• Archives of Plastic Surgery
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• v.48 no.5
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• pp.473-482
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• 2021

Background The increasing number of bilateral breast cancer patients has been accompanied by a growing need for bilateral mastectomy with immediate reconstruction. However, little research has investigated the complications and aesthetic outcomes related to bilateral reconstruction. Therefore, we analyzed retrospective data comparing the outcomes of bilateral reconstruction using deep inferior epigastric perforator (DIEP) flaps or implants. Methods This study included 52 patients (24 DIEP group and 28 implant group) who underwent bilateral mastectomy with immediate reconstruction between 2010 and 2020. Patient demographics, surgical characteristics, and complications were recorded. The difference between the left and right position of the nipple-areolar complex with respect to the sternal notch point at the clavicle was measured, and breast symmetry was evaluated. Results The average weight of breasts reconstructed with DIEP flaps (417.43±152.50 g) was higher than that of breasts with implants. The hospitalization period and operation time were significantly longer in the DIEP group. Early complications were significantly more common in the implant group (36.53%) than in the DIEP group. The angles between the nipples and the horizontal line were 1.09°±0.71° and 1.75°±1.45° in the DIEP and implant groups, respectively. Conclusions Although the surgical burden is lower, breast reconstruction using implants requires greater attention with respect to implant positioning, asymmetry, and complications than DIEP flap reconstruction. DIEP flap reconstruction has a prolonged operation time and a high risk of flap failure, but yields excellent cosmetic results and does not require intensive follow-up. Patients should be consulted to determine the most suitable option for them.

• Archives of Craniofacial Surgery
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• v.20 no.1
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• pp.37-43
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• 2019

Background: Tongue reconstruction is challenging with the unique function and anatomy. Goals for reconstruction differ depending on the extent of reconstruction. Thin and pliable flaps are useful for tongue tip reconstruction, for appearance and mobility. This study reports lateral arm free flap (LAFF) as a safe and optimal option for hemi-tongue reconstruction, especially for tongue tip after hemiglossectomy. Methods: Thirteen LAFFs were performed for hemi-tongue reconstruction after hemiglossectomy from 1995 to 2018. Of the 13 patients, seven were male and six were female, age varying from 24 to 64 years. Results: All flaps healed uneventfully without complications. Donor sites were closed primarily. The recipient vessels for microvascular anastomosis were mainly superior thyroidal artery, external jugular vein. All patients returned to normal diet, with no complaints regarding reconstructed tongue and donor site. Conclusion: The LAFF is hairless, thin (especially with lateral epicondyle approach), and potentially sensate. They are advantageous features for tongue tip and hemi-tongue reconstruction. Donor site sacrifices the inessential posterior radial collateral artery, and the scar is hidden under short sleeve shirts. We believe that LAFF can be considered as the first choice flap for hemitongue reconstruction, over radial forearm free flaps.

• Archives of Plastic Surgery
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• v.48 no.6
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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.

• Architectural research
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• v.24 no.3
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• pp.85-91
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• 2022

The public rental housing policy aims to provide the housing to the vulnerable class who do not have enough credit to own houses. The Korean government introduced new policies for housing supply to improve the availability of new houses. However, it is difficult to expand the supply because of the accumulated deficit of public rental housing. In this study, the economic feasibility of long-term public rental housing reconstruction projects was examined to ensure the economic and sustainable growth of public rental housing. The research found that the compensation for the accumulated deficit is needed. Also the research analyzed and identified the factors affecting the economic feasibility of reconstruction projects. The significant factors identified in this research are: the supply price of pre-sale/rental housing in the reconstruction project, total cost of the reconstruction project, and total floor area of the reconstruction project. According to the analysis results, it is necessary to increase the rent of existing long-term public rental housing, expand the government subsidy, increase the supply price of pre-sale/rental housing, and reduce the total project cost. However, there are limitations. For example, the fluctuations of construction market, residents' burden of housing costs, and the limit of the budget of the public housing authority. The increasing total Floor Area Ratio(FAR) limitation of the reconstruction project would be the realistic solution to the problem because it gives incentives to the reconstruction project.

• Archives of Plastic Surgery
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• v.50 no.4
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• pp.361-369
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• 2023

The latissimus dorsi (LD) flap is a reliable option for breast reconstruction. This is particularly true in patients with contraindications to abdominally based autologous breast reconstruction. A systematic review of patient satisfaction and health related quality of life following LD breast reconstruction using the BREAST-Q survey was conducted. The scope of the review was to determine the degree of patient satisfaction following the procedure and to examine how patient satisfaction from the pedicled LD flap compares to other breast reconstructive procedures. A literature search on BREAST-Q in LD flap reconstruction was performed. Only articles written in English and in published peer-reviewed journals were included. Studies with less than 20 patients in their sample and those with a follow-up period of less than 1 year were excluded. Five articles representing 331 patients were reviewed, including one case-control study and four retrospective cohort studies. Level of evidence was either III (4) or IV (1). The average age was 53 with average body mass index of 25. Most reconstructions were delayed (67%) and unilateral (88%), and most patients required radiation (79%). The average length of follow-up was 36 months, and the response rate was 75%. Overall, patients who underwent LD flap reconstruction reported favorable outcomes in satisfaction domains and quality of life domains with few complications. A meta-analysis also demonstrated higher satisfaction in LD flap without implants compared with LD flap with implants. Patient-reported outcomes following LD breast reconstruction compare favorably with other techniques of breast reconstruction.

