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Publication Metadata only Inverted T Pattern Breast Reduction(Springer International Publishing, 2022) Karacaoǧlu, Ercan; Zienowicz, Richard J.; Karacaoǧlu, Ercan, Department of Plastic Surgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Zienowicz, Richard J., Division of Plastic Surgery, The Warren Alpert Medical School, Providence, United StatesPatients with large breasts are associated with severe physical complaints. Reduction mammoplasty typically improves or eliminates complaints and enhances physical activity and quality of life. The extensive removal of breast tissue and pedicled transfer of the nipple–areola complex (NAC) requires a planned design in any reduction mammoplasty technique. In this chapter, SIM-based pedicle, with inverted T scar pattern, that provides an intact neurovascular source to the NAC for breast reduction is studied. Preoperative marking is explained in detail. The AQ1 surgical procedure starts with NAC marking with a cookie cutter. The inferior pedicle is marked and is de-epithelialized. Incisions are deepened through the dermis and glandular tissue to delineate an inferior pyramidal pedicle while preserving the horizontal septum. Caution is taken to preserve the medial ligaments surrounding the glandular and adipose tissue in order to include the medial ligament and medial pedicle en bloc. Skin closure is carried out with tailor tacking followed by layered closure in an inverted T pattern. Inverted T pattern as a skin excision type can be applied to a wide spectrum of large breasts with different degrees of ptosis and breast volume. This scar pattern helps to give an optimal conical breast shape. Inverted T pattern breast reduction with SIM-based pedicle technique is a safe procedure that ensures an intact neurovascular source to the breast and NAC. This technique assures a favorable breast contour, improved sensation and perfusion to the NAC complex by recruiting the robust and major neurovascular supply to breast. Surgery for macromastia, particularly for gigantomastia, is a challenging combination of form and function in plastic surgery. Reduction mammoplasty improves or eliminates pain, and restores physical activity and quality of life. The International Society of Aesthetic Plastic Surgery (ISAPS) reports a 20% increase in reduction mammoplasty over the last 4 years. Over 500,000 breast reductions were performed in 2018. This trend is likely to increase (International Society of Aesthetic Plastic Surgery. n.d., https://www.isaps.org/wp-content/uploads/2019/12/ISAPS-Global-SurveyResults2018new.pdf). © 2023 Elsevier B.V., All rights reserved.Publication Metadata only Introduction to Whole Body Contouring(Springer International Publishing, 2022) Zienowicz, Richard J.; Karacaoǧlu, Ercan; Zienowicz, Richard J., Division of Plastic Surgery, The Warren Alpert Medical School, Providence, United States; Karacaoǧlu, Ercan, Department of Plastic Surgery, Bahçeşehir Üniversitesi, Istanbul, Turkey[No abstract available]Publication Metadata only Augmentation Mastopexy(Springer International Publishing, 2022) Zienowicz, Richard J.; Karacaoǧlu, Ercan; Zienowicz, Richard J., Division of Plastic Surgery, The Warren Alpert Medical School, Providence, United States; Karacaoǧlu, Ercan, Department of Plastic Surgery, Bahçeşehir Üniversitesi, Istanbul, TurkeyThe breast is exposed to hormonal, physical, and physiologic changes throughout life. All these periods affect breast shapes and contours and may result in ptosis. A detailed approach is needed to reverse the ptosis and to restore a youthful configuration. The discussion of breast rejuvenation should include whether breast implants should be recommended. Most experienced aesthetic breast surgeons feel that addition of an implant to the sagging breast results in a more predictable breast mound elevation and longer lasting result due to the inherent structure of the implants which confer immediate shape enhancement to the breast. In this technique, a vertical incision is made in the lower pole, and a dual plane pocket is created and an implant is placed. The surgical opening is then closed. Tailor-tack stapling of the previously marked vertical edges is performed in a cephalic to caudal direction. Then the NAC is marked with a cookie cutter. The base of the NAC marking is incised