• Archives of Plastic Surgery
• /
• v.46 no.6
• /
• pp.544-549
• /
• 2019

Background As the indications for postmastectomy radiotherapy expand, innovative solutions are required to reduce operative complications and reconstructive failure after prosthetic breast reconstruction. In this study, we investigated the effectiveness of acellular dermal matrix (ADM) inlay grafts in preventing postoperative wound dehiscence of irradiated breasts in the context of prosthetic breast reconstruction. Methods A retrospective analysis was conducted of 45 patients who received two-stage prosthetic reconstruction and radiotherapy following mastectomy. An ADM graft was placed beneath the incisional site during the second-stage operation in 19 patients using marionette sutures, whereas the control group did not receive the ADM reinforcement. Patient demographics and complications such as wound dehiscence, capsular contracture, peri-prosthetic infection, cellulitis, and seroma were compared between the two groups. Results During an average follow-up period of 37.1 months, wound dehiscence occurred significantly less often in the ADM-reinforced closure group (0%) than in the non-ADM group (23.1%) (P=0.032). There was no significant difference between the two groups in relation to other complications, such as capsular contracture, postoperative infection, or seroma. Conclusions The ADM inlay graft is a simple and easily reproducible technique for preventing incisional dehiscence in the setting of radiotherapy after prosthetic breast reconstruction. The ADM graft serves as a buttress to offload tension during healing and provides a mechanical barrier against pathogens. Application of this technique may serve to reduce complications in prosthetic breast reconstruction after radiotherapy.

• Archives of Plastic Surgery
• /
• v.38 no.6
• /
• pp.803-807
• /
• 2011

Purpose: The safety of radiation therapy after breast reconstruction using transverse rectus abdominis myocutaneous (TRAM) flap is still being debated, and few studies exist on the outcome of irradiation after immediate TRAM breast reconstruction. Some authors presented satisfactory outcomes after adjuvant radiation therapy on reconstructed breast with pedicled TRAM flap, while others reported significant post radiation changes of the flap. Effect of radiation therapy on TRAM flap was evaluated to see whether adjuvant radiation therapy was tolerable. Methods: 1000 immediate TRAM breast reconstruction was done by a single surgeon from July, 2001 to December, 2009. Among them 105 patients required adjuvant radiation therapy because of advanced disease or locoregional recurrence. Fat necrosis, radiation fibrosis, mastectomy skin flap necrosis, need for secondary touch up procedures, patient satisfaction were evaluated. Results: The incidence of fat necrosis was 10.5% and significant radiation fibrosis occurred in only one patient. Delayed wound problem did not occur during or after irradiation. Secondary touch-up procedures were performed in 12.3%, the most common being fat graft (8.6%). Average patient satisfaction score was 8.62/10, which was not significantly different from the authors' previous report involving all the TRAM patients (8.50). Conclusion: Radiation therapy did not increase the complication rate significantly. Aesthetic result was affected but was tolerated in most cases. The fear of adjuvant radiation is not a negative factor in selecting immediate breast reconstruction with TRAM flap.

• Archives of Reconstructive Microsurgery
• /
• v.19 no.1
• /
• pp.56-60
• /
• 2010

Purpose: Breast reconstruction with abdominal flap has many advantages. However, it might cause abdominal complications such as bulging or hernia. SIEA (Superficial inferior epigastric artery) flap is the most advanced form of abdominal flap which has no adverse effect on abdominal fascia. We report 2 cases of breast reconstruction with SIEA flap with reference review. Methods: From Jun 2006 to Jan 2009, 110 patients underwent breast reconstruction with free abdominal flap. We tried to find the SIEA in every cases and adopted SIEP flap if the diameter was larger than 1mm and it had visible pulsation. 2 patients underwent breast reconstruction with SIEA flap. After design of abdominal flap SIEA was investigated with portable Doppler. SIEA was usually found 4-5 cm lateral to the midline. Flap was elevated with SIEA and SIEV to their maximal length at hiatus. Results: There were no complications, such as infection, hematoma, and necrosis of flap. In both cases, flaps survived completely with excellent vascularity and breast reconstruction was successful. In one case, there was skin necrosis of mastectomy flap, and it was healed by conservative management. Conclusion: With the SIEA flap, donor site morbidity can be minimized along with reduction of operation time. If there is reliable SIEA, SIEA flap would be the preferred skills. However, the limitation of the SIEA flap is difficulty in identifying the SIEA. The reason for less availability of the flap in Korea might include high prevalence of the Caesarian section scar and relatively higher level of the lower margin of the flap.

