Contents

Video Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix

Acknowledgments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . x

Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi

1 The Process of Breast Augmentation ..................................................................... 1

William P. Adams Jr.

2 Patient Education ............................................................................................. 11

William P. Adams Jr. and Christy Aguilar

3 Tissue-Based Planning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
William P. Adams Jr.

4 Three-Dimensional Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
` Kevin H. Small and Jason Roostaeian

5 Shaped versus Round Implants ............................................................................ 41

Patrick Mallucci and Paolo Montemurro

6 Biofilms and Breast Implants: How Science Guides Us to Do the Best for Our Patients ....... 55
W. Louis F. Wessels, Karen Vickery, and Anand K. Deva

7 Dual-Plane Breast Augmentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66

William P. Adams Jr.

8 The Inframammary Approach and the Dual-Plane Pocket ........................................... 80

William P. Adams Jr.

9 The Transaxillary Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106

Louis L. Strock

10 Periareolar Mastopexy Augmentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121

Ruth Graf, Maria Cecília Closs Ono, and Priscilla Balbinot

11 Infra-areolar Zigzag Augmentation Mammaplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130

Ruth Graf, Priscilla Balbinot, and Daniele Tanuri Pace

12 Breast Augmentation with Large Volume Fat Grafting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137

Ran Y. Stark, Louis P. Bucky, and Daniel A. Del Vecchio

13 Revision Breast Augmentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152

Bradley P. Bengtson and Steven Teitelbaum

14 Postoperative Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191

William P. Adams Jr. and Louis L. Strock

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198

vii
 Video Contents
3 Tissue-Based Planning
3.1 Superior pole pinch
3.2 Inferior pole pinch
3.3 Breast base width
3.4 Skin stretch

4 Three-Dimensional Imaging
4.1 Breast augmentation Vectra simulation

7 Dual-Plane Breast Augmentation

7.1 The dual-plane technique

8 The Inframammary Approach and the Dual-Plane Pocket

8.1 Patient markings
8.2 Dissection sequence
8.3 Dissection Part 1
8.4 Dissection Part 2
8.5 Dissection Part 3
8.6 Dissection Part 4
8.7 Dual-plane adjustment
8.8 Contralateral dissection
8.9 IMF breast augmentation

9 The Transaxillary Approach

9.1 Incision design
9.2 Initial dissection
9.3 Muscle dissection Part I: Optical cavity creation
9.4 Muscle dissection Part II: Muscle division
9.5 Device placement
9.6 Closure

10 Periareolar Mastopexy Augmentation

10.1 Periareolar subfascial breast augmentation
10.2 Secondary breast augmentation

11 Infra-areolar Zigzag Augmentation Mammaplasty

11.1 Zigzag infra-areolar breast augmentation

13 Revision Breast Augmentation

13.1 Revision case developing a new prepectoral pocket Part 1
13.2 Revision case developing a new prepectoral pocket Part 2

viii
Preface
Surgical statistics consistently have shown that breast aug-
mentation is the number 1 or 2 surgical procedure in the
United States.
The Top 5 cosmetic surgical procedures in 2016:
• Breast augmentation: 290,000.
• Liposuction: 235,000.
• Nose Reshaping: 223,000.
• Eyelid surgery: 209,000.
• Face Lift: 131,000.
Data from the American Society for Aesthetic Plastic
Surgery.
Globally, these trends are consistent, and this procedure
continues to gain popularity with patients who are
seeking to improve the size and shape of their breasts.
Simultaneously, there has also been a refinement in the
level of delivery of breast augmentation procedures, which
has further led to market growth; however, the potential for
further market growth based on known processes remains
mammoth. Although breast augmentation historically has
been characterized as a surgical procedure consisting of
placing an implant into a pocket, we know now that there
is much more involved than merely the surgical aspect. In
fact, the nonsurgical aspects of breast augmentation are
likely more important collectively than the surgical pro-
cedure itself. This is indeed the essence of the process of
breast augmentation.
Hence, it is the implementation of these new and
proven processes that drive patient outcomes and market
growth in breast augmentation. Nevertheless, many surge-
ons still want to know how to deliver breast augmentati-
on at the highest level. With this need in mind, the “How
Do I DO It?”–illustrated video text-atlas has been compiled
to allow surgeons of all levels to benefit from its content.
The target audience is any plastic surgeon who desires to
take the practice of breast augmentation to the “next” level
for their patients. The primary focus is on specific surgical
techniques, which are described and also illustrated step by
step to allow the reader to understand the subtle princip-
les, techniques, and nuances that have been refined over the
last 10 years to surgically deliver optimal results to patients.
It is our hope that the book will serve as a reference to
all surgeons with a love of breast augmentation. The chap-
ters will focus on different aspects and different approaches
of both primary and revision breast augmentation. The
photographs and illustrations have been placed directly
next to the corresponding text to further define and detail
the procedures described.
It is important for surgeons at all levels to be astute in
recognizing that globally the practice of breast augmentati-
on has not been ideal. When one looks at reoperation rates,
which have ranged from 15 to 24% within 2 to 3 years in
the largest studies available, and patient recovery, another
excellent indicator of the quality of the delivered procedure
not yet optimal with prolonged periods of pain and conva-
lescence, it is clear that we can do better with this procedu-
re collectively. The techniques and methodology described
in this book can serve as the central algorithm that allows
surgeons to deliver a higher-quality product/service to their
patients.
At the end of the day, enhancing patient outcomes is
what everything is measured by, and the techniques descri-
bed in this chapter will help surgeons improve their patient
outcomes no matter how experienced they may be.
I would like to thank all of the authors and contributors
for the many hours and sacrifices that they made to develop
their excellent chapters. Finally, I would like to thank Sue
Hodgson and her team (Thieme/formerly CRC Press), who
are the primary reasons this book became a reality.
I hope that you enjoy this book and feel that it improves
your practice and ultimately improves outcomes for your
patients.
ix
 Acknowledgments
There are many people who deserve credit for this book. Thanks also to Jennifer Gann, Brenda Bunch, Elizabeth
Thanks to Sue Hodgson, who is great to work with and Palumbo, and the Thieme team for their help with
who was critical to making this book a reality. production.