Aesthetic Surgery of the Breast

Aesthetic Surgery of the Breast

Melvin A. Shiffman Editors Aesthetic Surgery of the Breast

Editors Medestet Clinic Cluj-Napoca Romania Melvin A. Shiffman Department of Surgery Newport Specialty Hospital Tustin, CA USA Videos to this book can be accessed at http://springerimages.com/videos/978-3-662-43406-2 ISBN 978-3-662-43406-2 ISBN 978-3-662-43407-9 (ebook) DOI 10.1007/978-3-662-43407-9 Springer Heidelberg New York Dordrecht London Library of Congress Control Number: 2014951830 Springer-Verlag Berlin Heidelberg 2015 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifically for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher's location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com)

Foreword To talk about aesthetics in life, you can have maybe thousands of speakers; to talk about aesthetics in medicine, you can have maybe hundreds of speakers; but to talk about aesthetic breasts, there is only, with maybe tens of other aesthetic surgeons! Breasts are the symbol of a woman s fertility and, being like the eyes of the body, attract the opposite sex. The more voluptuous they look, the greater the chances of attracting potential partners. In the present day, when it is easy to access information on any subject in medicine, and especially in the field of aesthetic surgery, this book, Aesthetic Surgery of the Breast, provides an excellent opportunity to obtain in-depth information directly from the specialists, with step-by-step explanations on different procedures. This book is unique as the reader is privileged to share s tremendous experience in the field. Mugea has focused on aesthetic surgery of the breast for the last 15 years in a very scientific way, creating new concepts on breast assessment, breast aesthetic score, and programs for implant selection in breast augmentation. He introduced a new classification for breast ptosis, including, for the first time, assessing the volume of the breast using a computer program. He has also dealt with tubular breasts using new classification and surgical techniques and has discussed complications in aesthetic surgery of the breast in detail. This book is, therefore, comprehensive and easy to understand; it also consists of original drawings and representative pictures. This represents a great achievement for aesthetic surgeons, especially the younger ones, allowing them to have a precise case evaluation and to select the right surgical technique for their specific cases. All the contributors have shared their experience and original concepts on different aspects of aesthetic surgery of the breast, creating, like a diamond, a book of several glittering dimensions. The book discusses new and challenging subjects and presents them in an attractive manner. I would like to invite the reader to partake in the great pleasure of reading this masterpiece on aesthetic surgery of the breast. Bucharest, Romania Mircea Ifrim, M.D., Ph.D. v

Preface I was around 15 years old when, as a young student at Andrei Saguna National College in Brasov, Romania (old German name Kronstadt), we did our first dissection in biology class on a frog. This incident opened the gates to a new word, and, thanks to the encouragement from my teacher, Prof. Laurian Taller, I started reading and learning more about this fascinating field in the book Brehm s Life of Animals. The double-helix structure of DNA, the genetic code fundamental principles of action, and the camp as the second messenger in the cell signaling description were, at that time, some of the most exciting scientific discoveries, winning a series of Nobel Prizes in Medicine. My teacher and myself often indulged in exciting discussions during class hours and outside of it, even pondering on the origins of life in the universe and on Earth! Even now, after more than 40 years, we still dream and think like old teenagers about nature, the meaning of life, and the beauty of the universe and about love, happiness, and other fundamental values. vii

