Clinical studies of HRUS and breast implant evaluation\n Conclusions\n References\n14\n 14 Breast implant explantation: indications and strategies to optimize aesthetic outcomes\n Indications for breast explantation\n Capsular contracture\n Implant rupture\n Implant exposure and infection\n BIA-ALCL\n Breast implant illness\n Patient preference\n Explantation techniques: capsule management\n Capsulotomy\n Partial capsulectomy\n Total capsulectomy\n Neopectoral pocket\n En bloc capsulectomy\n Explantation techniques: adjunctive aesthetic procedures\n Mastopexy\n Fat grafting\n Autoaugmentation with flaps\n Conclusion\n References\n15\n 15 Management strategies for gynecomastia\n Introduction\n Presentation\n Etiology and diagnostic evaluation\n Histopathological variations\n Treatment\n Surgical Tips And Tricks\n Treatment Algorithms\n Example Algorithm A: Bailey et al.8,29\n Example Algorithm B: Waltho et al.6\n Example Algorithm C: Holzmer et al.19\n Outcomes\n Pitfalls\n Conclusions\n References\n16\n 16 Management options for gender affirmation surgery of the breast\n Background\n Gender identity and terminology\n History\n Gender-affirming mastectomy\n Gender-affirming breast augmentation\n Gender-affirming care\n Standards of care\n Best practices\n General preoperative considerations\n Gender-affirming mastectomy\n Preoperative evaluation\n General considerations\n History and physical exam\n Preoperative planning\n Surgical technique\n Periareolar mastectomy\n Double-incision mastectomy with free nipple grafts\n Postoperative care\n Perioperative period\n Complications\n Long-term considerations\n Gender-affirming breast augmentation\n Preoperative evaluation\n General considerations\n History and physical exam\n Preoperative planning\n Surgical technique\n Postoperative care\n Perioperative period\n Complications\n Long-term considerations\n Conclusions\n References\n17\n 17 Preoperative evaluation and planning for breast reconstruction following mastectomy\n Introduction\n Breast cancer history and considerations\n Stage\n Nipple-sparing mastectomy\n Contralateral prophylactic mastectomy\n Reconstructive options\n Implant-based reconstruction\n Autologous reconstruction\n Radiation\n Chemotherapy\n Hormone and biologic therapies\n Host factors\n Health and nutrition status\n Surgical history\n Medications\n Physical exam, photography, and preoperative imaging\n Conclusions\n References\n18\n 18 Perfusion assessment techniques following mastectomy and reconstruction\n Introduction\n Perfusion imaging in implant-based breast reconstruction\n History\n Intra-operative use\n Imaging in autologous tissue transfer\n Verifying essential anatomy\n Perforator mapping and selection\n Assessing boundaries of perfusion\n Conclusion\n References\n19\n 19 Introduction to prosthetic breast reconstruction\n Introduction\n Anaplastic large cell lymphoma\n Breast implant illness\n Acellular dermal matrix\n Subpectoral placement of prosthetic devices\n Prepectoral placement of prosthetic devices\n Two-stage versus one-stage reconstruction\n Conclusions\n References\n20\n 20 One- and two-stage prepectoral reconstruction with prosthetic devices\n One-stage prepectoral reconstruction\n Introduction\n Indications for prepectoral DTI\n Patient selection\n Surgical technique\n Incision location\n Use of meshes\n Complete wrap with a pre-shaped mesh\n Complete wrap with flat sheet mesh\n Anterior wrap with flat sheet mesh\n Conclusions\n Two-stage prepectoral reconstruction\n History of prepectoral reconstruction\n Indications and contraindications\n Reconstructive contraindications\n Oncologic contraindications\n Multidisciplinary approach\n Delayed reconstruction\n Preoperative evaluations\n Surgical technique\n Prepectoral pocket management\n Acellular dermal matrix insetting\n Tissue expander insertion\n Drain placement\n Skin flap management\n Implant selection\n Expander to implant exchange\n Aseptic conditions\n Postoperative care\n Management of complications\n Fat grafting\n Conclusions\n References\n21\n 21 One-stage dual-plane reconstruction with prosthetic devices\n Introduction\n Background\n Direct-to-implant breast reconstruction\n Preoperative considerations\n Patient Selection\n Patient Goals and Evaluation\n Medical and Surgical