• Archives of Plastic Surgery
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• 제45권4호
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• pp.367-374
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• 2018

Background This analysis presents patient-reported outcomes of breast augmentation procedures performed in Singapore using an inframammary fold incision and the "5 Ps" best practice principles for breast augmentation. These data are the first of their kind in Southeast Asian patients. Methods Through a retrospective chart review, patients who underwent primary breast augmentation with anatomical form-stable silicone gel breast implants using an inframammary fold incision were followed for ${\geq}6$ months postoperatively. The BREAST-Q Augmentation Module (scores standardized to 0 [worst] - 100 [best]) and Patient and Observer Scar Assessment Scale (POSAS; 1 [normal skin] to 10 [worst scar imaginable]) were administered. Responses were summarized using descriptive statistics. Patient-reported events were collected. Results Twenty-two Southeast Asian patients (mean age, 35.1 years) completed ${\geq}1$ postoperative BREAST-Q and POSAS assessment and were assessed 11 months to 5.5 years postoperatively. The mean postoperative BREAST-Q satisfaction with breasts and psychosocial well-being scores were 69.2 and 84.0, respectively. The mean POSAS score for their overall opinion of the scar was 4.2; the mean scores for all scar characteristics ranged from 1.2 to 4.2. Over 90% of patients (20/22) said that they would recommend the procedure. Patient complaints following surgery included anisomastia (possibly pre-existing; n=2), sensory loss at the nipple (n=2) or around the nipple (n=3), scarring (n=4), and slight capsular contracture (n=1). No patients required reoperation. Conclusions Southeast Asian patients reported high long-term satisfaction scores on the BREAST-Q scale and with their scar characteristics following breast augmentation using an inframammary fold incision, and nearly all said they would recommend this procedure. No reoperations were necessary in patients assessed for up to 5.5 years postoperatively.

• 구강회복응용과학지
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• 제16권2호
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• pp.123-132
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• 2000

The field of maxillofacial prosthetics is concerned with the prosthetic reconstruction of missing head and neck tissue. Currently, facial prostheses are usually applied in cases of defects caused by the surgical removal of tumors or congenital defects. While silicone has been most widely used for the reconstruction of missing maxillofacial defects, it does not have ideal physical properties. Therefore, bonding a thin polyurethane sheet to silicone prostheses was recommended. In this case skin adhesives were used for the retention of maxillofacial prostheses. But retention of devices has always been problematic. The contributions of implants can be made to solve these problems. Implants have reduced the need for adhesive use, simplifying cleaning procedures and thus extending the life of the prostheses. For implant-retained prostheses, retentive matrix is necessary to hold attachments and/or magnets. The retentive matrix is usually fabricated with autopolymerizing acrylic resin or visible light- polymerized resin. The purpose of this study was to compare the adhesion-in-peel force of silicone adhesive to autopolymerizing acrylic resin and polyurethane sheet with two different surface textures : pumice polish only or retention groove, and three surface primers : Dow corning 1205 primer or Dow corning S-2260 primer or FactorII A-304 primer, and two polymerization methods : room temperature or dry heat oven. The t-peel bond strength of specimens was determined as described in ASTM Standard D1876-72. The results were statistically analyzed using the ANOVA test, multiple range test and t-test The results were as follows. 1. The t-peel bond strength of A-304 primer was the highest and statistically higher than that of S-2260(p<0.05). 2. The t-peel bond strength of specimens with retention groove was statistically higher than that of specimens polished with pumice(p<0.05). 3. The t-peel bond strength of specimens polymerized in dry heat oven was statistically higher than that of specimens in room temperature(p<0.01).

• Archives of Plastic Surgery
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• 제44권6호
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• pp.516-522
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• 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.

• KSBB Journal
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• 제16권3호
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• pp.302-306
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• 2001

점도(평균 분자량)의 차이가 있는 카토산을 펼름형태로 제조하여 실험통불언 백서의 펴하에 삽입하여 백서에서의 적합성을 관찰하였으며 또한 우수한 적합성올 나타낸 키토산을 화상연고제로 제조하여 인와적 2도 화상을 입힌 백서의 피부에 대한 치료전후의 육안적 관찰과 혈액학적 분석올 실시l하여 천연고분자인 치토산의 생체적용 가능성을 연구하였다 제초한 키토산펼룹의 중량 변화와 혈액학적 결과에서 확인하 였듯이 재료의 생처l척합성은 여러 생체내 인자들에 의한 복 합적인 결과임을 확인할 수 있었으며 실험 결과 저점도 키토 산이 비교적 우수한 분해속도와 혈액학적 결과를 보여주는 생체 적합성을 나타내었다. 화상설험으로 기존 수용성 연고 베이스확 유사한 키토산 연고베이스물 제조하고 대조군으로 논 자연치유군(negative군)과 기존 수용성연고베이스(positive군) 웅의 두 군올 설정하여 백서의 화상 피부에서 6일과 12 열 후익 육안적 관찰 및 혈액학쩍 검사블 실시하였다 육안 적 관찰로서 실험가간 중에 사망한 백서는 없였으며 대조군 을 포함한 모든 실험군에서 화상실험 힐주일 후부터 백서의 화상부위에 가피(crust)가 형성되기 시작하였다. 백서의 혈액학적 결파 중 백혈구늠 실험 6일 후에는 백혈구가 감소하였으나 12일 후에는 대부분의 설험군에서 백혈구가 증가하여 염증발현의 가능성을 나타내었다. 특히, 자연치유군으로 설정 한 n$\xi$gative군에서는 높은 백혈구 수치를 나타내었다.

