Plastic Surgery, Volume Five: Breast (Fourth Edition): Cẩm nang Toàn diện Phẫu thuật Thẩm mỹ và Tái tạo Vú – Maurice Y. Nahabedian & Peter C. Neligan

Plastic
Fourth Edition
Breast
Volume Five
Surgery

Content Strategist: Belinda Kuhn
Content Development Specialists: Louise Cook, Sam Crowe, Alexandra Mortimer
e-products, Content Development Specialist: Kim Benson
Project Managers: Anne Collett, Andrew Riley, Julie Taylor
Designer: Miles Hitchen
Illustration Managers: Karen Giacomucci, Amy Faith Heyden
Marketing Manager: Melissa Fogarty
Video Liaison: Will Schmitt

Volume Editor
Maurice Y. Nahabedian
MD, FACS
Professor and Chief
Section of Plastic Surgery
MedStar Washington Hospital Center
Washington DC, USA;
Vice Chairman
Department of Plastic Surgery
MedStar Georgetown University Hospital
Washington DC, USA
Surgery
Plastic
Fourth Edition
Editor-in-Chief
Peter C. Neligan
MB, FRCS(I), FRCSC, FACS
Professor of Surgery
Department of Surgery, Division of Plastic Surgery
University of Washington
Seattle, WA, USA
London, New York, Oxford, Philadelphia, St Louis, Sydney 2018
Volume Five
Breast
Multimedia Editor
Daniel Z. Liu
MD
Plastic and Reconstructive Surgeon
Cancer Treatment Centers of America at
Midwestern Regional Medical Center
Zion, IL, USA
For additional online figures, videos and video lectures visit Expertconsult.com

© 2018, Elsevier Inc. All rights reserved.
First edition 1990
Second edition 2006
Third edition 2013
Fourth edition 2018
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or
mechanical, including photocopying, recording, or any information storage and retrieval system, without permis­
sion in writing from the publisher. Details on how to seek permission, further information about the Publisher’s
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This book and the individual contributions contained in it are protected under copyright by the Publisher
(other than as may be noted herein).
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Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden
our understanding, changes in research methods, professional practices, or medical treatment may become
necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and
using any information, methods, compounds, or experiments described herein. In using such information or
methods they should be mindful of their own safety and the safety of others, including parties for whom they
have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most current
information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered,
to verify the recommended dose or formula, the method and duration of administration, and contraindications.
It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make
diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate
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Video Contents
Chapter 11: Asian facial cosmetic surgery
1.1: Medial epicanthoplasty
11.2: Eyelidplasty: Non-incisional method
11.3: Rhinoplasty
11.4: Subclinical ptosis correction (total)
11.5: Secondary rhinoplasty: Septal extension graft and costal
cartilage strut fixed with K-wire
Kyung S. Koh, Jong Woo Choi, and Clyde H. Ishii
Chapter 12: Neck rejuvenation
12.1: Anterior lipectomy
James E. Zins, Colin M. Morrison, and C. J. Langevin
Chapter 13: Structural fat grafting
13.1: Structural fat grafting of the face
Sydney R. Coleman and Alesia P. Saboeiro
Chapter 14: Skeletal augmentation
14.1: Chin implant
Michael J. Yarumchuk
© Mesa J, Havlik R, Mackay D, Buchman S, Losee J, eds. Atlas of
Operative Craniofacial Surgery, CRC Press, 2019.
14.2: Mandibular angle implant
14.3: Midface skeletal augmentation and rejuvenation
Michael J. Yarumchuk
© Michael J. Yaremchuk
Chapter 16: Open technique rhinoplasty
16.1: Open technique rhinoplasty
Allen L. Van Beek
Chapter 20: Otoplasty and ear reduction
20.1: Setback otoplasty
Leila Kasrai
Chapter 23: Abdominoplasty procedures
23.1: Abdominoplasty
Dirk F. Richter and Alexander Stoff
Chapter 24: Lipoabdominoplasty
24.1: Lipoabdominoplasty (including secondary lipo)
Osvaldo Saldanha, Sérgio Fernando Dantas de Azevedo,
Osvaldo Ribeiro Saldanha Filho, Cristianna Bonnetto Saldanha, and
Luis Humberto Uribe Morelli
Chapter 26.2: Buttock augmentation: Buttock
augmentation with implants
26.2.1: Buttock augmentation
Terrence W. Bruner, Jose Abel De la Peña Salcedo,
Constantino G. Mendieta, and Thomas L. Roberts III
Chapter 27: Upper limb contouring
27.1: Brachioplasty
27.2: Upper limb contouring
Joseph F. Capella, Matthew J. Trovato, and Scott Woehrle
Volume One:
Chapter 15: Skin graft
15.1: Harvesting a split-thickness skin graft
Dennis P. Orgill
Chapter 34: Robotics in plastic surgery
34.1: Robotic microsurgery
34.2: Robotic rectus abdominis muscle flap harvest
34.3: Trans-oral robotic surgery
34.4: Robotic latissimus dorsi muscle harvest
34.5: Robotic lymphovenous bypass
Jesse C. Selber
Volume Two:
Chapter 6.2: Facelift: Principles of and surgical
approaches to facelift
6.2.1: Parotid masseteric fascia
6.2.2: Anterior incision
6.2.3: Posterior incision
6.2.4: Facelift skin flap
6.2.5: Facial fat injection
Richard J. Warren
6.2.6: Anthropometry, cephalometry, and orthognathic surgery
Jonathon S. Jacobs, Jordan M. S. Jacobs, and Daniel I. Taub
Chapter 6.3: Facelift: Platysma-SMAS plication
6.3.1: Platysma-SMAS plication
Dai M. Davies and Miles G. Berry
Chapter 6.4: Facelift: Facial rejuvenation with loop
sutures – the MACS lift and its derivatives
6.4.1: Loop sutures MACS facelift
Patrick L. Tonnard
From Aston SJ, Steinbrech DS, Walden JL, eds. Aesthetic Plastic
Surgery, Saunders Elsevier; 2009; with permission from Elsevier
Chapter 6.7: Facelift: SMAS with skin attached – the
“high SMAS” technique
6.7.1: The high SMAS technique with septal reset
Fritz E. Barton Jr.
© Fritz E. Barton Jr.
Chapter 6.8: Facelift: Subperiosteal midface lift
6.8.1: Subperiosteal midface lift: Endoscopic temporo-midface
Oscar M. Ramirez
Chapter 9: Blepharoplasty
9.1: Periorbital rejuvenation
Julius Few Jr. and Marco Ellis
© Julius Few Jr.

xiii
Video Contents
Chapter 26: Velopharyngeal dysfunction
26.1: Velopharyngeal incompetence – 1
26.2: Velopharyngeal incompetence – 2
26.3: Velopharyngeal incompetence – 3
Richard E. Kirschner and Adriane L. Baylis
Chapter 27: Secondary deformities of the cleft lip,
nose, and palate
27.1: Abbé flap
27.2: Alveolar bone grafting
27.3: Complete takedown
27.4: Definitive rhinoplasty
Evan M. Feldman, John C. Koshy, Larry H. Hollier Jr., and
Samuel Stal
27.5: Thick lip and buccal sulcus deformities
Evan M. Feldman and John C. Koshy
Chapter 36: Pierre Robin Sequence
36.1: Mandibular distraction
Arun K. Gosain and Chad A. Purnell
Chapter 39: Vascular anomalies
39.1: Lip hemangioma
Arin K. Greene
Chapter 43: Reconstruction of urogenital defects:
Congenital
43.1: First-stage hypospadias repair with free inner preputial
graft
43.2: Second-stage hypospadias repair with tunica vaginalis
flap
Mohan S. Gundeti and Michael C. Large
Volume Four:
Chapter 2: Management of lower extremity trauma
2.1: Anterolateral thigh flap harvest
Michel Saint-Cyr
Chapter 3: Lymphatic reconstruction of the
extremities
3.1: End-to-side lymphovenous bypass technique
© Cheng M-H, Chang D, Patel K. Principles and Practice of
Lymphedema Surgery, Elsevier; 2015.
3.2: Recipient site preparation for vascularized lymph node
transfer – axilla
© Cheng M-H, Chang D, Patel K. Principles and Practice of
Lymphedema Surgery, Elsevier; 2015.
3.3: Indocyanine green lymphography
David W. Chang
3.4: Charles procedure
Peter C. Neligan
Chapter 6: Diagnosis and treatment of painful
neuroma and nerve compression in the lower
extremity
6.1: Diagnosis and treatment of painful neuroma and of nerve
compression in the lower extremity 1
6.2: Diagnosis and treatment of painful neuroma and of nerve
compression in the lower extremity 2
Chapter 28: Post-bariatric reconstruction
28.1: Post-bariatric reconstruction – bodylift procedure
J. Peter Rubin and Jonathan W. Toy
© J. Peter Rubin
Volume Three:
Chapter 6: Aesthetic nasal reconstruction
6.1: The three-stage folded forehead flap for cover and lining
6.2: First-stage transfer and intermediate operation
Frederick J. Menick
Chapter 7: Auricular construction
7.1: Total auricular construction
Akira Yamada
Chapter 8: Acquired cranial and facial bone
deformities
8.1: Removal of venous malformation enveloping intraconal
optic nerve
Renee M. Burke, Robert J. Morin, and S. Anthony Wolfe
Chapter 13: Facial paralysis
13.1: Facial paralysis
Eyal Gur
13.2: Facial paralysis
13.3: Cross facial nerve graft
13.4: Gracilis harvest
Peter C. Neligan
Chapter 14: Pharyngeal and esophageal
reconstruction
14.1: Reconstruction of pharyngoesophageal defects with the
anterolateral thigh flap
Peirong Yu
Chapter 15: Tumors of the facial skeleton: Fibrous
dysplasia
15.1: Surgical approaches to the facial skeleton
Yu-Ray Chen, You-Wei Cheong, and Alberto Córdova-Aguilar
Chapter 17: Local flaps for facial coverage
17.1: Facial artery perforator flap
17.2: Local flaps for facial coverage
Peter C. Neligan
Chapter 21.2: Rotation advancement cheiloplasty
21.2.1: Repair of unilateral cleft lip
Philip Kuo-Ting Chen, M. Samuel Noordhoff, Frank Chun-Shin,
Chang, and Fuan Chiang Chan
21.2.2: Unilateral cleft lip repair – anatomic subunit
approximation technique
David M. Fisher
Chapter 24: Alveolar clefts
24.1: Unilateral cleft alveolar bone graft
24.2: Mobilized premaxilla after vomer osteotomy prior to
setback and splint application
Richard A. Hopper and Gerhard S. Mundinger

xiv
Video Contents
6.3: Diagnosis and treatment of painful neuroma and of nerve
compression in the lower extremity 3
A. Lee Dellon
Chapter 7: Skeletal reconstruction
7.1: Medial femoral condyle/medial geniculate artery
osteocutaneous free flap dissection for scaphoid nonunion
Stephen J. Kovach III and L. Scott Levin
Chapter 10: Reconstruction of the chest
10.1: Sternal rigid fixation
David H. Song and Michelle C. Roughton
Chapter 12: Abdominal wall reconstruction
12.1: Component separation innovation
Peter C. Neligan
Chapter 13: Reconstruction of male genital defects
13.1: Complete and partial penile reconstruction
Stan Monstrey, Peter Ceulemans, Nathalie Roche,
Philippe Houtmeyers, Nicolas Lumen, and Piet Hoebeke
Volume Five:
Chapter 6: Mastopexy options and techniques
6.1: Circumareolar mastopexy
Kenneth C. Shestak
Chapter 7: One- and two-stage considerations for
augmentation mastopexy
7.1: Preoperative markings for a single-stage augmentation
mastopexy
W. Grant Stevens
Chapter 10: Reduction mammaplasty with short scar
techniques
10.1: SPAIR technique
Dennis C. Hammond
Chapter 11: Gynecomastia surgery
11.1: Ultrasound-assisted liposuction
Charles M. Malata
Chapter 15: One- and two-stage prosthetic
reconstruction in nipple-sparing mastectomy
15.1: Pectoralis muscle elevation
15.2: Acellular dermal matrix
15.3: Sizer
Amy S. Colwell
Chapter 16: Skin-sparing mastectomy: Planned
two-stage and direct-to-implant breast
reconstruction
16.1: Mastectomy and expander insertion: First stage
16.2: Mastectomy and expander insertion: Second stage
Maurizio B. Nava, Giuseppe Catanuto, Angela Pennati,
Valentina Visintini Cividin, and Andrea Spano
Chapter 19: Latissimus dorsi flap breast
reconstruction
19.1: Latissimus dorsi flap technique
Scott L. Spear†
19.2: Markings
19.3: Intraoperative skin paddles
19.4: Tendon division
19.5: Transposition and skin paddles
19.6: Inset and better skin paddle explanation
Neil A. Fine and Michael S. Gart
Chapter 20.2: The deep inferior epigastric artery
perforator (DIEAP) flap
20.2.1: The Deep Inferior Epigastric Artery Perforator (DIEAP)
flap breast reconstruction
Phillip N. Blondeel and Robert J. Allen, Sr
Chapter 21.2: Gluteal free flaps for breast
reconstruction
21.2.1: Superior Gluteal Artery Perforator (SGAP) flap
21.2.2: Inferior Gluteal Artery Perforator (IGAP) flap
Peter C. Neligan
Chapter 21.3: Medial thigh flaps for breast
reconstruction
21.3.1: Transverse Upper Gracilis (TUG) flap 1
Peter C. Neligan
21.3.2: Transverse Upper Gracilis (TUG) flap 2
Venkat V. Ramakrishnan
Chapter 23.2: Partial breast reconstruction using
reduction and mastopexy techniques
23.2.1: Partial breast reconstruction using reduction
mammoplasty
Maurice Y. Nahabedian
23.2.2: Partial breast reconstruction with a latissimus dorsi flap
Neil A. Fine
23.2.3: Partial breast reconstruction with a pedicle TRAM
Maurice Y. Nahabedian
Volume Six:
Chapter 1: Anatomy and biomechanics of the hand
1.1: The extensor tendon compartments
1.2: The contribution of the interosseous and lumbrical
muscles to the lateral bands
1.3: Extrinsic flexors and surrounding vasculonervous
elements, from superficial to deep
1.4: The lumbrical plus deformity
1.5: The sensory and motor branches of the median nerve in
the hand
James Chang, Vincent R. Hentz, Robert A. Chase, and
Anais Legrand
Chapter 2: Examination of the upper extremity
2.1: Flexor profundus test in a normal long finger
2.2: Flexor sublimis test in a normal long finger
2.3: Extensor pollicis longus test in a normal person
2.4: Test for the Extensor Digitorum Communis (EDC) muscle
in a normal hand
2.5: Test for assessing thenar muscle function
2.6: The “cross fingers” sign
2.7: Static Two-Point Discrimination Test (s-2PD Test)
2.8: Moving 2PD Test (m-2PD Test) performed on the radial or
ulnar aspect of the finger

xv
Video Contents
2.9: Semmes–Weinstein monofilament test: The patient should
sense the pressure produced by bending the filament
2.10: Allen’s test in a normal person
2.11: Digital Allen’s test
2.12: Scaphoid shift test
2.13: Dynamic tenodesis effect in a normal hand
2.14: The milking test of the fingers and thumb in a normal
hand
2.15: Eichhoff test
2.16: Adson test
2.17: Roos test
Ryosuke Kakinoki
Chapter 3: Diagnostic imaging of the hand and
wrist
3.1: Scaphoid lunate dislocation
Alphonsus K. Chong and David M. K. Tan
3.2: Right wrist positive midcarpal catch up clunk
Alphonsus K. Chong
Chapter 4: Anesthesia for upper extremity surgery
4.1: Supraclavicular block
Subhro K. Sen
Chapter 5: Principles of internal fixation as applied
to the hand and wrist
5.1: Dynamic compression plating and lag screw technique
Christopher Cox
5.2: Headless compression screw
5.3: Locking vs. non-locking plates
Jeffrey Yao and Jason R. Kang
Chapter 7: Hand fractures and joint injuries
7.1: Bennett reduction
7.2: Hemi-Hamate arthroplasty
Warren C. Hammert
Chapter 9: Flexor tendon injury and reconstruction
9.1: Zone II flexor tendon repair
9.2: Incision and feed tendon forward
9.3: Distal tendon exposure
9.4: Six-strand M-tang repair
9.5: Extension–flexion test – wide awake
Jin Bo Tang
Chapter 10: Extensor tendon injuries
10.1: Sagittal band reconstruction
10.2: Setting the tension in extensor indicis transfer
Kai Megerle
Chapter 11: Replantation and revascularization
11.1: Hand replantation
James Chang
Chapter 12: Reconstructive surgery of the mutilated
hand
12.1: Debridement technique
James Chang
Chapter 13: Thumb reconstruction: Non-
microsurgical techniques
13.1: Osteoplastic thumb reconstruction
13.2: First Dorsal Metacarpal Artery (FDMA) flap
Jeffrey B. Friedrich
Chapter 14: Thumb reconstruction: Microsurgical
techniques
14.1: Trimmed great toe
14.2: Second toe for index finger
14.3: Combined second and third toe for metacarpal hand
Nidal F. Al Deek
Chapter 19: Rheumatologic conditions of the hand
and wrist
19.1: Extensor tendon rupture and end–side tendon transfer
James Chang
19.2: Silicone metacarpophalangeal arthroplasty
Kevin C. Chung and Evan Kowalski
Chapter 20: Osteoarthritis in the hand and wrist
20.1: Ligament reconstruction tendon interposition arthroplasty
of the thumb carpometacarpal joint
James W. Fletcher
Chapter 21: The stiff hand and the spastic hand
21.1: Flexor pronator slide
David T. Netscher
Chapter 22: Ischemia of the hand
22.1: Radial artery sympathectomy
Hee Chang Ahn and Neil F. Jones
22.2: Interposition arterial graft and sympathectomy
Hee Chang Ahn
Chapter 24: Nerve entrapment syndromes
24.1: The manual muscle testing algorithm
24.2: Scratch collapse test – carpal tunnel
Elisabet Hagert
24.3: Injection technique for carpal tunnel surgery
24.4: Wide awake carpal tunnel surgery
Donald Lalonde
24.5: Clinical exam and surgical technique – lacertus
syndrome
Elisabet Hagert
24.6: Injection technique for cubital tunnel surgery
24.7: Wide awake cubital tunnel surgery
Donald Lalonde
24.8: Clinical exam and surgical technique – radial tunnel
syndrome
24.9: Clinical exam and surgical technique – lateral
intermuscular syndrome
24.10: Clinical exam and surgical technique – axillary nerve
entrapment
Elisabet Hagert
24.11: Carpal tunnel and cubital tunnel releases in the same
patient in one procedure with field sterility: Part 1 – local
anesthetic injection for carpal tunnel
24.12: Carpal tunnel and cubital tunnel releases in the same
patient in one procedure with field sterility: Part 2 – local
anesthetic injection for cubital tunnel
Donald Lalonde and Michael Bezuhly
Chapter 25: Congenital hand I: Embryology,
classification, and principles
25.1: Pediatric trigger thumb release
James Chang

xvi
Video Contents
Chapter 27: Congenital hand III: Thumb hypoplasia
27.1: Thumb hypoplasia
Joseph Upton III and Amir Taghinia
Chapter 30: Growth considerations in pediatric
upper extremity trauma and reconstruction
30.1: Epiphyseal transplant harvesting technique
Marco Innocenti and Carla Baldrighi
Chapter 31: Vascular anomalies of the upper
extremity
31.1: Excision of venous malformation
Joseph Upton III and Amir Taghinia
Chapter 32: Peripheral nerve injuries of the upper
extremity
32.1: Suture repair of the cut digital nerve
32.2: Suture repair of the median nerve
Simon Farnebo and Johan Thorfinn
Chapter 35: Free-functioning muscle transfer in the
upper extremity
35.1: Gracilis functional muscle harvest
Gregory H. Borschel
Chapter 36: Brachial plexus injuries: Adult and
pediatric
36.1: Pediatric: shoulder correct and biceps-to-triceps transfer
with preserving intact brachialis
36.2: Adult: results of one-stage surgery for C5 rupture, C6–T1
root avulsion 10 years after
36.3: Nerve transfer results 1
36.4: Nerve transfer results 2
36.5: Nerve transfer results 3
36.6: Nerve transfer results 4
36.7: Nerve transfer results 5
David Chwei-Chin Chuang
Chapter 37: Restoration of upper extremity function
in tetraplegia
37.1: The single-stage grip and release procedure
37.2: Postoperative results after single-stage grip release
procedure in OCu3–5 patients
Carina Reinholdt and Catherine Curtin
Chapter 38: Upper extremity vascularized composite
allotransplantation
38.1: Upper extremity composite tissue allotransplantation
W. P. Andrew Lee and Vijay S. Gorantla
Chapter 39: Hand therapy
39.1: Goniometric measurement
39.2: Threshold testing
Christine B. Novak and Rebecca L. Neiduski

