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Objectives: to present the algorithm for management of gynecomastia at our centre, using the Divine Classification of gynecomastia.

Introduction: Gynecomastia treatment is generally fairly standardized and following certain standard operating protocols we have created guidelines for management of gynecomastia at a Centre divine cosmetic surgery in New Delhi India. over the last 9 years we have treated more than 5000 gynecomastia surgery and have also created our own classification for the same. using this clinical classification we have been able to categorise previously unclassifiable cases of gynecomastia and have been able to manage them better

Materials / method: standardised protocols as per the algorithm based on Divine classification is used

Results: creating a standard protocol has helped us define the time of anesthesia, standardise treatment, teach younger Plastic Surgeons as well as get better results

Conclusion: Using the Divine classification we have been able t create a smooth flow. we want to present to you all how we manage gynecomastia patients, from Preop to post op

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Objectives: Breast augmentation is still one of the most performed aesthetic surgeries.
With chances in the implant options within the last years and patients demanding a more natural results, implants alone breast augmentation comes a bit short.

Materials / method: We re-evaluated our technical approach in breast augmentation, expanding and filling the cleavage, equalizing volume differences with water-jet harvested fat grafting, injecting with an expansion device. Combined with not anatomic shaped silicone gel implants on the basis of the last 150 cases.
The presentation provides a systematic overview of the chosen technique and the combination as well as a review of achieved benefits, difficulties and complications we encountered as well as advantages in our approach.

Results: The combination of these techniques, expansion fat grafting and silicone gel implant, results in a more natural appearance and narrowing of the cleavage gap

Conclusion: The combination of silicone implant breast augmentation with autologous expansion fat transfer synergistically combines the advantages of both procedures. Here we show some tricks and advantages in our approach.
Both, surgeons and patients, are rewarded with superior results without additional recovery.

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Objectives: This study aimed to describe clinical manifestations of complications following FoMBI, and to evaluate the impact of surgical treatment and breast reconstruction (BR) on patient-reported satisfaction and quality of life. Ultimately, the FoMBI classification and management algorithm depending on breast imaging and clinical findings are purposed.

Introduction: Foreign material breast injection (FoMBI) has been acclaimed as minimally invasive procedure for enhancing the breast volume. Nevertheless, safety issue and subsequent complications have contributed to restriction of the procedure. Development of clinical symptoms lead various treatments among individuals. To date, the patient-reported satisfaction and health-related quality of life have been uncommonly mentioned regarding the treatment outcomes. Additionally, classification and standard practice guideline on management of the complications have not been distinctly established.

Materials / method: Patients who had received FoMBI were attained through an institutional review board-approved retrospective study during the period of August 2017 and September 2020. All patients surgically treated by the single author (VL) were inquired a patient-reported satisfaction questionnaire at preoperative period and at least 6-month follow-up. The satisfaction assessment was based on volume, shape, softness, nipple sensation, symmetry of both breasts, and overall aesthetic result. The 5-level EQ-5D (EQ-5D-5L) instrument was also submitted as a standardized measure of patient health outcomes.

Results: A total of 101 FoMBI patients. The mean age at first injection was 28.6 years (range, 17 to 46 years). Polyacrylamide hydrogel was the most injected agents (31.9 percent). The average volume was 148.7 mL (range, 30 to 500 mL). The most common presenting symptoms was palpable breast lump (81.9 percent). 29 patients underwent surgical treatments without BR. BR was performed on 44 patients (21 immediate and 23 delayed reconstruction). Majority of the BR were Implant-based BR (n=41). There was significant improvement in breast volume, shape, softness, symmetry, and overall aesthetic result in BR.

Conclusion: Breast volume enhancement with FoMBI can eventually lead to hazardous complications with the unpredictable onset. The management algorithm, based on clinical symptoms and the imaging findings, could be applied as an essential guide for the appropriate treatment. FoMBI classification base on clinical and radiological finding can guide physician to solve patient problems. Apart from impairment of nipple sensitivity, improvement in all breast conditions potentially contributes to patient satisfaction and quality of life in those who received breast reconstruction.

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Objectives: Botulinum Toxin type A (BTXA) has been documented for its use in breast
augmentation. Intradermal, fascial, and intramuscular injections of BTXA are administered directly to the breast to achieve results. Furthermore, intradermal injection of BTXA on the breast has been documented to be effective in treating saggy breasts. In this study, we determined the efficacy of BTXA injections for breast augmentation and breast lift.

Introduction: 35 patients were injected with BTXA on the breast and followed up for eight weeks to determine the efficacy of BTXA injections for breast augmentation. Also, 40 patients were injected with BTXA using only the intradermal injection technique to assess the breast lifting effects of BTXA injections.

Results: Improvements in breast shape and size were recorded as soon as two weeks after the injections. After eight weeks, the average enlargement from the injections was equivalent to the surgical placement of a 100-cc silicone implant. Moreover, 40 patients were injected BTXA on the breast intradermally to determine the breast lifting effects of BTXA. Visible lifting was observed immediately following the injections.

Conclusion: BTXA injection into the breast is a safe and effective alternative for breast augmentation and breast lift surgeries. The technique is limited to women with mild breast sagging and women looking for moderate enhancements to their breast size. However, the injections are practical for patients and surgeons due to minimal invasiveness compared to traditional surgical procedures.

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