• Archives of Plastic Surgery
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• 제38권4호
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• pp.401-407
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• 2011

Purpose: A number of flap for nipple reconstruction have been well described in the literature. However, most of these techniques do not permit the reconstruction of a projecting nipple and all are hampered to some extent by long-term loss of nipple projection. The objective of this study is to evaluate the long-term result and clinical efficacy of nipple reconstruction using skate flap technique after breast reconstruction. Methods: A retrospective chart review was carried out on 23 patients who underwent 25 nipple reconstructions. In those patients with greater than 10 mm nipple projection, reconstruction with skate flap and full-thickness skin graft and/or tattooing was performed. Maintenance of nipple projection was then carefully assessed over one-year follow-up. The following factors were analyzed: type of breast reconstruction, type of areola reconstruction, followup period, decrease in nipple projection, complication, and whether secondary nipple reconstruction was necessary and/or performed. Results: Breast reconstructions were performed in 17 patients with free transverse rectus abdominis musculocutaneous flap, 3 patients with extended latissimus dorsi musculocutaneous flap, and 3 patients with expander and implant. The mean follow-up after nipple reconstruction was 17 months. Mean loss of projection were $17.0{\pm}13.99%$, $25.0{\pm}12.70%$, $30.0{\pm}12.57%$ and $30.8{\pm}12.49%$ at 3, 6, 9 months and over one year, respectively. The greatest decrease in projection was noted in the first 3 months following surgery. Conclusion: These results indicated that nipple reconstruction with skate flap showed about 70 percent of the projection achieved over one year postoperation. Therefore, the skate flap may be a reliable method of nipple reconstruction in those patients with greater than 10 mm nipple projection.

• Archives of Plastic Surgery
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• 제41권5호
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• pp.550-555
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• 2014

Background Nipple reconstruction following breast mound reconstruction is the final step in breast reconstruction. Although nipple reconstruction is a simple surgery, the psychological aspects of nipple reconstruction are thought to be important. Nipple projection is a key factor in determining patient satisfaction with the surgery. In the present study, the Hammond flap technique was introduced for nipple reconstruction. Methods Twenty-six patients who had undergone breast reconstruction from February 2008 to March 2012 were enrolled in this prospective study. All patients were evaluated based on preoperative photos, and their nipple diameters and heights were measured. Postoperative evaluation was conducted 3, 6, 9, and 12 months following nipple reconstruction. A questionnaire on patient satisfaction with the nipple reconstruction was administered 12 months after nipple reconstruction. Moreover, the same plastic surgeon scored nipple projection and overall cosmetic result of the new nipple. Results The mean projection was 4.4 mm (range, 3-6 mm), and it well matched the contralateral nipple. Twelve months following nipple reconstruction, the mean reduction rate in the nipple projection was 43.6%. Patients were satisfied or very satisfied with the nipple projection and the overall cosmetic result in 80.7% cases. Conclusions In the present study, compared with other techniques, the use of the Hammond flap technique in nipple reconstruction showed competitive results with regard to nipple projection and patient satisfaction.

• Archives of Plastic Surgery
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• 제43권5호
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• pp.470-473
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• 2016

Nipple-areolar complex (NAC) reconstruction is the final step in the long journey of breast reconstruction for mastectomy patients. Successful NAC reconstruction depends on the use of appropriate surgical techniques that are simple and reliable. To date, numerous techniques have been used for nipple reconstruction, including contralateral nipple sharing and various local flaps. Recently, it has been common to utilize local flaps. However, the most common nipple reconstruction problem encountered with local flaps is the loss of nipple projection; there can be approximately 50% projection loss in reconstructed nipples over long-term follow-up. Several factors might contribute to nipple projection loss, and we tried to overcome these factors by performing nipple reconstructions using a boomerang flap technique, which is a modified C-V flap that utilizes the previous mastectomy scar to maintain long-term nipple projection.

• 대한자기공명의과학회:학술대회논문집
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• 대한자기공명의과학회 2001년도 제6차 학술대회 초록집
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• pp.148-148
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• 2001

