Toma T. Mugea – Aesthetic Surgery of the Breast (2015)

Описание

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 fi rst 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 fi eld
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 scientifi c 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

My fi elds of research specialization were in mathematics, geometry, physics,
chemistry, and biology, and I fi rst published my articles in Buds , the
“Andrei Saguna” College journal, and then, as a medical student, participated
in students’ scientifi c meetings. I also participated in the International
Symposium on Applications of Mathematics in System Theory (Brasov
1978) and spoke on “Information and Signifi cance in Biological Systems.”
The audience was surprised to see a young physician speak on information
contained by an event, the signifi cance 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,
fi nally, the necessity of the existence of a double helix as a safe way to store
information with high signifi cance 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 fi rst time at Oxford . In 2008, almost 30 years since the
original idea was propagated, our concepts were given fi nal shape, when we
published an essay entitled “life, the universe, and the human body.”
I won my fi rst 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 fi rst 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 scientifi c 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 scientifi c
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!

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 fi rst rupestrian drawings to Renaissance art, the signifi –
cance of breasts was understood by all and was represented in work across
the ages. Breasts are not only for scientifi c 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 defi nition of aesthetic breasts, and the
infl uence of surgery on breasts, whatever be the procedure (augmentation,
reduction, mastopexy, or a combination of all of these).
As a fi rst 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 fi nd the relation between the
body mass index, trunk dimension, and breast proportion and have derived a
specifi c language for breast surgeons to compare their evaluation and surgical
results. All these are included in the fi rst 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 classifi
cation and surgical procedure fi t 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 fi nd 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 classifi cation
system with related surgical procedures. Tubular breasts are also covered,
with a new classifi cation 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 diffi cult
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 fi rst 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
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 fl eeting moments like the
“opened gates for a wormhole.” But this is life. We have to accept and to
enjoy it.