Lecture Video Contents
Volume One:
Chapter 1: Plastic surgery and innovation in medicine
Plastic surgery and innovation in medicine
Peter C. Neligan
Chapter 7: Digital imaging in plastic surgery
Digital imaging in plastic surgery
Daniel Z. Liu
Chapter 15: Skin graft
Skin graft
Peter C. Neligan
Chapter 19: Repair and grafting of peripheral nerve
Nerve injury and repair
Kirsty Usher Boyd, Andrew Yee, and Susan E. Mackinnon
Chapter 20: Reconstructive fat grafting
Reconstructive fat grafting
J. Peter Rubin
Chapter 21: Vascular territories
Vascular territories
Steven F. Morris
Chapter 22: Flap classification and applications
Flap classification and applications
Joon Pio Hong
Chapter 23: Flap pathophysiology and pharmacology
Flap pathophysiology and pharmacology
Cho Y. Pang and Peter C. Neligan
Chapter 24: Principles and techniques of
microvascular surgery
Principles and techniques of microvascular surgery
Fu-Chan Wei, Nidal F. Al Deek, and
Sherilyn Keng Lin Tay
Chapter 25: Principles and applications of tissue
expansion
Principles and applications of tissue expansion
Ivo Alexander Pestana, Louis C. Argenta, and
Malcolm W. Marks
Chapter 26: Principles of radiation
Therapeutic radiation: principles, effects, and complications
Gabrielle M. Kane
Chapter 28: Benign and malignant nonmelanocytic
tumors of the skin and soft tissue
Benign and malignant nonmelanocytic tumors of the skin and soft
tissue
Rei Ogawa
Chapter 31: Facial prosthetics in plastic surgery
Facial prosthetics in plastic surgery
Gordon H. Wilkes
Volume Two:
Chapter 4: Skincare and nonsurgical skin
rejuvenation
Skincare and nonsurgical skin rejuvenation
Leslie Baumann and Edmund Weisberg
Chapter 5.2: Injectables and resurfacing techniques:
Soft-tissue fillers
Soft-tissue fillers
Trevor M. Born, Lisa E. Airan, and Daniel Suissa
Chapter 5.3: Injectables and resurfacing techniques:
Botulinum toxin (BoNT-A)
Botulinum toxin
Michael A. C. Kane
Chapter 5.4: Injectables and resurfacing techniques:
Laser resurfacing
Laser resurfacing
Steven R. Cohen, Ahmad N. Saad, Tracy Leong,
and E. Victor Ross
Chapter 5.5: Injectables and resurfacing techniques:
Chemical peels
Chemical peels
Suzan Obagi
Chapter 6.1: Facelift: Facial anatomy and aging
Anatomy of the aging face
Bryan Mendelson and Chin-Ho Wong
Chapter 6.2: Facelift: Principles of and surgical
approaches to facelift
Principles of and surgical approaches to facelift
Richard J. Warren
Chapter 6.3: Facelift: Platysma-SMAS plication
Platysma-SMAS plication
Miles G. Berry

xviii
Lecture Video Contents
Chapter 6.4: Facelift: Facial rejuvenation with loop
sutures – the MACS lift and its derivatives
Facial rejuvenation with loop sutures – the MACS lift and its
derivatives
Mark Laurence Jewell
Chapter 6.5: Facelift: Lateral SMASectomy facelift
Lateral SMASectomy facelift
Daniel C. Baker and Steven M. Levine
Chapter 6.6: Facelift: The extended SMAS technique
in facial rejuvenation
The extended SMAS technique in facelift
James M. Stuzin
Chapter 6.7: Facelift: SMAS with skin attached – the
“high SMAS” technique
SMAS with skin attached – the high SMAS technique
Fritz E. Barton Jr.
Chapter 6.8: Facelift: Subperiosteal midface lift
Subperiosteal midface lift
Alan Yan and Michael J. Yaremchuk
Chapter 6.9: Facelift: Male facelift
Male facelift
Timothy J. Marten and Dino Elyassnia
Chapter 6.10: Facelift: Secondary deformities and
the secondary facelift
Secondary deformities and the secondary facelift
Timothy J. Marten and Dino Elyassnia
Chapter 7: Forehead rejuvenation
Forehead rejuvenation
Richard J. Warren
Chapter 8: Endoscopic brow lifting
Endoscopic brow lift
Renato Saltz and Alyssa Lolofie
Chapter 9: Blepharoplasty
Blepharoplasty
Julius Few Jr. and Marco Ellis
Chapter 11: Asian facial cosmetic surgery
Asian facial cosmetic surgery
Clyde H. Ishii
Chapter 12: Neck rejuvenation
Neck rejuvenation
James E. Zins, Joshua T. Waltzman, and Rafael A. Couto
Chapter 13: Structural fat grafting
Structural fat grafting
Sydney R. Coleman and Alesia P. Saboeiro
Chapter 15: Nasal analysis and anatomy
Nasal analysis and anatomy
Rod J. Rohrich
Chapter 19: Secondary rhinoplasty
Secondary rhinoplasty
Ronald P. Gruber, Simeon H. Wall Jr., David L. Kaufman,
and David M. Kahn
Chapter 21: Hair restoration
Hair restoration
Jack Fisher
Chapter 22.1: Liposuction: A comprehensive review
of techniques and safety
Liposuction
Phillip J. Stephan, Phillip Dauwe, and Jeffrey Kenkel
Chapter 22.2: Correction of liposuction deformities
with the SAFE liposuction technique
SAFE liposuction technique
Simeon H. Wall Jr. and Paul N. Afrooz
Chapter 23: Abdominoplasty procedures
Abdominoplasty
Dirk F. Richter and Nina Schwaiger
Chapter 25.2: Circumferential approaches to truncal
contouring: Belt lipectomy
Belt lipectomy
Al S. Aly, Khalid Al-Zahrani, and Albert Cram
Chapter 25.3: Circumferential approaches to truncal
contouring: The lower lipo-bodylift
Circumferential lower bodylift
Dirk F. Richter and Nina Schwaiger
Chapter 25.4: Circumferential approaches to truncal
contouring: Autologous buttocks augmentation with
purse string gluteoplasty
Purse string gluteoplasty
Joseph P. Hunstad and Nicholas A. Flugstad
Chapter 25.5: Circumferential approaches to truncal
contouring: Lower bodylift with autologous gluteal
flaps for augmentation and preservation of gluteal
contour
Lower bodylift with gluteal flaps
Robert F. Centeno and Jazmina M. Gonzalez
Chapter 26.3: Buttock augmentation: Buttock
shaping with fat grafting and liposuction
Buttock shaping with fat grafting and liposuction
Constantino G. Mendieta, Thomas L. Roberts III,
and Terrence W. Bruner
Chapter 27: Upper limb contouring
Upper limb contouring
Joseph F. Capella, Matthew J. Trovato, and Scott Woehrle
Chapter 30: Aesthetic genital surgery
Aesthetic genital surgery
Gary J. Alter

xix
Lecture Video Contents
Volume Three:
Chapter 10.3: Midface reconstruction: The M. D.
Anderson approach
Midfacial reconstruction: The M. D. Anderson approach
Matthew M. Hanasono and Roman Skoracki
Chapter 12: Lip reconstruction
Lip reconstruction
Peter C. Neligan and Lawrence J. Gottlieb
Chapter 14: Pharyngeal and esophageal
reconstruction
Pharyngoesophageal reconstruction
Peirong Yu
Chapter 15: Tumors of the facial skeleton: Fibrous
dysplasia
Fibrous dysplasia
Alberto Córdova-Aguilar and Yu-Ray Chen
Chapter 17: Local flaps for facial coverage
Local flaps for facial coverage
David W. Mathes
Chapter 19: Facial transplant
Facial transplant
Michael Sosin and Eduardo D. Rodriguez
Chapter 32: Nonsyndromic craniosynostosis
Nonsyndromic craniosynostosis
Patrick A. Gerety, Jesse A. Taylor, and Scott P. Bartlett
Chapter 36: Pierre Robin Sequence
Pierre Robin sequence
Chad A. Purnell and Arun K. Gosain
Chapter 39: Vascular anomalies
Vascular anomalies
Arin K. Greene and John B. Mulliken
Volume Four:
Chapter 2: Management of lower extremity trauma
Management of lower extremity trauma
Yoo Joon Sur, Shannon M. Colohan, and Michel Saint-Cyr
Chapter 15: Surgery for gender identity disorder
Surgery for gender identity disorder
Loren S. Schechter
Chapter 16: Pressure sores
Pressure sores
Robert Kwon, Juan L. Rendon, and Jeffrey E. Janis
Chapter 17: Perineal reconstruction
Perineal reconstruction
Hakim K. Said and Otway Louie
Volume Five:
Chapter 5: Breast augmentation with autologous fat
grafting
Breast augmentation with autologous fat grafting
E. Delay
Chapter 6: Mastopexy options and techniques
Mastopexy
Robert Cohen
Chapter 9: Reduction mammaplasty with inverted-T
techniques
Reduction mammaplasty with inverted-T techniques
Maurice Y. Nahabedian
Chapter 15: One- and two-stage prosthetic
reconstruction in nipple-sparing mastectomy
Prosthetic reconstruction in nipple-sparing mastectomy
Amy S. Colwell
Chapter 20.1: Abdominally based free flaps:
Introduction
Abdominally-based autologous breast reconstruction
Maurice Y. Nahabedian, Phillip N. Blondeel, and David H. Song
Chapter 20.2: The deep inferior epigastric artery
perforator (DIEAP) flap
Abdominally-based autologous breast reconstruction
Maurice Y. Nahabedian, Phillip N. Blondeel, and David H. Song
Chapter 20.3: The superficial inferior epigastric
artery (SIEA) flap
Abdominally-based autologous breast reconstruction
Maurice Y. Nahabedian, Phillip N. Blondeel, and David H. Song
Chapter 20.4: The free TRAM flap
Abdominally-based autologous breast reconstruction
Maurice Y. Nahabedian, Phillip N. Blondeel, and David H. Song
Chapter 25: Radiation therapy considerations in the
setting of breast reconstruction
Radiation therapy in breast reconstruction
Steven Kronowitz
Volume Six:
Chapter 7: Hand fractures and joint injuries
Hand fractures and joint injuries
Joseph S. Khouri and Warren C. Hammert
Chapter 13: Thumb reconstruction: Non-
microsurgical techniques
Thumb reconstruction
Nicholas B. Vedder and Jeffrey B. Friedrich
Chapter 21: The stiff hand and the spastic hand
The stiff hand
David T. Netscher, Kenneth W. Donohue, and Dang T. Pham

xx
Lecture Video Contents
Chapter 24: Nerve entrapment syndromes
Tips and pearls on common nerve compressions
Elisabet Hagert and Donald Lalonde
Chapter 30: Growth considerations in pediatric
upper extremity trauma and reconstruction
Growth considerations in pediatric upper extremity trauma and
reconstruction
Marco Innocenti and Carla Baldrighi
Chapter 33: Nerve transfers
Nerve injury and repair
Kirsty Usher Boyd, Andrew Yee, and Susan E. Mackinnon
Chapter 37: Restoration of upper extremity function
in tetraplegia
Restoration of upper extremity function in tetraplegia
Carina Reinholdt and Catherine Curtin

Preface to the Fourth Edition
When I wrote the preface to the 3rd edition of this book, I
remarked how honored and unexpectedly surprised I was to
be the Editor of this great series. This time ‘round, I’m equally
grateful to carry this series forward. When Elsevier called me
and suggested it was time to prepare the 4th edition, my
initial reaction was that this was way too soon. What could
possibly have changed in Plastic Surgery since the 3rd edition
was launched in 2012? As it transpires, there have been many
developments and I hope we have captured them in this
edition.
We have an extraordinary specialty. A recent article by
Chadra, Agarwal and Agarwal entitled “Redefining Plastic
Surgery” appeared in Plastic and Reconstructive Surgery—Global
Open. In it they gave the following definition: “Plastic surgery
is a specialized branch of surgery, which deals with deformi­
ties, defects and abnormalities of the organs of perception,
organs of action and the organs guarding the external pas­
sages, besides innovation, implantation, replantation and
transplantation of tissues, and aims at restoring and improv­
ing their form, function and the esthetic appearances.” This is
an all-encompassing but very apt definition and captures the
enormous scope of the specialty.1
In the 3rd edition, I introduced volume editors for each of
the areas of the specialty because the truth is that one person
can no longer be an expert in all areas of this diverse specialty,
and I’m certainly not. I think this worked well because the
volume editors not only had the expertise to present their area
of subspecialty in the best light, but they were tuned in to
what was new and who was doing it. We have continued this
model in this new edition. Four of the seven volume editors
from the previous edition have again helped to bring the latest
and the best to this edition: Drs Gurtner, Song, Rodriguez,
Losee, and Chang have revised and updated their respective
volumes with some chapters remaining, some extensively
revised, some added, and some deleted. Dr. Peter Rubin has
replaced Dr. Rick Warren to compile the Aesthetic volume
(Vol. 2). Dr. Warren did a wonderful job in corralling this
somewhat disparate, yet vitally important, part of our spe­
cialty into the Aesthetic volume in the 3rd edition but felt that
the task of doing it again, though a labor of love, was more
than he wanted to take on. Similarly, Dr. Jim Grotting who did
a masterful job in the last edition on the Breast volume,
decided that doing a major revision should be undertaken by
someone with a fresh perspective and Dr. Maurice Nahabe­
dian stepped into that breach. I hope you will like the changes
you see in both of these volumes.
Dr. Allen Van Beek was the video editor for the last edition
and he compiled an impressive array of movies to comple­
ment the text. This time around, we wanted to go a step
further and though we’ve considerably expanded the list of
videos accompanying the text (there are over 170), we also
added the idea of lectures accompanying selected chapters.
What we’ve done here is to take selected key chapters and
include the images from that chapter, photos and artwork,
and create a narrated presentation that is available online;
there are annotations in the text to alert the reader that this is
available. Dr. Daniel Liu, who has taken over from Dr. Van
Beek as multimedia editor (rather than video editor) has done
an amazing job in making all of this happen. There are over
70 presentations of various key chapters online, making it as
easy as possible for you, the reader, to get as much knowledge
as you can, in the easiest way possible from this edition. Many
of these presentations have been done by the authors of the
chapters; the rest have been compiled by Dr. Liu and myself
from the content of the individual chapters. I hope you find
them useful.
The reader may wonder how this all works. To plan this
edition, the Elsevier team, headed by Belinda Kuhn, and I,
convened a face-to-face meeting in San Francisco. The volume
editors, as well as the London based editorial team, were
present. We went through the 3rd edition, volume by volume,
chapter by chapter, over an entire weekend. We decided what
needed to stay, what needed to be added, what needed to be
revised, and what needed to be changed. We also decided
who should write the various chapters, keeping many exist­
ing authors, replacing others, and adding some new ones; we
did this so as to really reflect the changes occurring within the
specialty. We also decided on practical changes that needed to
be made. As an example, you will notice that we have omitted
the complete index for the 6 Volume set from Volumes 2-6
and highlighted only the table of contents for that particular
volume. The complete index is of course available in Volume
1 and fully searchable online. This allowed us to save several
hundred pages per volume, reducing production costs and
diverting those dollars to the production of the enhanced online
content.
In my travels around the world since the 3rd edition was
published, I’ve been struck by what an impact this publication
has had on the specialty and, more particularly, on training.
Everywhere I go, I’m told how the text is an important part
of didactic teaching and a font of knowledge. It is gratifying
to see that the 3rd edition has been translated into Portuguese,
Spanish, and Chinese. This is enormously encouraging. I
hope this 4th edition continues to contribute to the specialty,
remains a resource for practicing surgeons, and continues to
prepare our trainees for their future careers in Plastic Surgery.
Peter C. Neligan
Seattle, WA
September, 2017
1 Chandra R, Agarwal R, Agarwal D. Redefining Plastic Surgery. Plast
Reconstr Surg Glob Open. 2016;4(5):e706.

List of Editors
Editor-in-Chief
Peter C. Neligan, MB, FRCS(I), FRCSC, FACS
Professor of Surgery
Department of Surgery, Division of Plastic Surgery
University of Washington
Seattle, WA, USA
Volume 1: Principles
Geoffrey C. Gurtner, MD, FACS
Johnson and Johnson Distinguished Professor of
Surgery and Vice Chairman,
Department of Surgery (Plastic Surgery)
Stanford University
Stanford, CA, USA
Volume 2: Aesthetic
J. Peter Rubin, MD, FACS
UPMC Professor of Plastic Surgery
Chair, Department of Plastic Surgery
Professor of Bioengineering
University of Pittsburgh
Pittsburgh, PA, USA
Volume 3: Craniofacial, Head and Neck Surgery
Eduardo D. Rodriguez, MD, DDS
Helen L. Kimmel Professor of Reconstructive
Plastic Surgery
Chair, Hansjörg Wyss Department of Plastic
Surgery
NYU School of Medicine
NYU Langone Medical Center
New York, NY, USA
Volume 3: Pediatric Plastic Surgery
Joseph E. Losee, MD
Ross H. Musgrave Professor of Pediatric Plastic
Surgery
Department of Plastic Surgery
University of Pittsburgh Medical Center;
Chief Division of Pediatric Plastic Surgery
Children’s Hospital of Pittsburgh
Pittsburgh, PA, USA
Volume 4: Lower Extremity, Trunk, and Burns
David H. Song, MD, MBA, FACS
Regional Chief, MedStar Health
Plastic and Reconstructive Surgery
Professor and Chairman
Department of Plastic Surgery
Georgetown University School of Medicine
Washington, DC, USA
Volume 5: Breast
Maurice Y. Nahabedian, MD, FACS
Professor and Chief
Section of Plastic Surgery
MedStar Washington Hospital Center
Washington, DC, USA;
Vice Chairman
Department of Plastic Surgery
MedStar Georgetown University Hospital
Washington, DC, USA
Volume 6: Hand and Upper Extremity
James Chang, MD
Johnson & Johnson Distinguished
Professor and Chief
Division of Plastic and Reconstructive Surgery
Stanford University Medical Center
Stanford, CA, USA
Multimedia editor
Daniel Z. Liu, MD
Plastic and Reconstructive Surgeon
Cancer Treatment Centers of America at Midwest­
ern Regional Medical Center
Zion, IL, USA