• Archives of Plastic Surgery
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• v.51 no.1
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• pp.52-61
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• 2024

Background Although prepectoral implant-based breast reconstruction has recently gained popularity, dual-plane reconstruction is still a better option for patients with poor-quality mastectomy skin flaps. However, shoulder morbidity is aggravated by subpectoral reconstruction, especially in irradiated patients. This study aimed to demonstrate shoulder exercise improvement in subpectoral reconstruction by delayed prepectoral conversion with an acellular dermal matrix (ADM) inlay graft technique at the time of expander-to-implant exchange after irradiation. Methods Patients with breast cancer treated for expander-to-implant exchange after subpectoral expander insertion and subsequent radiotherapy between January 2021 and June 2022 were enrolled. An ADM inlay graft was inserted between the pectoralis major muscle and the previously inserted ADM. The ADM was sutured partially overlapping the pectoralis muscle from the medial side with the transition part, to the muscle border at the lateral side. Perioperative shoulder joint active range-of-motion (ROM) for forward flexion, abduction, and external rotation was also evaluated. Results A total of 35 patients were enrolled in the study. Active shoulder ROM significantly improved from 163 degrees preoperatively to 176 degrees postoperatively in forward flexion, 153 to 175 degrees in abduction, and 69 to 84 degrees in external rotation. There was no difference in patient satisfaction regarding the final outcome between the conventional prepectoral reconstruction group and the study group. Conclusion Shoulder exercises in irradiated patients who underwent subpectoral reconstruction were improved by delayed prepectoral conversion using an ADM inlay graft. It is recommended that subpectoral reconstruction not be ruled out due to concerns regarding muscle contracture and shoulder morbidity in radiation-planned patients with poor mastectomy skin flaps.

• Archives of Plastic Surgery
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• v.50 no.6
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• pp.541-549
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• 2023

Background Despite its many advantages, prepectoral breast reconstruction also carries the risk of implant rippling. The recent introduction of partial superior implant coverage using a pectoralis muscle slip in prepectoral direct-to-implant (DTI) breast reconstruction has shown the potential to minimize upper pole rippling. The purpose of this study was to identify factors associated with rippling and the effectiveness of our surgical technique. Methods In total, 156 patients (186 breasts) who underwent prepectoral DTI breast reconstruction between August 2019 and March 2021 were identified retrospectively. Patient data were analyzed from medical records. Univariable and multivariable logistic analyses were performed to contextualize the risks associated with rippling deformity relative to demographic characteristics and other clinical factors. Retrospective propensity-matched analysis was performed to identify the relationship between rippling deformity and the reconstruction method. Results Patients with body mass index (BMI; odds ratio [OR], 0.736; p < 0.001), those with a postoperative chemotherapy history (OR, 0.324; p = 0.027) and those who received breast reconstruction via the superior coverage technique (OR, 0.2; p = 0.004), were less likely to develop rippling deformity. The median follow-up period was 64.9 weeks, and there were no significant differences between patients in types of mastectomy, implant, or acellular dermal matrix. Patients who underwent superior coverage technique-based reconstruction showed significantly reduced rippling (OR, 0.083; p = 0.017) Conclusion Patients with higher BMI and prior postoperative chemotherapy were less likely to develop rippling deformity. The superior coverage technique can be effective in minimizing upper pole rippling.

• Archives of Plastic Surgery
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• v.34 no.5
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• pp.653-655
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• 2007

Purpose: The umbilicus is an important aesthetic component of the abdomen. Its absence is both cosmetically and psychologically distressing to the patient. Umbilical reconstruction should always be aimed at creating an umbilicus of sufficient depth and good morphology with less scarring. The C-V flap developed for nipple reconstruction was used in an inverted fashion in case of umbilical reconstruction. The aim of this article is to report our experience of scarred umbilical reconstruction using inverted C-V flap. Methods: A 22-year-old woman presented with contracted scar tissue in the umbilical region because she had undergone surgical correction of an umbilical hernia at 5 year of age. Pedicle of the inverted C-V flap was based cephalically. For enhancing depth of the umbilicus, three anchoring sutures to linea alba were done at both lateral and caudal aspects of the umbilical tube. Primary closures were done at donor sites of the V flaps and bolster sutures were done in the caudal direction of the inverted umbilical tube. Results: The patient was satisfied with the appearance of umbilicus. Major complications such as dehiscence, infection, and delayed healing did not occur. Conclusion: The inverted C-V flap is easy and simple technique, and it can produce a satisfactory reconstruction of umbilical structure.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.14 no.7
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• pp.3460-3467
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• 2013

The In this paper, we have made numerical experiments to compare 2D image reconstruction algorithm of earth model by electrical resistance tomograpy (ERT). Gauss-Newton, simultaneous iterative reconstruction technieque (SIRT) and truncated least squares (TLS) approaches for Wenner and Schlumberger electrode arrays are presented for the solution of the ERT image reconstruction. Computer simulations show that the Gauss-Newton and TLS approach in ERT are proper for 2D image reconstruction of an earth model.

• KSII Transactions on Internet and Information Systems (TIIS)
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• v.6 no.10
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• pp.2679-2691
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• 2012

In this paper, a high accuracy stereo reconstruction method for surgery instruments positioning is proposed. Usually, the problem of surgical instruments reconstruction is considered as a basic task in computer vision to estimate the 3-D position of each marker on a surgery instrument from three pairs of image points. However, the existing methods considered the 3-D reconstruction of the points separately thus ignore the structure information. Meanwhile, the errors from light variation, imaging noise and quantization still affect the reconstruction accuracy. This paper proposes a method which takes the structure information of surgical instruments as constraints, and reconstructs the whole markers on one surgical instrument together. Firstly, we calibrate the instruments before navigation to get the structure parameters. The structure parameters consist of markers' number, distances between each markers and a linearity sign of each instrument. Then, the structure constraints are added to stereo reconstruction. Finally, weighted filter is used to reduce the jitter. Experiments conducted on surgery navigation system showed that our method not only improve accuracy effectively but also reduce the jitter of surgical instrument greatly.