Melvin A. Shiffman

Advanced surgical facial rejuvenation

Advanced surgical facial rejuvenation , Advanced surgical facial rejuvenation , کتابخانه دیجیتالی دانشگاه علوم پزشکی و خدمات درمانی شهید بهشتی

Case 70: Widely Spaced Breasts

This patient had tubular breasts and wanted them to be larger, D cup. Suggestion was high-profile implants through a periareolar incision but she would have no cleavage. The Group covered information on moderate profile implants and mastopexy with lifting the nipple-areolar complex higher, anatomical low height and extra projection with high-cohesive gel implants in front of the muscle, a variety of possible implants, and scoring of the bottom of the breasts.

Case 197: Another Recurrent Capsule Contracture

This patient had subglandular breast augmentation with smooth silicone gel implants in 2011. After 2 years, right capsule contracture occurred and did not respond to montelukast given for 3 months. Capsulotomy was performed in 2014. One year after surgery, the capsule contracture had recurred. The suggestion was that the pocket site be changed to subpectoral and a textured implant be used to replace the smooth implant. Polyurethane-coated implant might be considered.

Case 135: Augmentation After Massive Weight Loss

This patient had extreme weight loss from 100 to 59 kg. There was mild ptosis. Mastopexy and mastopexy with breast augmentation were discussed. The patient decided on breast augmentation alone. Postoperatively there was some ptosis and Snoopy deformity. Patient was dissatisfied with the implant size. There was discussion about the types of procedures that could be used. It was elected to insert polyurethane-covered prostheses.

Case 153: Unexpected Rippling

This patient had cohesive gel implants for augmentation in subglandular pockets, and 3 months postoperative rippling was noted that was worse at 6 months postoperative. The contributors discuss the various methods of treatment of rippling with change in implant, change of pocket, and Tebbetts’ TEPID system. The results of treatment of the patient’s condition are described.

Case 61: Bruising After Vertical Mastopexy

This patient had bruising of the breasts after augmentation. The Group discussed the symptoms of hematoma in the breast versus bruising, the treatment of expanding hematoma, and prevention of bruising. There were comments on the use of labetalol to prevent bleeding and the opinions of not to use unnecessary drugs in cosmetic procedures.

Case 97: Upper Pole Problem

This patient had breast augmentation with subglandular textured silicone gel implants through an inframammary incision. The upper poles appear blunted and palpably irregular but not hardened. Discussion centered around the size of implant, possible change in subglandular pocket, type of implant, and possible mastopexy.

Case 127: Sad Breasts

This patient had breast augmentation with subglandular insertion of saline-filled implants. She developed upper rippling and she had a revision with left capsulectomy and excision of scar on the right side. Three months later, she had thinning and discoloration of the left upper breast. This was treated with bilateral capsulectomies and changing the implants to a subpectoral position. This resulted in ptosis, and revision was performed by capsulectomies and replacement of implants in new subglandular pockets. Now, 12 years later, she has bilateral capsular contracture and ptosis as well as a 3 cm mass in the lower part of the left breast that was benign on needle aspiration.

Case 22: High Implants

This patient had breast augmentation with cohesive gel implants placed submuscularly. Postoperatively the implants were too high. This discussion concerned revision. After 3 months, there was some improvement without surgery, and it was decided not to do anything.

Case 81: Phuket Double Bubble

This patient had breast augmentation in Phuket 6 months previously. After taking off supportive bra (D cup), she noted that the implants had descended and there were double bubble. The Group discussed placing implants in subglandular position, replacement with high-profile implants, and raising the inferior border of capsules with internal sutures (capsulorrhaphy). Described were techniques such as excision of skin and breast tissue for double bubble and dissecting “Moye’s corner” more adequately to prevent double bubble.