• Archives of Plastic Surgery
• /
• v.36 no.4
• /
• pp.422-427
• /
• 2009

Purpose: Breast cancer is second most common cancer in women. Almost of patients with breast cancer treated with mastectomy undergoes breast reconstruction. Nipple reconstruction is an important step in breast reconstruction. Many surgeons have investigated of nipple reconstruction using the flap technique after breast reconstruction with the autologous tissue. The objective of this study is to evaluate the results of nipple reconstruction using the C - V flap technique after breast reconstruction with the only breast expander. Methods: From April 2006 to May 2008, the authors treated 17 patients of nipple reconstruction using C - V flap technique, who were received breast reconstruction with the only breast expander. We have predicted decrease of the size of reconstructed nipple and designed flap a little larger than wanted nipple size. Nipple splint was applied for 4 - 6 months for minimizing decrease of the size of reconstructed nipple. The diameter and height of the reconstructed nipple were measured and patient's satisfaction score was assessed. Results: Mean follow-up duration was 12.5 months. Among the 17 patients, the average absorption rate by height of nipple was 47.0%. Partial necrosis was noted in 1 case, and treated well with conservative management. There was no other significant complications noted. Patient's satisfactory score was assessed by the height, design and location of the nipple. The average of satisfaction score was 85%, 68%, 62% and total average was 83%. Conclusion: The authors experienced 17 patients of nipple reconstruction using the C - V flap technique after breast reconstruction with the only breast expander. The absorption rate of the size of the nipple, complications and patient's satisfactory score of this study were similar to those of nipple reconstruction after breast reconstruction with the autologous tissue. It is expected that nipple reconstruction after breast reconstruction with the only breast expander is safe and reliable. It is considered that a long - term study is necessary.

• Perspectives in Nursing Science
• /
• v.12 no.2
• /
• pp.115-123
• /
• 2015

Purpose: This study aimed to investigate the quality of patient-centered nursing care (PCNC) among women with breast cancer at a cancer center in Seoul, Korea. Methods: In a cross-sectional survey design, 223 women with breast cancer were recruited from the oncology surgery unit. The Korean version of the oncology patients' perceptions of the quality of nursing care scale, which is conceptualized in four sub-dimensions (individualization, proficiency, responsiveness, and coordination) was used for measurement. Data were analyzed using descriptive statistics and ANOVA. Results: The participants were all women, with a mean age of 51.3 years. The mean score of PCNC was high and significantly different from each other according to age group. Breast cancer women, who had mastectomy, were satisfied highly in terms of proficiency and responsiveness care, but less satisfied with individualization and coordination care than those of other women. Conclusion: The findings of this study show the quality of cancer nursing care, especially focusing on patient-centeredness, can be measured from the patients'perspective. The individualized and coordinated nursing care is considered to be the core of quality cancer care implying patient-centeredness. Based on the findings of this study, more research is necessary to explore the patients' view of quality cancer care and to test the effects of PCNC within the context of comparative effectiveness.

• Archives of Plastic Surgery
• /
• v.44 no.6
• /
• pp.516-522
• /
• 2017

Background Implant-based breast reconstruction is being performed more frequently, and implants are associated with an increased risk of infection. We reviewed the clinical features of cases of implant infection and investigated the risk factors for breast device salvage failure. Methods We retrospectively analyzed 771 patients who underwent implant-based breast reconstruction between January 2010 and December 2016. Age, body mass index, chemotherapy history, radiation exposure, and smoking history were assessed as potential risk factors for postoperative infection. We also evaluated the presence and onset of infection symptoms, wound culture pathogens, and other complications, including seroma, hematoma, and mastectomy skin necrosis. Additionally, we examined the mastectomy type, the use of acellular dermal matrix, the presence of an underlying disease such as hypertension or diabetes, and axillary node dissection. Results The total infection rate was 4.99% (58 of 1,163 cases) and the total salvage rate was 58.6% (34 of 58). The postoperative duration to closed suction drain removal was significantly different between the cellulitis and implant removal groups. Staphylococcus aureus infection was most frequently found, with methicillin resistance in 37.5% of the cases of explantation. Explantation after infection was performed more often in patients who had undergone 2-stage expander/implant reconstruction than in those who had undergone direct-to-implant reconstruction. Conclusions Preventing infection is essential in implant-based breast reconstruction. The high salvage rate argues against early implant removal. However, when infection is due to methicillin-resistant S. aureus and the patient's clinical symptoms do not improve, surgeons should consider implant removal.