List of Contributors
VOLUME ONE
Hatem Abou-Sayed, MD, MBA
Vice President
Physician Engagement
Interpreta, Inc.
San Diego, CA, USA
Paul N. Afrooz, MD
Resident
Plastic and Reconstructive Surgery
University of Pittsburgh Medical Center
Pittsburgh, PA, USA
Claudia R. Albornoz, MD, MSc
Research Fellow
Plastic and Reconstructive Surgery
Memorial Sloan Kettering Cancer Center
New York, NY, USA
Nidal F. Al Deek, MD
Doctor of Plastic and Reconstructive Surgery
Chang Gung Memorial Hospital
Taipei, Taiwan
Amy K. Alderman, MD, MPH
Private Practice
Atlanta, GA, USA
Louis C. Argenta, MD
Professor of Plastic and Reconstructive Surgery
Department of Plastic Surgery
Wake Forest Medical Center
Winston Salem, NC, USA
Stephan Ariyan, MD, MBA
Emeritus Frank F. Kanthak Professor of Surgery,
Plastic Surgery, Surgical Oncology,
Otolaryngology
Yale University School of Medicine;
Associate Chief
Department of Surgery;
Founding Director, Melanoma Program
Smilow Cancer Hospital, Yale Cancer Center
New Haven, CT, USA
Tomer Avraham, MD
Attending Plastic Surgeon
Mount Sinai Health System
Tufts University School of Medicine
New York, NY, USA
Aaron Berger, MD, PhD
Clinical Assistant Professor
Division of Plastic Surgery
Florida International University School of
Medicine
Miami, FL, USA
Kirsty Usher Boyd, MD, FRCSC
Assistant Professor Surgery (Plastics)
Division of Plastic and Reconstructive Surgery
University of Ottawa
Ottawa, Ontario, Canada
Charles E. Butler, MD, FACS
Professor and Chairman
Department of Plastic Surgery
Charles B. Barker Endowed Chair in Surgery
The University of Texas MD Anderson Cancer
Center
Houston, TX, USA
Peter E. M. Butler, MD, FRCSI, FRCS,
FRCS(Plast)
Professor
Plastic and Reconstructive Surgery
University College and Royal Free London
London, UK
Yilin Cao, MD, PhD
Professor
Shanghai Ninth People’s Hospital
Shanghai Jiao Tong University School of
Medicine
Shanghai, China
Franklyn P. Cladis, MD, FAAP
Associate Professor of Anesthesiology
Department of Anesthesiology
The Children’s Hospital of Pittsburgh of UPMC
Pittsburgh, PA, USA
Mark B. Constantian, MD
Private Practice
Surgery (Plastic Surgery)
St. Joseph Hospital
Nashua, NH, USA
Daniel A. Cuzzone, MD
Plastic Surgery Fellow
Hanjörg Wyss Department of Plastic Surgery
New York University Medical Center
New York, NY, USA
Gurleen Dhami, MD
Chief Resident
Department of Radiation Oncology
University of Washington
Seattle, WA, USA
Gayle Gordillo, MD
Associate Professor
Plastic Surgery
The Ohio State University
Columbus, OH, USA
Geoffrey C. Gurtner, MD, FACS
Johnson and Johnson Distinguished Professor
of Surgery and Vice Chairman,
Department of Surgery (Plastic Surgery)
Stanford University
Stanford, CA, USA
Phillip C. Haeck, MD
Surgeon
Plastic Surgery
The Polyclinic
Seattle, WA, USA
The late Bruce Halperin†, MD
Formerly Adjunct Associate Professor of
Anesthesia
Department of Anesthesia
Stanford University
Stanford, CA, USA
Daniel E. Heath
Lecturer
School of Chemical and Biomedical Engineering
University of Melbourne
Parkville, Victoria, Australia
Joon Pio Hong, MD, PhD, MMM
Professor
Plastic Surgery
Asan Medical Center, University of Ulsan
Seoul, South Korea
Michael S. Hu, MD, MPH, MS
Postdoctoral Fellow
Division of Plastic Surgery
Department of Surgery
Stanford University School of Medicine
Stanford, CA, USA
C. Scott Hultman, MD, MBA
Professor and Chief
Division of Plastic and Reconstructive Surgery
University of North Carolina
Chapel Hill, NC, USA
Amir E. Ibrahim
Division of Plastic Surgery
Department of Surgery
American University of Beirut Medical Center
Beirut, Lebanon
Leila Jazayeri, MD
Microsurgery Fellow
Plastic and Reconstructive Surgery
Memorial Sloan Kettering Cancer Center
New York, NY, USA
The editors would like to acknowledge and offer grateful thanks for the input of all previous editions’ contributors, without whom this new edition would
not have been possible.

xxiv
List of Contributors
Brian Jeffers
Student
Bioengineering
University of California Berkeley
Berkeley, CA USA
Lynn Jeffers, MD, FACS
Private Practice
Oxnard, CA, USA
Mohammed M. Al Kahtani, MD, FRCSC
Clinical Fellow
Division of Plastic Surgery
Department of Surgery
University of Alberta
Edmonton, Alberta, Canada
Gabrielle M. Kane, MB, BCh, EdD, FRCPC
Associate Professor
Radiation Oncology
University of Washington
Seattle, WA, USA
Raghu P. Kataru, PhD
Senior Research Scientist
Memorial Sloan-Kettering Cancer Center
New York, NY, USA
Carolyn L. Kerrigan, MD, MSc, MHCDS
Professor of Surgery
Surgery
Dartmouth–Hitchcock Medical Center
Lebanon, NH, USA
Timothy W. King, MD, PhD, FAAP, FACS
Associate Professor with Tenure
Departments of Surgery and Biomedical
Engineering;
Director of Research, Division of Plastic Surgery
University of Alabama at Birmingham (UAB)
Craniofacial and Pediatric Plastic Surgery
Children’s of Alabama – Plastic Surgery;
Chief, Plastic Surgery Section
Birmingham VA Hospital
Birmingham, AL, USA
Brian M. Kinney, MD, FACS, MSME
Clinical Assistant Professor of Plastic Surgery
University of Southern California
School of Medicine
Los Angeles, CA, USA
W. P. Andrew Lee, MD
The Milton T. Edgerton MD, Professor and
Chairman
Department of Plastic and Reconstructive
Surgery
Johns Hopkins University School of Medicine
Baltimore, MD, USA
Sherilyn Keng Lin Tay, MBChB, MSc,
FRCS(Plast)
Consultant Plastic Surgeon
Canniesburn Plastic Surgery Unit
Glasgow Royal Infirmary
Glasgow, UK
Daniel Z. Liu, MD
Plastic and Reconstructive Surgeon
Cancer Treatment Centers of America at
Midwestern Regional Medical Center
Zion, IL, USA
Wei Liu, MD, PhD
Professor
Plastic and Reconstructive Surgery
Shanghai Ninth People’s Hospital
Shanghai Jiao Tong University School of
Medicine
Shanghai, China
Michael T. Longaker, MD, MBA, FACS
Deane P. and Louise Mitchell Professor and Vice
Chair
Department of Surgery
Stanford University
Stanford, CA, USA
H. Peter Lorenz, MD
Service Chief and Professor, Plastic Surgery
Lucile Packard Children’s Hospital
Stanford University School of Medicine
Stanford, CA, USA
Susan E. Mackinnon, MD
Sydney M. Shoenberg Jr. and Robert H.
Shoenberg Professor
Department of Surgery, Division of Plastic and
Reconstructive Surgery
Washington University School of Medicine
St. Louis, MO, USA
Malcolm W. Marks, MD
Professor and Chairman
Department of Plastic Surgery
Wake Forest University School of Medicine
Winston-Salem, NC, USA
Diego Marre, MD
Fellow
O’Brien Institute
Department of Plastic and Reconstructive
Surgery
St. Vincent’s Hospital
Melbourne, Australia
David W. Mathes, MD
Professor and Chief of the Division of Plastic
and Reconstructive Surgery
University of Colorado
Aurora, CO, USA
Evan Matros MD, MMSc
Plastic Surgeon
Memorial Sloan-Kettering Cancer Center
New York, NY, USA
Isabella C. Mazzola, MD
Attending Plastic Surgeon
Klinik für Plastische und Ästhetische Chirurgie
Klinikum Landkreis Erding
Erding, Germany
Riccardo F. Mazzola, MD
Plastic Surgeon
Department of Specialistic Surgical Sciences
Fondazione Ospedale Maggiore Policlinico, Ca’
Granda IRCCS
Milano, Italy
Lindsay D. McHutchion, MS, BSc
Anaplastologist
Institute for Reconstructive Sciences in Medicine
Edmonton, Alberta, Canada
Babak J. Mehrara, MD, FACS
Associate Member, Associate Professor of
Surgery (Plastic)
Memorial Sloan Kettering Cancer Center
Weil Cornell University Medical Center
New York, NY, USA
Steven F. Morris, MD, MSc, FRCSC
Professor of Surgery
Department of Surgery
Dalhousie University
Halifax, Nova Scotia, Canada
Wayne A. Morrison, MBBS, MD, FRACS
Professorial Fellow
O’Brien Institute
Department of Surgery, University of Melbourne
Department of Plastic and Reconstructive
Surgery, St. Vincent’s Hospital
Melbourne, Australia
Peter C. Neligan, MB, FRCS(I), FRCSC,
FACS
Professor of Surgery
Department of Surgery, Division of Plastic
Surgery
University of Washington
Seattle, WA, USA
Andrea J. O’Connor, BE(Hons), PhD
Associate Professor
Department of Chemical and Biomolecular
Engineering
University of Melbourne
Parkville, Victoria, Australia
Rei Ogawa, MD, PhD, FACS
Professor and Chief
Department of Plastic
Reconstructive and Aesthetic Surgery
Nippon Medical School
Tokyo, Japan
Dennis P. Orgill, MD, PhD
Professor of Surgery
Harvard Medical School
Medical Director, Wound Care Center;
Vice Chairman for Quality Improvement
Department of Surgery
Brigham and Women’s Hospital
Boston, MA, USA

xxv
List of Contributors
Cho Y. Pang, PhD
Senior Scientist
Research Institute
The Hospital for Sick Children;
Professor
Departments of Surgery/Physiology
University of Toronto
Toronto, Ontario, Canada
Ivo Alexander Pestana, MD, FACS
Associate Professor
Plastic and Reconstructive Surgery
Wake Forest University
Winston Salem, NC, USA
Giorgio Pietramaggior, MD, PhD
Swiss Nerve Institute
Clinique de La Source
Lausanne, Switzerland
Andrea L. Pusic, MD, MHS, FACS
Associate Professor
Plastic and Reconstructive Surgery
Memorial Sloan Kettering Cancer Center
New York, NY, USA
Russell R. Reid, MD, PhD
Associate Professor
Surgery/Section of Plastic and Reconstructive
Surgery
University of Chicago Medicine
Chicago, IL, USA
Neal R. Reisman, MD, JD
Chief
Plastic Surgery
Baylor St. Luke’s Medical Center
Houston, TX, USA
Joseph M. Rosen, MD
Professor of Surgery
Plastic Surgery
Dartmouth–Hitchcock Medical Center
Lebanon, NH, USA
Sashwati Roy, MS, PhD
Associate Professor
Surgery, Center for Regenerative Medicine and
Cell based Therapies
The Ohio State University
Columbus, OH, USA
J. Peter Rubin, MD, FACS
UPMC Professor of Plastic Surgery
Chair, Department of Plastic Surgery
Professor of Bioengineering
University of Pittsburgh
Pittsburgh, PA, USA
Karim A. Sarhane, MD
Department of Surgery
University of Toledo Medical Center
Toledo, OH, USA
David B. Sarwer, PhD
Associate Professor of Psychology
Departments of Psychiatry and Surgery
University of Pennsylvania School of Medicine
Philadelphia, PA, USA
Saja S. Scherer-Pietramaggiori, MD
Plastic and Reconstructive Surgeon
Plastic Surgery
University Hospital Lausanne
Lausanne, Vaud, Switzerland
Iris A. Seitz, MD, PhD
Director of Research and International
Collaboration
University Plastic Surgery
Rosalind Franklin University;
Clinical Instructor of Surgery
Chicago Medical School
Chicago, IL, USA
Jesse C. Selber, MD, MPH, FACS
Associate Professor, Director of Clinical
Research
Department of Plastic Surgery
MD Anderson Cancer Center
Houston, TX, USA
Chandan K. Sen, PhD
Professor and Director
Center for Regenerative Medicine and Cell-
Based Therapies
The Ohio State University Wexner Medical
Center
Columbus, OH, USA
Wesley N. Sivak, MD, PhD
Resident in Plastic Surgery
Department of Plastic Surgery
University of Pittsburgh
Pittsburgh, PA, USA
M. Lucy Sudekum
Research Assistant
Thayer School of Engineering at Dartmouth
College
Hanover, NH, USA
G. Ian Taylor, AO, MBBS, MD, MD(Hon
Bordeaux), FRACS, FRCS(Eng), FRCS(Hon
Edinburgh), FRCSI(Hon), FRSC(Hon
Canada), FACS(Hon)
Professor
Department of Plastic Surgery
Royal Melbourne Hospital;
Professor
Department of Anatomy
University of Melbourne
Melbourne, Victoria, Australia
Chad M. Teven, MD
Resident
Section of Plastic and Reconstructive Surgery
University of Chicago
Chicago, IL, USA
Ruth Tevlin, MB BAO BCh, MRCSI, MD
Resident in Surgery
Department of Plastic and Reconstructive
Surgery
Stanford University School of Medicine
Stanford, CA, USA
E. Dale Collins Vidal, MD, MS
Chief
Section of Plastic Surgery
Dartmouth–Hitchcock Medical Center
Lebanon, NH, USA
Derrick C. Wan, MD
Associate Professor
Division of Plastic Surgery
Department of Surgery
Director of Maxillofacial Surgery
Lucile Packard Children’s Hospital
Stanford University School of Medicine
Stanford, CA, USA
Renata V. Weber, MD
Assistant Professor Surgery (Plastics)
Division of Plastic and Reconstructive Surgery
Albert Einstein College of Medicine
Bronx, NY, USA
Fu-Chan Wei, MD
Professor
Department of Plastic Surgery
Chang Gung Memorial Hospital
Taoyuan, Taiwan
Gordon H. Wilkes, BScMed, MD
Clinical Professor of Surgery
Department of Surgery University of Alberta
Institute for Reconstructive Sciences in Medicine
Misericordia Hospital
Edmonton, Alberta, Canada
Johan F. Wolfaardt, BDS,
MDent(Prosthodontics), PhD
Professor
Division of Otolaryngology – Head and Neck
Surgery
Department of Surgery
Faculty of Medicine and Dentistry;
Director of Clinics and International Relations
Institute for Reconstructive Sciences in Medicine
University of Alberta
Covenant Health Group
Alberta Health Services
Alberta, Canada
Kiryu K. Yap, MBBS, BMedSc
Junior Surgical Trainee & PhD Candidate
O’Brien Institute
Department of Surgery, University of Melbourne
Department of Plastic and Reconstructive
Surgery, St. Vincent’s Hospital
Melbourne, Australia
Andrew Yee
Research Assistant
Division of Plastic and Reconstructive Surgery
Washington University School of Medicine
St. Louis, MO, USA
Elizabeth R. Zielins, MD
Postdoctoral Research Fellow
Surgery
Stanford University School of Medicine
Stanford, CA, USA

xxvi
List of Contributors
VOLUME TWO
Paul N. Afrooz, MD
Resident
Plastic and Reconstructive Surgery
University of Pittsburgh Medical Center
Pittsburgh, PA, USA
Jamil Ahmad, MD, FRCSC
Director of Research and Education
The Plastic Surgery Clinic
Mississauga;
Assistant Professor
Surgery
University of Toronto
Toronto, Ontario, Canada
Lisa E. Airan, MD
Aesthetic Dermatologist NYC
Private Practice;
Associate Clinical Professor Department of
Dermatology
Mount Sinai School of Medicine
New York, NY, USA
Gary J. Alter, MD
Assistant Clinical Professor
Division of Plastic Surgery
University of California
Los Angeles, CA, USA
Al S. Aly, MD
Professor of Plastic Surgery
Aesthetic and Plastic Surgery Institute University
of California Irvine
Orange, CA, USA
Khalid Al-Zahrani, MD, SSC-PLAST
Assistant Professor
Consultant Plastic Surgeon
King Khalid University Hospital
King Saud University
Riyadh, Saudi Arabia
Bryan Armijo, MD
Plastic Surgery Chief Resident
Department of Plastic and Reconstructive
Surgery
Case Western Reserve/University Hospitals
Cleveland, OH, USA
Daniel C. Baker, MD
Professor of Surgery
Institute of Reconstructive Plastic Surgery
New York University Medical Center
Department of Plastic Surgery
New York, NY, USA
Fritz E. Barton Jr., MD
Clinical Professor
Department of Plastic Surgery
UT Southwestern Medical Center
Dallas, TX, USA
Leslie Baumann, MD
CEO
Baumann Cosmetic and Research Institute
Miami, FL, USA
Miles G. Berry, MS, FRCS(Plast)
Consultant Plastic and Aesthetic Surgeon
Institute of Cosmetic and Reconstructive
Surgery
London, UK
Trevor M. Born, MD
Division of Plastic Surgery
Lenox Hill/Manhattan Eye Ear and Throat
Hospital North Shore-LIJ Hospital
New York, NY, USA;
Clinical Lecturer
Division of Plastic Surgery
University of Toronto Western Division
Toronto, Ontario, Canada
Terrence W. Bruner, MD, MBA
Private Practice
Greenville, SC, USA
Andrés F. Cánchica, MD
Chief Resident of Plastic Surgery
Plastic Surgery Service Dr. Osvaldo Saldanha
São Paulo, Brazil
Joseph F. Capella, MD
Chief Post-bariatric Body Contouring
Division of Plastic Surgery
Hackensack University Medical Center
Hackensack, NJ, USA
Robert F. Centeno, MD, MBA
Medical Director
St. Croix Plastic Surgery and MediSpa;
Chief Medical Quality Officer
Governor Juan F. Luis Hospital and Medical
Center
Christiansted, Saint Croix, United States Virgin
Islands
Ernest S. Chiu, MD, FACS
Associate Professor of Plastic Surgery
Department of Plastic Surgery
New York University
New York, NY, USA
Jong Woo Choi, MD, PhD, MMM
Associate Professor
Department of Plastic and Reconstructive
Surgery
Seoul Asan Medical Center
Seoul, South Korea
Steven R. Cohen, MD
Senior Clinical Research Fellow, Clinical
Professor
Plastic Surgery
University of California
San Diego, CA;
Director
Craniofacial Surgery
Rady Children’s Hospital, Private Practice,
FACES+ Plastic Surgery, Skin and Laser Center
La Jolla, CA, USA
Sydney R. Coleman, MD
Assistant Clinical Professor
Plastic Surgery
New York University Medical Center
New York;
Assistant Clinical Professor
Plastic Surgery
University of Pittsburgh Medical Center
Pittsburgh, PA, USA
Mark B. Constantian, MD
Private Practice
Surgery (Plastic Surgery)
St. Joseph Hospital
Nashua, NH, USA;
Adjunct Clinical Professor
Surgery (Plastic Surgery)
University of Wisconsin School of Medicine
Madison, WI, USA;
Visiting Professor
Plastic Surgery
University of Virginia Health System
Charlottesville, VA, USA
Rafael A. Couto, MD
Plastic Surgery Resident
Department of Plastic Surgery
Cleveland Clinic
Cleveland, OH, USA
Albert Cram, MD
Professor Emeritus
University of Iowa
Iowa City Plastic Surgery
Coralville, IO, USA
Phillip Dauwe, MD
Department of Plastic Surgery
University of Texas Southwestern Medical
School
Dallas, TX, USA
Dai M. Davies, FRCS
Consultant and Institute Director
Institute of Cosmetic and Reconstructive
Surgery
London, UK
Jose Abel De la Peña Salcedo, MD, FACS
Plastic Surgeon
Director
Instituto de Cirugia Plastica S.C.
Huixquilucan
Estado de Mexico, Mexico
Barry DiBernardo, MD, FACS
Clinical Associate Professor, Plastic Surgery
Rutgers, New Jersey Medical School
Director New Jersey Plastic Surgery
Montclair, NJ, USA
Felmont F. Eaves III, MD, FACS
Professor of Surgery, Emory University
Medical Director, Emory Aesthetic Center
Medical Director, EAC Ambulatory Surgery
Center
Atlanta, GA, USA