History\n Chemotherapy/Radiotherapy\n Surgical planning (Table 21.1)\n Ablative Technique\n Oncologic Plan – Mastectomy Type and Incision\n Plane for Reconstruction\n Internal Support Matrices\n Biologic\n Synthetic\n Implant Selection\n Intraoperative technique: immediate subpectoral DTI reconstruction with ADM\n Preoperative\n Initial Inspection and Prosthesis Selection\n Pocket Creation\n Pectoralis Muscle Release\n Pocket Creation and Adm Inset\n Troubleshooting\n Implant Placement and Closure\n Implant Placement\n Closure\n Postoperative considerations\n Postoperative Care\n Outcomes\n Complications\n Skin Necrosis\n Infection\n Other Complications\n Revisions and Refinements\n Fat Grafting\n Malposition\n Capsular Contracture\n Nipple-Specific Refinements\n References\n22\n 22 Two-stage dual-plane reconstruction with prosthetic devices\n History\n Current state of alloplastic breast reconstruction\n The evolution of implant planes\n Preoperative evaluation\n General considerations\n Patient history\n Physical exam\n Preoperative planning\n One-stage versus two-stage reconstruction\n Implant plane\n Mastectomy technique\n Tissue-expander selection\n Support material\n Dual-plane tissue-expander reconstruction\n Preoperative markings and patient preparation\n Surgical technique\n Mastectomy\n Pocket dissection\n Expander and ADM insertion\n Closure\n Postoperative management\n Immediate postoperative period\n Expansion\n Implant exchange\n Preoperative planning\n Timing\n Implant choice\n Expander evaluation\n Surgical technique\n Postoperative management\n Complications\n First-stage complications\n Second-stage complications\n Conclusions\n References\n23\n 23 Two-stage prosthetic reconstruction with total muscle coverage\n Introduction\n Preoperative counseling\n Procedure selection\n Surgical technique: two-stage reconstruction\n Tissue-expander placement\n Expansion Phase\n Second Stage/Exchange Surgery\n Implant Selection\n Advantages/disadvantages\n References\n24\n 24 Skin reduction using “smile mastopexy” technique in breast reconstruction\n Introduction\n Surgical technique\n Preoperative markings\n Surgery\n Postsurgical care\n Second stage reconstruction\n Results\n Limitations\n Conclusion\n References\n25\n 25 Management of complications of prosthetic breast reconstruction\n Introduction\n Predicting the risk of complications\n Timing of complications\n Managing complications\n Hematoma\n Risk factors and prevention\n Presentation and management\n Seroma\n Risk factors\n Prevention\n Presentation and management\n Mastectomy flap necrosis\n Risk factors\n Management and prevention\n Infection\n Microbiology\n Risk factors and prevention\n Presentation and management\n Implant exposure\n Implant rupture\n Presentation and management\n Aesthetic complications\n Implant rippling and animation deformity\n Animation deformity\n Thin soft-tissue envelope\n Implant-related issues\n Implant malposition\n Nipple malposition\n Inadequate size or projection\n Conclusion\n References\n26\n 26 Secondary refinement procedures following prosthetic breast reconstruction\n Introduction\n Autologous fat grafting\n NAC repositioning\n Animation deformity correction\n Contralateral breast symmetrization in unilateral prosthetic breast reconstruction\n Breast augmentation mammaplasty\n Breast reduction mammaplasty\n Reduction/augmentation-mastopexy\n References\n27\n 27 Introduction to autologous breast reconstruction with abdominal free flaps\n Introduction\n References\n28\n 28 Breast reconstruction with the pedicle TRAM flap\n Introduction\n History\n Anatomy\n Initial markings\n Surgical timing/preoperative planning\n Patient selection\n Surgical procedure\n The “Bikini Inset” in delayed TRAM flaps in irradiated breasts (Video 28.4 )\n TRAM flap modifications\n Double-pedicled folded TRAM flap for a single mastectomy site\n Bilateral pedicled stacked TRAM flaps (Fig. 28.9)\n Prior abdominal surgeries and scars\n TRAM flap delay\n Additional flap modifications\n Postoperative care\n Outcomes, prognosis, risk factors, complications\n Risk factors\n Complications\n Recipient site\n Donor site\n Secondary procedures\n References\n29\n 29 Breast reconstruction with the latissimus dorsi flap\n Introduction\n Operative strategy\n