목적： 자기 공명 혈관 영상(MR Angiography)법으로 혈관 촬영시, 혈관 협착으로 인하여 난류 현상이 발생되는 곳에서는 영상 자체가 얻어지지 않는다. 기존에 TE를 줄이거나 또는 projection reconstruction 방법은 2차원 TOF(Time of Flight)에 적용이 되어서 좋은 결과를 얻었다. 그런데, 2차원 TOF보다는 3차원 TOF으로 보다 좋은 혈관 영상을 얻을 수가 있다. 하지만, 3차원 TOF 방법에 projection reconstruction 방법을 적용하는 데는 여러 가지 문제점이 있어서 개발되어 있는 것이 거의 없다. 본 연구에서는 3차원 TOF 방법에 projection reconstruction 방법을 적용하여서 혈관내의 난류 현상에 의한 영상의 왜곡을 극복하는 방법을 개발한다. 대상 및 방법： 3차원 projection reconstruction을 위한 pulse sequence를 실제 진단에 사용하는 GE사의 자기공명영상장치(1.5T)에 맞게 독자적으로 개발한다. GE사의 장비에서 자료를 얻어서 일반 컴퓨터에서 영상을 재구성하는 알고리즘을 자체 개발한다. 혈관에서와 비슷한 형태의 난류를 발생시킬 수 있는 기구를 만들어서 실제 혈관영상에 사용하는 방법과 개발한 방법으로 영상을 비교한다.

• 한국의학물리학회:학술대회논문집
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• 한국의학물리학회 2002년도 Proceedings
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• pp.439-441
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• 2002

The aim of this study is to reconstruct the 3D target volume from multiple projection images. It was assumed that we were already aware of the target position exactly, and all processes were performed in Target Coordinates whose origin was the center of the target. We used six projections: two projections were used to make a Reconstruction Box and four projections were for image acquisition. Reconstruction Box was made up of voxels of 3D matrix. Projection images were transformed into 3D volume in this virtual box using geometrical based back-projection method. Algorithm was applied to an ellipsoid model and horse-shoe shaped model. Projection images were created using C program language by geometrical method and reconstruction was also accomplished using C program language and Matlab(The Mathwork Inc., USA). For ellipsoid model, reconstructed volume was slightly overestimated but target shape and position was proved to be correct. For horse-shoe shaped model, reconstructed volume was somewhat different from original target model but there was a considerable improvement in target volume determination.

• Archives of Plastic Surgery
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• 제48권6호
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• pp.590-598
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• 2021

Background Although the initial projection after primary nipple reconstruction is excellent, nipple projection gradually flattens in most cases due to multiple causes. Although various methods have been reported to rebuild the nipple after nipple flattening, the most effective method of secondary nipple reconstruction remains unknown. The aim of this study was to review our institution's experiences with secondary nipple reconstruction. Methods We conducted a retrospective review from March 2012 to January 2019. We performed secondary nipple reconstruction if the primary reconstructed nipple height differed by more than 6 mm from the normal nipple height. We chose the method of nipple revision according to the degree of tissue scarring and the remaining nipple projection. Results We performed secondary nipple reconstruction on a total of 27 nipples, using purse-string sutures for 19 nipples and star flaps in eight nipples. The median follow-up period was 8 months (range, 6-19 months) after the final nipple reconstruction. Among the 19 nipples reconstructed using purse-string sutures, 10 (53%) demonstrated acceptable projection of more than 5 mm. Among the eight nipples reconstructed using star flaps, six (75%) showed acceptable projection of more than 5 mm. Most of the patients (73%) were satisfied (scores of 4 or 5) with the nipple reconstruction overall. Conclusions Few studies have presented favorable outcomes of secondary nipple reconstruction. When the star flap and purse-string suture methods were used depending on the remaining nipple height and scarring, appropriate projection could be achieved.

• Archives of Plastic Surgery
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• 제48권2호
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• pp.179-184
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• 2021

Women attach great importance to the presence of a three-dimensional nipple upon completion of the breast reconstruction process. To meet patients' expectations, nipple-areolar complex reconstruction should achieve symmetry in position, size, shape, texture, and color, as well as minimizing donor-site morbidity. However, it is well known that regardless of the reconstructive technique, loss of nipple projection can be reasonably expected. We developed and evaluated a quick, simple, and innovative technique using injectable Integra Flowable Wound Matrix to increase nipple projection after reconstruction. Twenty breast cancer patients who underwent nipple reconstruction resulting in unsatisfactory projection were enrolled in our retrospective study. Nipple projection was measured at the time of surgery and after 6 and 12 months. A visual analogue scale was used to assess patients' satisfaction. Our technique yielded reliable results in terms of the long-lasting maintenance of nipple projection. This method is high-priced, but cost-effective, since one kit may suffice for three patients. Furthermore, our patients were very appreciative of this technique as a single-step, minimally invasive, painless procedure with no reported necessity of re-intervention.