xxvii
List of Contributors
Marco Ellis, MD
Director of Craniofacial Surgery
Northwestern Specialists in Plastic Surgery;
Adjunct Assistant Professor
University of Illinois Chicago Medical Center
Chicago, IL, USA
Dino Elyassnia, MD
Associate Plastic Surgeon
Marten Clinic of Plastic Surgery
San Francisco, CA, USA
Julius Few Jr., MD
Director
The Few Institute for Aesthetic Plastic Surgery;
Clinical Professor
Plastic Surgery
University of Chicago Pritzker School of
Medicine
Chicago, IL, USA
Osvaldo Ribeiro Saldanha Filho, MD
Professor of Plastic Surgery
Plastic Surgery Service Dr. Osvaldo Saldanha
São Paulo, Brazil
Jack Fisher, MD
Associate Clinical Professor
Plastic Surgery
Vanderbilt University
Nashville, TN, USA
Nicholas A. Flugstad, MD
Flugstad Plastic Surgery
Bellevue, WA, USA
James D. Frame, MBBS, FRCS, FRCSEd,
FRCS(Plast)
Professor of Aesthetic Plastic Surgery
Anglia Ruskin University
Chelmsford, UK
Jazmina M. Gonzalez, MD
Bitar Cosmetic Surgery Institute
Fairfax, VA, USA
Richard J. Greco, MD
CEO
The Georgia Institute For Plastic Surgery
Savannah, GA, USA
Ronald P. Gruber, MD
Adjunct Associate Clinical Professor
Division of Plastic and Reconstructive Surgery
Stanford University
Stanford, CA
Clinical Association Professor
Division of Plastic and Reconstructive Surgery
University of California San Francisco
San Francisco, CA, USA
Bahman Guyuron, MD, FCVS
Editor in Chief, Aesthetic Plastic Surgery Journal
Emeritus Professor of Plastic Surgery
Case School of Medicine
Cleveland, OH, USA
Joseph P. Hunstad, MD, FACS
Associate Consulting Professor
Division of Plastic Surgery
The University of North Carolina at Chapel Hill;
Private Practice
Huntersville/Charlotte, NC, USA
Clyde H. Ishii, MD, FACS
Assistant Clinical Professor of Surgery
John A. Burns School of Medicine;
Chief, Department of Plastic Surgery
Shriners Hospital
Honolulu Unit
Honolulu, HI, USA
Nicole J. Jarrett, MD
Department of Plastic Surgery
University of Pittsburgh
Pittsburgh, PA, USA
Elizabeth B. Jelks, MD
Private Practice
Jelks Medical
New York, NY, USA
Glenn W. Jelks, MD
Associate Professor
Department of Ophthalmology
Department of Plastic Surgery
New York University School of Medicine
New York, NY, USA
Mark Laurence Jewell, MD
Assistant Clinical Professor Plastic Surgery
Oregon Health Science University
Portland, OR, USA
David M. Kahn, MD
Clinical Associate Professor of Plastic Surgery
Department of Surgery
Stanford University School of Medicine
Stanford, CA, USA
Michael A. C. Kane, BS, MD
Attending Surgeon
Plastic Surgery
Manhattan Eye, Ear, and Throat Hospital
New York, NY, USA
David L. Kaufman, MD, FACS
Private Practice Plastic Surgery
Aesthetic Artistry Surgical and Medical Center
Folsom, CA, USA
Jeffrey Kenkel, MD
Professor and Chairman
Department of Plastic Surgery
UT Southwestern Medical Center
Dallas, TX, USA
Kyung S. Koh, MD, PhD
Professor of Plastic Surgery
Asan Medical Center, University of Ulsan School
of Medicine
Seoul, South Korea
Tracy Leong, MD
Dermatology
Rady Children’s Hospital - San Diego;
Sharp Memorial Hospital;
University California San Diego Medical Center
San Diego;
Private Practice, FACES+ Plastic Surgery, Skin
and Laser Center
La Jolla, CA, USA
Steven M. Levine, MD
Assistant Professor of Surgery (Plastic)
Hofstra Medical School, Northwell Health,
New York, NY, USA
Michelle B. Locke, MBChB, MD
Senior Lecturer in Surgery
Department of Surgery
University of Auckland Faculty of Medicine and
Health Sciences;
South Auckland Clinical Campus
Middlemore Hospital
Auckland, New Zealand
Alyssa Lolofie
University of Utah
Salt Lake City, UT, USA
Timothy J. Marten, MD, FACS
Founder and Director
Marten Clinic of Plastic Surgery
San Francisco, CA, USA
Bryan Mendelson, FRCSE, FRACS, FACS
The Centre for Facial Plastic Surgery
Toorak, Victoria, Australia
Constantino G. Mendieta, MD, FACS
Private Practice
Miami, FL, USA
Drew B. Metcalfe, MD
Division of Plastic and Reconstructive Surgery
Emory University
Atlanta, GA, USA
Gabriele C. Miotto, MD
Emory School of Medicine
Atlanta, GA, USA
Foad Nahai, MD
Professor of Surgery
Division of Plastic and Reconstructive Surgery
Department of Surgery
Emory University School of Medicine
Emory Aesthetic Center at Paces
Atlanta, Georgia, USA
Suzan Obagi, MD
Associate Professor of Dermatology
Dermatology
University of Pittsburgh;
Associate Professor of Plastic Surgery
Plastic Surgery
University of Pittsburgh
Pittsburgh, PA, USA

xxviii
List of Contributors
Sabina Aparecida Alvarez de Paiva, MD
Resident of Plastic Surgery
Plastic Surgery Service Dr. Ewaldo Bolivar de
Souza Pinto
São Paulo, Brazil
Galen Perdikis, MD
Assistant Professor of Surgery
Division of Plastic Surgery
Emory University School of Medicine
Atlanta, GA, USA
Jason Posner, MD, FACS
Private Practice
Boca Raton, FL, USA
Dirk F. Richter, MD, PhD
Clinical Professor of Plastic Surgery
University of Bonn
Director and Chief
Dreifaltigkeits-Hospital
Wesseling, Germany
Thomas L. Roberts III, FACS
Plastic Surgery Center of the Carolinas
Spartanburg, SC, USA
Jocelyn Celeste Ledezma Rodriguez, MD
Private Practice
Guadalajara, Jalisco, Mexico
Rod J. Rohrich, MD
Clinical Professor and Founding Chair
Department of Plastic Surgery
Distinguished Teaching Professor
University of Texas Southwestern Medical Center
Founding Partner
Dallas Plastic Surgery Institute
Dallas, TX, USA
E. Victor Ross, MD
Director of Laser and Cosmetic Dermatology
Scripps Clinic
San Diego, CA, USA
J. Peter Rubin, MD, FACS
Chief
Plastic and Reconstructive Surgery
University of Pittsburgh Medical Center;
Associate Professor
Department of Surgery
University of Pittsburgh
Pittsburgh, PA, USA
Ahmad N. Saad, MD
Private Practice
FACES+ Plastic Surgery
Skin and Laser Center
La Jolla, CA, USA
Alesia P. Saboeiro, MD
Attending Physician
Private Practice
New York, NY, USA
Cristianna Bonnetto Saldanha, MD
Plastic Surgery Service Dr. Osvaldo Saldanha
São Paulo, Brazil
Osvaldo Saldanha, MD, PhD
Director of Plastic Surgery Service Dr. Osvaldo
Saldanha;
Professor of Plastic Surgery Department
Universidade Metropolitana de Santos
- UNIMES
São Paulo, Brazil
Renato Saltz, MD, FACS
Saltz Plastic Surgery
President
International Society of Aesthetic Plastic Surgery
Adjunct Professor of Surgery
University of Utah
Past-President, American Society for Aesthetic
Plastic Surgery
Salt Lake City and Park City, UT, USA
Paulo Rodamilans Sanjuan MD
Chief Resident of Plastic Surgery
Plastic Surgery Service Dr. Ewaldo Boliar de
Souza Pinto
São Paulo, Brazil
Nina Schwaiger, MD
Senior Specialist in Plastic and Aesthetic
Surgery
Department of Plastic Surgery
Dreifaltigkeits-Hospital Wesseling
Wesseling, Germany
Douglas S. Steinbrech, MD, FACS
Gotham Plastic Surgery
New York, NY, USA
Phillip J. Stephan, MD
Clinical Faculty
Plastic Surgery
UT Southwestern Medical School;
Plastic Surgeon
Texoma Plastic Surgery
Wichita Falls, TX, USA
David Gonzalez Sosa, MD
Plastic and Reconstructive Surgery
Hospital Quirónsalud Torrevieja
Alicante, Spain
James M. Stuzin, MD
Associate Professor of Surgery
(Plastic) Voluntary
University of Miami Leonard M. Miller School of
Medicine
Miami, FL, USA
Daniel Suissa, MD, MSc
Clinical Instructor
Section of Plastic and Reconstructive Surgery
Yale University
New Haven, CT, USA
Charles H. Thorne, MD
Associate Professor of Plastic Surgery
Department of Plastic Surgery
NYU School of Medicine
New York, NY, USA
Ali Totonchi, MD
Assistant Professor
Plastic Surgery
Case Western Reserve University;
Medical Director Craniofacial Deformity Clinic
Plastic Surgery
MetroHealth Medical center
Cleveland, OH, USA
Jonathan W. Toy, MD, FRCSC
Program Director, Plastic Surgery Residency
Program Assistant Clinical Professor
University of Alberta
Edmonton, Alberta, Canada
Matthew J. Trovato, MD
Dallas Plastic Surgery Institute
Dallas, TX, USA
Simeon H. Wall Jr., MD, FACS
Director
The Wall Center for Plastic Surgery;
Assistant Clinical Professor
Plastic Surgery
LSU Health Sciences Center at Shreveport
Shreveport, LA, USA
Joshua T. Waltzman, MD, MBA
Private Practice
Waltzman Plastic and Reconstructive Surgery
Long Beach, CA, USA
Richard J. Warren, MD, FRCSC
Clinical Professor
Division of Plastic Surgery
University of British Columbia
Vancouver, British Columbia, Canada
Edmund Weisberg, MS, MBE
University of Pennsylvania
Philadelphia, PA, USA
Scott Woehrle, MS BS
Physician Assistant
Department of Plastic Surgery
Jospeh Capella Plastic Surgery
Ramsey, NJ, USA
Chin-Ho Wong, MBBS, MRCS, MMed(Surg),
FAMS(Plast Surg)
W Aesthetic Plastic Surgery
Mt Elizabeth Novena Specialist Center
Singapore
Alan Yan, MD
Former Fellow
Adult Reconstructive and Aesthetic
Craniomaxillofacial Surgery
Division of Plastic and Reconstructive Surgery
Massachusetts General Hospital
Boston, MA, USA

xxix
List of Contributors
Michael J. Yaremchuk, MD
Chief of Craniofacial Surgery
Massachusetts General Hospital;
Clinical Professor of Surgery
Harvard Medical School;
Program Director
Harvard Plastic Surgery Residency Program
Boston, MA, USA
James E. Zins, MD
Chairman
Department of Plastic Surgery
Dermatology and Plastic Surgery Institute
Cleveland Clinic
Cleveland, OH, USA
VOLUME THREE
Neta Adler, MD
Senior Surgeon
Department of Plastic and Reconstructive
Surgery
Hadassah University Hospital
Jerusalem, Israel
Ahmed M. Afifi, MD
Assistant Professor of Plastic Surgery
Department of Surgery
University of Wisconsin
Madison, WI, USA;
Associate Professor
Department of Plastic Surgery
Cairo University
Cairo, Egypt
Marta Alvarado, DDS, MS
Department of Orthodontics
Facultad de Odontología
Universidad de San Carlos de Guatemala
Guatemala
Eric Arnaud, MD
Pediatric Neurosurgeon and Co-Director
Unité de Chirurgie Craniofaciale
Hôpital Necker Enfants Malades
Paris, France
Stephen B. Baker, MD, DDS
Associate Professor and Program Director
Co-Director Inova Hospital for Children
Craniofacial Clinic
Department of Plastic Surgery
Georgetown University Hospital
Georgetown, WA, USA
Scott P. Bartlett, MD
Professor of Surgery
Surgery
University of Pennsylvania;
Chief Division of Plastic Surgery
Surgery
Children’s Hospital of Philadelphia
Philadelphia, PA, USA
Bruce S. Bauer, MD
Chief
Division of Plastic Surgery
NorthShore University HealthSystem
Highland Park;
Clinical Professor of Surgery
Department of Surgery
University of Chicago Pritzker School of
Medicine
Chicago, IL, USA
Adriane L. Baylis, PhD
Speech Scientist
Section of Plastic and Reconstructive Surgery
Nationwide Children’s Hospital
Columbus, OH, USA
Mike Bentz, MD, FAAP, FACS
Interim Chairman
Department of Surgery
University of Wisconsin;
Chairman Division of Plastic Surgery
Department of Surgery
University of Wisconsin
Madison, WI, USA
Craig Birgfeld, MD, FACS
Associate Professor, Pediatric Plastic and
Craniofacial Surgery
Seattle Children’s Hospital
Seattle, WA, USA
William R. Boysen, MD
Resident Physician, Urology
University of Chicago Medicine
Chicago, IL, USA
James P. Bradley, MD
Professor and Chief
Section of Plastic and Reconstructive Surgery
Temple University
Philadelphia, PA, USA
Edward P. Buchanan, MD
Division of Plastic Surgery
Baylor College of Medicine
Houston, TX, USA
Michael R. Bykowski, MD, MS
Plastic Surgery Resident
Plastic Surgery
University of Pittsburgh Medical Center
Pittsburgh, PA, USA
Edward J. Caterson, MD, PhD
Director of Craniofacial Surgery
Division of Plastic Surgery
Brigham and Women’s Hospital
Boston, MA, USA
Rodney K. Chan, MD
Chief Plastic and Reconstructive Surgery
Clinical Division and Burn Center
United States Army Institute of Surgical
Research
Joint Base San Antonio, TX, USA
Edward I. Chang, MD
Assistant Professor
Department of Plastic Surgery
The University of Texas M. D. Anderson Cancer
Center
Houston, TX, USA
Constance M. Chen, MD, MPH
Director of Microsurgery
Plastic and Reconstructive Surgery
New York Eye and Ear Infirmary of Mt Sinai;
Clinical Assistant Professor
Plastic and Reconstructive Surgery
Weil Medical College of Cornell University;
Clinical Assistant Professor
Plastic and Reconstructive Surgery
Tulane University School of Medicine
New York, NY, USA
Yu-Ray Chen, MD
Professor of Surgery
Plastic and Reconstructive Surgery
Chang Gung Memorial Hospital
Taoyuan City, Taiwan
Philip Kuo-Ting Chen, MD
Professor
Craniofacial Center
Chang Gung Memorial Hospital
Taoyuan City, Taiwan
Ming-Huei Cheng, MD, MBA
Professor
Division of Reconstructive Microsurgery
Department of Plastic and Reconstructive
Surgery
Chang Gung Memorial Hospital
Taoyuan City, Taiwan
Gerson R. Chinchilla, DDS MS
Director
Department of Orthodontics
Facultad de Odontología
Universidad de San Carlos de Guatemala
Guatemala
Peter G. Cordeiro, MD
Chief
Plastic and Reconstructive Surgery
Memorial Sloan Kettering Cancer Center;
Professor of Surgery
Surgery
Weil Medical College of Cornell University
New York, NY, USA
Alberto Córdova-Aguilar, MD, MPH
Attending Plastic Surgeon
Surgery
Faculty of Medicine Ricardo Palma University
Lima, Peru
Edward H. Davidson, MA(Cantab), MBBS
Resident Plastic Surgeon
Department of Plastic Surgery
University of Pittsburgh
Pittsburgh, PA, USA

xxx
List of Contributors
Sara R. Dickie, MD
Clinician Educator
Surgery
University of Chicago Hospital Pritzker School of
Medicine;
Attending Surgeon
Section of Plastic and Reconstructive Surgery
NorthShore University HealthSystem
Northbrook, IL, USA
Risal S. Djohan, MD
Microsurgery Fellowship Program Director
Plastic Surgery
Cleveland Clinic;
Surgery ASC Quality Improvement Officer
Plastic Surgery
Cleveland Clinic
Cleveland, OH, USA
Amir H. Dorafshar, MBChB, FACS, FAAP
Associate Professor
Plastic and Reconstructive Surgery
Johns Hopkins Medical Institute;
Assistant Professor
Plastic Surgery
R Adams Cowley Shock Trauma Center
Baltimore, MD, USA
Jeffrey A. Fearon, MD
Director
The Craniofacial Center
Dallas, TX, USA
Alexander L. Figueroa, DMD
Craniofacial Orthodontist
Rush Craniofacial Center
Rush University Medical Center
Chicago, IL, USA
Alvaro A. Figueroa, DDS, MS
Co-Director
Rush Craniofacial Center
Rush University Medical Center
Chicago, IL, USA
David M. Fisher, MB, BCh, FRCSC, FACS
Medical Director Cleft Lip and Palate Program
Plastic Surgery
Hospital for Sick Children;
Associate Professor
Surgery
University of Toronto
Toronto, Ontario, Canada
Roberto L. Flores, MD
Associate Professor of Plastic Surgery
Director of Cleft Lip and Palate
Hansjörg Wyss Department of Plastic Surgery
NYU Langone Medical Center
New York, NY, USA
Andrew Foreman, B. Physio, BMBS(Hons),
PhD, FRACS
Consultant Surgeon, Department of
Otolaryngology - Head and Neck Surgery
University of Adelaide,
Royal Adelaide Hospital,
Adelaide, SA, Australia
Patrick A. Gerety, MD
Assistant Professor of Surgery
Division of Plastic and Reconstructive Surgery
Indiana University and Riley Hospital for
Children
Philadelphia, PA, USA
Jesse A. Goldstein, MD
Chief Resident
Department of Plastic Surgery
Georgetown University Hospital
Washington, DC, USA
Arun K. Gosain, MD
Chief
Division of Plastic Surgery
Ann and Robert H. Lurie Children’s Hospital of
Chicago
Chicago, IL, USA
Lawrence J. Gottlieb, MD
Professor of Surgery
Department of Surgery
Section of Plastic and Reconstructive Surgery
University of Chicago
Chicago, IL, USA
Arin K. Greene, MD, MMSc
Department of Plastic and Oral Surgery
Boston Children’s Hospital;
Associate Professor of Surgery
Harvard Medical School
Boston, MA, USA
Patrick J. Gullane, MD, FRCS
Wharton Chair in Head and Neck Surgery
Professor of Surgery, Department of
Otolaryngology - Head and Neck Surgery
University of Toronto
Toronto, Ontario, Canada
Mohan S. Gundeti, MB, MCh, FEBU,
FRCS(Urol), FEAPU
Associate Professor of Urology in Surgery and
Pediatrics, Director Pediatric Urology, Director
Centre for Pediatric Robotics and Minimal
Invasive Surgery
University of Chicago and Pritzker Medical
School Comer Children’s Hospital
Chicago, IL, USA
Eyal Gur, MD
Professor of Surgery, Chief
Department of Plastic and Reconstructive
Surgery
The Tel Aviv Sourasky Medical Center
Tel Aviv, Israel
Bahman Guyuron, MD, FCVS
Editor in Chief, Aesthetic Plastic Surgery
Journal;
Emeritus Professor of Plastic Surgery
Case School of Medicine
Cleveland, OH, USA
Matthew M. Hanasono, MD
Associate Professor
Department of Plastic Surgery
The University of Texas MD Anderson Cancer
Center
Houston, TX, USA
Toshinobu Harada, PhD
Professor in Engineering
Department of Systems Engineering
Faculty of Systems Engineering
Wakayama University
Wakayama, Japan
Jill A. Helms, DDS, PhD
Professor
Surgery
Stanford University
Stanford, CA, USA
David L. Hirsch, MD, DDS
Director of Oral Oncology and Reconstruction
Lenox Hill Hospital/Northwell Health
New York, NY, USA
Jung-Ju Huang, MD
Associate Professor
Division of Microsurgery
Plastic and Reconstructive Surgery
Chang Gung Memorial Hospital
Taoyuan, Taiwan
William Y. Hoffman, MD
Professor and Chief
Division of Plastic and Reconstructive Surgery
UCSF
San Francisco, CA, USA
Larry H. Hollier Jr., MD
Division of Plastic Surgery
Baylor College of Medicine
Houston, TX, USA
Richard A. Hopper, MD, MS
Chief
Division of Craniofacial Plastic Surgery
Seattle Children’s Hospital;
Surgical Director
Craniofacial Center
Seattle Children’s Hospital;
Associate Professor
Department of Surgery
University of Washington
Seattle, WA, USA
Gazi Hussain, MBBS, FRACS
Clinical Senior Lecturer
Macquarie University
Sydney, Australia
Oksana Jackson, MD
Assistant Professor
Plastic Surgery
Perelman School of Medicine at the University
of Pennsylvania;
Assistant Professor
Plastic Surgery
The Children’s Hospital of Philadelphia
Philadelphia, PA, USA

