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MohanThomas
JamesD‘silva
Editors
Manual ofCosmetic
Medicine and Surgery
Volume 2 - Breast Reshaping
Foreword by Dr. Ted Eisenberg
123
Manual of Cosmetic Medicine and Surgery
Mohan Thomas • James D‘silva
Editors
Manual of Cosmetic Medicine
and Surgery
Volume 2- Breast Reshaping
Editors
Mohan Thomas
Plastic Surgery
D.Y.Patil University
Mumbai, India
James D‘silva
Plastic Surgery
The cosmetic Surgery Institute
Mumbai, Maharashtra, India
ISBN 978-981-99-3725-7 ISBN 978-981-99-3726-4 (eBook)
https://doi.org/10.1007/978-981-99-3726-4
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or
part of the material is concerned, specically the rights of translation, reprinting, reuse of illustrations, recitation,
broadcasting, reproduction on microlms or in any other physical way, and transmission or information storage and
retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter
developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not
imply, even in the absence of a specic statement, that such names are exempt from the relevant protective laws and
regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed
to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty,
expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been
made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer Nature Singapore Pte Ltd.
The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore
Paper in this product is recyclable.
This manual is dedicated to my Parents Mr. and Mrs. K.T. Thomas,
https://t.me/medicina_free
Wife Margaret, and my children Susheela, Joshua, Jason, Kyle, and Megan.
I hope my efforts will inspire and motivate my children and others to dream
on and propel them to greater heights in whatever eld they choose to be in.
Mohan Thomas MD, FAACS
Dedicated to my dear Parents, wife Tresa and sons Jonathan and Joshua.
Thank you for all your love, care and support!
James D’silva MCh, DNB
Foreword
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It is an honor and a privilege to write the foreword to this comprehensive Manual of Cosmetic
Medicine and Surgery: Volume 2—Breast Reshaping.
Cosmetic breast surgery is becoming more and more of a specialty unto itself. For the past
5 years, breast augmentation has been the world’s most popular cosmetic procedure, according
to the International Society of Aesthetic Plastic Surgery. On average, more than 2 million
women worldwide choose to have breast lift and breast augmentation surgery each year.
Drs. Mohan Thomas and James D’Silva deserve to be congratulated for their monumental
effort in editing and coordinating this excellent book, which details traditional and new surgical approaches to cosmetic breast surgery.
“Why this book?” I asked Dr. Thomas. “This manual could be for beginners as well as for
those who have been in practice longer,” he said. “It seemed like a good idea to include leaders
in their area of expertise so that readers would be the beneciaries. The book is authoritative,
with surgeons providing a global avor.”
By denition, a manual is a book of instruction or guidance, and this Breast Reshaping manual
is just that. The authors, all skilled, experienced surgeons, generously share their expertise on a wide
variety of cosmetic breast surgery topics, offering techniques that might simplify your surgical
approach and provide a better result. For example, an entire chapter is devoted to an innovative
approach to simultaneous augmentation mastopexy that maximizes the lift and minimizes the scar.
The reader gets an experience of the adage, “Measure twice, and cut once.” Another chapter
describes a new simpler, less-invasive, one-stage approach to correcting tuberous breast deformity.
Every chapter includes step-by-step instructions, risks and complications, and pearls and
pitfalls. The accompanying videos, as well as before, after, and intraoperative photos, make it
seem as if the authors have invited you into the operating room with them.
Drs. Thomas and D’Silva have been dedicated to educating and publishing in their own
right. Dr. Thomas is Clinical Professor of Surgery and Visiting Scholar at Mt. Sinai Medical
Center in NewYork and Clinical Professor of Surgery, Advanced Cosmetic Surgery, for DY
Patil University, Mumbai. He has demonstrated his leadership as founder and president of the
Society of Cosmetic Surgeons, the Asian Academy of Cosmetic Surgery, and the Academy of
Anti-Ageing Medicine. He has extended his desire to educate beyond the academics of cosmetic surgery: As an ex-member of the Advisory Council on Tourism for the Government of
India, he speaks widely on bringing Quality Healthcare to people from all walks of life.
Dr. D’Silva, who got his cosmetic training rsthand from Dr. Thomas, has enlightened delegates at conferences in India and abroad on the techniques of cosmetic surgery. He is the joint
secretary of the Indian Society of Cosmetic Surgery, which regularly provides training to postdoctoral and other physicians in cosmetic surgery practice.
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This essential manual compiles years of experience and cutting-edge ideas from global
experts and places it in your capable hands—hands that will, most importantly, enhance a
patient’s experience and aesthetic results.
While cosmetic breast surgery is not for every woman, for those who desire it, it can make
a big difference. So, too, can this book.
TedEisenberg, DFACOS, FAACS
Associate Professor of Plastic and Reconstructive Surgery
Philadelphia, PA, USA
Foreword
Preface
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I have always thought of Aesthetic or Cosmetic Surgery as a Fusion of Art and Science. In
many ways it is hard to dene Aesthetic or Cosmetic Surgery as there are so many body parts
involved; perceptions of beauty, ethnicities, and sometimes psychosomatic disorders as well.