viii Preface My fields of research specialization were in mathematics, geometry, physics, chemistry, and biology, and I first published my articles in Buds, the Andrei Saguna College journal, and then, as a medical student, participated in students scientific meetings. I also participated in the International Symposium on Applications of Mathematics in System Theory (Brasov 1978) and spoke on Information and Significance in Biological Systems. The audience was surprised to see a young physician speak on information contained by an event, the significance of the event related to the receiver, and informational symbiosis in biological systems. In 1977, we described the mathematical way of calculating information contained by an event and, finally, the necessity of the existence of a double helix as a safe way to store information with high significance as in biological systems. Years later, in 1991, we developed the concept of the human body in a cybernetic form and published this for the first time at Oxford. In 2008, almost 30 years since the original idea was propagated, our concepts were given final shape, when we published an essay entitled life, the universe, and the human body. I won my first medical competition as a student for internship in general surgery at the Central Army Hospital in Bucharest, and soon after, I underwent training as a plastic surgeon under the guidance of Prof. Agrippa Ionescu, the renowned Romanian teacher who opened one of the first plastic surgery units in Europe in 1957. I then specialized in general surgery and plastic surgery and worked as a consultant for some time before working as professor of plastic and aesthetic surgery at Oradea University, Romania. I then had the great opportunity to be one of the BAPS fellows in 1991 and to be working in close collaboration with Anthony C. H. Watson at Edinburgh in Bangour General Hospital Plastic Surgery Unit and, thereafter, with John P. Gower in Birmingham Accident Hospital till 1993, learning from them the intricacies involved in plastic surgery. I then had to take the bold decision of starting my private practice in aesthetic surgery in 1996, since before the revolution, this was not considered a viable career option by communist leaders in Romania. I had to rely on my short experience abroad and had to constantly learn from guests invited at our workshops and from scientific events we organized under the aegis of the Romanian Aesthetic Surgery Society and the Romanian Academy of Medical Sciences. It is a pleasure to remember brilliant plastic surgeons like Tom Biggs, Nazim Cerkes, Anthony Erian, Julio Ferreira, Pierre F. Fournier, Alberto Di Giusepe, Giovani Botti, Fhad Beslimane, Mario Pelle Ceravolo, Wolgang Gubisch, Per Heden, Steven B. Hopping, Yves Gerard Illouz, Jose Juri, Ermete de Longis, Cesar E. Morillas, Mauritio Nava, Magnus Noah, Robert Oelinger, Trevor O Neil, Angelo Rebelo, Schulte Uebbing, Vijay Sharma, Melvin A. Shiffman, Bryan A. Toth, Carlos Uebel, Rene Villedieu, Michelle Zocchi, and many others who shared their experience and provided tips with regard to aesthetic surgery procedures. We have all become friends now and meet each other in different scientific meetings worldwide every now and then. I still fondly remember Mario Pelle Ceravolo saying at one of our congresses organized in Romania that initially he used to come to teach us the techniques in aesthetic surgery but that he now comes to pick important ideas from our lectures!

Preface ix For me, aesthetic surgery of the breast is a perfect combination of art and science since breasts are the eyes of the body and represent femininity and fertility. From the first rupestrian drawings to Renaissance art, the significance of breasts was understood by all and was represented in work across the ages. Breasts are not only for scientific study, they represent life, sexuality, and pleasure. They need respect. As plastic surgeons, we have to not only know the anatomy, physiology, and pathology of breasts, we also need to understand the artistic principles of the body and breast proportions, the definition of aesthetic breasts, and the influence of surgery on breasts, whatever be the procedure (augmentation, reduction, mastopexy, or a combination of all of these). As a first step, one needs to measure the breasts, including the normal and aesthetic breasts as referees. Based on hundreds of cases documented in our Toma T Mugea (TTM) chart, we have tried to find the relation between the body mass index, trunk dimension, and breast proportion and have derived a specific language for breast surgeons to compare their evaluation and surgical results. All these are included in the first chapters of this book. This is followed by the algorithm of implant selection and if the breast augmentation will be the indication, this is followed by the algorithm of implant selection, presented as a computer program. Accurate breast examination leads naturally to the classification and surgical procedure fit for the problem. There is an algorithm and computer program also for breast reduction and mastopexy, with the suggested measurements, if the inverted T scar procedure is the option. This book is centered around the techniques we use. The reader can see, use, and learn from our experience on breast surgery. Apart from classical concepts concerning aesthetic surgery of the breast, you will find in our book new, interesting chapters about breast golden number, breast score and anatomical implant selection, life and aging with breast implants, breast implants and tissue reaction, breast augmentation for asymmetric breasts, and breast augmentation in chest malformation. Some chapters provide a detailed account of the complications of breast augmentation including pericapsular lymphangitis and acute seroma syndrome in augmented breasts and explain the long-term risks of silicone implants. For breast reduction and mastopexy, we have introduced a new breast volume and ptosis classification system with related surgical procedures. Tubular breasts are also covered, with a new classification related to the volume, and a new technique of breast reduction creating a new inframammary fold level. All our photos are original; all cases are well documented pre-, intra-, and postoperatively; and new techniques are always explained by hand drawings that I have done myself. Our intention was to explain in the most direct way what we do and how we do it not only in simple cases but also in difficult cases, even if we have to admit that some of the postoperative results were not always excellent. It is better to admit problem areas and to learn from mistakes than to try and be a showman pretending that all our techniques are successful. I would first like to thank my good friend Melvin A. Shiffman, the coeditor of this book, for his kindness and patience during the hard times I underwent