• Archives of Plastic Surgery
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• 제43권5호
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• pp.424-429
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• 2016

Background The objective of this paper was to describe a novel technique for improving the maintenance of nipple projection in primary nipple reconstruction by using acellular dermal matrix as a strut in one of three different configurations, according to the method of prior breast reconstruction. The struts were designed to best fill the different types of dead spaces in nipple reconstruction depending on the breast reconstruction method. Methods A total of 50 primary nipple reconstructions were performed between May 2012 and May 2015. The prior breast reconstruction methods were latissimus dorsi (LD) flap (28 cases), transverse rectus abdominis myocutaneous (TRAM) flap (10 cases), or tissue expander/implant (12 cases). The nipple reconstruction technique involved the use of local flaps, including the C-V flap or star flap. A $1{\times}2-cm$ acellular dermal matrix was placed into the core with O-, I-, and L-shaped struts for prior LD, TRAM, and expander/implant methods, respectively. The projection of the reconstructed nipple was measured at the time of surgery and at 3, 6, and 9 months postoperatively. Results The nine-month average maintenance of nipple projection was $73.0%{\pm}9.67%$ for the LD flap group using an O-strut, $72.0%{\pm}11.53%$ for the TRAM flap group using an I-strut, and $69.0%{\pm}10.82%$ for the tissue expander/implant group using an L-strut. There were no cases of infection, wound dehiscence, or flap necrosis. Conclusions The application of an acellular dermal matrix with a different kind of strut for each of 3 breast reconstruction methods is an effective addition to current techniques for improving the maintenance of long-term projection in primary nipple reconstruction.

• Archives of Plastic Surgery
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• 제42권3호
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• pp.309-315
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• 2015

Background Breast projection is a critical element of breast reconstruction aesthetics, but little has been published regarding breast projection as the firm expander is changed to a softer implant. Quantitative data representing this loss in projection may enhance patient education and improve our management of patient expectations. Methods Female patients who were undergoing immediate tissue-expander breast reconstruction with the senior author were enrolled in this prospective study. Three-dimensional camera software was used for all patient photographs and data analysis. Projection was calculated as the distance between the chest wall and the point of maximal projection of the breast form. Values were calculated for final tissue expander expansion and at varying intervals 3, 6, and 12 months after implant placement. Results Fourteen breasts from 12 patients were included in the final analysis. Twelve of the 14 breasts had a loss of projection at three months following the implant placement or beyond. The percentage of projection lost in these 12 breasts ranged from 6.30% to 43.4%, with an average loss of projection of 21.05%. Conclusions This study is the first prospective quantitative analysis of temporal changes in breast projection after expander-implant reconstruction. By prospectively capturing projection data with three-dimensional photographic software, we reveal a loss of projection in this population by three months post-implant exchange. These findings will not only aid in managing patient expectations, but our methodology provides a foundation for future objective studies of the breast form.

• 한국의학물리학회지:의학물리
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• 제14권3호
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• pp.167-174
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• 2003

정위적방사선수술과 같은 경우 치료계획 수립 시 병변의 정확한 위치뿐만 아니라 정확한 부피와 모양을 아는 것도 매우 중요하다. 병변의 확인을 위해서 때로는 혈관조영영상이 이용되기도 하는데 동정맥 기형과 같은 경우 이 방법이 병변의 구별을 위하여 가장 좋은 방법이기 때문이다. 병변의 정확한 위치는 두개의 투사영상으로부터 얻을 수 있지만 두 개의 투사영상 만으로는 병변을 3차원적으로 재구성하는 것은 불가능하다고 여겨지고 있다. 본 연구의 목적은 다수의 투사 영상들을 이용하여 병변을 3차원적으로 재구성하는 것이다. 이때 병변의 위치는 기존에 제안된 방법에 의하여 이미 알고 있다고 가정하였으며 모든 과정은 병변의 중심을 원점으로 하는 표적좌표계에서 수행되었다. 본 연구에서는 6개의 투사영상이 이용되었는데 정면과 측면 투사영상은 체적소(voxel)로 구성된 재구성상자를 구하기 위하여 이용되었으며 나머지 네 개의 투사영상은 역투사 방법(back-projection method)에 의하여 재구성 상자(Reconstruction Box) 내에서 3차원적으로 재구성하는데 이용되었다. 이 방법의 정확도와 해상도는 병변의 크기와 모양에 따라 달라질 수 있다. 본 연구에서 제안된 알고리듬의 검증을 위하여 C 언어와 Matlab을 이용하여 타원체 모델과 말굽형 모델에 대하여 투사영상을 얻고 그 영상을 이용하여 재구성해보았다. 타원체모델의 경우에는 원래의 모델보다 약간 크게 재구성되었지만 모양과 방향, 위치가 정확함을 확인할 수 있었다. 말굽형 모델은 재구성된 모양이 원래의 모양과 차이가 많이 났지만 기존 방법에 비하여 실제 모양에 근접하게 재구성할 수 있었으므로 병변을 확인하는 경우에는 도움이 될 것으로 사료된다.