With reference to psychosomatic disorders, body dysmorphic disorders come rst to my mind
and the most common body part often associated with this disorder is the nose. There are cases
wherein a patient has undergone 10 plus surgeries on the nose with disastrous results. Recently,
I have discovered another condition wherein this time it is gender based; men obsessed with
their chest. Within the description of gynecomastia, there is often a “complaint of puffy nipples.” The ones obsessing the most about their chest are single men between the ages of 25 and
35 and “Buffs” for the most part.
There is a plethora of cosmetic surgical procedures out there ranging from Hair Transplants
to the Rejuvenation of Hands, Surgery of the Face, Nose, Intimate parts, Body contouring
procedures, and now procedures for achieving pretty feet. There is a segment of women that
have taken on to high heeled and narrow shoes, early in life leading to Bunions and other Foot
issues.
I believe that this Surgical Manual is one of a kind, presenting step-by-step instructions,
comprehensive enough for private practitioners, students in the eld, those starting their practices, and surgeons already in practice who ought to benet from the included schematics,
pictures, and short video clips within the relevant chapters.
Volume 2 is a compendium of Breast Surgeries that are commonly performed and part of
mainstream Cosmetic Surgery: everything from Breast Augmentation and the various
approaches and the latest in reconstruction and management of Capsular contracture. This
volume also deals with Breast Lifts and Breast Reduction along with techniques to achieve
simultaneous Breast Augmentation and a Lift (the tailor tacking method and more).
To my good fortune about two decades ago I came across the American Academy of
Cosmetic Surgery which I gladly joined. Over the years, I have made many friends globally
from whom I have learnt a lot and I greatly respect them. I am afraid to mention names for fear
of missing someone out from the list of distinguished Cosmetic Plastic Surgeons. The Mission
and Vision of the AACS, started by Dr. Richard Webster, a Plastic Surgeon, had a very good
inuence on me and spurred me to start a Fellowship program in 2003 through a University,
and I have mentored many along the way. As a medical student in Pennsylvania I often came
across Dr. Julian Newman, a stalwart as well.
Cosmetic Surgery grew with inputs from many specialities such as General Surgeon—Dr.
Illouz (France), Gynecologist—Dr. Robert Fisher (Italy), and Dermatology—Dr. Klein (USA)
to mention a few.
I am a great believer in Mentorship and committed to creating a second and third line of
Surgeons who I hope one day would be better than me and I hope to learn from them as well
as time goes by. The learning process is a continuum wherein I like many learn something
every day. As a “Lifetime Student” I have learnt a lot from quarters other than surgical colleagues such as nursing staff as well as patients. Humility and kindness (empathy) are virtues
that one must possess not only to be successful as a Surgeon but also to serve the needs of the
patients. In entering private practice, the most important thing one must learn is to assess,
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evaluate, and manage expectations of potential patients and obtain a Psychiatric Consultation
to rule out body dysmorphic disorder, depression, etc. when indicated. This is critical when
making a decision to operate. In many ways, management of patient expectations and a gut
feeling to pick up obsessive nature in patients who may seek out care are important virtues.
Having conceived the idea of editing as well as contributing to the Manual I have tried to
include Global Leaders in various elds as well as provide a platform for younger Surgeons to
be seen and recognized and “Undivide the great Divide.”
This Book is dedicated to Sushruta, the First Plastic Surgeon, and the Pioneer from India
and to the Stalwarts of the eld who carved a path for all of us.
The momentous task of setting out on this journey of putting together a six volume Manual
in Cosmetic Surgery and Medicine came to fruition with the release of the rst Volume on
Body Contouring.
Our Medical and Surgical Colleagues rose to the occasion and supported us whole heartedly; as a result the manual was a home run.
Mumbai, India MohanThomas
Preface
Contents
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Part I Anatomy
1 Cosmetic Surgery of the Breast: “Art, Science & Safety” . . . . . . . . . . . . . . . . . . . 3
Michael S. Kluska
2 Anatomy of the Breast and Pre- operative Assessment for Breast Surgery . . . . . . 15
Angelo Cuzalina, Pasquale G. Tolomeo, and Victoria A. Mañón
3 Regional Blocks for Peri and Post- operative Analgesia . . . . . . . . . . . . . . . . . . . . . . 25
Nitin Bhorkar
Part II Breast Augmentation
4 The Science of Choosing a Breast Implant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Anup Dhir and Noopur Bansal
5 Periareolar Breast Augmentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Joseph J. Castellano and Bradley C. Stephan
6 Breast Augmentation: Inframammary Approach . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Jacob Haiavy
7 Transaxillary Mammoplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Joe Dan Metcalf and Gregory Laurence
8 TUBA: Transumbilical Breast Augmentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Ehab Akkary and Robert Shumway
9 Transumbilical Breast Augmentation With Saline and Silicone Implants. . . . . . . 103
Gabriel H. Patino
10 Breast Augmentation: Autologous Fat Transfer . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
Kristine Brecht
Part III Breast Reduction and/or Breast Lift
11 Mastopexy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Julian Duran
12 Combined Mastopexy and Breast Augmentation . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
Angelo Cuzalina, Pasquale G. Tolomeo, and Victoria A. Mañón
13 The I.D.E.A.L.® Breast Lift for Moderately to Severely Ptotic Breasts: A
Staple-First Technique That Can Be Combined with Breast Augmentation . . . . . 185
Ted S. Eisenberg
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