Augmentation Mammoplasty, Mastopexy, and Mastopexy-Augmentation

Question 1

the primary goal of breast augmentation

Answer 1

the primary goal to increase the size ofthe breast

Question 2

Mastopexy-augmentation can be performed as a single-stage procedure to alter both the size and shape of the
breast

Answer 2

T

Question 3

The main goal of BA is to increase the volume ofthe breast and centralize the nipple on the breast mound

Answer 3

T

Question 4

The chest wall is the foundation
upon which a prosthetic device will sit

Answer 4

T

Question 5

Standard
measurements before BA

Answer 5

base width (BW),
sternal notch to nipple distance (SN-N),
nipple to the inframammary fold (N-IMF),
NAC diameter, and internipple distance

Question 6

The BW is a key measure for determining the appropriate transverse
dimension ofa breast implant and chest wall diameter

Answer 6

T

Question 7

2 cm of pinch thickness is considered the minimum necessary for placement of an implant in the subglandular or subfacial
plane

Answer 7

T

Question 8

The
interface between the skin and the breast parenchyma should also
be evaluated why?

Answer 8

as postpartum women or patients with poor dermis
due to massive weight loss may have skin that very easily glides over
the underlying breast parenchyma.

Question 9

The lower pole of the breast can
be constricted in patients with micromastia or mild tuberous breast
deformity

Answer 9

T

Question 10

In case of lower pole constriction what you will do to treat the like this patients?

Answer 10

Lowering of the IMF and recruitment of upper abdominal
skin may be warranted in these patients and should be considered
during the evaluation.

Question 11

An assessment of the width of the sternum is
important why?

Answer 11

That can help the surgeon talk to a patient about expected
superomedial fullness and interbreast distance that will likely persist
after augmentation

Question 12

the width of sternal can be decreased by placing the implant submuscular

Answer 12

F This distance can be decreased and even lead
to symmastia when the implant is placed subglandularly, but is less
likely with submuscular placement because the medial pectoralis
muscle attachments are left intact and prevent medial migration.

Question 13

BA can lead to increase the risk for Breast cancer

Answer 13

F Women with augmented breasts are at no
increased risk of breast cancer compared to women with nonaugmented breasts.

Question 14

Women with breast implant can not make mamogram screening

Answer 14

F Women with
a history of breast augmentation undergo screening mammography
with special implant-displaced or Eklund views to better assess the
tissue anterior to the implant

Question 15

The sensitivity is increased with ultrasound (US) or magnetic resonance imaging (MRI) compare with mamogram alone

Answer 15

T

Question 16

(FDA) recommended screening with MRI
for silent ruptures 3 years after placement and then every 2 years
thereafter

Answer 16

T

Question 17

Mamogram mandatory for women seeking BA

Answer 17

F For women desiring breast augmentation, routine mammographic screening should be performed or reviewed if indicated
preoperatively using the US Preventative Services Task Force guidelines based on age over 40 and risk

Question 18

Patients who seek
BA who have no visible breast skin below the NAC on a frontal view
(grade II ptosis)

Answer 18

F Patients who seek
BA who have no visible breast skin below the NAC on a frontal view
(grade III ptosis) likely need a mastopexy as well to reposition the
NAC on the breast mound

Question 19

patients who have visible breast skin below the NAC (pseudoptosis or grade I and II ptosis)
on a frontal view may be candidates for BA alone

Answer 19

T

Question 20

patientwith an IMF at the junction ofthe middle and distal thirds ofthe
humerus may be considered “high” breasted

Answer 20

F patientwith an IMF at the junction ofthe middle and distal thirds ofthe
humerus may be considered “low” breasted

Question 21

IMF at the middle of the humerus may be considered “high” breasted

Answer 21

T

Question 22

The pectoralis major’s inferior attachments can be above or below the NAC and at
or above the IMF.

Answer 22

T

Question 23

Why the location pf pectoralis major muscle important relative to the NAC ?

