Search Our Scientific Publications & Authors

Breast J 2021 Apr 12;27(4):352-358. Epub 2021 Feb 12.

Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA.

Transfeminine patients facing barriers to gender confirming surgery sometimes pursue illicit feminization procedures such as "street" hormones and silicone injections. These procedures often yield complications and disfigurement, making surgeons and insurance companies wary of secondary breast reconstruction. This clinical series assesses illicit treatment among our transfeminine breast surgery patients and describes the presentation, surgical approaches, and outcomes of each patient. Read More

Plast Reconstr Surg Glob Open 2021 Jan 21;9(1):e3362. Epub 2021 Jan 21.

Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass.

Transgender women seeking gender-affirming breast augmentation often present with differences in preoperative chest measurements and contours in comparison with cisgender women. These include a more robust pectoralis muscle and limited glandular tissue, raising important considerations in determining the optimal anatomical plane for implantation. Abundant literature has described advantages and drawbacks of the available planes for breast augmentation in cisgender women. Read More

J Plast Reconstr Aesthet Surg 2021 05 7;74(5):1093-1100. Epub 2020 Nov 7.

Department of Plastic, Reconstructive and Aesthetic Surgery, Training and Research State University Hospital of Rio de Janeiro - UERJ-RJ, av. Mal.Rondon, 381.São francisco Xavier. Rio de Janeiro. CEP: 20950-003, Brazil. Electronic address:

Background: Breast prostheses could be associated with complications, despite many studies on surgical materials and techniques. The role of surgical drainage in preventing complications on breast prostheses surgery is controversial.

Objectives: This study aimed to evaluate the role and effectiveness of vacuum drainage in the augmentation mammoplasty. Read More

Plast Reconstr Surg 2020 12;146(6):1249-1257

From private practice.

Background: Subfascial placement of breast implants has the advantages of subglandular and submuscular placement without the adverse outcomes. There are few large series with longitudinal follow-up and outcome measures.

Methods: Seven hundred eighty-three patients underwent subfascial breast augmentation and were followed up for 10 years. Read More

Aesthetic Plast Surg 2020 Oct 19. Epub 2020 Oct 19.

, 2/40 Clyde Road, Berwick, VIC, 3806, Australia.

Background: The management of capsular contraction following breast augmentation has numerous, often conflicting potential treatment protocols, each designed to reduce the incidence of further recurrence. The use of the subfascial plane has not been investigated as an alternative to other treatment options.

Objectives: To examine the outcomes from patients presenting with recurrent capsular contraction after being treated for the first capsule by placement of an implant into the subfascial (SF) plane. Read More

J Plast Reconstr Aesthet Surg 2020 Dec 26;73(12):2225-2231. Epub 2020 May 26.

Chimay Plastic Surgery Clinic, 2F, No. 50, Section 4, Ren'ai Road, Da'an District, Taipei 106, Taiwan; School of Health Care Administration, Taipei Medical University, Taiwan. Electronic address:

Capsulectomy is a standard treatment for capsular contracture after breast augmentation. Incision via the endoscopic transaxillary approach is generally preferred by Asian women, but relevant literature addressing endoscopic transaxillary capsulectomy is limited. This study described the techniques of endoscopic transaxillary capsulectomy with reimplantation performed as a single-operator outpatient procedure. Read More

Aesthet Surg J 2020 08;40(9):981-986

Department of Plastic and Reconstructive Surgery, Brest University Hospital, Brest Cedex, France.

Background: Secondary procedures following breast augmentation are often more difficult than primary cases because the soft-tissue envelope changes over time.

Objectives: This study was conducted to confirm the utility of a composite technique in breast revisional surgery.

Methods: This was a 9-year retrospective chart and photographic data study of one surgeon's experience with the combined use of fat and implants in revisional cases. Read More

Ann Plast Surg 2021 01;86(1):115-120

Department of Breast Surgery, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom.

Aims: To review cases of galactorrhea and galactocele postbreast augmentation, determine possible risk factors and consider management strategies of this rare complication.

Methods: A systematic literature review was conducted in July 2019 searching Pubmed, Embase, and Google Scholar.

Results: The searches revealed 19 articles (17 case reports/series and 2 retrospective chart reviews) collectively comprising 38 women. Read More

Aesthetic Plast Surg 2021 02 14;45(1):127-134. Epub 2020 Feb 14.

Department of Plastic Surgery, Odense University Hospital and OPEN, Open Patient data Explorative Network, Odense University Hospital, Region of Southern Denmark, J. B. Winsløws Vej 4, 5000, Odense, Denmark.

Background: Breast reshaping or mastopexy following massive weight loss can be challenging. The LOPOSAM (lower pole subglandular advancement mastoplasty) technique has shown promising results for correction of ptotic, wide, lateralized and deflated breasts following massive weight loss.

Materials And Methods: We compared the LOPOSAM technique to the mastopexy technique after massive weight loss described by Rubin JP, in a randomized trial. Read More

Plast Reconstr Surg 2020 Feb;145(2):330-332

From the Department of Plastic Surgery, Kaplan Medical Center.