• Archives of Plastic Surgery
• /
• v.42 no.3
• /
• pp.316-320
• /
• 2015

Background CGCryoDerm was first introduced in 2010 and offers a different matrix preservation processes for freezing without drying preparation. From a theoretical perspective, CGCryoDerm has a more preserved dermal structure and more abundant growth factors for angiogenesis and recellularization. In the current study, the authors performed a retrospective study to evaluate freezing- and freeze-drying-processed acellular dermal matrix (ADM) to determine whether any differences were present in an early complication profile. Methods Patients who underwent ADM-assisted tissue expander placement for two stage breast reconstruction between January of 2013 and March of 2014 were retrospectively reviewed and divided into two groups based on the types of ADM-assisted expander reconstruction (CGDerm vs. CGCryoDerm). Complications were divided into four main categories and recorded as follows: seroma, hematoma, infection, and mastectomy skin flap necrosis. Results In a total of 82 consecutive patients, the CGCryoDerm group had lower rates of seroma when compared to the CGDerm group without statistical significance (3.0% vs. 10.2%, P=0.221), respectively. Other complications were similar in both groups. Reconstructions with CGCryoDerm were found to have a significantly longer period of drainage when compared to reconstructions with CGDerm (11.91 days vs. 10.41 days, P=0.043). Conclusions Preliminary findings indicate no significant differences in early complications between implant/expander-based reconstructions using CGCryoderm and those using CGDerm.

• Archives of Plastic Surgery
• /
• v.33 no.1
• /
• pp.101-106
• /
• 2006

Nipple reconstruction is an important step in breast reconstruction after mastectomy. The authors' preferred reconstructive technique is the local C-V flap in case that a small opposite nipple is not adequate for composite graft. This flap produces an excellent reconstruction, but it is not easy to produce an adequate projection and firmness of the nipple. This article describes the technique and experience in nine patients treated over two years with dermis(scar tissue) graft for nipple reconstruction. This is the first report of application of autologous dermis(scar tissue) grafting to reconstruct a nipple primarily after breast mound reconstruction, decreasing the absorption of the reconstructed nipple and increasing the hardness. The dermis(scar tissue) is taken from scar revision and/or dog-ear correction in the second stage operation after free TRAM flap breast reconstruction. And the dermis(scar tissue) graft is inserted vertically between the local flaps and horizontally under the reconstructed nipple base. Between September 2002 and February 2005, nine patients underwent C-V flap with dermis(scar tissue) graft as a part of their nipple reconstruction. The patient's ages ranged from 28 to 55 years old (mean, 41.1 years old). The follow-up period ranged from 5 to 35 months, with an average of 14.5 months. None of the nipples showed skin flap necrosis or local infection, and uneventful wound healing. Our result showed good nipple projection with less absorption and enough firmness. Our experiences shows that dermis(scar tissue) grafts in C-V flap is a very useful method for nipple reconstruction.

• Archives of Plastic Surgery
• /
• v.36 no.2
• /
• pp.161-166
• /
• 2009

Purpose: Using the implant for the breast reconstruction still remains the options, despite the breast reconstruction using autologous tissue is an ideal method. In this study, we used AlloDerm$^{(R)}$ to extend subpectoral pocket for covering implants to reduce implant related complications. Met hods : From January 2005 to June 2007, 18 breasts in 16 patients were reconstructed using implant and AlloDerm$^{(R)}$ immediately after mastectomy. Hospital records, database files, and clinical photographs were reviewed. A ten - point scale was used to evaluate the patient's satisfaction, with a range from 2(poor) to 10(excellent). Results: Mean age of the patients was 38.7 years at the time of operation. Mean weight of removed breast tissue was 287g. AlloDerm$^{(R)}$ was used to extend subpectoral coverage. Any systemic complication was not reported. Breast complication was developed in 4 cases. Implant removal or change was not experienced. Conclusion: Immediate breast reconstruction using Implant is useful methods for certain conditions, when donor tissue is insufficient and breast is non ptotic with round shape. In those cases, extension of muscle coverage using AlloDerm$^{(R)}$ could reduce complications and lead more acceptable results.

• Archives of Plastic Surgery
• /
• v.36 no.6
• /
• pp.755-760
• /
• 2009

Purpose: Breast surgeons usually insert tissue expander or implant beneath the subpectoral - subglandular dual plane in breast reconstruction. But sometimes it happens unsatisfactory lower pole fullness, asymmetric inframammary fold and breast shape because there is implant migration due to the pectoralis major muscle contraction and gravity. To solve all the problem like these, we introduce implant breast reconstruction using AlloDerm$^{(R)}$(LifeCell Corp., Branchburg, N.J.) sling. Methods: The AlloDerm$^{(R)}$ sling was used in 13 patients and 18 breasts for implant breast reconstruction. After mastectomy, costal and lower sternal insertion of pectoralis major muscle was detached. Rehydrated AlloDerm$^{(R)}$ was sutured to the chest wall and serratus anterior fascia at the level of inframammary fold downward and to lower border of the pectoralis major muscle upward like crescent shape with tension free technique after implant insertion into the subpectoral - subAlloDerm dual pocket. Results: We make satisfactory lower pole fullness, symmetric inframammary fold and breast shape. In conclusion, patients obtain relatively natural breast shape. There was no complication except one case of capsular contracture and one case of breast cellulitis. Conclusion: Implant breast reconstruction using AlloDerm$^{(R)}$ sling makes easy to get natural breast shape through satisfactory lower pole fullness, symmetric inframammary fold and implant positioning.