on the junction of circular and the vertical marking, and a single suture is placed to secure this important landmark. The marked area is then de-epithelialized, and NAC is inset to its new position. The center of the stapled vertical closure is carefully marked with methylene blue. Staples are removed leaving the IMF securely buttressed by the 0-Maxon, and the marked area is excised by tandem parallel vertical cuts, and redundant skin is finally excised. The pillars of breast tissue (as they are referred to) are then plicated with strong buried sutures followed by skin closure. Circumvertical mastopexy (CVM) by design recreates an ideal breast shape. The technique involves tightening in a vertical direction that maximally elevates the glandular tissues and restores projection more than any other method. Limitations of this technique are seen with massive ptosis and where Weiss pattern excision of redundant lower pole tissues is sometimes a preferable option. Mastopexy with augmentation is a common procedure in breast surgery. According to the International Society of Aesthetic Plastic Surgery (ISAPS), 1,862,506 breast augmentation and 710,014 mastopexies were performed in 2018, representing a 27.6% and 29.7% increase from 2014, respectively. There is no ISAPS statistics specifically showing the number of augmentation mastopexy, but it would not be wrong to expect a similar increase in the numbers of augmentation mastopexies within the last year. © 2023 Elsevier B.V., All rights reserved.Publication Metadata only Body Fat Contouring(Springer International Publishing, 2022) Zienowicz, Richard J.; Karacaoǧlu, Ercan; Zienowicz, Richard J., Division of Plastic Surgery, The Warren Alpert Medical School, Providence, United States; Karacaoǧlu, Ercan, Department of Plastic Surgery, Bahçeşehir Üniversitesi, Istanbul, Turkey[No abstract available]Publication Metadata only Back Contouring(Springer International Publishing, 2022) Zienowicz, Richard J.; Karacaoǧlu, Ercan; Zienowicz, Richard J., Division of Plastic Surgery, The Warren Alpert Medical School, Providence, United States; Karacaoǧlu, Ercan, Department of Plastic Surgery, Bahçeşehir Üniversitesi, Istanbul, Turkey[No abstract available]Publication Metadata only Lower Leg Contouring(Springer International Publishing, 2022) Zienowicz, Richard J.; Karacaoǧlu, Ercan; Zienowicz, Richard J., Division of Plastic Surgery, The Warren Alpert Medical School, Providence, United States; Karacaoǧlu, Ercan, Department of Plastic Surgery, Bahçeşehir Üniversitesi, Istanbul, Turkey[No abstract available]Publication Metadata only Thigh Contouring(Springer International Publishing, 2022) Zienowicz, Richard J.; Karacaoǧlu, Ercan; Zienowicz, Richard J., Division of Plastic Surgery, The Warren Alpert Medical School, Providence, United States; Karacaoǧlu, Ercan, Department of Plastic Surgery, Bahçeşehir Üniversitesi, Istanbul, Turkey[No abstract available]Publication Metadata only Circumvertical Mastopexy(Springer International Publishing, 2022) Karacaoǧlu, Ercan; Zienowicz, Richard J.; Karacaoǧlu, Ercan, Department of Plastic Surgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Zienowicz, Richard J., Division of Plastic Surgery, The Warren Alpert Medical School, Providence, United StatesThe breast is exposed to almost all physiologic changes in a woman’s life, i.e., pregnancy, breastfeeding, changes in weight, and finally gravity and gravity-related changes. These all affect breast shape and contour and result in breast ptosis. Youthful breast is the breast that has minimal ptosis and a nipple-areolar complex located on the breast meridian, at the most projecting part of the breast mound. Marking for CV mastopexy is key and starts with the patient in standing position. Midline, breast meridian with its extrapolation on the chest wall, and IMF are marked. The lateral and medial markings are made. The location of the new areola is marked in a classic dome shape. A cookie cutter is used to mark the areola, and reference markings are placed. The marked area is deepithelized. The pedicle is created directly down to the chest wall. The breast tissue is removed en bloc. Medial and lateral pillars are re-approximated in vertical fashion. The first suture is placed to restore areola opening and underlying breast tissue. The nipple is typically situated 6–8 cm above the existing IMF