Historical perspective\n Anatomy\n Patient marking\n Delayed breast reconstruction: marking\n Immediate breast reconstruction: marking\n Surgical technique\n Patient positioning\n Defect preparation\n Flap elevation\n Pedicle identification\n Flap inset\n Device placement\n Skin island inset\n Delayed breast reconstruction\n Immediate breast reconstruction\n Final closure: postoperative care\n Second stage reconstruction\n Immediate breast reconstruction\n Delayed breast reconstruction\n Autologous reconstruction\n Lumpectomy reconstruction\n Revision reconstruction\n Complications\n Persistent seroma\n Flap necrosis\n Capsular contracture\n Persistent breast animation\n Contour irregularity\n Summary\n References\n30\n 30 Autologous breast reconstruction with the DIEP flap\n Introduction\n History\n Patient selection\n Choosing the recipient vessels\n Anatomy of internal mammary vessels\n Vascular anatomy and relevance to lower abdominal tissue transfer\n Perfusion zones\n Perforator mapping\n Ultrasonography\n Angiography\n Thermal imaging\n Perforator selection\n Strategies to maximize flap volume\n Enhanced recovery after surgery\n Preoperative preparation\n Preoperative marking\n Operative setup\n Preparation and draping\n Surgical technique\n Flap elevation\n Suprafascial dissection\n Intramuscular dissection\n Submuscular dissection\n Recipient vessel dissection\n Microvascular flap transfer (see Videos 30.4 & 30.5 )\n Closure of the donor site and fashioning of the umbilicus\n Flap orientation, inset, and shaping\n Flap orientation\n Flap inset and shaping\n Footprint\n Conus shaping\n Skin envelope\n Advances in DIEP breast reconstruction\n Sensory restoration\n Vascularized lymph node transfer\n Minimally invasive approaches to flap harvest\n Postoperative care\n Complications\n Secondary surgical procedures\n Conclusion\n References\n31\n 31 Autologous breast reconstruction with the free TRAM flap\n Introduction\n Basic science/anatomy\n Fat layer, muscle and vessels of the lower abdomen\n Structure of the free TRAM flap\n Superficial inferior epigastric vein and dominance of the venous drainage system\n Midline cross-over vessels\n Recipient vessels in breast reconstruction\n Patient selection\n Preoperative planning using angiography\n Surgical technique\n Preoperative marking\n Flap elevation\n Donor closure\n Microanastomosis\n Inset of the flap\n Delayed breast reconstruction\n Utility of indocyanine green infrared fluorescence angiography\n Postoperative care\n Complications\n Recipient site\n Donor site\n Conclusion\n References\n32\n 32 Autologous breast reconstruction with the superficial inferior epigastric artery (SIEA) flap\n Introduction\n Preoperative evaluation and indications\n Pre-surgical preparation\n SIEA flap elevation\n Recipient vessel preparation\n Flap inset\n Flap monitoring\n Postoperative care\n References\n33\n 33 Introduction to autologous reconstruction with alternative free flaps\n Introduction\n Gluteal perforator flaps\n Medial thigh flaps\n Posterior thigh flaps\n Lumbar artery perforator flap\n Clinical review\n References\n34\n 34 Gluteal free flaps for breast reconstruction\n Introduction\n History\n Patient selection and considerations\n Preoperative perforator mapping\n Operative approach (Videos 34.1 & 34.2 )\n Patient markings and flap harvest\n Anastomosis and flap inset\n Postoperative care\n Immediate\n Revision surgery\n Complications and management\n Early (0–3 months)\n Late (>3 months)\n Conclusion\n References\n35\n 35 Autologous breast reconstruction with medial thigh flaps\n Introduction\n History\n Basic science/disease process\n Diagnosis/patient presentation\n Patient selection\n Treatment/surgical technique\n Patient positioning\n Flap harvest\n Step 1: caudal incision with fat recruitment\n Step 2: anterior flap elevation (see Videos 35.1 & 35.2 )\n Step 3: division of distal gracilis\n Step 4: elevation of posterior flap\n Step 5: division of proximal gracilis\n Step 6: pedicle dissection and flap detachment\n Step 7: flap molding and inset\n Step 8: Microsurgery\n Postoperative care\n Outcomes, prognosis, complications\n Double TUG flaps for one breast\n Flap orientation\n Anastomotic sites\n Secondary procedures: TUG plus…\n Lipofilling\n Implant\n DIEP and