Answer 23

For example,
a low breasted patient with a pectoralis major muscle attachment that
is higher than the NAC may not benefit from subpectoral placement
of the breast because the implant will ride high behind the pectoral
muscle whereas the NAC will remain in a lower position and not be
centered on the implant and augmented breast mound

Question 24

Silicone implants are considered “off label” when
used in women less than 18 years old per the FDA

Answer 24

F Silicone implants are considered “off label” when
used in women less than 22 years old per the FDA

Question 25

A major difference besides cost and feel is that saline and silicone implants differ in how a device rupture is detected

Answer 25

T

Question 26

First and second generation silicone ruptures led to free floating silicone in the pocket leading to inflammation and silicone granuloma formation

Answer 26

T

Question 27

Ruptures of the current fifth-generation implants are just like the first and second generation rapture

Answer 27

F Ruptures of the current fifth generation implants are very different. Silicone ruptures with cohesive gel implants can be detected on mammogram but more often require MRI to confirm a suspected rupture. Often delayed capsular contracture can be due to a silent rupture ofa highly cohesive gel implant

Question 28

For a round device, height and width will be the same

Answer 28

T for a given base width with a round device, an implant can vary in volume and projection

Question 29

it is not possible to accurately detect a shaped versus round implant in the submuscular plan intraoperatively

Answer 29

T

Question 30

Round implant has a more round superomedial curve whereas an anatomic implant has a more teardrop look when placed in the submascular

Answer 30

f round implant has a more round superomedial curve whereas an anatomic implant has a more teardrop look when placed in the subglandular or subfascial plan

Question 31

Which factors play a role in soft tissue integration with the breast implant surface

Answer 31

Surface area, pore size, and distribution may play a role in soft tissue integration with the breast implant surface, the organization of myofibroblasts and matrix proteins, and potential for accumulation of bacterial biofilms

Question 32

Textured devices have lower rates of capsular contracture, or the formation of a capsule that leads to deformity and/or pain in the breast following BA

Answer 32

T

Question 33

Textured devices are thought to be less likely to migrate beyond the dissected pocket

Answer 33

F anatomic, textured devices have demonstrated that even these implants can have rotation and malposition necessitating reoperation

Question 34

anatomic implants are all textured devices. Round devices can come as either textured or smooth.

Answer 34

T

Question 35

The subglandular plane used by the breast surgeons when they perform mastectomies

Answer 35

F The subfascial plane is below the fascia of the pectoralis muscle and above the muscle itself

Question 36

retropectoral pocket

Answer 36

Submascular plane

Question 37

Dual-plane breast augmentations, as graded I, II, and Ill, vary by the amount of pectoralis muscle release inferiorly and subsequent amount of contact between the implant and breast parenchyma inferiorly.

Answer 37

T

Question 38

The IMF incision is placed in the original IMF crease

Answer 38

The IMF incision is placed in the desired IMF crease, which may be below the native IMF if the IMF is going to be lowered in a BA

Question 39

Transaxillary incisions are made in the hair-bearing region of the axilla

Answer 39

T

Question 40

Delayed seromas with or without an associated mass should raise suspicion for breast implant-associated anaplastic large cell lymphoma (BIA-ALCL)

Answer 40

T

Question 41

A MRI is recommended to visualize a suspicious seroma or mass

Answer 41

F A PET-CT scan is recommended to visualize a suspicious seroma or mass

Question 42

Treatment of BIA-ALCL always requires complete capsulectomy, and depending on the stage of disease, it may also need adjuvant chemotherapy or immunotherapy

Answer 42

T

Question 43

complications after BA

Answer 43

1 % to 2% for hematoma 1 % for infection and deep vein thrombosis/pulmonary embolism (DVT/PE)

Question 44

Capsular contracture rates from long-term studies demonstrate variability based on implant manufacturer

Answer 44

T

Question 45

The Baker classification system of capsular contracture depend on what ?

Answer 45

It relies on physical examination to assess how soft the augmented breast and whether or not the patient reports pain

Question 46

Applanation tonometry, adopted for measuring intramammary compliance, and ultrasound elastography are routinely used for breast contracture

Answer 46

F Applanation tonometry, adopted for measuring intramammary compliance, and ultrasound elastography represent more modern less widely adopted techniques for assessing capsular contracture

Question 47

Capsular contracturescanoccur "early" within 1 year of placement or in adelayed fashion several years later

Answer 47

T

Question 48

smooth devices placed in the subglandular plane have had the highest rates of capsular contracture

Answer 48

T

Question 49

Baker

Answer 49

I Soft No pain II Palpable, minimal firmness No pain III Easily palpable ,firmness, moderate Pain IV Firm distorted Painful

Question 50

Patients with grade III or IV capsular contracture can be treated conservatively if there are not capsule rapture

Answer 50

F Patients with grade III or IV capsular contracture with or without concomitant silicone rupture or silicone granulomas, and those with asymmetry requesting a revision procedure will require operative management

Question 51

Treatment involves either open capsulectomy or capsulotomy.