xxxi
List of Contributors
Syril James, MD
Clinic Marcel Sembat
Boulogne-Billancourt
Paris, France
Leila Jazayeri, MD
Microsurgery Fellow
Plastic and Reconstructive Surgery
Memorial Sloan Kettering Cancer Center
New York, NY, USA
Sahil Kapur, MD
Assistant Professor
Department of Plastic Surgery
University of Texas - MD Anderson Cancer
Center
Houston, TX, USA
Henry K. Kawamoto Jr., MD, DDS
Clinical Professor
Surgery Division of Plastic Surgery
UCLA
Los Angeles, CA, USA
David Y. Khechoyan, MD
Division of Plastic Surgery
Baylor College of Medicine
Houston, TX, USA
Richard E. Kirschner, MD
Section Chief
Plastic and Reconstructive Surgery
Nationwide Children’s Hospital;
Senior Vice Chair
Plastic Surgery
The Ohio State University Medical College
Columbus, OH, USA
John C. Koshy, MD
Division of Plastic Surgery
Baylor College of Medicine
Houston, TX, USA
Michael C. Large, MD
Urologic Oncologist
Urology of Indiana
Greenwood, IN, USA
Edward I. Lee, MD
Division of Plastic Surgery
Baylor College of Medicine
Houston, TX, USA
Jamie P. Levine, MD
Chief of Microsurgery
Associate Professor
Plastic Surgery
NYU Langone Medical Center
New York, NY, USA
Jingtao Li, DDS, PhD
Consultant Surgeon
Oral and Maxillofacial Surgery
West China Hospital of Stomatology
Chengdu, Sichuan, People’s Republic of China
Lawrence Lin, MD
Division of Plastic Surgery
Baylor College of Medicine
Houston, TX, USA
Joseph E. Losee, MD
Ross H. Musgrave Professor of Pediatric Plastic
Surgery
Department of Plastic Surgery
University of Pittsburgh Medical Center;
Chief, Division of Pediatric Plastic Surgery
Children’s Hospital of Pittsburgh
Pittsburgh, PA, USA
David W. Low, MD
Professor of Surgery
Division of Plastic Surgery
Perelman School of Medicine at the University
of Pennsylvania;
Clinical Associate
Department of Surgery
Children’s Hospital of Philadelphia
Philadelphia, PA, USA
Ralph T. Manktelow, MD, FRCSC
Professor of Surgery,
The University of Toronto,
Toronto, Ontario, Canada
Paul N. Manson, MD
Distinguished Service Professor
Plastic Surgery
Johns Hopkins University
Baltimore, MD, USA
David W. Mathes, MD
Professor and Chief of the Division of Plastic
and Reconstructive Surgery
Surgery Division of Plastic and Reconstructive
Surgery
University of Colorado
Aurora, CO, USA
Frederick J. Menick, MD
Private Practitioner
Tucson, AZ, USA
Fernando Molina, MD
Director
Craniofacial Anomalies Foundation A.C.
Mexico City;
Professor of Plastic Reconstructive and
Aesthetic Surgery
Medical School
Universidad La Salle
Mexico City, Distrito Federal, Mexico
Laura A. Monson, MD
Division of Plastic Surgery
Baylor College of Medicine
Houston, TX, USA
Reid V. Mueller, MD
Associate Professor
Plastic Surgery
Oregon Health and Science University
Portland, OR, USA
John B. Mulliken, MD
Professor
Department of Plastic and Oral Surgery
Boston Children’s Hospital
Harvard Medical School
Boston, MA, USA
Gerhard S. Mundinger, MD
Assistant Professor
Craniofacial, Plastic, and Reconstructive Surgery
Louisiana State University Health Sciences
Center
Children’s Hospital of New Orleans
New Orleans, LA, USA
Blake D. Murphy, BSc, PhD, MD
Craniofacial Fellow
Plastic Surgery
Nicklaus Children’s Hospital
Miami, FL, USA
Peter C. Neligan, MB, FRCS(I), FRCSC,
FACS
Professor of Surgery
Department of Surgery, Division of Plastic
Surgery
University of Washington
Seattle, WA, USA
M. Samuel Noordhoff, MD, FACS
Emeritus Professor in Surgery
Chang Gung University
Taoyuan City, Taiwan
Giovanna Paternoster, MD
Unité de chirurgie crânio-faciale du departement
de neurochirurgie
Hôpital Necker Enfants Malades
Paris, France
Jason Pomerantz, MD
Assistant Professor
Surgery
University of California San Francisco;
Surgical Director
Craniofacial Center
University of California San Francisco
San Francisco, CA, USA
Julian J. Pribaz, MD
Professor of Surgery
University of South Florida, Morsani College of
Medicine
Tampa General Hospital
Tampa, FL, USA
Chad A. Purnell, MD
Division of Plastic Surgery
Lurie Children’s Hospital of Northwestern
Feinberg School of Medicine
Chicago, IL, USA
Russell R. Reid, MD, PhD
Associate Professor
Surgery/Section of Plastic and Reconstructive
Surgery
University of Chicago Medicine
Chicago, IL, USA
Eduardo D. Rodriguez, MD, DDS
Helen L. Kimmel Professor of Reconstructive
Plastic Surgery
Chair, Hansjörg Wyss Department of Plastic
Surgery
NYU School of Medicine
NYU Langone Medical Center
New York, NY, USA

xxxii
List of Contributors
Craig Rowin, MD
Craniofacial Fellow
Plastic Surgery
Nicklaus Children’s Hospital
Miami, FL, USA
Ruston J. Sanchez, MD
Plastic and Reconstructive Surgery Resident
University of Wisconsin
Madison, WI, USA
Lindsay A. Schuster, DMD, MS
Director Cleft-Craniofacial Orthodontics
Pediatric Plastic Surgery
Children’s Hospital of Pittsburgh of UMPC;
Clinical Assistant Professor of Plastic Surgery
Department of Plastic Surgery
University of Pittsburgh School of Medicine
Pittsburgh, PA, USA
Jeremiah Un Chang See, MD
Plastic Surgeon
Department of Plastic and Reconstructive
Surgery
Penang General Hospital
Georgetown, Penang, Malaysia
Pradip R. Shetye, DDS, BDS, MDS
Assistant Professor (Orthodontics)
Hansjörg Wyss Department of Plastic Surgery
NYU Langone Medical Center
New York, NY, USA
Roman Skoracki, MD
Plastic Surgery
The Ohio State University
Columbus, OH, USA
Mark B. Slidell, MD, MPH
Assistant Professor of Surgery
Department of Surgery
Section of Pediatric Surgery
University of Chicago Medicine Biological
Sciences
Chicago, IL, USA
Michael Sosin, MD
Research Fellow
Department of Plastic Surgery Institute of
Reconstructive Plastic Surgery
NYU Langone Medical Center
New York, NY, USA;
Research Fellow
Division of Plastic Reconstructive and
Maxillofacial Surgery
R Adams Cowley Shock Trauma Center
University of Maryland Medical Center
Baltimore, MD, USA;
Resident
Department of Surgery
Medstar Georgetown University Hospital
Washington, DC, USA
Youssef Tahiri, MD, MSc, FRCSC, FAAP,
FACS
Associate Professor
Pediatric Plastic & Craniofacial Surgery
Cedars Sinai Medical Center
Los Angeles, CA, USA
Peter J. Taub, MD
Professor
Surgery Pediatrics Dentistry and Medical
Education
Surgery Division of Plastic and Reconstructive
Surgery
Icahn School of Medicine at Mount Sinai
New York, NY, USA
Jesse A. Taylor, MD
Mary Downs Endowed Chair of Pediatric
Craniofacial Treatment and Research;
Director, Penn Craniofacial Fellowship;
Co-Director, CHOP Cleft Team
Plastic, Reconstructive, and Craniofacial Surgery
The University of Pennsylvania and
Children’s Hospital of Philadelphia
Philadelphia, PA, USA
Kathryn S. Torok, MD
Assistant Professor
Pediatric Rheumatology
University of Pittsburgh
Pittsburgh, PA, USA
Ali Totonchi, MD
Assistant Professor
Plastic Surgery
Case Western Reserve University;
Medical Director Craniofacial Deformity Clinic
Plastic Surgery
MetroHealth Medical Center
Cleveland, OH, USA
Kris Wilson, MD
Division of Plastic Surgery
Baylor College of Medicine
Houston, TX, USA
S. Anthony Wolfe, MD
Plastic Surgery
Miami Children’s Hospital
Miami, FL, USA
Akira Yamada, MD, PhD
Professor of Plastic Surgery
World Craniofacial Foundation
Dallas, TX, USA;
Clinical Assistant Professor
Plastic Surgery
Case Western Reserve University
Cleveland, OH, USA
Peirong Yu, MD
Professor
Plastic Surgery
M. D. Anderson Cancer Center;
Adjunct Professor
Plastic Surgery
Baylor College of Medicine
Houston, TX, USA
Ronald M. Zuker, MD, FRCSC, FACS,
FRCSEd(Hon)
Professor of Surgery
Department of Surgery
University of Toronto;
Staff Plastic and Reconstructive Surgeon
Department of Surgery
SickKids Hospital
Toronto, Ontario, Canada
VOLUME FOUR
Christopher E. Attinger, MD
Professor, Interim Chairman
Department of Plastic Surgery
Center for Wound Healing
Medstar Georgetown University Hospital
Washington, DC, USA
Lorenzo Borghese, MD
Plastic Surgeon
Chief of International Missions
Ospedale Pediatrico Bambino Gesù
Rome, Italy
Charles E. Butler, MD, FACS
Professor and Chairman
Department of Plastic Surgery
Charles B. Barker Endowed Chair in Surgery
The University of Texas M. D. Anderson Cancer
Center
Houston, TX, USA
David W. Chang, MD
Professor of Surgery
University of Chicago
Chicago, IL, USA
Karel Claes, MD
Department of Plastic and Reconstructive
Surgery
Ghent University Hospital
Ghent, Belgium
Mark W. Clemens II, MD, FACS
Associate Professor
Plastic Surgery
MD Anderson Cancer Center,
Houston, TX, USA
Shannon M. Colohan, MD, MSc
Assistant Professor of Surgery
University of Washington
Seattle, WA, USA
Peter G. Cordeiro, MD
Chief
Plastic and Reconstructive Surgery
Memorial Sloan Kettering Cancer Center
New York, NY, USA
Salvatore D’Arpa, MD, PhD
Department of Plastic and Reconstructive
Surgery
Ghent University Hospital
Ghent, Belgium

xxxiii
List of Contributors
Michael V. DeFazio, MD
Department Plastic Surgery
MedStar Georgetown University Hospital
Washington, DC, USA
A. Lee Dellon, MD, PhD
Professor of Plastic Surgery
Professor of Neurosurgery
Johns Hopkins University
Baltimore, MD, USA
Sara R. Dickie, MD
Clinical Associate of Surgery
University of Chicago Hospitals
Pritzker School of Medicine
Chicago, IL, USA
Ivica Ducic, MD, PhD
Clinical Professor of Surgery
GWU Washington Nerve Institute
McLean, VA, USA
Gregory A. Dumanian, MD
Stuteville Professor of Surgery
Division of Plastic Surgery
Northwestern Feinberg School of Medicine
Chicago, IL, USA
John M. Felder III, MD
Fellow in Hand Surgery
Plastic Surgery
Washington University in Saint Louis
St. Louis, MO, USA
Goetz A. Giessler, MD, PhD
Professor Director
Plastic-Reconstructive, Aesthetic and Hand
Surgery
Gesundheit Nordhessen
Kassel, Germany
Kevin D. Han, MD
Department of Plastic Surgery
MedStar Georgetown University Hospital
Washington, DC, USA
Piet Hoebeke
Department of Urology
Ghent University Hospital
Ghent, Belgium
Joon Pio Hong, MD, PhD, MMM
Professor of Plastic Surgery
Asan Medical Center, University of Ulsan
Seoul, South Korea
Michael A. Howard, MD
Clinical Assistant Professor of Surgery
Plastic Surgery
NorthShore University HealthSystem/University
of Chicago
Chicago, IL, USA
Jeffrey E. Janis, MD, FACS
Professor of Plastic Surgery, Neurosurgery,
Neurology, and Surgery;
Executive Vice Chairman, Department of Plastic
Surgery;
Chief of Plastic Surgery, University Hospitals
Ohio State University Wexner Medical Center
Columbus, OH, USA
Leila Jazayeri, MD
Microsurgery Fellow
Plastic and Reconstructive Surgery
Memorial Sloan Kettering Cancer Center
New York, NY, USA
Grant M. Kleiber, MD
Assistant Professor of Surgery
Division of Plastic and Reconstructive Surgery
Washington University School of Medicine
St. Louis, MO, USA
Stephen J. Kovach III, MD
Assistant Professor
Division of Plastic Surgery
University of Pennsylvania
Philadelphia, PA, USA
Robert Kwon, MD
Southwest Hand and Microsurgery
3108 Midway Road, Suite 103
Plano, TX, USA
Raphael C. Lee, MS, MD, ScD, FACS,
FAIMBE
Paul and Allene Russell Professor
Plastic Surgery, Dermatology, Anatomy and
Organismal Biology, Molecular Medicine
University of Chicago
Chicago, IL, USA
L. Scott Levin, MD, FACS
Chairman of Orthopedic Surgery
Department of Orthopaedic Surgery
University of Pennsylvania School of Medicine
Philadelphia, PA, USA
Otway Louie, MD
Associate Professor
Surgery
University of Washington Medical Center
Seattle, WA, USA
Nicolas Lumen, MD, PhD
Head of Clinic
Urology
Ghent University Hospital
Ghent, Belgium
Alessandro Masellis, MD
Plastic Surgeon
Euro-Mediterranean Council for Burns and Fire
Disasters
Palermo, Italy
Michele Masellis, MD
Former Chief of Department of Plastic and
Reconstructive Surgery and Burn Therapy
Department of Plastic and Reconstructive
Surgery and Burn Therapy - ARNAS Ospedale
Civico e Benfratelli
Palermo, Italy
Stephen M. Milner, MB BS, BDS
Professor of Plastic Surgery
Surgery
Johns Hopkins School of Medicine
Baltimore, MD, USA
Arash Momeni, MD
Fellow, Reconstructive Microsurgery
Division of Plastic Surgery
University of Pennsylvania Health System
Philadelphia, PA, USA
Stan Monstrey, MD, PhD
Department of Plastic and Reconstructive
Surgery
Ghent University Hospital
Ghent, Belgium
Venkateshwaran N, MBBS, MS, DNB, MCh,
MRCS(Intercollegiate)
Consultant Plastic Surgeon
Jupiter Hospital
Thane, India
Rajiv P. Parikh, MD, MPHS
Resident Physician
Department of Surgery, Division of Plastic and
Reconstructive Surgery
Washington University School of Medicine
St. Louis, MO, USA
Mônica Sarto Piccolo, MD, MSc, PhD
Director
Pronto Socorro para Queimaduras
Goiânia, Goiás, Brazil
Nelson Sarto Piccolo, MD
Chief
Division of Plastic Surgery
Pronto Socorro para Queimaduras
Goiânia, Goiás, Brazil
Maria Thereza Sarto Piccolo, MD, PhD
Scientific Director
Pronto Socorro para Queimaduras
Goiânia, Goiás, Brazil
Vinita Puri, MS, MCh
Professor and Head
Department of Plastic, Reconstructive Surgery
and Burns
Seth G S Medical College and KEM Hospital
Mumbai, Maharashtra, India
Andrea L. Pusic, MD, MHS, FACS
Associate Professor
Plastic and Reconstructive Surgery
Memorial Sloan Kettering Cancer Center
New York, NY, USA

xxxiv
List of Contributors
Vinay Rawlani, MD
Division of Plastic Surgery
Northwestern Feinberg School of Medicine
Chicago, IL, USA
Juan L. Rendon, MD, PhD
Clinical Instructor Housestaff
Department of Plastic Surgery
The Ohio State University Wexner Medical
Center
Columbus, OH, USA
Michelle C. Roughton, MD
Assistant Professor
Division of Plastic and Reconstructive Surgery
University of North Carolina at Chapel Hill
Chapel Hill, NC, USA
Hakim K. Said, MD, FACS
Associate Professor
Division of Plastic surgery
University of Washington
Seattle, WA, USA
Michel Saint-Cyr, MD, FRSC(C)
Professor
Plastic Surgery
Mayo Clinic
Rochester, MN, USA
Michael Sauerbier, MD, PhD
Professor, Chair
Department for Plastic, Hand, and
Reconstructive Surgery
Academic Hospital Goethe University Frankfurt
am Main
Frankfurt am Main, Germany
Loren S. Schechter, MD
Associate Professor and Chief
Division of Plastic Surgery
Chicago Medical School
Morton Grove, IL, USA
David H. Song, MD, MBA, FACS
Regional Chief, MedStar Health
Plastic and Reconstructive Surgery
Professor and Chairman
Department of Plastic Surgery
Georgetown University School of Medicine
Washington, DC, USA
Yoo Joon Sur, MD, PhD
Associate Professor
Department of Orthopedic Surgery
The Catholic University of Korea, College of
Medicine
Seoul, Korea
Chad M. Teven, MD
Resident
Section of Plastic and Reconstructive Surgery
University of Chicago
Chicago, IL, USA
VOLUME FIVE
Jamil Ahmad, MD, FRCSC
Director of Research and Education
The Plastic Surgery Clinic
Mississauga, Ontario, Canada;
Assistant Professor of Surgery
University of Toronto
Toronto, Ontario, Canada
Robert J. Allen Sr., MD
Clinical Professor of Plastic Surgery
Department of Plastic Surgery
New York University Medical Center
Charleston, NC, USA
Ryan E. Austin, MD, FRCSC
Plastic Surgeon
The Plastic Surgery Clinic
Mississauga, ON, Canada
Brett Beber, BA, MD, FRCSC
Plastic and Reconstructive Surgeon
Lecturer, Department of Surgery
University of Toronto
Toronto, Ontario, Canada
Philip N. Blondeel, MD
Professor of Plastic Surgery
Department of Plastic Surgery
University Hospital Ghent
Ghent, Belgium
Benjamin J. Brown, MD
Gulf Coast Plastic Surgery
Pensacola, FL, USA
Mitchell H. Brown, MD, MEd, FRCSC
Plastic and Reconstructive Surgeon
Associate Professor, Department of Surgery
University of Toronto
Toronto, Ontario, Canada
M. Bradley Calobrace, MD, FACS
Plastic Surgeon
Calobrace and Mizuguchi Plastic Surgery Center
Departments of Surgery, Divisions of Plastic
Surgery
Clinical Faculty, University of Louisville and
University of Kentucky
Louisville, KY, USA
Grant W. Carlson, MD
Wadley R. Glenn Professor of Surgery
Emory University
Atlanta, GA, USA
Bernard W. Chang, MD
Chief of Plastic and Reconstructive Surgery
Mercy Medical Center
Baltimore, MD, USA
Mark W. Clemens II, MD, FACS
Assistant Professor Plastic Surgery
M. D. Anderson Cancer Center
Houston, TX, USA
Robert Cohen MD, FACS
Medical Director
Plastic Surgery
Scottsdale Center for Plastic Surgery
Paradise Valley, AZ and;
Santa Monica, CA, USA
Amy S. Colwell, MD
Associate Professor
Harvard Medical School
Massachusetts General Hospital
Boston, MA, USA
Edward H. Davidson, MA(Cantab), MB, BS
Resident Plastic Surgeon
Department of Plastic Surgery
University of Pittsburgh Medical Center
Pittsburgh, PA, USA
Emmanuel Delay, MD, PhD
Unité de Chirurgie Plastique et Reconstructrice
Centre Léon Bérard
Lyon, France
Francesco M. Egro, MB ChB, MSc, MRCS
Department of Plastic Surgery
University of Pittsburgh Medical Center
Pittsburgh, PA, USA
Neil A. Fine, MD
President
Northwestern Specialists in Plastic Surgery;
Associate Professor (Clinical) Surgery/Plastics
Northwestern University Fienberg School of
Medicine
Chicago, IL, USA
Jaime Flores, MD
Plastic and Reconstructive Microvascular
Surgeon
Miami, FL, USA
Joshua Fosnot, MD
Assistant Professor of Surgery
Division of Plastic Surgery
The Perelman School of Medicine
University of Pennsylvania Health System
Philadelphia, PA, USA
Allen Gabriel, MD
Clinical Associate Professor
Department of Plastic Surgery
Loma Linda University Medical Center
Loma Linda, CA, USA
Michael S. Gart, MD
Resident Physician
Division of Plastic Surgery
Northwestern University Feinberg School of
Medicine
Chicago, IL, USA
Matthew D. Goodwin, MD
Plastic Surgeon
Plastic Reconstructive and Cosmetic Surgery
Boca Raton Regional Hospital
Boca Raton, FL, USA