• Archives of Plastic Surgery
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• 제37권1호
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• pp.26-30
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• 2010

Purpose: Common complications of immediate breast reconstruction with implant are capsular contracture, malposition of implant, hematoma and seroma. Especially, the most severe complication is implant exposure caused by inflammation or necrosis of skin flap margin of mastectomy site. This article reports the experience of cases of salvage in such an exposure of implant. Methods: From July, 2002 to Feb., 2009, sixty-five patients who underwent immediate breast reconstruction with implant were retrospectively analyzed. Exposure of implant was happened in 5 of 65 patients and they were treated at out patient district. Two of five patients were reconstructed with saline implnt and all of them underwent the enveloping of the implant with AlloDerm$^{(R)}$ and Serratus muscle flap. Remaning three patients were reconstructed with silicone implant and all of them underwent the enveloping of the implant with AlloDerm$^{(R)}$. Results: In the group of patients who underwent reconstruction with saline implant, implant exposure was found in one patient due to partial necrosis of the margin of skin flap and debridement and primary repair were done. In the other one patient, dressing with antibiotic ointment were done. And debridement and primary repair were proceeded. In the group of patients who underwent reconstruction with silicone implant, implant exposure was found in one patient. After removal of the implant, tissue expansion was done and a new silicone implant was inserted. Implant exposure were found in the other two patients, antibiotics ointment application and primarily repaired. Conclusion: It was the common knowledge that the exposed implant should be removed. But salvage of the exposed implants may be possible with proper treatment. Four of five patients (80%) with exposed breast implant were salvaged with conservative management.

• Archives of Plastic Surgery
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• 제32권5호
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• pp.573-581
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• 2005

Breast cancer is the second leading cause of death in woman. Unfortunately, the frequency of breast cancer and mastectomy are increasing in Korea. This paper introduces the breast reconstruction by use of pectoralis major muscle transfer with breast implant for small size defect after skin sparing mastectomy for more satisfaction. We reviewed 24 consecutive patients who underwent breast reconstruction by pectoralis major muscle transfer with implant and only breast implant in Dong-A University from April 2002 to March 2004. The patient's age ranged between 29 and 54 years with mean of 42.3 years. We used pectorals major muscle transfer with breast implant in 12 patients and breast implant alone in 12 patients as control. The follow-up period of patients ranged from 10 months to 3 years with mean of 18.5 months. The points of comparison with control group reconstructed by breast implant alone were doctor and patient satisfaction score, operation time, duration of admission, amount of drainage, complication and satisfaction according to mass location. In conclusion, there is no difference with control group in the point of operation time, mount of drainage, duration of admission. And there is higher level of doctor's and patient's satisfaction in group reconstructed by pectoralis major muscle transfer with breast implant than implant only group. Especially, pectoralis major muscle transfer with breast implant was especially necessary for the defect in upper lateral quadrant of the breast to get more satisfaction. The advantage of pectoralis major muscle transfer with breast implant is prevention of the protruding and palpability of implant and aesthetically satisfactory result by intraoperative modification of breast shape.

• Archives of Plastic Surgery
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• 제34권2호
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• pp.222-228
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• 2007

Purpose: Report of the good results of breast reconstruction using Becker permanent tissue expander that showed a short operation time and a quick post-operation recovery time, little side effects and usually superb aesthetic results without the need for additional incisions or donor site morbidity. The authors, after carrying out breast reconstruction operations using Becker permanent tissue expander on patients with appropriate indications, attempted to analyze several factors such as complication rates and patient satisfaction measurements. Methods: 11 cases of breast reconstruction using Becker expander implants were carried out on a total of 10 patients between March 2000 and February 2003. The patients were followed up at outpatient visit for an average of 6 months. Results: The most common post-operation complication was pain resulting from saline injection into the expanders, complained by 5 patients(50%). rib fractures, skin necrosis, implant removal due to infection, and breast cancer recurrence each occurred in 1 patient (9.9%). There was no occurrence of skin contracture complications which occurs frequently in case of silicone implant insertion. Patient complacency was surveyed by patient interviews made right after the operations and during outpatient follow-up periods: 5(50%) patients out of 10 showed excellent, 3(30%) good, and 2(20%) showed fair, leaving no patients who were disappointed with operation results. On routine follow-up, 80% of patients expressed satisfaction with the cosmetic outcome of their post-mastectomy beast reconstruction. Conclusion: Breast reconstruction using the Becker expander is a reliable alternative to other reconstructive methods but good patient selection is essential for satisfactory results.