Answer 51

T

Question 52

Closed capsulotomy that involved external, manual compression to break through the capsule is utelized till now

Answer 52

F Is no longer recommended due to risk of implant rupture or possible hematoma formation and incomplete management of the problematic capsule

Question 53

leukotriene inhibitors has shown some benefit in preventing and improving capsular contracture

Answer 53

T

Question 54

Intraluminal steroids and pocket irrigation with steroids were once performed, but no longer are common practice due to risk of implant rupture, wound dehiscence, and atrophy of tissues.

Answer 54

T

Question 55

Recurrent capsular contracture often requires placement in an alternative plane or neosubpectoral pocket after a capsulectomy.

Answer 55

T

Question 56

Acellular dermal matrices (ADM) have no role in breast contracture

Answer 56

F Acellular dermal matrices (ADM) have also been used in recalcitrant cases of capsular contracture to create an interface between implant and breast tissue

Question 57

Implant rupture can occur regardless of implant fill material

Answer 57

T

Question 58

Saline rupture can easily be identified by unilateral deflation and breast asymmetry that occurs suddenly always proceeded by trauma

Answer 58

F This can sometimes be preceded by trauma

Question 59

Silicone rupture can present with the presence of silicone granulomas or can be silent and diagnosed on mammography or MRI

Answer 59

T

Question 60

Treatment of rupture often requires removal of one or both implants and any ruptured material in the case of silicone rupture with capsulectomy or capsulotomy.

Answer 60

F with or without capsulectomy or capsulotomy.

Question 61

Fat grafting has unpredictable rates of long-term fat graft survival

Answer 61

T

Question 62

with fat graft can easly adjust the breast to the reliable breast size

Answer 62

F it may be difficult to reliably augment a breast to a desired cup size.

Question 63

More than one surgery or round of fat grafting may be required to achieve a patient's goals

Answer 63

T

Question 64

In Composite BA the fat graft is mainly put in the inferior pole to augment the breast

Answer 64

F often placed in the superior pole to blunt the transition between native tissue and the implant

Question 65

Fat can be placed laterally and inferiorly when the soft tissue envelope is thin to reduce visible rippling or mask implant palpability

Answer 65

T

Question 66

Autologous BA with flaps are common in patients who have had a massive weight loss because they have a paucity of breast tissue

Answer 66

T

Question 67

Mastopexy focuses on changing the shape of the breast to one that appears youthful and beautiful; it also addresses descent of the NAC relative to the IMF.

Answer 67

T

Question 68

the discrepancy between the skin and breast tissue can be reduced with mastopexy

Answer 68

T By addressing the outer lamella of the breast (the skin) and/or the inner lamella of the breast (the parenchyma)

Question 69

Benelli demonstrated that skin only mastopexies address the skin only

Answer 69

T

Question 70

Benelli demonstrated that skin only mastopexies were not as durable as mastopexies that address the skin and parenchyma by redistributing the parenchyma.

Answer 70

T

Question 71

addressing both the outer lamella (skin) and inner lamella (parenchyma), more durable and predictable changes can be achieved in the ptotic, involuted breast

Answer 71

T

Question 72

Periareolar mastopexies can be used in patients who have grade II or III ptosis, nipple asymmetry, or widened areola

Answer 72

F Periareolar mastopexies can be used in patients who have grade I or II ptosis, nipple asymmetry, or widened areola

Question 73

Periareolar mastopexies can elevate the nipple up tO 5 CM

Answer 73

F 2 CM

Question 74

All The periareolar mastopexy can decrease the projection of the breast

Answer 74

F The concentric pattern peri areolar mastopexy only

Question 75

Removing skin in a concentric pattern can,

Answer 75

Can flatten and reduce breast projection. Scar widening and eventual widening of the areola can occur, . If there is circumferential full thickness violation of the dermis, decreased nipple sensitivity may occur

Question 76

some have advocated the use of a barbed or permanent suture to control this

Answer 76

T

Question 77

vertical techniques is to both incorporate ptosis correction with excision of glandular material

Answer 77

T

Question 78

vertical techniques can be used for severe ptosis only

Answer 78

This technique can be used for all grades of breast ptosis.