x Preface in the last few years. Without his support and positive attitude, I would never have been able to publish this book. Many thanks to the Secretary General of the Romanian Academy of Medical Sciences, Acad. Prof. Dr. Mircea Ifrim, who has always been a friend in need and a constant supporter of the development of aesthetic surgery speciality in Romania. His truthful persona and charming manners made it easy for us to work with him. Special thanks to my wife, Camelia, for understanding my efforts and absences from the family even though she may still be waiting for the end of busy time to enjoy our walking, dancing, and moments together. She brought up our lovely daughters Sanziana (studying oboe as fellowship master class at the Royal Conservatoire of Scotland) and Ruxandra (designer) and now dotes on her grandchildren, Sophia and Victor. Being a proud grandfather has provided me several unforgettable moments, generating a parallel universe to which we can have access only for a few fleeting moments like the opened gates for a wormhole. But this is life. We have to accept and to enjoy it. Cluj-Napoca, Romania, M.D., Ph.D. General References 1. Mugea TT. Information and significance in biologic systems, at the international symposium on applications of mathematics in system theory. Brasov. 27 28 Dec 1978. 2. Mugea TT. The role of the triad camp-cgmp-chalone in the cell regulation First European Tissue Repair Society Meeting. Oxford. Aug 1991. 3. Life and Universe, Human Body, Professor, Medestet. 4. www.stumbleupon.com/content/7blweytraducerea.acestei pagini. 5. Aug. 2008 Life and Universe, Human Body, Professor, Medestet Life-universe-ttm.ro Informatii domeniu InfoDomenii.ro 6. www.infodomenii.ro/life-universe-ttm-ro-dm05439456.html Life and Universe, Human Body, Professor, Medestet view of human body, organism regulation, Medestet, Professor, clinica.

Contents Part I General 1 Definition of Beauty... 3 2 About Life, Universe, and Human Body... 7 3 History of Aesthetic Breast Surgery... 25 Melvin A. Shiffman Part II Anatomy, Development, and Assessment 4 Fascia, Nerve Supply, and Lymphatics of the Breast... 39 Peter M. Prendergast 5 Arterial Blood Supply of the Breast... 43 Melvin A. Shiffman 6 Breast Development and Aging... 45 7 Breast Assessment... 57 8 Breast Golden Number... 69 Part III Anesthesia 9 Anesthesia in Breast Surgery... 87 Simona Claudia Margarit 10 Tumescent Anesthetic Breast Surgery (TABS): Breast Augmentation Surgery in an Office-Based Surgical Center... 107 Julio Cesar Novoa xi

xii Contents Part IV Breast Augmentation 11 Breast Score and Anatomical Implant Selection Using Computer Program... 123 12 Life and Aging with Breast Implants... 171 13 Breast Implant and Tissue Reaction... 215, Bogdan Fetica, and Simona Maria Barsan 14 Subglandular Breast Augmentation... 255 Felix Rudiger G. Giebler 15 Subfascial Prepectoral Breast Augmentation... 263 16 Can the Integrity of the Pectoral Fascia Be Preserved During the Subfascial Breast Augmentation Through Axillary Approach?... 287 Lin Jinde, Chen Xiaoping, Zhang Wanquan, Gao Xia, Xu Ligang, and Yuan Yugang 17 Transaxillary Breast Augmentation: The Impact on Axillary Lymphatic Drainage and Sentinel Lymph Node Evaluation... 291 Alexandre Mendonça Munhoz and Rolf Gemperli 18 Transumbilical Breast Augmentation... 303 Robert A. Shumway 19 Periareolar and Intra-areolar Approach in Breast Augmentation... 309 Robert M. Dryden 20 Retromusculofascial Dual-Plane Breast Augmentation... 317 21 Breast Augmentation for Asymmetric Breasts... 339 22 Breast Augmentation in Chest Malformation... 377 23 Breast Augmentation by Autologous Fat Transfer... 411 Marco A. Pelosi III and Marco A. Pelosi II Part V Complications and Revision Surgery 24 Complications of Breast Augmentation... 425