depending on breast base width and volume. The periareolar incisions and the skin margins along the vertical limb are closed. The main advantage of CV mastopexy is its short scar pattern. The procedure is faster, recovery for the patient is shorter, and patient satisfaction rates are high. However, it has its own drawbacks. Immediate postoperative results are often unsatisfactory. Other disadvantages of the technique are bottoming out, lower pole scar problems, and puckering at the distal end of the vertical limb. The breasts, as objects of beauty and femininity, are preferably maintained in their youthful configuration throughout life (Fig. 6.1). Unfortunately with the many changes in a woman’s life, this rarely happens. One of the changes is involution or loss of the intrinsic volume of breast parenchyma. Involution may develop after giving birth, breast feeding, and/or significant weight alterations. In all cases, inadequate breast volume and breast ptosis needed to be addressed by mastopexy to restore breast form and contour. According to the International Society of Aesthetic Plastic Surgery (ISAPS), 710,014 mastopexies were performed in 2018, representing a 29.7% increase from 2014. This trend is likely to increase in the following years (International Society of Aesthetic Plastic Surgery. n.d.. https://www.isaps.org/wpcontent/uploads/2019/12/ISAPS-Global-Survey-Results-2018-new.pdf). © 2023 Elsevier B.V., All rights reserved.Publication Metadata only Breast Contouring and Augmentation via Reverse Abdominoplasty(Springer International Publishing, 2022) Karacaoǧlu, Ercan; Zienowicz, Richard J.; Karacaoǧlu, Ercan, Department of Plastic Surgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Zienowicz, Richard J., Division of Plastic Surgery, The Warren Alpert Medical School, Providence, United StatesBreast contouring and augmentation via reverse abdominoplasty is considerably a novel technique that provides autologous tissues for breast augmentation and simultaneously rejuvenates the abdomen. Previous reporting describes the procedure as Augmentation Mammaplasty by Reverse Abdominoplasty (AMBRA) and will be referred henceforth as AMBRA. Ideal candidates are women complaining of the upper abdominal pannus and laxity and whose lower abdomen is typically less aesthetically compromised. The skin over the upper abdominal pannus is harvested as de-epithelialized adipofascial flaps while maintaining their connection to and thus blood supply from the attached breast parenchyma. Adipofascial flaps can be harvested as superiorly or inferiorly based. These flaps are transposed subglandularly, creating autologous tissue breast implants, and reverse abdominoplasty accomplishes donor-site closure and abdominal contouring. Complications in the superior pedicle group are minimal. In the inferior pedicle group, complications are more extensive because the re-suspension of the abdominal wall apron is less facile than closure with superiorly based flaps. AMBRA is a versatile procedure that addresses two aesthetic concerns simultaneously: providing durable autologous tissue that can obviate or enhance the outcome provided by prosthetic implants and rejuvenating the abdomen. © 2023 Elsevier B.V., All rights reserved.Publication Metadata only The Art and Science of Whole-Body Contouring(Springer International Publishing, 2022) Karacaoǧlu, Ercan; Zienowicz, Richard J.; Karacaoǧlu, Ercan, Department of Plastic Surgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Zienowicz, Richard J., Division of Plastic Surgery, The Warren Alpert Medical School, Providence, United StatesBody contouring, art, and science are related in a variety of ways. Science, specifically math, has itself been described as an art mutually stimulated even by the third millennium. The Egyptian Canon of Proportions was a rational approach to constructing beauty in art. It clearly suggests, Height and width have a definite geometrical relation to one another. The fundamental question was whether beauty could be defined through an external set of criteria. Such a notion has been evident throughout time. One of the best examples for the concept of art and proportion is reflected in the works of da Vinci in Vitruvian Man, which simply can be summarized, as The span of a man’s outstretched arms is equal to his height. © 2023 Elsevier B.V., All rights reserved.