TUG flaps for one breast\n References\n36\n 36 Autologous breast reconstruction with the profunda artery perforator (PAP) flap\n Introduction\n Historical perspective\n Basic science/anatomy\n Patient selection\n Surgical technique\n Postoperative care\n Outcomes and complications\n Secondary procedures\n Trends/alterations\n Conclusion\n References\n37\n 37 Autologous reconstruction with the lumbar artery perforator (LAP) free flap\n Introduction\n Historical perspective\n The lumbar artery perforator (LAP) flap anatomy\n Recipient vessels\n Interposition graft\n Patient selection\n Donor site\n CT imaging\n Surgical technique\n Preoperative marking\n Operative procedure\n Shaping of the lumbar flap\n Postoperative care\n Outcome, prognosis and complications\n Conclusion\n References\n38\n 38 Hybrid breast reconstruction: combining flaps and implants\n Introduction\n Hybrid breast reconstruction\n Plane of implant placement\n Timing of implant placement\n Radiation therapy\n Surgical technique: immediate hybrid breast reconstruction\n Summary\n References\n39\n 39 Innervation of autologous flaps\n Introduction\n Breast sensation anatomy\n Understanding nerve anatomy and physiology\n Neurotization techniques\n Innervated implant-based reconstruction\n Outcomes\n Future directions\n References\n40\n 40 Stacked and conjoined flaps\n Introduction\n Patient selection and preoperative assessment\n Surgical technique\n Flap harvest\n DIEP flap\n LAP flap\n PAP flap\n Recipient site preparation\n Microsurgery\n Inset\n Postoperative care\n Outcomes\n Conclusions\n References\n41\n 41 Management of complications following autologous breast reconstruction\n Introduction\n Systemic complications\n Breast complications\n Mastectomy flap necrosis\n Total flap failure\n Partial flap failure\n Fat necrosis\n Donor site complications\n Early complications\n Late complications\n Preventing complications\n DIEP flap perforator selection\n DIEP flap zone selection\n Venous outflow enhancement\n Conclusion\n References\n42\n 42 Enhanced recovery after surgery (ERAS) protocols in breast surgery: techniques and outcomes\n Introduction\n What is pain?\n Opioids\n ERAS\n Components of an ERAS protocol\n Preoperative optimization\n Multimodal analgesia\n Local anesthesia\n Liposomes and other adjuvants\n Surgical-site infiltration\n Regional blocks\n Transversus abdominis plane blocks\n Technique\n Outcomes\n Complications\n Breast blocks (PECS I, PECS II, SAP, intercostal nerve)\n Pectoralis (PECS I) block technique\n Modified pectoralis (PECS II) block technique\n Serratus anterior plane (SAP) block technique\n Intercostal nerve block technique\n Outcomes\n Complications\n Paravertebral blocks and epidural analgesia\n Technique\n Outcomes\n Complications\n Anesthesia ERAS considerations\n Summary\n References\n43\n 43 Secondary procedures following autologous reconstruction\n Introduction\n Timing of secondary procedures\n Treatment algorithm for secondary procedures\n Procedure planning\n Procedures\n Correction of volume discrepancies and shaping of the flap\n Correction of contour and structural irregularities\n Surgical tools for refining volume and contour abnormalities\n Autologous fat grafting (AFG)\n Liposuction\n Direct tissue excision\n Implant augmentation\n NAC (nipple–areolar complex) reconstruction\n Symmetrization of the contralateral breast\n Mastopexy\n Reduction mammoplasty\n Breast augmentation\n Augmentation/mastopexy\n Corrections to donor site\n Concurrent procedures with secondary procedures\n Conclusion\n References\n44\n 44 Introduction to oncoplastic breast surgery\n Introduction\n Safety and efficacy of oncoplastic surgery\n Immediate reconstruction of the partial mastectomy deformity\n Volume displacement techniques\n Reduction mammaplasty\n Adjacent tissue rearrangement\n Volume replacement techniques\n Local and remote flaps\n Implantable devices\n Clinical outcomes\n Conclusions\n References\n45\n 45 Partial breast reconstruction using reduction and mastopexy techniques\n Introduction\n Patient presentation/selection\n Surgical technique\n Benefits\n Timing\n Management of positive margins\n Outcomes\n Surveillance postoperative care\n Conclusion\n References\n46\n 46 Oncoplastic breast reconstruction: local flap