xxxv
List of Contributors
Samia Guerid, MD
Cabinet
50 rue de la République
Lyon, France
Moustapha Hamdi, MD, PhD
Professor of Plastic and Reconstructive Surgery
Brussels University Hospital
Vrij Universitaire Brussels
Brussels, Belgium
Alexandra M. Hart, MD
Emory Division of Plastic and Reconstructive
Surgery
Emory University School of Medicine
Atlanta, GA, USA
Emily C. Hartmann, MD, MS
Aesthetic Surgery Fellow
Plastic and Reconstructive Surgery
University of Southern California
Los Angeles, CA, USA
Nima Khavanin, MD
Resident Physician
Department of Plastic and Reconstructive
Surgery
Johns Hopkins Hospital
Baltimore, MD, USA
John Y. S. Kim, MD
Professor and Clinical Director
Department of Surgery
Division of Plastic Surgery
Northwestern University Feinberg School of
Medicine
Chicago, IL, USA
Steven Kronowitz, MD
Owner, Kronowitz Plastics
PLLC;
University of Texas, M. D. Anderson Medical
Center
Houston, TX, USA
John V. Larson, MD
Resident Physician
Division of Plastic and Reconstructive Surgery
Keck School of Medicine of USC
University of Southern California
Los Angeles, CA, USA
Z-Hye Lee, MD
Resident
Department of Plastic Surgery
New York University Medical Center
New York, NY, USA
Frank Lista, MD, FRCSC
Medical Director
The Plastic Surgery Clinic
Mississauga, Ontario, Canada;
Assistant Professor Surgery
University of Toronto
Toronto, Ontario, Canada
Albert Losken, MD, FACS
Professor of plastic surgery and Program
Director
Emory Division of Plastic and Reconstructive
Surgery
Emory University School of Medicine
Atlanta, GA, USA
Charles M. Malata, BSc(HB), MB ChB,
LRCP, MRCS, FRCS(Glasg), FRCS(Plast)
Professor of Academic Plastic Surgery
Postgraduate Medical Institute
Faculty of Health Sciences
Anglia Ruskin University
Cambridge and Chelmsford, UK;
Consultant Plastic and Reconstructive Surgeon
Department of Plastic and Reconstructive
Surgery
Cambridge Breast Unit at Addenbrooke’s
Hospital
Cambridge University Hospitals NHS
Foundation Trust
Cambridge, UK
Jaume Masià, MD, PhD
Chief and Professor of Plastic Surgery
Sant Pau University Hospital
Barcelona, Spain
G. Patrick Maxwell, MD, FACS
Clinical Professor of Surgery
Department of Plastic Surgery
Loma Linda University Medical Center
Loma Linda, CA, USA
James L. Mayo, MD
Microsurgery Fellow
Plastic Surgery
New York University
New York, NY, USA
Roberto N. Miranda, MD
Professor
Department of Hematopathology
Division of Pathology and Laboratory Medicine
MD Anderson Cancer Center
Houston, TX, USA
Colin M. Morrison, MSc (Hons) FRCSI
(Plast)
Consultant Plastic Surgeon
St. Vincent’s University Hospital
Dublin, Ireland
Maurice Y. Nahabedian, MD, FACS
Professor and Chief
Section of Plastic Surgery
MedStar Washington Hospital Center
Washington DC, USA;
Vice Chairman
Department of Plastic Surgery
MedStar Georgetown University Hospital
Washington DC, USA
James D. Namnoum, MD
Clinical Professor of Plastic Surgery
Atlanta Plastic Surgery
Emory University School of Medicine
Atlanta, GA, USA
Maria E. Nelson, MD
Assistant Professor of Clinical Surgery
Department of Surgery, Division of Upper GI/
General Surgery, Section of Surgical Oncology
Keck School of Medicine
University of Southern California
Los Angeles, CA, USA
Julie Park, MD
Associate Professor of Surgery
Section of Plastic Surgery
University of Chicago
Chicago, IL, USA
Ketan M. Patel, MD
Assistant Professor of Surgery
Division of Plastic and Reconstructive Surgery
Keck Medical Center of USC
University of Southern California
Los Angeles, CA, USA
Nakul Gamanlal Patel, BSc(Hons),
MBBS(Lond), FRCS(Plast)
Senior Microsurgery Fellow
St. Andrew’s Centre for Plastic Surgery
Broomfield Hospital
Chelmsford, UK
Gemma Pons, MD, PhD
Head
Microsurgery Unit
Plastic Surgery
Hospital de Sant Pau
Barcelona, Spain
Julian J. Pribaz, MD
Professor of Surgery
Brigham and Women’s Hospital
Harvard Medical School
Boston, MA, USA
Venkat V. Ramakrishnan, MS, FRCS,
FRACS(Plast Surg)
Consultant Plastic Surgeon
St. Andrew’s Centre for Plastic Surgery
Broomfield Hospital
Chelmsford, UK
Elena Rodríguez-Bauzà, MD
Plastic Surgery Department
Hospital Santa Creu i Sant Pau
Barcelona, Spain
Michael R. Schwartz, MD
Board Certified Plastic Surgeon
Private Practice
Westlake Village, CA, USA
Stephen F. Sener, MD
Professor of Surgery, Clinical Scholar
Chief of Breast, Endocrine, and Soft Tissue
Surgery
Department of Surgery, Keck School of
Medicine of USC
Chief of Surgery and Associate Medical Director
Perioperative Services
LAC+USC (LA County) Hospital
Los Angeles, CA, USA

xxxvi
List of Contributors
Joseph M. Serletti, MD, FACS
The Henry Royster–William Maul Measey
Professor of Surgery and Chief
Division of Plastic Surgery
University of Pennsylvania Health System
Philadelphia, PA, USA
Deana S. Shenaq, MD
Chief Resident
Department of Surgery - Plastic Surgery
The University of Chicago Hospitals
Chicago, IL, USA
Kenneth C. Shestak, MD
Professor, Department of Plastic Surgery
University of Pittsburgh Medical Center
Pittsburgh, PA, USA
Ron B. Somogyi, MD MSc FRCSC
Plastic and Reconstructive Surgeon
Assistant Professor, Department of Surgery
University of Toronto
Toronto, ON, Canada
David H. Song, MD, MBA, FACS
Regional Chief, MedStar Health
Plastic and Reconstructive Surgery
Professor and Chairman
Department of Plastic Surgery
Georgetown University School of Medicine
Washington, DC, USA
The late Scott L. Spear†, MD
Formerly Professor of Plastic Surgery
Division of Plastic Surgery
Georgetown University
Washington, MD, USA
Michelle A. Spring, MD, FACS
Program Director
Glacier View Plastic Surgery
Kalispell Regional Medical Center
Kalispell, MT, USA
W. Grant Stevens, MD, FACS
Clinical Professor of Surgery
Marina Plastic Surgery Associates;
Keck School of Medicine of USC
Los Angeles, CA, USA
Elizabeth Stirling Craig, MD
Plastic Surgeon and Assistant Professor
Department of Plastic Surgery
University of Texas
MD Anderson Cancer Center
Houston, TX, USA
Simon G. Talbot, MD
Assistant Professor of Surgery
Brigham and Women’s Hospital
Harvard Medical School
Boston, MA, USA
Jana Van Thielen, MD
Plastic Surgery Department
Brussels University Hospital
Vrij Universitaire Brussel (VUB)
Brussels, Belgium
Henry Wilson, MD, FACS
Attending Plastic Surgeon
Private Practice
Plastic Surgery Associates
Lynchburg, VA, USA
Kai Yuen Wong, MA, MB BChir, MRCS,
FHEA, FRSPH
Specialist Registrar in Plastic Surgery
Department of Plastic and Reconstructive
Surgery
Cambridge University Hospitals NHS
Foundation Trust
Cambridge, UK
VOLUME SIX
Hee Chang Ahn, MD, PhD
Professor
Department of Plastic and Reconstructive
Surgery
Hanyang University Hospital School of Medicine
Seoul, South Korea
Nidal F. Al Deek, MD
Surgeon
Plastic and Reconstructive Surgery
Chang Gung Memorial Hospital
Taipei, Taiwan
Kodi K. Azari, MD, FACS
Reconstructive Transplantation Section Chief
Professor
Department of Orthopedic Surgery
UCLA Medical Center
Santa Monica, CA, USA
Carla Baldrighi, MD
Staff Surgeon
Pediatric Surgery Meyer Children’s Hospital
Pediatric Hand and Reconstructive Microsurgery
Unit
Azienda Ospedaliera Universitaria Careggi
Florence, Italy
Gregory H. Borschel, MD, FAAP, FACS
Assistant Professor
University of Toronto Division of Plastic and
Reconstructive Surgery;
Assistant Professor
Institute of Biomaterials and Biomedical
Engineering;
Associate Scientist
The SickKids Research Institute
The Hospital for Sick Children
Toronto, Ontario, Canada
Kirsty Usher Boyd, MD, FRCSC
Assistant Professor
Division of Plastic Surgery, University of Ottawa
Ottawa, Ontario, Canada
Gerald Brandacher, MD
Scientific Director
Department of Plastic and Reconstructive
Surgery
Johns Hopkins University School of Medicine
Baltimore, MD, USA
Lesley Butler, MPH
Clinical Research Coordinator
Charles E. Seay, Jr. Hand Center
Texas Scottish Rite Hospital for Children
Dallas, TX, USA
Ryan P. Calfee, MD
Associate Professor
Department of Orthopedic Surgery
Washington University School of Medicine
St. Louis, MO, USA
Brian T. Carlsen, MD
Associate Professor
Departments of Plastic Surgery and Orthopedic
Surgery
Mayo Clinic
Rochester, MN, USA
David W. Chang, MD
Professor
Division of Plastic and Reconstructive Surgery
The University of Chicago Medicine
Chicago, IL, USA
James Chang, MD
Johnson & Johnson Distinguished Professor
and Chief
Division of Plastic and Reconstructive Surgery
Stanford University Medical Center
Stanford, CA, USA
Robert A. Chase, MD
Holman Professor of Surgery – Emeritus
Stanford University Medical Center
Stanford, CA, USA
Alphonsus K. S. Chong, MBBS, MRCS,
MMed(Orth), FAMS (Hand Surg)
Senior Consultant
Department of Hand and Reconstructive
Microsurgery
National University Health System
Singapore;
Assistant Professor
Department of Orthopedic Surgery
Yong Loo Lin School of Medicine
National University of Singapore
Singapore
David Chwei-Chin Chuang, MD
Senior Consultant, Ex-President, Professor
Department of Plastic Surgery
Chang Gung University Hospital
Tao-Yuan, Taiwan
Kevin C. Chung, MD, MS
Chief of Hand Surgery
Michigan Medicine
Charles B G De Nancrede Professor, Assistant
Dean for Faculty Affairs
University of Michigan Medical School
Ann Arbor, Michigan, USA
Christopher Cox, MD
Attending Surgeon
Kaiser Permanente
Walnut Creek, CA, USA

xxxvii
List of Contributors
Catherine Curtin, MD
Associate Professor
Department of Surgery Division of Plastic
Surgery
Stanford University
Stanford, CA, USA
Lars B. Dahlin, MD, PhD
Professor and Consultant
Department of Clinical Sciences, Malmö – Hand
Surgery
University of Lund
Malmö, Sweden
Kenneth W. Donohue, MD
Hand Surgery Fellow
Division of Plastic Surgery
Department of Orthopedic Surgery
Baylor College of Medicine
Houston, TX, USA
Gregory A. Dumanian, MD, FACS
Stuteville Professor of Surgery
Division of Plastic Surgery
Northwestern Feinberg School of Medicine
Chicago, IL, USA
William W. Dzwierzynski, MD
Professor and Program Director
Department of Plastic Surgery
Medical College of Wisconsin
Milwaukee, WI, USA
Simon Farnebo, MD, PhD
Associate Professor and Consultant Hand
Surgeon
Department of Plastic Surgery, Hand Surgery
and Burns
Institution of Clinical and Experimental
Medicine, University of Linköping
Linköping, Sweden
Ida K. Fox, MD
Assistant Professor of Plastic Surgery
Department of Surgery
Division of Plastic and Reconstructive Surgery
Washington University School of Medicine
St. Louis, MO, USA
Paige M. Fox, MD, PhD
Assistant Professor
Department of Surgery, Division of Plastic and
Reconstructive Surgery
Stanford University Medical Center
Stanford, CA, USA
Jeffrey B. Friedrich, MD
Professor of Surgery and Orthopedics
Department of Surgery, Division of Plastic
Surgery
University of Washington
Seattle, WA, USA
Steven C. Haase, MD, FACS
Associate Professor
Department of Surgery, Section of Plastic
Surgery
University of Michigan Health
Ann Arbor, MI, USA
Elisabet Hagert, MD, PhD
Associate Professor
Department of Clinical Science and Education
Karolinska Institute;
Chief Hand Surgeon
Hand Foot Surgery Center
Stockholm, Sweden
Warren C. Hammert, MD
Professor of Orthopedic and Plastic Surgery
Chief, Division of Hand Surgery
Department of Orthopedics and Rehabilitation
University of Rochester
Rochester, NY, USA
Isaac Harvey, MD
Clinical Fellow
Department of Pediatric Plastic and
Reconstructive Surgery
Hospital for SickKids
Toronto, Ontario, Canada
Vincent R. Hentz, MD
Emeritus Professor of Surgery and Orthopedic
Surgery (by courtesy)
Stanford University
Stanford, CA, USA
Jonay Hill, MD
Clinical Assistant Professor
Anesthesiology, Perioperative and Pain Medicine
Stanford University School of Medicine
Stanford, CA, USA
Steven E. R. Hovius, MD, PhD
Former Head, Department of Plastic,
Reconstructive and Hand Surgery
Erasmus MC
University Medical Center
Rotterdam, the Netherlands;
Xpert Clinic, Hand and Wrist Center
The Netherlands
Jerry I. Huang, MD
Associate Professor
Department of Orthopedics and Sports
Medicine
University of Washington;
Program Director
University of Washington Hand Fellowship
University of Washington
Seattle, WA, USA
Marco Innocenti, MD
Associate Professor of Plastic Surgery,
University of Florence;
Director, Reconstructive Microsurgery
Department of Oncology
Careggi University Hospital
Florence, Italy
Neil F. Jones, MD, FRCS
Professor and Chief of Hand Surgery
University of California Medical Center;
Professor of Orthopedic Surgery;
Professor of Plastic and Reconstructive Surgery
University of California Irvine
Irvine, CA, USA
Ryosuke Kakinoki, MD, PhD
Professor of Hand Surgery and Microsurgery,
Reconstructive, and Orthopedic Surgery
Department of Orthopedic Surgery
Faculty of Medicine
Kindai University
Osakasayama, Osaka, Japan
Jason R. Kang, MD
Chief Resident
Department of Orthopedic Surgery
Stanford Hospital & Clinics
Redwood City, CA, USA
Joseph S. Khouri, MD
Resident
Division of Plastic Surgery, Department of
Surgery
University of Rochester
Rochester, NY, USA
Todd Kuiken, MD, PhD
Professor
Departments of PM&R, BME, and Surgery
Northwestern University;
Director, Neural Engineering Center for Artificial
Limbs
Rehabilitation Institute of Chicago
Chicago, IL, USA
Donald Lalonde, BSC, MD, MSc, FRCSC
Professor of Surgery
Division of Plastic and Reconstructive Surgery
Saint John Campus of Dalhousie University
Saint John, New Brunswick, Canada
W. P. Andrew Lee, MD
The Milton T. Edgerton MD, Professor and
Chairman
Department of Plastic and Reconstructive
Surgery
Johns Hopkins University School of Medicine
Baltimore, MD, USA
Anais Legrand, MD
Postdoctoral Research Fellow
Plastic and Reconstructive Surgery
Stanford University Medical Center
Stanford, CA, USA
Terry Light, MD
Professor
Department of Orthopedic Surgery
Loyola University Medical Center
Maywood, IL, USA
Jin Xi Lim, MBBS, MRCS
Senior Resident
Department of Hand and Reconstructive
Microsurgery
National University Health System
Singapore
Joseph Lopez, MD, MBA
Resident, Plastic and Reconstructive Surgery
Department of Plastic and Reconstructive
Surgery
Johns Hopkins University School of Medicine
Baltimore, MD, USA

xxxviii
List of Contributors
Susan E. Mackinnon, MD
Sydney M. Shoenberg, Jr. and Robert H.
Shoenberg Professor
Department of Surgery, Division of Plastic and
Reconstructive Surgery
Washington University School of Medicine
St. Louis, MO, USA
Brian Mailey, MD
Assistant Professor of Surgery
Institute for Plastic Surgery
Southern Illinois University
Springfield, IL, USA
Steven J. McCabe, MD, MSc, FRCS(C)
Director of Hand and Upper Extremity Program
University of Toronto
Toronto Western Hospital
Toronto, Ontario, Canada
Kai Megerle, MD, PhD
Assistant Professor
Clinic for Plastic Surgery and Hand Surgery
Technical University of Munich
Munich, Germany
Amy M. Moore, MD
Assistant Professor of Surgery
Division of Plastic and Reconstructive Surgery
Department of Surgery
Washington University School of Medicine
St. Louis, MO, USA
Steven L. Moran, MD
Professor and Chair of Plastic Surgery
Division of Plastic Surgery, Division of Hand and
Microsurgery;
Professor of Orthopedics
Rochester, MN, USA
Rebecca L. Neiduski, PhD, OTR/L, CHT
Dean of the School of Health Sciences
Professor of Health Sciences
Elon University
Elon, NC, USA
David T. Netscher, MD
Program Director, Hand Surgery Fellowship;
Clinical Professor, Division of Plastic Surgery
and Department of Orthopedic Surgery
Baylor College of Medicine;
Adjunct Professor of Clinical Surgery (Plastic
Surgery)
Weill Medical College
Cornell University
Houston, TX, USA
Michael W. Neumeister, MD
Professor and Chairman
Division of Plastic Surgery
Springfield Illinois University School of Medicine
Springfield, IL, USA
Shelley Noland, MD
Assistant Professor
Division of Plastic Surgery
Mayo Clinic Arizona
Phoenix, AZ, USA
Christine B. Novak, PT, PhD
Associate Professor
Department of Surgery, Division of Plastic and
Reconstructive Surgery
University of Toronto
Toronto, Ontario, Canada
Scott Oates, MD
Deputy Department Chair;
Professor
Department of Plastic Surgery, Division of
Surgery
The University of Texas MD Anderson Cancer
Center
Houston, TX, USA
Kerby Oberg, MD, PhD
Associate Professor
Department of Pathology and Human Anatomy
Loma Linda University School of Medicine
Loma Linda, CA, USA
Scott Oishi, MD
Director, Charles E. Seay, Jr. Hand Center
Texas Scottish Rite Hospital for Children;
Professor, Department of Plastic Surgery and
Department of Orthopedic Surgery
University of Texas Southwestern Medical Center
Dallas, TX, USA
William C. Pederson, MD, FACS
President and Fellowship Director
The Hand Center of San Antonio;
Adjunct Professor of Surgery
The University of Texas Health Science Center at
San Antonio
San Antonio, TX, USA
Dang T. Pham, MD
General Surgery Resident
Department of Surgery
Houston Methodist Hospital
Houston, TX, USA
Karl-Josef Prommersberger, MD, PhD
Chair, Professor of Orthopedic Surgery
Clinic for Hand Surgery
Bad Neustadt/Saale, Germany
Carina Reinholdt, MD, PhD
Senior Consultant in Hand Surgery
Center for Advanced Reconstruction of
Extremities
Sahlgrenska University Hospital/ Mölndal
Mölndal, Sweden;
Assistant Professor
Department of Orthopedics
Institute for Clinical Sciences
Sahlgrenska Academy
Goteborg, Sweden
Justin M. Sacks, MD, MBA, FACS
Director, Oncological Reconstruction;
Assistant Professor
Department of Plastic and Reconstructive
Surgery
Johns Hopkins School of Medicine
Baltimore, MD, USA
Douglas M. Sammer, MD
Associate Professor of Plastic and Orthopedic
Surgery
Chief of Plastic Surgery at Parkland Memorial
Hospital
Program Director Hand Surgery Fellowship
University of Texas Southwestern Medical Center
Dallas, TX, USA
Subhro K. Sen, MD
Clinical Associate Professor
Plastic and Reconstructive Surgery
Robert A. Chase Hand and Upper Limb Center
Stanford University School of Medicine
Stanford, CA, USA
Pundrique R. Sharma, MBBS, PhD and
FRCS (Plast)
Consultant Plastic Surgeon
Department for Plastic and Reconstructive
Surgery
Alder Hey Children’s Hospital
Liverpool, UK
Randolph Sherman, MD, FACS
Vice Chair
Department of Surgery
Cedars-Sinai Medical Center
Los Angeles, CA, USA
Jaimie T. Shores, MD
Clinical Director, Hand/Arm Transplant Program
Department of Plastic and Reconstructive
Surgery
Johns Hopkins University School of Medicine
Baltimore, MD, USA
Vanila M. Singh, MD, MACM
Clinical Associate Professor
Anesthesiology, Perioperative and Pain Medicine
Stanford University School of Medicine
Stanford, CA, USA
Jason M. Souza, MD, LCDR, MC, USN
Staff Plastic Surgeon, United States Navy
Walter Reed National Military Medical Center
Bethesda, MD, USA
Amir Taghinia, MD, MPH
Attending Surgeon
Department of Plastic and Oral Surgery
Boston Children’s Hospital;
Assistant Professor of Surgery
Harvard Medical School
Boston, MA, USA
David M. K. Tan, MBBS
Senior Consultant
Department of Hand and Reconstructive
Microsurgery
National University Health System
Singapore;
Assistant Professor
Department of Orthopedic Surgery
Yong Loo Lin School of Medicine
National University Singapore
Singapore

xxxix
List of Contributors
Jin Bo Tang, MD
Professor and Chair
Department of Hand Surgery;
Chair, The Hand Surgery Research Center
Affiliated Hospital of Nantong University
Nantong, The People’s Republic of China
Johan Thorfinn, MD, PhD
Senior Consultant of Plastic Surgery, Burn Unit;
Co-Director
Department of Plastic Surgery, Hand Surgery
and Burns
Linköping University Hospital
Linköping, Sweden
Michael Tonkin, MBBS, MD, FRACS(Orth),
FRCS(Ed Orth)
Professor of Hand Surgery
Department of Hand Surgery and Peripheral
Nerve Surgery
Royal North Shore Hospital
The Children’s Hospital at Westmead
University of Sydney Medical School
Sydney, New South Wales, Australia
Joseph Upton III, MD
Staff Surgeon
Department of Plastic and Oral Surgery
Boston Children’s Hospital;
Professor of Surgery
Harvard Medical School
Boston, MA, USA
Francisco Valero-Cuevas, PhD
Director
Brain-Body Dynamics Laboratory;
Professor of Biomedical Engineering;
Professor of Biokinesiology and Physical
Therapy;
(By courtesy) Professor of Computer Science
and Aerospace and Mechanical Engineering
The University of Southern California
Los Angeles, CA, USA
Christianne A. van Nieuwenhoven, MD, PhD
Plastic Surgeon/Hand Surgeon
Plastic and Reconstructive Surgery
Erasmus Medical Centre
Rotterdam, the Netherlands
Nicholas B. Vedder, MD
Professor of Surgery and Orthopedics
Chief of Plastic Surgery Vice Chair
Department of Surgery
University of Washington
Seattle, WA, USA
Andrew J. Watt, MD
Attending Hand and Microvascular Surgeon;
Associate Program Director, Buncke Clinic Hand
and Microsurgery Fellowship;
Adjunct Clinical Faculty, Stanford University
Division of Plastic and Reconstructive Surgery
The Buncke Clinic
San Francisco, CA, USA
Fu-Chan Wei, MD
Professor
Department of Plastic Surgery
Chang Gung Memorial Hospital
Taoyuan, Taiwan
Julie Colantoni Woodside, MD
Orthopedic Surgeon
OrthoCarolina
Gastonia, NC, USA
Jeffrey Yao, MD
Associate Professor
Department of Orthopedic Surgery
Stanford Hospital & Clinics
Redwood City, CA, USA