Contents xiii 25 Pericapsular Lymphangitis and Acute Seroma Syndrome in Augmented Breast... 513 and Anca Ciurea 26 Capsular Contracture: Etiology, Prevention, and Treatment... 529 Maurice Sherman 27 Subglandular to Muscle Splitting Biplane Conversion for Revision Augmentation Mammoplasty... 535 Umar D. Khan 28 Treatment of Symmastia... 543 Istvan B. Szemerey and Akos Szemerey 29 Diagnosis and Treatment of Iatrogenic Pneumothorax in Aesthetic Breast Surgery... 549 Enoc V. Chambi 30 Breast Implant Rippling and Palpability... 557 Gregory N. Laurence 31 Diagnostic Imaging of the Breast in Aesthetic Breast Surgery... 563 Karina A. Ravera Part VI Mastopexy 32 New Breast Volume and Ptosis Classification System... 605 33 Cat s Tail Vertical Scar Mastopexy with Bipedicle Flap for Ptotic Breasts... 635 Umar D. Khan 34 The Modified Benelli Breast Lift... 643 Nikolas Chugay 35 Use of Nipple-Areolar Complex to Inframammary Crease Measurements to Reduce Bottoming Out Following Augmentation Mastopexy... 649 Umar D. Khan 36 Modified Passot Mastopexy... 657 Melvin A. Shiffman 37 The Modified Peixoto Breast Lift... 663 Nikolas Chugay 38 Mastoptosis Aesthetic Surgery: Thread Lifting Techniques... 669 Marlen Sulamanidze, George Sulamanidze, and Constantin Sulamanidze

xiv Contents 39 Breast Augmentation and Mastopexy... 693 40 Mastopexy with Inferior Deepithelialized Flap... 723 Cristina Isac and Aurelia Isac 41 The Use of High-Profile and Extra-High- Profile Implants in Ptotic Breasts as an Alternative to Staged Augmentation/Mastopexy... 739 Julio Cesar Novoa Part VII Breast Reduction 42 Breast Reduction/Mastopexy with Short Inverted-T Scar... 767 43 Does the Reductive Mastopexy with Implant Approach Prevent Late Bottoming Out?... 797 Abder-Rahman Mounir, Shahab Mahdi, and Paul Clark 44 Bipedicle Breast Reduction... 805 Melvin A. Shiffman 45 Variation of the Pitanguy Breast Reduction... 811 Nikolas Chugay 46 Breast Reduction/Mastopexy with Superomedial Pedicle... 819 Nicolae Antohi, Cristina Isac, Tiberiu Bratu, Stan Vitalie, and Bodog Florian 47 Chain Purse-String Suture Used to Shorten the Vertical Incision in Vertical Breast Reduction... 833 Selman Karaci 48 Tuberous Breast Surgery... 837 Cristina Isac and Aurelia Isac 49 Tubular Breast Deformity: New Analysis and Classification... 849 and Mircea Ifrim 50 Tubular Breast Reduction/Mastopexy with New Inframammary Fold Level: Skin Deepithelialization and Plication... 863 51 Breast Liposuction... 883 Marco A. Pelosi III and Marco A. Pelosi II 52 Liposuction Breast Reduction... 895 Michael J. Brumfield and Robert M. Dryden

Contents xv 53 Gigantomastia Reduction: Inferior Pedicle Versus Free Nipple Areola Graft... 905 and Andrei Miron Martin 54 Complications of Mastopexy and Breast Reduction... 935, Laura Maria Curic, and Andrei Miron Martin Part VIII Miscellaneous 55 Modification of the Wise Pattern Breast Reduction for Therapeutic Mammoplasty... 949 Christina Summerhayes, Ramsey I. Cutress, and Jeremy S. Hurren 56 Breast Reshaping After Massive Weight Loss... 955 Cristina Isac and Aurelia Isac 57 Poland Syndrome... 967 Renato da Silva Freitas, André Ricardo Dall Oglio Tolazzi, and Maria Cecilia Closs Ono 58 Gynecomastia... 985 Cristina Isac and Aurelia Isac 59 Inverted Nipples... 1009 Cristina Isac and Aurelia Isac 60 Congenital Breast Syndromes: History, Etiology, and Treatment... 1017 Melvin A. Shiffman Part IX Commentary 61 Author s Commentary: My Thoughts on Aesthetic Breast Surgery... 1045 Erratum... E1 Index... 1047