• Archives of Plastic Surgery
• /
• v.50 no.1
• /
• pp.63-69
• /
• 2023

Background An increasing number of nonbinary patients are receiving gender-affirming procedures due to improved access to care. However, the preferred treatments for nonbinary patients are underdescribed. The purpose of this study was to investigate the goals and treatments of nonbinary patients. Methods A retrospective study of patients who self-identified as nonbinary from our institutional Gender Health Program was conducted. Patient demographics, clinical characteristics, surgical goals, and operative variables were analyzed. Results Of the 375 patients with gender dysphoria, 67 (18%) were nonbinary. Over half of the nonbinary patients were assigned male at birth (n = 57, 85%) and nearly half preferred the gender pronoun they/them/theirs (n = 33, 49%). A total of 44 patients (66%) received hormone therapy for an average of 2.5±3.6 years, primarily estrogen (n = 39). Most patients (n = 46, 69%) received or are interested in gender-affirming surgery, of which, almost half were previously on hormone therapy (n = 32, 48%). The most common surgeries completed or desired were facial feminization surgery (n = 15, 22%), vaginoplasty (n = 15, 22%), mastectomy (n = 11, 16%), and orchiectomy (n = 9, 13%). Nonbinary patients who were assigned male at birth (NB-AMAB) were more often treated with hormones compared to nonbinary patients assigned female at birth (NB-AFAB) (72% vs. 30%, p = 0.010). Conversely, patients who were AFAB weremore likely to complete or desire surgical intervention than those who were AMAB (100% vs. 63.0%, p < 0.021). Conclusion Majority of nonbinary patients were assigned male at birth. NB-AFAB patients all underwent surgical treatment, whereas NB-AMAB patients were predominantly treated with hormone therapy.

• The Korean Journal of Nuclear Medicine Technology
• /
• v.14 no.2
• /
• pp.186-189
• /
• 2010

Purpose: As many patients often showed the value of menopause although they were women of childbearing age, this study looked into their previous history. According to the findings, they were patients with a mastectomy due to breast cancer and were taking breast cancer treatment Tamoxifen (the women hormone inhibitor) after chemotherapy. This study is conducted to examine changes in FSH and E2 concentration of patients breast cancer patients of childbearing age according to Tamoxifen used to prevent recurrence of breast cancer and proliferation of mammary parenchyma. Materials and Methods: This study aims to investigate similarity in patients treated with surgery who were in their childbearing age and in values of FSH and E2 by dividing test results of FSH and E2 requested at the department of nuclear medicine among patients who visited this hospital from Jan. 2009 to Mar. 2010 into women of childbearing age (n=50), menopausal women (n=50), and patients with breast cancer surgery who take Tamoxifen (n=50) and then comparing the test results. Results: The FSH and E2 test results of 50 patients were compared and analyzed as average${\pm}$standard deviation, and the results showed that the figure of women of childbearingage (n=50) was FSH : $7.14{\pm}6.19$, E2 : $138.76{\pm}85.40$, that of menopausal women (n=50) was FSH : $52.12{\pm}24.43$, E2 : $15.06{\pm}4.43$, and that of patients with breast cancer surgery who were in their childbearing age (n=50) was FSH : $44.21{\pm}21.07$, E2 : $13.53{\pm}4.26$. When these different results of FSH and E2 were compared, the value of patients with breast cancer surgery who were in their childbearing age with Tamoxifen was somewhat similar to that of menopausal women. Conclusion: The test results of FSH and E2 have reportedly found the test values of patients with breast cancer surgery could be similar to that of menopausal women eventhough they were in their childbearing age due to the women hormone inhibitor Tamoxifen. Therefore, if a tester conducts this experiment after understanding the clinical meaning, the reliability of the tester reporting test results would be increased.

• Archives of Plastic Surgery
• /
• v.34 no.5
• /
• pp.617-621
• /
• 2007

Purpose: With the necessity of comprehensive care for the breast cancer patients, Breast Care Center of our hospital started to work in March 2004. This study examined the 3-year execution of Breast Care Center. The role of Breast Care Center was evaluated in aspect of clinical activities in quality and quantity. Methods: A retrospective review was carried out from 2001 to 2007 with breast cancer patients. The number and type of breast cancer surgery and breast reconstruction procedure were compared before and after Breast Care Center's foundation. Time required for the diagnosis and treatment was also compared. Regression analysis and T-test were used to identify the statistical significance. Results: The number of breast cancer surgery did not statistically increase compared with progressive increase of breast cancer. QUART(quadrantectomy, axillary dissection, radiotherapy) procedure statistically significantly increased and MRM(Modified Radical Mastectomy) procedure decreased for breast cancer surgery after foundation of Breast Care Center. The number of breast reconstruction procedures statistically significantly increased. The number of immediate TRAM free flap (Transverse Rectus Abdominal muscle free flap) procedures has grown 3.8 times after foundation of Breast Care Center. The time required for diagnosis and treatment was also shortened. Conclusion: After foundation of Breast Care Center, the number of breast reconstruction surgery increased, while the counselling time in breast reconstruction was reduced. Breast Care Center provided a prompt and comprehensive care to the breast cancer patients through the multidisciplinary therapeutic approaches.

