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TABLE OF CONTENTS

 

 AUGMENTATION MAMMACOSMY

 

 

 

1.   FOREWORD

 

2.   INTRODUCTION

 

3.   BEFORE SURGERY COUNSELING

 

4.   INDICATIONS AND CONTRAINDICATIONS

 

5.   CONSENTS AND INSTRUCTIONS

 

6.   SURGICAL METHODS

 

7.   SUBPECTORAL VS. SUBGLANDULAR

 

8.   AVOIDING COMPLICATIONS

 

9.   MANAGEMENT OF HEMATOMA

 

10.  MANAGEMENT OF INFECTION

 

11.   MANAGEMENT OF CAPSULE CONTRACTION

 

12.  CHOICE OF IMPLANTS

 

13.  STEROIDS  

 

14.    SUBCUTANEOUS MASTECTOMY

 

15.    BREAST CANCER DETECTION AND TREATMENT

 

16.  SAFETY OF BREAST IMPLANTS

 

17.  OTHER TOPICS

 

18.  THE INFRAMAMMARY FOLD: DOUBLE-FOLD AND BUBBLE

 

1986, 2002   ©William Roy Morgan, M.D., F.A.C.S.©

 

  

1. FOREWORD

 

Purpose and Design

The purpose of this handbook is to communicate some thoughts on the subject of breast implant surgery to the beginner. It is intended to convey ideas informally, as though we are verbally discussing each of the subjects, rather than as an article in a medical journal. It is full of opinions, many or all of which may be incorrect.

A danger of an opinionated writing is that in court it may be said that X is better than Y because it is written, or that the surgeon who does it in a different way is wrong. Consider all the opinions and conclusions written here to be open to questions and refutation. They are merely expressed for the sake of argument as a reference point. The information presented here is just something to discuss. In addition, I reserve the right to change my opinions at any time, even without new facts or information.

To say that anything can only be properly done one way would be like saying you should only hit the baseball right handed; in this case, the best batters would be eliminated.

And so, if I disparage a method you like, forgive my ignorance. Many people still disagree with Darwin.

 

Why Breast Implants?

If a person were born without hands or feet, it would be nice if they could be restored. If a young woman does not develop breasts, it is a good thing that she can have them if she wishes.

 Should not crooked, unattractive teeth be straightened? Shouldn't every woman have as beautiful a chest as possible if she wants?

Part of the negative attitude towards breast implant surgery is that a beautiful female chest is a turn on to the opposite sex. And that's' true, but so is beautiful skin, hair, good health, and a friendly smile. Back to nature is fine. But I prefer the advantages of modern medicine and science over disease and deformity.

 In the 1970s, I heard Richard Webster say that breast implant surgery ranks highest of all cosmetic operations in terms of patient satisfaction. Also, the surgery is easier to perform than other cosmetic procedures and provides more consistently attractive results than other procedures such as facelift or nose surgery.

Breast implant surgery was the most common cosmetic operation in the United States in the 1970s and 1980s until the FDA frightened the public in 1992 about the risks of breast implant surgery.  More than 100,000 procedures a year were being done. Some 1.5 million women in this country have had this surgery. In 1994, the number of surgeries fell to 39,247, and breast implant removal increased to 28,655. 1 (Los Angeles Times, Saturday 1-24-96, according to American Society of Plastic and Reconstructive Surgery)

From1996 through 1998, the FDA explanations had markedly declined and implantations are now back up to previous levels of more than 100,000 per year.

In addition to the demand to make breast implants more natural-looking and more attractive, there is a tremendous need for reconstruction of the patient following mastectomy. These patients can sometimes be made to feel more “whole” again and much more back-to-normal via the simple insertion of a breast implant (a procedure that can often be done at the time of the partial mastectomy), saving the patient another operation to restore the breast. The surgeon who has training in breast implant surgery can offer patients who must undergo deforming operations for cancer the option of a breast implant type of reconstruction at the time of the surgery, or a short time later, as well as nipple repair if needed.

Many other surgeons who perform major cosmetic and gynecological surgery find the procedure of augmentation mammaplasty relatively straightforward and uncomplicated to perform, and yet there is a lot to know in terms of avoidance  and management of complications and in selecting the most favorable patients, surgical methods, and implants.