Contributors Nicolae Antohi, M.D., Ph.D. Department of Plastic Surgery, University Hospital for Plastic Surgery and Burns, Bucharest, Romania Esthera Medical Centre, University for Medicine and Pharmacy Carol Davila, Bucharest, Romania Tiberiu Bratu, M.D., Ph.D. Brol Medical Center, Timisoara, Romania Department of Plastic Surgery, County Hospital Timisoara, University of Medicine and Pharmacy Victor Babes, Casa, Austria Michael J. Brumfield, D.O. Department of General Surgery, Tri-County Surgical, Portland, IN, USA Enoc V. Chambi, M.D. Private practice, Montclair, CA, USA Nikolas Chugay, D.O. Private Practice, Long Beach, CA, USA Anca Ciurea, M.D., Ph.D. Radiology Department, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania Paul Clark, M.D. Plastic and Cosmetic Department, Abbey Pines Hospital, Manchester, UK Laura Maria Curic, M.D., Ph.D. Department of Plastic and Reconstructive Surgery, Iasi Emergency Hospital, Perugia, Italy Ramsey I. Cutress, FRCS Cancer Sciences Division, Cancer Research UK Research Centre, University of Southampton and University Hospital Southampton, School of Medicine, Centre Southampton General Hospital, Southampton, UK Robert M. Dryden, M.D. Department of Cosmetic Surgery, Arizona Centre Plastic Surgery, Arizona Stem Cell Treatment Center, Tuscon, AZ, USA Bogdan Fetica, M.D. Department of Pathology, The Oncology Institute Prof. Ion Chiricuta, Cluj-Napoca, Romania Bodog Florian, M.D., Ph.D. Department of Surgery, Public Health Department Ministry of Health, Oradea University of Medicine and Pharmacy, Oradea, Romania Renato da Silva Freitas, M.D., Ph.D. Plastic Surgery Unit, Hospital de Clínicas of Federal University of Paraná, Curitiba, PR, Brazil xvii

xviii Contributors Rolf Gemperli, M.D. Division of Plastic Surgery, University of São Paulo, School of Medicine, São Paulo, Brazil Felix Rudige G. Giebler, M.D. Vincemus Clinic for Plastic and Reconstructive Surgery, Friedrichstadt, Eider, Germany Jeremy S. Hurren, FRCS Portsmouth Breast Care Centre, Queen Alexandra Hospital, Portsmouth, UK Breast Services, D Level, Queen Alexandra Hospital, Cosham, UK Mircea Ifrim, M.D., Ph.D. Arad Medical University, Bucharest, Romania Aurelia Isac, M.D., Ph.D. Department of Plastic Surgery, University Hospital for Plastic Surgery and Burns, Bucharest, Romania Christina Isac, M.D., Ph.D. Department of Plastic Surgery, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Department of Plastic Surgery, University Hospital for Plastic Surgery and Burns, Bucharest, Romania Lin Jinde, M.D. Department of Plastic Surgery, Nanjing Friendship Plastic Surgery Hospital, Nanjing Medical University, Nanjing, Jiangsu province, China Selman Karaci, M.D. Department of Plastic and Reconstructive Surgery, Kahramanmaras Necip Fazil State Hospital, Karacasu Mevkii, Kahramanmaras, Turkey Umar D. Khan, M.D. ReShape Cosmetic Surgery UK, ReShape House, West Malling, Kent, UK Gregory N. Laurence, M.D. Private practice, Germantown Aesthetics, Germantown, TN, USA Shahab Mahdi, M.D. Plastic and Cosmetic Department, Abbey Pines Hospital, Manchester, UK Andrei Miron Martin M.D. Departament of Plastic and Aesthetic Surgery, Medestet Centre of Excelence, Cluj-Napoca, Romania Simona Claudia Margarit, M.D., Ph.D. Department of Anesthesiology, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania Department of Anesthesiology, Regional Institute of Gastroenterology- Hepatology Prof. Dr Octavian Fodor and Medestet Center of Excelence in Aesthetic Surgery, Cluj-Napoca, Romania Barsan Simona Maria, M.D., Ph.D. Department of Plastic and Reconstructive Surgery, Children s Emergency Hospital Cluj-Napoca, Cluj-Napoca, Romania Abder-Rahman Mounir, M.D., M.Sc. Plastic and Cosmetic Department, Abbey Pines Hospital, Manchester, UK, M.D., Ph.D. Department of Plastic and Aesthetic Surgery, Oradea Medical University, Oradea, Romania Medestet Clinic, Cluj-Napoca, Romania