Dual-plane breast augmentation offers the advantages of a subpectoral implant location with the ability to expand its use to glandular ptotic and constricted lower pole breasts. Alas, high implant position or very loose breast tissue can lead to a notorious breast shape known as the "waterfall deformity." To prevent many of these undesired deformities, the authors introduce a novel pectoralis major median myotomy they call the "median cut. Read More

J Med Radiat Sci 2020 Jun 24;67(2):102-110. Epub 2020 Jan 24.

Faculty of Science, School of Dentistry & Health Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia.

Aim: This study seeks to document the imaging series used in contemporary Australian practice for imaging the augmented breast, with a secondary focus on differences in practice and opinion between BreastScreen Australia and diagnostic imaging services.

Methods: A SurveyMonkey link was distributed through the Australian Society of Medical Imaging and Radiation Therapy (ASMIRT) and was assessable during December 2017 and January 2018. The questionnaire investigated: years of experience, facility type and location, image acquisition systems, appointment times, patients imaged per week, technique and imaging series used, use of limited compression views, rationale for variation in imaging series and the use of ultrasound. Read More

Aesthet Surg J 2020 04;40(5):513-515

Clinical Faculty Member, Division of Plastic Surgery, University of Louisville, Louisville, KY.

J Plast Reconstr Aesthet Surg 2019 Dec 24;72(12):1986-1995. Epub 2019 Sep 24.

Department of Plastic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou 310003, China. Electronic address:

Background: Techniques based on three planes of implant placement, including the subglandular (SG), subpectoral (SP), and subfascial (SF) planes are used for breast augmentation. The placement that offers the greatest balance of risks and benefits is unclear. This study presents a systematic review with a Bayesian network meta-analysis to compare different implant placement techniques for augmentation mammaplasty. Read More

Plast Reconstr Surg Glob Open 2019 Aug 12;7(8):e2344. Epub 2019 Aug 12.

Plastic & Reconstructive Surgery, Clinical Professor of Surgery, University of California-San Francisco, 2100 Webster St Suite 424, San Francisco, Calif.

Dual-plane augmentation mammaplasty has gained wide popularity in treating breast ptosis. However, in our experience, dual-plane augmentation mastopexy fails to treat severe cases of ptosis (grade 3) and glandular ptosis. Therefore, we conceived a method to manage these cases effectively. Read More

Aesthet Surg J 2020 04;40(5):499-512

Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.

Background: Previous studies have reported decreased rates of capsular contracture associated with the use of textured surface breast implants placed in the subglandular plane during breast augmentation. However, since the publication of these studies, our understanding of the pathophysiology of capsular contracture, as well as the surgical techniques utilized to minimize bacterial contamination of the implant, have advanced considerably.

Objectives: The purpose of this study was to re-evaluate the relation between implant surface texturization and capsular contracture rates for breast implants placed in the subglandular plane during primary breast augmentation. Read More

Aesthet Surg J 2020 04;40(5):NP253-NP262

Department of Sport and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom.

Background: Breast implants may increase breast skin tension and interact with surrounding tissues to alter breast position and motion during dynamic activity. Reducing implant mass and changing implant location (submuscular/subglandular) may also affect breast kinematics and the subsequent loads on breast structures.

Objectives: The aim of this pilot study was to describe the kinematics of breasts augmented with reduced-mass implants during standing, walking, and running, compared with natural breasts, and to provide insight into how implant location (submuscular/subglandular) alters breast kinematics. Read More

Aesthetic Plast Surg 2019 12 6;43(6):1437-1438. Epub 2019 Sep 6.

106-75 Dyrgas Gate, Banff Plastic Surgery, Canmore, AB, T1W 06, Canada.

Med Arch 2019 Jun;73(3):178-182

University Clinical Centre Sarajevo, Sarajevo, Bosnia and Herzegovina.

Introduction: Breast augmentation is one of the most frequently performed aesthetic surgical procedures in the world. The most important preoperative decisions which influence the final appearance of the augmented breast are the breast implant pocket choice and selection of the most appropriate implant. Described pocket locations are subglandular, subfascial, partially retropectoral, totally submuscular and dual plane. Read More

Aesthetic Plast Surg 2019 12 30;43(6):1429-1436. Epub 2019 Jul 30.

Plastic Surgery Service at Hospital de Clínicas, UFPR, Sao Paulo, Brazil.

Introduction: Subfascial breast augmentation is gaining popularity because of no distortion when the pectoral muscle is contracted and minimizing visualization of the edges of the implant. Although some studies have reported a satisfactory outcome with subfascial technique, it still is controversial the influence of the pectoral fascia and outcome compared to the subglandular technique. Therefore, this prospective randomized study aimed to investigate whether there are clinical/radiological differences between subfascial and subglandular pockets following primary breast augmentation. Read More

Aesthetic Plast Surg 2019 08 28;43(4):890-898. Epub 2019 May 28.

Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, 100144, China.