 

History of the Workshops

The American Society of Cosmetic Breast Surgery was established in 1985 by a group of physicians who had been performing cosmetic surgery of the breasts for up to thirty years, and who had all together performed more than 20,000 cosmetic breast operations.

 This society was initially based on the experiences of the faculty who originally formed to teach breast operations. This society is dedicated to the welfare of the patients who need cosmetic surgery of the breasts. The ultimate purpose of this organization is to help all professionals provide high quality care to patients having cosmetic breast surgery through training, education, research, and the open exchange of ideas.

 When this society was formed in 1985, it offered the only workshops in Augmentation Mammacosmy (or, cosmetic breast surgery) in the world.  Hopefully, there will be others. Eventually, we hope that all surgeons who perform breast surgery will also do breast implant and cosmetic breast surgery for the benefit of all women.

 

2. INTRODUCTION

 

This text is meant to aid the physician who is already a surgeon who performs breast implant surgery, whether  for reconstruction or cosmetic purposes.

The outline of the booklet in the table of contents, and the workshop on Augmentation Mammacosmy given by the American Society of Cosmetic Breast Surgery, begins with the management of the patient when she enters the doctor's office. This is because the counseling of the patient is just as important, if not more important, than the particular surgical method used. In the workshop, many different approaches to the management of patients as well as surgical methods will be demonstrated and discussed. In this text, however, some basic surgical and management methods will be favored to simplify  the process and avoid confusion.

Since the information in this workshop is based on the experiences of the faculty, and since the literature on the subject of Augmentation Mammacosmy is quite accessible through computer searches of the literature, references to the literature and lists of bibliography are kept to the minimum.  While each student of a subject should carefully review all of the recent literature and draw careful and independent conclusions, it is more appropriate to attend a library than a workshop to accomplish a literature review. The training offered by the workshop is based on the practical experiences of the faculty.

In this textbook, many opinions will be expressed based on the experiences of the lecturers and sometimes on their study of the literature. There are many valid and different ways to perform a surgical procedure. At times, the best way may be obvious and at other times it will not. All of the faculty are interested in teaching and will answer questions of the workshop participants at the time of the course or in the future.

Most of the faculty will allow you to visit them and observe them during surgery.

 

3.  BEFORE SURGERY COUNSELING

 

The patient who comes to the office regarding breast implants comes for information, and it is this information that we want to supply.

We know, through reading articles found in ladies magazines, the patient can find out a lot of general information such as we will provide with the booklet, "Information About An Improved Appearance". This booklet can be ordered from the ASCBS with your name and address printed on it, and the order sheet and price list are enclosed in this manual.

What the patient can get by visiting the doctor is the specific information regarding their particular condition and what breast implants can do for them. The patient is encouraged to bring a friend or a relative to help them understand, remember, and evaluate the information received.

The information the patient receives by visiting the doctor's office can be divided into the following:

 

 a. What the operation will do for me

 b. Complications and risks involved

 c.  Anesthesia

 d.  Recovery

 e.  What it will cost

 f.   How, when, where, and by whom can it be done

 

Before discussing each of these categories of patient counseling, let us review a few important differences in cosmetic patients and other patients. The cosmetic patient, by definition, is a person who is healthy and who wants to look better.

Patients who submit to surgery for eradication of disease have fewer choices when the surgery is the best or only way of eliminating the problem. Yet the physician provides his patients with as much knowledge and information as reasonably possible, and our state law requires that the patient's consent be informed.

The patient contemplating cosmetic surgery has much more choice and may therefore ask for and be given considerably more information with which to choose what is best.

We can give this information verbally, with photographs, videotapes, on the Internet and in writing. Of these, the information we give in writing is most important, and samples of the booklet and the informed consent are included in this workbook and may be used by members. The instruction information sheet and the informed consent require the patient's signature on a copy in our records. The booklet is more general and less specific regarding complications. The following discussion is in addition to the information already contained in these forms.

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The American Society of Cosmetic Breast Surgery 2017    Last modified: June 23, 2017