Question 79

What are the two most surgical technique in vertical mastopexy

Answer 79

The short-scar periareolar inferior-pedicle reduction (SPAIR) and Hall-Findlay mastopexy techniques are the two vertical mastopexies with the highest surgeon satisfaction

Question 80

SPAIR mastopexy relies on the third intercostal perforator or inferior pedicle for blood supply to the nipple

Answer 80

F SPAIR mastopexy that relies on the fourth intercostal perforator or inferior pedicle for blood supply to the nipple

Question 81

It involves a periareolar closure in a pin-wheel or interlocking pattern, sometimes with a permanent suture

Answer 81

T

Question 82

Suspension sutures to the pectoralis fascia can be used to elevate the breast to higher position in the chest wall in SPAIR tech

Answer 82

T but the durability is debated

Question 83

Draw back of SPAIR tech

Answer 83

Because weight remains in the inferior portion of the breast, bottoming out remains a shortcoming. The periareolar closure can widen or have pleating that persists

Question 84

Breast Implants can be used with SPIAR tech

Answer 84

F This technique is not typically complemented with implant placement

Question 85

The Hall-Findlay vertical mastopexy most commonly uses the superomedial or medial pedicles for the NAC based on the second and third intercostal perforators, respectively

Answer 85

T

Question 86

the inferior pole of breast tissue is preserved in the Hall-Findlay technique

Answer 86

Different from the SPAIR technique that preserves the inferior pedicle, the inferior pole of breast tissue is excised in the Hall-Findlay technique.

Question 87

An implant cannot be placed with hall-Findlay tech

Answer 87

F An implant can be placed in the subglandular, subfascial or submuscular planes without concern for blood supply to the NAC as the second and/or third intercoastal perforators travel superficially in the gland and remain undisturbed by an augmentation

Question 88

vertical mastopexies create an inverted breast shape at the end of the procedure with exaggerated upper pole fullness and a sloped inferior pole

Answer 88

T

Question 89

The Wise-pattern can be used for all types of ptosis but carries a large scar burden

Answer 89

T

Question 90

The Wise-pattern can be used with practically with superior pedicles only to the NAC.

Answer 90

F can be used with practically any pedicle for blood supply to the NAC.

Question 91

The Wise-pattern or inverted-T mastopexy adapted from traditional Wise-pattern inferior-pedicle reduction mammoplasty techniques.

Answer 91

T

Question 92

The bottoming up is treated with Wise pattern tech

Answer 92

F can experience bottoming out when combined with an inferior pedicle

Question 93

An implant can be placed in the subglandular, subfascial, or submuscular plane depending on where the blood supply to the NAC is coming from.

Answer 93

T

Question 94

Complications less than I% rates for hematoma, infection, and DVT/PE.

Question 95

The most common reported complication

Answer 95

complications found suture spitting, excess scarring, and bottoming out to be the most commonly reported complications

Question 96

excess scarring with wich tech ?

Answer 96

was noted with the periareolar technique

Question 97

suture spitting

Answer 97

with the SPAIR technique

Question 98

persistent asymmetry with wich tech

Answer 98

with the vertical technique

Question 99

bottoming out

Answer 99

with the inverted-Tor Wise pattern mastopexy.

Question 100

Revision rates in periareolar approaches.

Answer 100

have been reported to be as high as 50% in

Question 101

Meta-analyses of reports ofsingle-stage mastopexy-augmentation have found an overall complication rate of 13% with a reoperation rate of 11 %

Answer 101

t

Question 102

There is no consensus of whether augmentation or mastopexy should be performed in a two-staged plan

Answer 102

T

Question 103

. Macrotextured devices are characterized by heterogeneously arranged pores

Answer 103

T

Question 104

Microtextured devices possess a more uniform pore distribution

Answer 104

T

Question 105

The submuscular plane is below the pectoralis muscle superiorly and inferiorly below the pectoralis muscle fascia as it interdigitates with the rectus muscle fascia

Answer 105

T

Question 106

Dual-plane breast augmentations, as graded I, II, and Ill, vary by the amount of pectoralis muscle release inferiorly and subsequent amount of contact between the implant and breast parenchyma inferiorly

Answer 106

T

Question 107

Transaxillary incisions are made in the hair-bearing region of the axilla

Answer 107

T

Question 108

Capsular contracture rates based on implant manufacturer

Question 109

The redundant skin inferiorly can be excised in a "J" or "T" pattern in SPAIR tech

Answer 109

T

Question 110

Lateral malposition is a common problem seen in mastopexy-augmentation in the massive weight loss patient population

Answer 110

T

Question 111

Areola can widen after an augmentation

Answer 111

T

Question 112

If a diagnosis of BIA-ALCL is made (CD30+/ALK-), then a PET-CT scan of the chest is indicated to further characterize the mass and fluid collection associated with the implant capsule and breast tissue

Answer 112

T

Question 113

Recurrent ptosis was the most commonly encountered complication after single stage mastopexy augmentation at 5.2%. This was followed by poor scarring (3.74%), capsular contracture (2.97%), asymmetry (2.94%), and seroma (1.42%).

Answer 113

T