Background: Subpectoral and prepectoral planes have commonly been used in implant-based breast augmentation. The effect of implant plane on complication rate was still unclear. This meta-analysis demonstrated current evidence with regard to comparison of complication rates between subpectoral and prepectoral breast augmentation. Read More

Aesthet Surg J 2020 01;40(2):167-173

Integrated Leader, Medical, Clinical and Preclinical, Mentor Worldwide, LLC, Irvine, CA.

Background: The relative risks and benefits of various textured breast implants are the focus of considerable discussion. Studies have suggested different risk-benefit profiles for different implant surface topographies.

Objectives: The study aim was to provide device-specific, quantitative information on Mentor's imprinted Siltex Textured breast implants with respect to textured surface characteristics and ISO 14607 classification, risk of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), and risk-reduction benefits relative to smooth implants. Read More

Aesthet Surg J 2019 08;39(9):953-965

Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.

The authors describe their surgical technique for single-stage periareolar mastopexy with subglandular breast augmentation. They have performed this procedure in 85 patients since 2009 and found that this operative technique has allowed them to achieve reproducible outcomes in a single-stage procedure. Periareolar mastopexy with subglandular breast augmentation is an excellent procedure for patients who desire a larger breast size and who present with mild to moderate nipple ptosis with a paucity of excess skin in the lower pole of the breast. Read More

J Plast Reconstr Aesthet Surg 2019 May 5;72(5):781-788. Epub 2019 Mar 5.

Division of Plastic and Reconstructive Surgery, Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montreal, Quebec, Canada. Electronic address:

Introduction: Animation deformity (AD) is a known complication of subpectoral implant placement and results from the contraction of the pectoralis major muscle with resultant movement of the underlying implant. This can lead to a poor cosmetic result, with the implant becoming distinctly visible postbreast reconstruction and augmentation. The prevalence and clinical significance of AD remain unclear. Read More

J Plast Reconstr Aesthet Surg 2019 Mar 22;72(3):419-423. Epub 2018 Nov 22.

Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin 70300, Israel.

Background: Breast augmentation is one of the most common aesthetic procedures performed worldwide. One of the worst associated complications is implant rupture, a topic that will be addressed in the present study. The risk of developing silicone gel breast implant rupture following breast augmentation is associated with multiple factors, including: older generation implant, increased implant age, implant type, specific manufacturer, severe capsular contracture (Baker grade III or IV), and the presence of local symptoms. Read More

Plast Reconstr Surg 2018 12;142(6):1456-1461

From the Section of Plastic Surgery, Department of Surgery, University of Michigan; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California, Los Angeles; the Department of Plastic Surgery, Division of Surgery, University of Texas M. D. Anderson Cancer Center; the Department of Plastic Surgery, University of Texas Southwestern Medical Center; and the Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University.

Background: Breast implants have evolved for decades. In 2011, the U.S. Read More

Aesthet Surg J 2019 07;39(8):863-872

Division of Plastic Surgery, The University of Texas Medical Branch, Galveston, TX.

Background: Various theories exist to explain the etiology of iatrogenic symmastia. Subglandular over-dissection of the medial breast pocket over the sternum, disruption of midline sternal fascia, oversized implant base diameter, and over-dissection of the medial pectoralis muscle attachments to the sternum are popular explanations.

Objectives: The authors hypothesized that the most common risk factor for iatrogenic symmastia is subpectoral breast augmentation. Read More

Aesthet Surg J 2019 05;39(6):615-623

Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX.

Background: Breast augmentation is the most common aesthetic surgery performed in the United States. Despite its popularity, there is no consensus on many aspects of the procedure.

Objectives: The authors assessed current trends and changes in breast augmentation from January 1, 2011 to December 31, 2015. Read More

J Cancer Prev 2018 Jun 30;23(2):93-98. Epub 2018 Jun 30.

Division of Plastic and Reconstructive Surgery, McGill University Faculty of Medicine, Montreal, QC, Canada.

Background: There is a paucity of data comparing the oncologic properties of breast cancer among patients previously having undergone breast augmentation in either the subglandular or subpectoral planes. The objective of the present systematic review was to evaluate whether implant location influenced the characteristics of breast tumors in previously augmented women.

Methods: A systematic literature search was performed to identify relevant articles reporting tumor characteristics in augmented patients. Read More

J Plast Reconstr Aesthet Surg 2018 09 9;71(9):e29-e48. Epub 2018 Jun 9.

Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.

Background: Capsular contracture is the most frequent complication in breast augmentation or reconstruction with breast implants. The exact mechanism for this complication is not completely understood. Yet, it is most likely to be a multifactorial condition. Read More

Ann Plast Surg 2018 09;81(3):257-262

Plastic Reconstructive and Aesthetic Surgery Department, Izmir Katip Celebi University, Ataturk Training and Research Hospital.

Background: Breast ptosis is an inevitable consequence of gravity and time. Every breast tends to become ptotic in different shapes and degrees. Many surgical techniques were described to solve this problematic issue. Read More