techniques\n Introduction\n Historical perspective\n Indications\n Contraindications\n Anatomy\n Classification\n Surgical technique\n Evaluation of volume deficit and location\n Flap design (Fig.46.3 A–C)\n Flap elevation\n Flap transfer\n Flap insetting\n Conventional TDAP flap (see Fig. 46.3 & 46.4)\n Propeller TDAP (Fig. 46.5)\n Secondary procedures\n TDAP lipofilling\n Stacked TDAP\n References\n47\n 47 Surgical and non-surgical management of breast cancer-related lymphedema\n Introduction\n Historical perspective\n Basic science\n Clinical evaluation\n Non-surgical treatment\n Complete decongestive therapy\n Pneumatic compression therapy\n Laser therapy\n Diagnostic imaging\n ICG-lymphography\n Lymphoscintigraphy\n MR-lymphography\n CT-angiography\n Preoperative patient selection\n Surgical treatments\n Immediate lymphatic reconstruction\n Lymphovenous bypass (LVB) (Video 47.1 )\n Vascularized lymph node transplant (Video 47.2 )\n Liposuction\n Conclusion\n References\n48\n 48 Breast reconstruction and radiotherapy: indications, techniques, and outcomes\n Introduction\n Radiotherapy in breast cancer\n Radiotherapy administration methods\n Radiotherapy doses and fractionation\n Radiotherapy and breast-conserving surgery\n Radiotherapy and mastectomy\n Effects of radiotherapy on chest wall tissues\n Partial breast reconstruction and radiotherapy\n Techniques\n Indications\n Timing\n Management of post-radiation deformities\n Management of the contralateral breast\n Breast reconstruction and postmastectomy radiotherapy\n Timing\n Autologous tissue-based reconstruction\n Technique\n Outcomes\n Implant-based reconstruction\n Technique\n Outcomes\n Hybrid reconstruction\n Technique\n Outcomes\n Management of the contralateral breast\n Nipple–areola complex reconstruction\n Breast reconstruction in pre-irradiated tissue\n Autologous tissue-based reconstruction\n Implant-based reconstruction\n Hybrid reconstruction\n Fat grafting\n Breast reconstruction with autologous fat graft alone\n Breast reconstruction with autologous fat graft and implant\n Conclusion\n References\n49\n 49 Robotic-assisted autologous breast reconstruction\n Introduction\n Robotic-assisted latissimus dorsi harvest (RALDH)\n Surgical anatomy of the latissimus dorsi muscle flap\n Patient selection\n Breast reconstruction protocol\n Operative procedure\n Positioning and defining landmarks\n Incision and port locations\n Robotic docking and dissection\n Undocking and extraction of the muscle\n Postoperative care\n Clinical cases and outcomes\n The RoboDIEP: robotic-assisted deep inferior epigastric perforator flaps for breast reconstruction\n Surgical anatomy of the DIEP flap\n Patient selection\n Operative procedure\n Positioning and defining landmarks\n Incision and port locations\n Robotic docking and dissection\n Flap extraction and closure\n Postoperative care\n Clinical outcomes\n Limitations\n Conclusion\n References\n50\n 50 Total breast reconstruction by external vacuum expansion (EVE) and autologous fat transfer (AFT)\n Introduction\n Indications\n Contraindications\n Fundamental principles and basis for the technique\n Basic concepts of fat grafting\n The surgery\n The seeds: liposuction/fat harvest and graft preparation\n Preoperative evaluation of graft volume needed\n Donor site marking\n The harvesting\n Graft processing\n The “soil”: EVE treatment protocol and recipient site preparation\n The “sowing”: micrografting fat particle in 3D\n Graft evenly\n Graft while moving the cannula\n Loosen/release the scars\n The “support”: post-graft treatment\n Complementary procedures: the reverse abdominoplasty and fat transfer (RAFT)\n RAFT suture insertion and flap dissection technique\n Complications and risks of the procedure\n Case examples\n Immediate reconstruction\n Delayed reconstruction\n Conclusion*\n References\n51\n 51 Current options for nipple reconstruction\n Introduction\n General principles\n Anatomy\n Preoperative planning\n Nipple–areolar complex preservation\n Surgical techniques\n Areolar reconstruction\n Nipple reconstruction\n Nipple graft\n Local flaps\n Nipple projection\n Tissue engineering\n Autologous augmentation\n Alloplastic augmentation\n Allograft augmentation\n 3D tattooing\n Conclusion\n References\nConfidence is ClinicalKey