Acknowledgments
My wife, Gabrielle Kane, has always been my rock. She not
only encourages me in my work but gives constructive criti­
cism bolstered by her medical expertise as well as by her
knowledge and training in education. I can never repay her.
The editorial team at Elsevier have made this series possible.
Belinda Kuhn leads the group of Alexandra Mortimer, Louise
Cook, and the newest addition to the team, Sam Crowe. The
Elsevier production team has also been vital in moving this
project along. The volume editors, Geoff Gurtner, Peter Rubin,
Ed Rodriguez, Joe Losee, David Song, Mo Nahabedian, Jim
Chang, and Dan Liu have shaped and refined this edition,
making vital changes to keep the series relevant and up-to-
date. My colleagues in the University of Washington, headed
by Nick Vedder, have provided continued encouragement
and support. Finally, and most importantly, the residents and
fellows who pass through our program keep us on our toes
and ensure that we give them the best possible solutions to
their questions.
Peter C. Neligan, MB, FRCS(I), FRCSC, FACS
The current edition of the Breast volume represents a com­
plete, thorough and up-to-date body of knowledge as it relates
to all aspects of aesthetic and reconstructive surgery of the
breast. I have invited academic and private practice thought
leaders and experts in breast surgery from around the globe
to share their knowledge and expertise that will undoubtedly
serve as a valuable resource for all surgeons. I would like to
thank every one of them for their hard work, time, and dili­
gence in preparing these chapters.
There are several individuals that I would like to person­
ally acknowledge. Dr. Scott Spear has been my greatest mentor
and friend, whose inspiration and teaching has guided me for
the past 12 years at Georgetown University. His untimely and
unexpected passing on March 16, 2017 is a loss to our specialty
and all that knew him. I would also like to thank the 66 chief
residents and all the students that I have had the privilege to
mentor and train over the past 22 years. They have challenged
and inspired me with their ideas, innovations, and brilliance.
Finally, none of this would have been possible without the
love and support of my wife and two daughters: Anissa,
Danielle, and Sophia Nahabedian who have enabled me to
realize the importance of family and to prioritize wisely.
Maurice Nahabedian, MD

Dedicated to future plastic surgeons. Take up the torch
and lead us forward!

SECTION I • Aesthetic Breast Surgery
1 
Breast anatomy for plastic surgeons
John V. Larson, Maria E. Nelson, Stephen F. Sener and Ketan M. Patel
SYNOPSIS
■ Size, shape, symmetry, proportionality, and location of the breast on
the chest wall all impact the attractiveness of the breast.
■ Breast shape is dependent on numerous factors, including fat and
glandular content, skin and connective tissue compliment, and
muscular and skeletal shape.
■ Knowledge of the anatomy of the breast and its associated structures,
as well as careful surgical technique, is extremely important in
minimizing operative complications and achieving successful patient
outcomes.
Introduction
Comprehensive knowledge of breast anatomy enables
safe and effective performance of the many aesthetic
and reconstructive breast procedures. Augmentation
mammoplasty, reduction mammoplasty, mastopexy, as
well as post-mastectomy reconstruction all require a
thorough understanding of normal as well as pathologic
anatomy. Vascular and soft-tissue anatomy may allow
for the execution of procedures with greater reliability
and predictability in outcomes, and minimize the occur­
rence of complications.
Embryology and breast development
Understanding the development of the chest wall and
breast allows for a better understanding of disease
processes, natural changes to the breast, and the super­
ficial manifestations of chest wall abnormalities. Starting
in the fourth week of gestation, ectoderm and underly­
ing mesoderm begin the process of proliferating and
differentiating into skin. It is during this time that
the glandular component of the breast also begins to
differentiate. Paired ectodermal thickenings, termed
mammary ridges, develop on the ventral surface of the
embryo, extend from the axilla to the groin, and later
disappear except at the level of the fourth intercostal
space on the anterolateral chest wall (Fig. 1.1). The
mammary ridge begins proliferating into a primary
mammary bud, which then propagates downward into
the underlying dermis and begins to branch, resulting
in secondary buds which eventually develop into the
mammary lobules. As these buds continue lengthening
and branching, small lumina develop within the buds
forming the lactiferous ducts. At term, approximately 20
lobes of glandular tissue have formed, each containing
a lactiferous duct. While the inward proliferation of
ectoderm results in mammary glands, the mesoderm
surrounding this area also proliferates, creating the
circular and longitudinally oriented smooth muscle
fibers of the nipple. Finally, the surrounding areola is
formed by ectoderm.
The female breast undergoes several age-related
anatomic and physiologic changes (Fig. 1.2). As previ­
ously stated, the glandular tissue of the breast is orga­
nized into approximately 20 major lobes, each made up
of lobules that contain milk-producing acini. Following
a brief period of activity shortly after birth in response
to maternal prolactin production, breast development is
quiescent until puberty, with ducts and stromal struc­
tures enlarging in proportion to body size but no lobular
development occurring. During puberty, rapid growth
of the breast is primarily due to deposition of fat and
connective tissue, although some growth of the ductal

2
SECTION I
CHAPTER 1 • Breast anatomy for plastic surgeons
Breast dimensions and architecture
The appearance of the breast is a crucial aspect defining
the female form. While size, shape, symmetry, propor­
tionality, and location of the breast on the chest wall all
impact the attractiveness of the breast, it is important to
understand that the appearance of the ideal breast is
fairly subjective. Each patient will have their own views
pertaining to the appearance of their breasts, which
should be given consideration when planning any
operative intervention.
Breast shape is dependent on numerous factors,
including fat and glandular content, skin and connec­
tive tissue compliment, and muscular and skeletal shape
(Fig. 1.4). The borders of the breast include the clavicle
superiorly, the inframammary fold inferiorly, the
sternum medially, and the anterior border of the latis­
simus dorsi laterally. The breast tissue that extends
system also occurs. Generally, parenchymal growth has
extended to its mature borders by age fourteen and is
complete by age twenty. During pregnancy, the glandu­
lar component completes differentiation and reaches
functional maturity with the formation of secretory
alveoli. During lactation, this alveolar epithelium is
stimulated by maternal hormones to produce milk. As
the woman ages, however, glandular tissue begins to
atrophy. The breast lobules involute, with a reduction in
the number and size of acini per lobule.1,2 Over time, the
glandular elements of the breast are progressively
replaced with fat and connective tissue. This increased
fatty tissue accumulation coupled with the attenuation
of fascial support results in a softer consistency to the
breast and progressive ptosis with age (Fig. 1.3).
Fig. 1.1  The milk lines. (Reproduced with permission from Standring S (ed).
Gray’s Anatomy, 40th edn. London: Churchill Livingston; 2008.)
Fig. 1.2  Stages in breast development. Pre- and
post-pubertal development and structure of the female
breast demonstrating changes in the shape and contour of
the breast. (Reproduced with permission from Standring S
(ed). Gray’s Anatomy, 40th edn. London: Churchill
Livingston; 2008.)
Fig. 1.3  Clinical example of a patient with moderate ptosis. The nipple areolar
complex is below the level of the inframammary fold at the lower aspect of the
breast.

3
Breast dimensions and architecture
Fig. 1.4  Structure of the breast. (© Elsevier Inc. All Rights Reserved.)
Anterolateral
dissection
Pectoralis
major muscle
(deep to
pectoral
fascia)
External
oblique muscle
Serratus anterior muscle
Clavicle
Intercostal
vessels
and nerve
Lactiferous sinus
Lactiferous duct
Sagittal section
Suspensory ligaments of breast (Cooper’s)
Gland lobes
Fat
Nipple
Areola
Suspensory
ligaments of
breast (Cooper’s)

4
SECTION I
CHAPTER 1 • Breast anatomy for plastic surgeons
19–21 cm. The distance from nipple to the inframam­
mary fold is 5–7 cm. The distance from the nipple to the
midline is 9–11 cm. Although these measurements are
useful as guidelines for modifying the breast, they must
be individualized for each patient based on size, shape,
proportionality, differences in chest wall anatomy, and
patient preference.
Blood supply
The breast has a rich and redundant vascular supply
from multiple arterial sources (Fig. 1.6). Blood supply to
the skin is robust, supplied by the subdermal plexus
which communicates through perforators with the
deeper vessels supplying the breast parenchyma. This
collateralization provides redundant vascular supply to
the overlying skin. The breast parenchyma is supplied
by the internal mammary artery perforators, lateral
thoracic artery, anterolateral and anteromedial intercos­
tal perforators, and the thoracoacromial artery (Figs.
1.7–1.9).16,17 The redundancy in arterial supply allows
for the safe division of breast tissue as long as one or
more of the vascular axes are preserved, allowing for
breast parenchymal flaps to be based on any of the
various vascular pedicles.
The internal mammary artery, or internal thoracic
artery, is a paired artery which after arising from the
subclavian artery courses along each side of the sternum.
The internal mammary perforators branch from the
internal mammary artery and enter the superior medial
portion of the breast via the second through sixth inter­
costal spaces, and provide approximately 60% of the
vascular supply for the breast. The second and third
perforators are the largest caliber of these perforating
vessels and are the preferred recipient vessels for free
tissue reconstruction using the internal mammary
perforators.18,19 The lateral thoracic artery, or external
mammary artery, supplies the superolateral aspect of
the breast. This vessel is a primary branch of the axillary
artery and enters the breast after following the lower
border of the pectoralis minor muscle and passing
around the lateral border of the pectoralis major muscle.
The lateral aspect of the breast is supplied by perfora­
tors from the anterolateral intercostal arteries. These
vessels perforate the serratus anterior just lateral to the
pectoral border and enter the breast at the anterior
margin of the latissimus dorsi muscle. The inferior
central aspect of the breast is supplied by anteromedial
intercostal perforators. After the anterior intercostal
arteries branch from the internal thoracic artery, antero­
medial intercostal perforators pass from deep to super­
ficial to supply the breast parenchyma and nipple
areolar complex. Finally, the thoracoacromial artery
laterally through the axillary fascia into the axillary fat
pad is referred to as the “tail of Spence”. Important
landmarks of the breast include the upper pole of the
breast, location of the nipple areolar complex, inframa­
mmary fold, and lateral breast fold. In the nonptotic
breast, the breast mound is situated over the pectoralis
major muscle between the second and sixth ribs.3 The
upper pole of the breast extends from just below the
clavicle to the level of the nipple. The contour should
be neither concave nor convex, but a plane that extends
out to the point of maximum projection of the breast at
the level of the nipple. In the ideal breast form, the
nipple areolar complex should be located above the
level of the inframammary fold. The inframammary
fold is a defining feature in the shape of the female
breast, and an extremely important landmark in breast
surgery. However, the anatomy and tissue components
of the inframammary fold remain controversial. Some
authors have suggested that the inframammary fold is
produced by a supporting ligament running between
the dermis in the fold region to a variety of locations on
the ribcage or pectoral fascia.4–6 Others have reported
that there is no evidence of any ligamentous structure,
but instead describe the fold as an intrinsic dermal
structure consisting of arrangements of collagen.7 Alter­
natively, other authors describe the fold as different
configurations of deep fascia being fused with superfi­
cial fascia, or the superficial fascial layer inserting into
the dermis.8
Statistical standards for breast dimensions have been
reported by various authors9–15 (Fig. 1.5). The distance
from the sternal notch to the nipple is 19–21 cm. The
distance from the midclavicular line to the nipple is also
Fig. 1.5  Statistical standards for the dimensions of the breast.
19 to 21 cm
19 to 21 cm
19 to 21 cm
5 to 6 cm
5 to 6 cm
9 to 11 cm
2cm

5
Innervation
Innervation
Sensory innervation to the breast includes the anterolat­
eral and anteromedial branches of thoracic intercostal
nerves, as well as the cervical plexus. Branches of the
cervical plexus course superficially in the subcutaneous
tissue and provide sensory innervation to the superior
medial aspect of the breast. Anterolateral and anterome­
dial branches of the thoracic intercostal nerves are
responsible for the majority of breast sensation, which
occurs in a dermatomal pattern (Fig. 1.10). The third
through sixth anterolateral intercostal nerves pass
through the interdigitations of the serratus muscles to
enter the lateral aspect of the breast, providing sensation
to the lateral portion of the breast extending to and
arises from the axillary artery and divides into a pectoral
branch, which descends between the pectoralis minor
and major muscles. This artery supplies the superior
aspect of the breast and anastomoses with the anterior
intercostal branches of the internal thoracic artery and
with the lateral thoracic artery.
Venous drainage of the breast is via two systems. The
subdermal venous plexus above the superficial fascia
represents the superficial system and anastomoses with
the deep system. The deep system parallels the arterial
supply, with the veins paired to their respective arteries.
Venous perforators following the internal mammary
perforators drain via the internal mammary vein to the
brachiocephalic vein, or innominate vein. The lateral
thoracic veins drain via the axillary vein into the supe­
rior vena cava.
Fig. 1.6  The relations of the breast. (Reproduced with permission from Drake R, et al. Gray’s Anatomy for Students. London: Churchill Livingstone; 2005.)
Parasternal nodes
Suspensory ligaments
Lactiferous sinuses
Lactiferous ducts
Retromammary space
Secretory lobules
Pectoralis major
Mammary branches of
internal thoracic artery
Axillary tail
Areola
Lateral thoracic artery
Lateral axillary nodes
Central axillary nodes
Apical axillary nodes
Pectoral branch of
thoracoacromial artery
Internal thoracic artery
Internal thoracic
artery perforators
Anterolateral
intercostal perforators
Lymphatic and venous drainage
passes from lateral and superior
part of the breast into axilla
Lymphatic and venous drainage passes from
medial part of the breast parasternally
Anteromedial intercostal perforators
Pectoral axillary nodes

6
SECTION I
CHAPTER 1 • Breast anatomy for plastic surgeons
Fig. 1.7  Blood supply to the breast. (© Elsevier Inc. All Rights Reserved.)
Subclavian artery
Internal thoracic
artery and its
perforating branches
Medial mammary branches
Axillary artery
Brachial plexus
Brachial artery
Lateral thoracic artery
Lateral mammary
branches
Lateral mammary
branches of
lateral cutaneous
branches of posterior
intercostal arteries
Axillary tail (of Spence)
Long thoracic nerve

7
Connective tissue
stratified squamous epithelium continuous with that
overlying the skin of the breast, and may project as
much as 1 cm or more, with a diameter of approximately
4–7 mm (Fig. 1.11). The nipple contains many lactifer­
ous sinus openings, each of which drains a lactiferous
duct which extends from the lactiferous sinus opening
on the surface of the nipple down to the parenchyma.
The lining of the ducts transitions from stratified squa­
mous epithelium on the surface of the nipple, to strati­
fied cuboidal epithelium within the lactiferous sinuses,
to simple cuboidal epithelium within the lactiferous
ducts. The areola comprises the pigmented skin sur­
rounding the nipple and is approximately 4–5 cm in
diameter, although diameters outside this range com­
monly occur. It consists of keratinized, stratified squa­
mous epithelium and contains lactiferous sinus
openings, sebaceous glands, and Montgomery glands.
Deep to the nipple and areola are smooth muscle fibers
arranged in a circumferential and radial distribution,
which attach to the thick connective tissue of the areola
and produce nipple erection.
Achieving proper location and maintaining nipple
function are crucial when performing breast surgery.
Pedicles employed during reduction mammoplasty or
mastopexy, for example, are based on preservation of
the blood supply to the nipple. Fortunately, the vascular
supply to the nipple is robust and redundant, supplied
by both the subdermal plexus as well as the previously
mentioned parenchymal vessels.22 Thus, preservation of
a vascular pedicle from underlying parenchyma will
maintain the viability of the nipple. Nipple sensation
also must be considered. Innervation of the nipple is
primarily from the lateral cutaneous branch of the fourth
intercostal nerve via two branches, one which passes
superficial to the gland and the other which passes
through the retromammary space.23 Contributions from
the third and fifth intercostal nerves also provide some
nipple sensation.
Connective tissue
Intricate fascial layers derived from the superficial
fascial system support the breast tissue (Fig. 1.12). Breast
parenchyma is fixed in placed by the superficial fascial
system. This superficial fascial system extends cephalad
from the abdomen and separates into a superficial and
deep layer which envelopes the breast tissue and main­
tains its attachment to the breast wall.24,25 The superficial
layer of superficial fascia envelopes the glandular tissue
deep to the dermal layer and can be difficult to distin­
guish from the dermis. However, subcutaneous adipose
tissue between the dermis and the superficial layer
distinguish the two layers. The deep layer of superficial
Fig. 1.8  Blood supply to the breast: cross-sectional view.
Lateral intercostal
perforator
Intercostal artery
Lateral thoracic artery
Internal mammary artery
Internal mammary
artery perforator
Anterior intercostal perforator
Fig. 1.9  Blood supply to the breast demonstrating redundancy from multiple
arterial sources.
Lateral thoracic artery
Thoracodorsal
artery
Anteromedial intercostal perforators
Anterolateral intercostal
perforators
Internal mammary
perforators
including the nipple areolar complex. Likewise, the
second through sixth anteromedial intercostal nerves
enter the medial aspect of the breast parenchyma along­
side the internal mammary perforating vessels, provid­
ing innervation to the medial breast and nipple areolar
complex.20,21
Nipple areolar complex
The nipple areolar complex is the focal point of the
breast, normally located at the prominence of the breast
mound. The nipple itself is covered by keratinizing