Contributors xix Alexandre Mendonça Munhoz, M.D. Division of Plastic Surgery, University of São Paulo, School of Medicine, São Paulo, Brazil Division of Plastic SurgeryHospital Sírio-Libanês, São Paulo, Brazil Julio Cesar Novoa, M.D. Perfect Image Cosmetic Surgery, El Paso, TX, USA Maria Cecilia Closs Ono, M.D. Plastic Surgery Unit and Organization, and Organization, Federal University of Parana (UFPR), Curitiba, PR, Brazil Marco A. Pelosi II, M.D. Pelosi Medical Center, Bayonne, NJ, USA Marco A. Pelosi III, M.D. Obstetrics and Gynecology, International College of Surgeons-United States Section, Bayonne, NJ, USA Peter M. Prendergast, M.B., M.Ch., MRCSI. Venus Medical Beauty, Dundrum, Dublin, Ireland Karina A. Ravera, M.D. Department of Breast Imaging, Sanatorio de la Trinidad Mitre, Buenos Aires, Argentina Maurice Sherman, M.D. Private practice, Del Mar, CA, USA Melvin A. Shiffman, M.D., J.D. Department of Surgery, Newport Specialty Hospital, Tustin, CA, USA Robert A. Shumway, M.D. Shumway Cosmetic Surgery, Scripps Memorial Hospital Campus, La Jolla, CA, USA George Sulamanidze, M.D. Clinic of Plastic and Aesthetic Surgery Total Charm, Moscow, Russia Constantin Sulamanidze, M.D. Clinic of Plastic and Aesthetic Surgery Total Charm, Moscow, Russia Marlen Sulamanidze, M.D., Ph.D. Clinic of Plastic and Aesthetic Surgery Total Charm, Moscow, Russia Christina Summerhayes, FRCS Southampton Breast Unit, University Southampton, Level C, Princess Anne Hospital, Southampton, UK Istvan B. Szemerey, M.D., Ph.D. Departement of Plastic Surgery, Mediburg Klinika, Budapest, Hungary Akos Szemerey, Departement of Plastic Surgery, Mediburg Klinika, Budapest, Hungary Andre Ricardo Dall Oglio Tolazzi, M.D. Federal University of Parana (UFPR), Curitiba, PR, Brazil Stan Vitalie, M.D., Ph.D. Department of Plastic Surgery, University Hospital for Plastic Surgery and Burns, Bucharest, Romania Zhang Wanquan, M.D. Department of Plastic Surgery, Nanjing Friendship Plastic Surgery Hospitlal, Nanjing Medical University, Nanjing, Jiangsu, China Gao Xia, M.D. Department of Plastic Surgery, Nanjing Friendship Plastic Surgery Hospitlal, Nanjing Medical University, Nanjing, Jiangsu, China

xx Contributors Chen Xiaoping, M.D. Department of Plastic Surgery, Nanjing Friendship Plastic Surgery Hospitlal, Nanjing Medical University, Nanjing, Jiangsu, China Xu Ligang, M.D. Department of Plastic Surgery, Nanjing Friendship Plastic Surgery Hospitlal, Nanjing Medical University, Nanjing, Jiangsu, China Yuan Yugang, M.D. Department of Plastic Surgery, Nanjing Friendship Plastic Surgery Hospitlal, Nanjing Medical University, Nanjing, Jiangsu, China