• Archives of Plastic Surgery
• /
• v.41 no.5
• /
• pp.529-534
• /
• 2014

Background In 2012, a new anatomic breast implant of form-stable silicone gel was introduced onto the Korean market. The intended use of this implant is in the area of aesthetic breast surgery, and many reports are promising. Thus far, however, there have been no reports on the use of this implant for breast reconstruction in Korea. We used this breast implant in breast reconstruction surgery and report our early experience. Methods From November 2012 to April 2013, the Natrelle Style 410 form-stable anatomically shaped cohesive silicone gel-filled breast implant was used in 31 breasts of 30 patients for implant breast reconstruction with an acellular dermal matrix. Patients were treated with skin-sparing mastectomies followed by immediate breast reconstruction. Results The mean breast resection volume was 240 mL (range, 83-540 mL). The mean size of the breast implants was 217 mL (range, 125-395 mL). Breast shape outcomes were considered acceptable. Infection and skin thinning occurred in one patient each, and hematoma and seroma did not occur. Three cases of wound dehiscence occurred, one requiring surgical intervention, while the others healed with conservative treatment in one month. Rippling did not occur. So far, complications such as capsular contracture and malrotation of breast implant have not yet arisen. Conclusions By using anatomic breast implants in breast reconstruction, we achieved satisfactory results with aesthetics better than those obtained with round breast implants. Therefore, we concluded that the anatomical implant is suitable for breast reconstruction.

• Journal of the Korean Society of Radiology
• /
• v.82 no.1
• /
• pp.49-65
• /
• 2021

With the increase in the number of cases of silicone implant insertion either for cosmetic surgery or breast reconstruction after mastectomy, it is not unusual to encounter patients with silicone implants in clinical settings. Recently, the first case of breast implant-associated anaplastic large cell lymphoma was reported in Korea. In addition to previously known complications, such as implant rupture or contracture, the number of implant-associated imaging examinations has also increased. Considering this background, radiologists should have sufficient knowledge about the type of examination required in patients who have undergone implant insertion and imaging findings to correctly identify implant-associated complications. In this article, various complications of silicone implants are discussed, including various imaging findings, which radiologists should know.

• Asian Pacific Journal of Cancer Prevention
• /
• v.14 no.11
• /
• pp.6905-6911
• /
• 2013

Background: Breast cancer (BC) is the top cancer among women worldwide and the most frequent malignancy among Iranian women over the past few decades. The increasing trend and high mortality rate of BC in the developing world necessitates studies concentrating on its characteristics in countries in Asia. The current study focused on clinical and histopathological features of BC among Iranian females. Materials and Methods: This retrospective study involved 714 Iranian patients with histopathologically proven BC undergoing resection of primary tumours and axillary clearance. Demographic, clinical and histopathological data were obtained and studied between ten year age groups (${\leq}40$ years, 41-50 years, 51-60 years, 61-70 years, and ${\leq}71$ years) in four chronologic phases from 1994-2009. Results: Mean age of patients was $49.4{\pm}13.1$ years. Most of cases (33.2%) were in 41-50 group. Mean size of primary tumors was $3.94{\pm}2.47$ cm and 87.1% of cases had infiltrative ductal carcinoma. Modified radical mastectomy was the most common method of surgery carried out (48.8%). Some 57.1% of tumors were in pT2 and tumor size decreased significantly during the period (p<0.05). The most common BC stage was llla (27%). Lower BC stages (0 and 1) constituted 13.9% of the diagnosed tumors. Our series of patients aged ${\leq}40$ had larger tumors (mean $4.73{\pm}3.02$ cm) compared to older age groups (p=0.003). Lower stages (0 and I) were more frequent among the oldest patients while nearly 50% of patients aged ${\leq}40$ had tumor stage III. We also observed a significant decreasing trend in the mean LN count (p<0.05) and blood vessel invasion (p=0.023) from younger to older age groups. Conclusions: More aggressive disease for younger age groups, earlier peak incidence age and high rate of advanced BC at the time of diagnosis among Iranian women, were the main findings of this study.