8
SECTION I
CHAPTER 1 • Breast anatomy for plastic surgeons
Fig. 1.10  Cross-sectional image demonstrating vasculature and sensory innervation to the breast: anterolateral and anteromedial branches of thoracic intercostal nerves.
(© Elsevier Inc. All Rights Reserved.)
Ventral root
Erector spinae muscle
Medial branch
Lateral branch
Dorsal ramus of thoracic nerve
Costotransverse ligament
Intercostal nerve (ventral
ramus of thoracic spinal nerve)
Internal intercostal membrane
deep to external intercostal
muscle
Serratus anterior muscle
Gray and white
rami communicantes
Sympathetic trunk and ganglia
Innermost intercostal muscle
Internal intercostal muscle
External intercostal muscle
Sternum
Transversus
thoracis muscle
Right posterior
intercostal
arteries (cut)
Thoracic aorta
Innermost intercostal muscle
Internal intercostal muscle
External intercostal muscle
Internal thoracic artery
External
oblique
muscle
Lateral cutaneous
branch of posterior
intercostal artery
External intercostal membrane
Anterior intercostal arteries
Rectus abdominis muscle
Superior
epigastric artery
Perforating
branch
Anterior cutaneous branch of intercostal nerve
Pectoralis major muscle
External oblique
muscle
Anterior branch
of lateral cutaneous
branch of
intercostal nerve
Lateral
cutaneous
branch of
intercostal
nerve
Serratus
anterior
muscle
Subscapularis muscle
Infraspinatus muscle
Scapula
Internal intercostal membrane
Posterior intercostal artery
Erector spinae muscle
Rhomboid major muscle
Trapezius muscle
Dorsal branch of posterior intercostal artery
Spinal (radicular, or segmental medullary)
branch of posterior intercostal artery
Dorsal root
(spinal) ganglion

9
Parenchyma
Fig. 1.11  (A) Cross-section of the nipple. (B) There is a layer of stratified
squamous epithelium over the nipple surface; approximately 20 lactiferous ducts
(L) open onto the surface; sebaceous glands (S) are deep to the epidermis. (A,
reproduced with permission from Standring S (ed). Gray’s Anatomy, 40th edn.
London: Churchill Livingstone; 2008; B, from Kerr JB. Atlas of Functional Histology.
London: Mosby; 1999, with permission from Dr. J.B. Kerr, Monash University.)
Sebaceous gland
Circular smooth muscle
Accessory gland
(of Montgomery)
Areola
Lactiferous duct
A
S
S
L
L
S
B
Fig. 1.12  Cross-section of the breast demonstrating the superficial fascial system,
which separates into a superficial and deep layer and envelopes the breast tissue.
(Reproduced with permission from Standring S (ed). Gray’s Anatomy, 40th edn.
London: Churchill Livingstone; 2008.)
Pectoralis
major
Pectoralis
fascia
Retromammary
space
Deep layer of
superficial fascia
Superficial layer of
superficial fascia
Ligaments of
Cooper
Lobes
Duct
Nipple
Collecting
duct
Lactiferous
sinus
Fat
fascia diverges at the level of the sixth rib, where the
inframammary fold is the inferior border of the paren­
chyma, and sits on the deep surface of the breast just
superficial to the pectoralis fascia. Between the deep
layer of superficial fascia and the pectoralis fascia is the
retromammary space filled with loose tissue that allows
the breast to move over the chest wall. Cooper’s liga­
ments provide numerous interconnections between the
deep and superficial layers. These ligaments penetrate
the deep layer of superficial fascia and invest into the
breast parenchyma to the superficial layer of superficial
fascia. With age, the suspensory structure becomes more
attenuated, resulting in progressive breast ptosis.
Parenchyma
The glandular tissue of the breast functions to produce
milk in the postpartum period. It consists of alveoli, the
secretory units of the gland, clustered together into
approximately 20 lobes separated by connective tissue
and fat. These alveoli are connected by interlobular
ducts which join to form approximately 20 primary
lactiferous ducts. Beneath the nipple, the dilated lactif­
erous ducts form lactiferous sinuses which open onto
the nipple areolar complex. As previously stated, the
ducts are lined with cuboidal cells which transition to
stratified squamous epithelium in the lactiferous sinuses.
This glandular parenchyma is distributed within a sig­
nificant amount of adipose tissue.26 Although widely
variable, adipose tissue generally comprises a consider­
able amount of the total breast volume at approximately
50–70%.27 In most breasts, between the dermis and the
breast parenchyma exists a consistent and distinct layer

10
SECTION I
CHAPTER 1 • Breast anatomy for plastic surgeons
of subcutaneous tissue with a thickness of approximately
1 cm (Fig. 1.13).28 By identifying and preserving this
layer during skin-sparing mastectomy, the oncologic
surgeon can perform an oncologically safe resection
while also achieving predictably viable skin flaps which
contain little to no breast parenchyma. Leaving this
layer of subcutaneous tissue not only maintains the
viability of the skins flaps but also enhances the final
reconstructive outcome by providing a uniform layer of
tissue beneath the skin flaps.
Musculature
The muscles associated with the anterior chest wall
include the pectoralis major, pectoralis minor, serratus
anterior, rectus abdominis, and the external oblique
(Fig. 1.14). While primarily attached to the pectoralis
major, the breast tissue also has attachments with the
serratus anterior, external oblique, and the superior
portion of the rectus abdominis.
The pectoralis major muscle is a broad muscle that
extends from its origin on the medial clavicle, lateral
sternum, and second through sixth ribs to its insertion
on the upper humerus on the lateral side of the intertu­
bercular sulcus. The muscle acts to flex, adduct, and
rotate the arm medially. It has a primary vascular supply
based on the thoracoacromial artery and a secondary
supply via the lateral thoracic artery, intercostal perfora­
tors, and internal mammary perforators. The muscle is
innervated by the medial and lateral pectoral nerves,
which enter posteriorly and laterally.
Fig. 1.13  Photomicrograph demonstrating the relationship among the epidermis
(black arrow), subcutaneous tissue (red arrow), and most superficial breast lobule
(blue arrow). Hematoxylin and eosin staining, 2× magnification. (Reproduced with
permission from Larson D, Basir Z, Bruce T. Is oncologic safety compatible with a
predictably viable mastectomy skin flap? Plast Reconstr Surg. 2011;127:27–33.)
By providing muscle coverage for breast implants,
the pectoralis major serves an extremely important role
in both aesthetic and reconstructive breast surgery. In
the setting of breast reconstruction, coverage of the
implant decreases the risk of implant exposure, where
post-mastectomy skin and underlying subcutaneous
tissues are often thin. Additionally, the muscle decreases
implant palpability by providing added tissue between
the implant and skin. However, subpectoral placement
of the implant can cause the implant to ripple and be
detected during contraction of the muscle. Releasing the
pectoralis muscle from its inferior and medial attach­
ments can serve to decrease this problem. Furthermore,
inferior release of the pectoralis muscle allows lower
positioning of the implant to be achieved, resulting in a
more aesthetic appearance.
The pectoralis minor is a flat and fan-shaped muscle
which lies between the pectoralis major and the chest
wall and extends from its origin on the anterolateral
surface of the third through fifth ribs to its insertion on
the coracoid process of the scapula. Blood supply to the
muscle is either directly from the axillary artery or as a
branch from the thoracoacromial artery or lateral tho­
racic artery. Innervation is derived from both the medial
and lateral pectoral nerves. Although not commonly
utilized in breast surgery, the pectoralis minor muscle
Fig. 1.14  Muscles of the chest wall.
Pectoralis minor muscle
Pectoralis major muscle
Serratus anterior
muscle
External oblique muscle
Internal oblique muscle
Rectus abdominis
muscle

11
Lymphatics
tubercle, and the aponeurosis of the linea alba from the
xiphoid to the pubis. This muscle borders the inferolat­
eral aspect of the breast. It acts to compress the abdomen,
flex and laterally rotate the spine, and depress the ribs.
Innervation to the muscle is provided by the seventh
through eleventh intercostal nerves and the subcostal
nerve. It receives its blood supply in a segmental fashion
from the inferior eight posterior intercostal arteries.
During implant-based reconstruction, the external
oblique along with the rectus abdominis may be elevated
to provide inferior coverage and proper placement of
the implant.
Skeletal support
Breast shape and symmetry are dependent on normal
skeletal support. Deformities of the chest wall such as
pectus excavatum or pectus carinatum can lead to
alterations in breast projection. Likewise, spinal abnor­
malities such as scoliosis can affect the appearance of
breast symmetry.32 Poland syndrome can lead to unilat­
eral underdevelopment or absence of the pectoralis
muscle, as well as abnormalities to the breast and nipple.
While abnormalities of the underlying chest wall may
be difficult to appreciate, they are extremely important
to consider when evaluating the breasts during preop­
erative planning. Any pre-existing spinal curvature or
chest wall deformities must be recognized and demon­
strated to the patient, as these may become more notice­
able postoperatively and affect the patient’s perception
of the appearance and symmetry of their breasts.
Lymphatics
The lymphatic anatomy of the breast has been exten­
sively investigated, particularly for its role in breast
cancer dissemination. Lymphatic drainage of the breast
includes a network of both superficial and deep lym­
phatic drainage (Fig. 1.15). Superficial lymphatic drain­
age originates from the periareolar lymphatic plexus,
while deep lymphatic drainage originates from each
lactiferous duct and lobule, and then penetrates the
deep fascia of the underlying musculature. The pre­
dominance of lymph drainage of the breast originates
from the lymphatic vessels within the breast lobules
which then flow to the subareolar plexus. From this
plexus, lymphatic drainage takes place through several
routes. Lymphatic drainage from the lateral and supe­
rior aspect of the breast courses around the inferior edge
of the pectoralis major muscle and communicates with
the pectoral group of axillary nodes. Additional lym­
phatics course through the pectoral muscles to the apical
lymph nodes. From the axillary lymph nodes, lymph
has been used as an innervated free flap in the field of
facial reanimation.29
The serratus anterior runs along the anterolateral
chest wall, extending from its origin at the anterolateral
aspect of the first through eighth ribs to its insertion on
the medial aspect of the scapula. Its vascular supply is
derived equally from the lateral thoracic artery, which
supplies the superior part of the muscle, and branches
from the thoracodorsal artery, which supplies the infe­
rior part. The muscle is responsible for rotation of the
scapula, raising the point of the shoulder and drawing
the scapula inward toward the body. Innervation of the
serratus anterior is provided by the long thoracic nerve.
One must be careful during axillary lymph node dissec­
tion to avoid transecting this nerve, as its loss results in
“winging” as the scapula moves upward and outward
away from the body. Because the serratus anterior
underlies the lateral aspect of the breast, blunt elevation
of the pectoralis major laterally for implant placement
can elevate a small portion of the serratus muscle.
During breast reconstruction, complete muscle cover­
age of the implant often necessitates that the serratus
anterior be partially elevated.
The rectus abdominis is an elongated muscle that
runs from its origin at the pubic symphysis, pubic crest,
and pubic tubercle to its insertion at the xiphoid process
and costal cartilages of the fifth through seventh ribs.
Breast tissue attaches to the superior limit of the rectus
abdominis, delineating the inferior border of the breast.
The function of the muscle includes compression of the
abdomen and flexion of the spine. Innervation is seg­
mental from the seventh through twelfth intercostal
nerves, while blood supply to the muscle is provided by
two dominant pedicles, the superior and inferior deep
epigastric arteries. The superior epigastric artery, a ter­
minal branch of the internal mammary artery, supplies
the upper portion of the muscle, whereas the inferior
epigastric artery runs superiorly on the posterior surface
of the rectus and penetrates the rectus at the arcuate line
to supply the lower portion. Additionally, many small
segmental contributions are provided by the lower six
intercostal arteries.
The rectus abdominis is particularly important in
breast reconstruction as it relates to the transverse rectus
abdominis myocutaneous (TRAM) flap, one of the most
common forms of autologous tissue reconstruction to
date.30,31 With regard to implant-based reconstruction, in
attempting to achieve complete coverage with muscle,
the rectus fascia can be elevated to place the implant
sufficiently caudal.
The external oblique muscle is a broad muscle origi­
nating from the fifth through twelfth ribs and inserting
along the anterior half of the iliac crest, the pubic

12
SECTION I
CHAPTER 1 • Breast anatomy for plastic surgeons
Fig. 1.15  Lymphatic drainage of the breast. (© Elsevier Inc. All Rights Reserved.)
Parasternal nodes
Apical axillary (subclavian) nodes
Interpectoral (Rotter) nodes
Central axillary nodes
Lateral axillary
(humeral) nodes
Posterior axillary
(subscapular) nodes
Anterior
axillary
(pectoral) nodes
Pathway to
anterior
mediastinal nodes
Pathways to opposite breast
Pathways to inferior phrenic (subdiaphragmatic) nodes and liver

13
Considerations for the plastic surgeon
and limited subcutaneous chest wall fat. Treatment
options include autologous tissue utilizing either pedi­
cled or free latissimus dorsi or rectus abdominis mus­
culocutaneous flaps, or implant-based reconstruction
alone or in combination with autologous tissue.
Radiation changes to the breast
and soft tissue
Although radiation dosimetry has improved in the past
several decades, radiation injury nevertheless results in
damage to the breast and soft tissue, which may lead
to significant wound-healing problems during breast
reconstruction.34 Theorized mechanisms of radiation-
induced injury include direct cellular damage with
chromosomal alteration, and the microvascular occlu­
sion theory. Irradiation may lead to permanent damage
to fibroblasts and fibroblast stem cells, including ultra­
structural damage to mitochondria, rough endoplasmic
reticulum, and nuclei. It may also inhibit wound healing
by preventing stem cells from replicating and providing
new blood vessels in the zone of injury. The progression
of radiation injury has been described as biphasic. Acute
effects of irradiation occur in the first days to weeks of
therapy and involve cellular death in rapidly proliferat­
ing cells. The resultant effects on breast skin include
edema from leaking capillaries, inflammation, and
desquamation. Delayed effects on the soft tissue of the
breast may occur after several months to years, resulting
in atrophy and fibrosis with replacement of the adipose
tissue with collagen. During preoperative planning for
breast reconstruction, communication with the radia­
tion oncologist regarding the timing and technique of
radiation are extremely important in order to minimize
complications and optimize aesthetic outcomes for
these patients.
Partial breast reconstruction
Due to the rising popularity of breast conservation
therapy for the management of breast cancer, plastic
surgeons are increasingly performing reconstruction on
partial mastectomy defects. Many reconstructive tech­
niques exist, and the decision concerning which to use
depends on breast size, tumor location and size, extent
and location of the resection, timing of the reconstruc­
tion in relation to radiation therapy, and patient
desires.35,36 Generally, women with defects in smaller,
nonptotic breasts benefit from volume replacement
techniques using local or distant flaps. Conversely,
women with moderate or large-sized breasts are often
amenable to reshaping procedures using local tissue
rearrangement techniques, usually mastopexy or reduc­
tion techniques. As this often removes enough breast
drains into the subclavian and supraclavicular lymph
nodes. Lymphatic drainage from the medial aspect of
the breast drains to the parasternal nodes, which then
drains into the bronchomediastinal trunks.
Considerations for the plastic surgeon
Recipient sites for free tissue transfer
The selection of suitable recipient vessels is an important
requirement when free tissue transfer is used for breast
reconstruction. The internal mammary arteries are very
common recipient vessels. The internal mammary vessel
may be preferred in delayed cases, especially in patients
who have had adjuvant radiation, as dissection of axil­
lary vessels can be very difficult. The use of the internal
mammary vessels facilitates shaping the medial portion
of the breast as compared to the thoracodorsal vessels.
Distal to the fourth rib, the internal mammary veins
become smaller (<2 mm) and bifurcate, thus making
suitable outflow less predictable. Therefore, the third rib
is a common level of access. The thoracodorsal vessels
have been used; however, the thoracodorsal artery can
be small (<2 mm) and lateralization of the flap may
occur as the pedicle may be tethered toward the axilla.
Use of the axillary vessels has also been reported.
However, the axillary vessels may limit flap movement
and shaping of the breast.
Deformities of the breast and chest wall
Pediatric chest wall and breast anomalies present as a
wide spectrum of irregularities.33 Chest wall anomalies
include Poland syndrome, pectus excavatum, pectus
carinatum, and various sternal anomalies. Breast abnor­
malities can be categorized into three groups, including
hypoplastic, hyperplastic, and deformational anomalies.
Hypoplastic and deformational anomalies are charac­
terized by breast tissue paucity and include Poland
syndrome, breast hypoplasia, tuberous breast, anthelia,
and amastia. These anomalies often benefit from breast
augmentation techniques and are frequently associated
with significant reoperative rates. Hyperplastic anoma­
lies are characterized by excess breast tissue and include
gynecomastia, polymastia, polythelia, and juvenile
hypertrophy. Treatment for these anomalies often
requires breast reduction techniques and is less likely to
require re-operation.
As previous stated, Poland syndrome is a severe form
of chest wall and breast hypoplasia that includes absence
of the pectoralis major and minor muscles and syndac­
tyly of the ipsilateral hand.33 The condition can also
include absence of multiple ribs, chest wall depression,
athelia, amastia, absence of the latissimus dorsi muscle,

14
SECTION I
CHAPTER 1 • Breast anatomy for plastic surgeons
performed with injection of 3–5 mL of dye (classically
isosulfan blue) and/or radiolabeled colloid into the
subareolar plexus, intradermally or peritumor region.
There is ongoing debate about the best site of injec­
tion.42,46 Preoperative lymphoscintigraphy, although not
mandatory, can be used to identify the sentinel lymph
node and document patterns of lymphatic drainage.
When injecting technetium sulfur colloid into the paren­
chyma surrounding the tumor, the mapping can go
either to the axillary or internal mammary nodes,
whereas injections performed into the periareolar
dermis almost uniformly map to the axillary nodes.
Conclusion
Although breast size and shape vary among patients,
knowing the anatomy of the breast facilitates safe surgi­
cal planning. When the breasts are carefully examined,
significant asymmetries are revealed in most patients,
which must be recognized and demonstrated to the
patient, as these may be difficult to correct and can
become noticeable in the postoperative period. Knowl­
edge of the anatomy of the breast and its associated
structures, as well as careful surgical technique, is
extremely important in minimizing operative complica­
tions and achieving successful patient outcomes.
tissue and skin to change breast size and nipple posi­
tion, these volume reduction procedures often require
a procedure to the contralateral breast to achieve
symmetry.
Role of lymphatics in mapping and biopsy of
sentinel lymph nodes
The management of staging the axilla was transformed
in clinically node negative early breast cancer patients
with the use of sentinel lymph node biopsy (SLNB).37
The concept of the sentinel lymph node evolved from
the observation that a primary tumor is drained by an
afferent lymphatic channel that courses to the first,
“sentinel”, lymph node in the specific regional lym­
phatic basin.38 This was originally described by Morton
and colleagues in the study of melanoma.39,40 Subsequent
studies by Giuliano and colleagues showed that
mapping lymphatic channels with isosulfan blue dye
identified the sentinel node with 100% accuracy, pre­
dicting the status of the axilla in breast cancer patients.41,42
In addition to the isosulfan blue dye technique, there
are other technical approaches for sentinel node identi­
fication, including preoperative injection of technetium
sulfur colloid (Tc-99) with lymphoscintigraphy, and the
combination of isosulfan blue dye and radio-isotope
techniques.43–45 Sentinel lymph node dissection is
11. Tepper OM, Unger JG, Small KH, et al. Mammometrics: the
standardization of aesthetic and reconstructive breast surgery. Plast
Reconstr Surg. 2010;125:393–400. This article summarizes three-
dimensional breast photography and its potential for establishing a
standardized method for breast analysis, in an effort to guide operative
planning and better analyze surgical results.
22. Nakajima H, Imanishi N, Aiso S. Arterial anatomy of the nipple-
areola complex. Plast Reconstr Surg. 1995;96:843–845. The publication
examines the blood supply to the nipple-areola complex, demonstrating
that branches of the external mammary artery (lateral thoracic artery) and
internal mammary artery provide the dominant blood supply to the
nipple-areola complex via small vessels that traverse the subcutaneous
tissue.
25. Lockwood TE. Reduction mammaplasty and mastopexy with
superficial fascial system suspension. Plast Reconstr Surg.
1999;103:1411–1420. This paper describes the anatomy of the superficial
fascial system of the breast, and describes a technique for implementing
superficial fascial system suspension during reduction mammoplasty and
mastopexy.
27. Lejour M. Evaluation of fat in breast tissue removed by vertical
mammaplasty. Plast Reconstr Surg. 1997;99:386–393. This publication
evaluated the relative fat content versus glandular tissue of the breast by
examining breast parenchyma specimens removed during reduction
mammaplasty. The study found that breast fat is highly variable between
patients, and increases with age, body mass, and total volume of the breast.
28. Larson D, Basir Z, Bruce T. Is oncologic safety compatible with a
predictably viable mastectomy skin flap? Plast Reconstr Surg.
2011;127:27–33. This paper describes the subcutaneous tissue layer
between the dermis and the parenchyma of the breast. The authors propose
that by preserving the subcutaneous tissue layer during mastectomy, an
oncologically safe resection can be performed while also achieving
predictably viable skin flaps.
Access the complete reference list online at

14.e1
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