• Asian Pacific Journal of Cancer Prevention
• /
• v.14 no.1
• /
• pp.547-552
• /
• 2013

To investigate patient, cancer and treatment characteristics in females with breast cancer from more remote areas of Australia, to better understand reasons for their poorer outcomes, bi-variable and multivariable analyses were undertaken using the National Breast Cancer Audit database of the Society of Breast Surgeons of Australia and New Zealand. Results indicated that patients from more remote areas were more likely to be of lower socio-economic status and be treated in earlier diagnostic epochs and at inner regional and remote rather than major city centres. They were also more likely to be treated by low case load surgeons, although this finding was only of marginal statistical significance in multivariable analysis (p=0.074). Patients from more remote areas were less likely than those from major cities to be treated by breast conserving surgery, as opposed to mastectomy, and less likely to have adjuvant radiotherapy when having breast conserving surgery. They had a higher rate of adjuvant chemotherapy. Further monitoring will be important to determine whether breast conserving surgery and adjuvant radiotherapy utilization increase in rural patients following the introduction of regional cancer centres recently funded to improve service access in these areas.

• Archives of Plastic Surgery
• /
• v.40 no.4
• /
• pp.367-373
• /
• 2013

Background Breast-conserving surgery is widely accepted as an appropriate method in breast cancer, and the lateral thoracodorsal flap provides a simple, reliable technique, especially when a mass is located in the lateral breast. This study describes the usefulness of a lateral thoracodorsal flap after breast conserving surgery in laterally located breast cancer. Methods From September 2008 to February 2013, a lateral thoracodorsal flap was used in 20 patients with laterally located breast cancer treated at our institution. The technique involves a local medially based, wedge shaped, fasciocutaneous transposition flap from the lateral region of the thoracic area. Overall satisfaction and aesthetic satisfaction surveys were conducted with the patients during a 6-month postoperative follow-up period. Aesthetic results in terms of breast shape and symmetry were evaluated by plastic surgeons. Results The average specimen weight was 76.8 g. The locations of the masses were the upper lateral quadrant (n=15), the lower lateral quadrant (n=2), and the central lateral area (n=3). Complications developed in four of the cases, partial flap necrosis in one, wound dehiscence in one, and fat necrosis in two. The majority of the patients were satisfied with their cosmetic outcomes. Conclusions Partial breast reconstruction using a lateral thoracodorsal flap is well matched with breast color and texture, and the surgery is less aggressive than other techniques with few complications. Therefore, the lateral thoracodorsal flap can be a useful, reliable technique in correcting breast deformity after breast conserving surgery, especially in laterally located breast cancer.

• Asian Pacific Journal of Cancer Prevention
• /
• v.17 no.12
• /
• pp.5107-5111
• /
• 2016

Background: Epidemiological studies have indicated an increasing incidence of radiation induced secondary cancer (SC) in breast cancer patients after radiotherapy (RT), most commonly in the contra-lateral breast (CLB). The present study was conducted to estimate the SC risk in the CLB following 3D conformal radiotherapy techniques (3DCRT) including wedge field and forward intensity modulated radiotherapy (fIMRT) based on the organ equivalent dose (OED). Material and Methods: RT plans treating the chest wall with conformal wedge field and fIMRT plans were created for 30 breast cancer patients. The risks of radiation induced cancer were estimated for the CLB using dose-response models: a linear model, a linear-plateau model and a bell-shaped model with full dose response accounting for fractionated RT on the basis of OED. Results: The plans were found to be ranked quite differently according to the choice of model; calculations based on a linear dose response model fIMRT predict statistically significant lower risk compared to the enhanced dynamic wedge (EDW) technique (p-0.0089) and a non-significant difference between fIMRT and physical wedge (PW) techniques (p-0.054). The widely used plateau dose response model based estimation showed significantly lower SC risk associated with fIMRT technique compared to both wedge field techniques (fIMRT vs EDW p-0.013, fIMRT vs PW p-0.04). The full dose response model showed a non-significant difference between all three techniques in the view of second CLB cancer. Finally the bell shaped model predicted interestingly that PW is associated with significantly higher risk compared to both fIMRT and EDW techniques (fIMRT vs PW p-0.0003, EDW vs PW p-0.0032). Conclusion: In conclusion, the SC risk estimations of the CLB revealed that there is a clear relation between risk associated with wedge field and fIMRT technique depending on the choice of model selected for risk comparison.

• Asian Oncology Nursing
• /
• v.3 no.1
• /
• pp.5-14
• /
• 2003

The purpose of this study was to identify key educational and counseling needs of breast cancer patients in Korea. The data were collected from 102 breast cancer survivors. The instrument consisted of 66 items and the items were divided into five treatment stages: pre-admission, admission, discharge, chemotherapy, and radiation therapy. The subjects' mean age was 50 years and most of them were housewives. All had a mastectomy and among them 69 had chemotherapy and 42 had radiation therapy. Average post-surgical period was 47 months. The mean score of the subjects' needs was 2.99 out of 4 points. The highest educational need was to know about the method of recurrence prevention. In terms of the treatment stages, mean score for pre-admission was 3.09, admission 3.06, chemotherapy 3.03, after discharge 2.95, and radiation therapy 2.80. In the pre-admission period, etiology, diagnostic tests, treatment and prevention of the breast cancer were needed the most. During the admission period, symptom management after the operation had the highest score. After discharge, prevention of recurrence had the highest score. The results of this research will help in developing educational and counseling programs by understanding the specific needs of breast cancer patients based on the treatment stages.