• 대한두개안면성형외과학회지
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• 제20권1호
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• pp.10-16
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• 2019

Background: Physicians tend to overcorrect when applying the acellular dermal matrix for reconstructive option because of volume decrement problem after absorption comparing with initial volume. However, there are no studies on the exact volume decrement and absorption rate with commercial products in South Korea. To figure out absorption rate of acellular dermal matrix product in South Korea (Megaderm), authors designed this experiment. Methods: Nine mice were used and randomly divided into three groups by the time with sacrificing. The implant (Megaderm) was tailored to fit a cuboid form ($1.0cm{\times}1.0cm$ in length and width and 2.0 mm in thickness). A skin incision was made at anterior chest with blade #15 scalpel with exposing the pectoralis major muscle. As hydrated Megaderm was located upon the pectoralis major muscle, the skin was sutured with Ethilon #5-0. After the surgical procedure, each animal group was sacrificed at 4, 8, and 12 weeks, respectively, for biopsies and histological analysis of the implants. All samples were stained with routine hematoxylin and eosin staining and Masson's trichrome staining and the thickness were measured. A measurements were analyzed using Friedman test. Statistically, the correlation between thicknesses of Megaderm before and after implantation was analyzed. Results: After sacrificing the animal groups at postoperative 4, 8, 12 weeks, the mean tissue thickness values were $2.10{\pm}1.03mm$, $2.17{\pm}0.21mm$, and $2.40{\pm}0.20mm$ (p= 0.368), respectively. The remaining ratios after absorption comparing with after initial hydrated Megaderm were 82.7%, 85.4%, and 94.5%, respectively. In histopathological findings, neovascularization and density of collagenous fiber was increased with time. Conclusion: Author's hypothesis was absorption rate of implant would be increased over time. But in this experiment, there is no statistical significance between mean absorption thickness of implant and the time (p= 0.368). Also it can be affected by graft site, blood supply, and animals that were used in the experiment.

• Archives of Plastic Surgery
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• 제46권3호
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• pp.204-213
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• 2019

Background In implant-based breast reconstruction, acellular dermal matrix (ADM) is essential for supporting the inferolateral pole. Recent studies have compared non-sterilized freeze-dried ADM and sterilized pre-hydrated ADM, but have not assessed whether differences were attributable to factors related to sterile processing or packaging. This study was conducted to compare the clinical outcomes of breast reconstruction using two types of sterile-processed ADMs. Methods Through a retrospective chart review, we analyzed 77 consecutive patients (85 breasts) who underwent tissue expander/implant breast reconstruction with either freeze-dried ADM (35 breasts) or pre-hydrated ADM (50 breasts) from March 2016 to February 2018. Demographic variables, postoperative outcomes, and operative parameters were compared between freeze-dried and pre-hydrated ADM. Biopsy specimens were obtained for histologic analysis. Results We obtained results after adjusting for variables found to be significant in univariate analyses. The total complication rate for freeze-dried and pre-hydrated ADMs was 25.7% and 22.0%, respectively. Skin necrosis was significantly more frequent in the freeze-dried group than in the pre-hydrated group (8.6% vs. 4.0%, P=0.038). All other complications and operative parameters showed no significant differences. In the histologic analysis, collagen density, inflammation, and vascularity were higher in the pre-hydrated ADM group (P=0.042, P=0.006, P=0.005, respectively). Conclusions There are limited data comparing the outcomes of tissue expander/implant breast reconstruction using two types of sterile-processed ADMs. In this study, we found that using pre-hydrated ADM resulted in less skin necrosis and better integration into host tissue. Pre-hydrated ADM may therefore be preferable to freeze-dried ADM in terms of convenience and safety.

• Archives of Plastic Surgery
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• 제49권3호
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• pp.332-338
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• 2022

Background Postmastectomy radiotherapy (PMRT) is allegedly associated with a higher risk of complications of combined nipple-sparing or skin-sparing mastectomy and subpectoral direct-to-implant immediate breast reconstruction ([N]SSM/SDTI-IBR). For this reason, this combination is usually advised against or, even, refused in women who need to undergo PMRT. Because this advice has never been justified, we assessed the short-term complications that may potentially be associated with PMRT after [N]SSM/SDTI-IBR. Methods We compared the complications requiring reintervention and implant loss occurring after 273 [N]SSM/SDTI-IBR that were exposed to PMRT within the first 16 postoperative weeks (interventional group) to those occurring in 739 similarly operated breasts that were not (control group). Additionally, we compared the fraction of complications requiring reintervention occurring after the onset of radiotherapy in the interventional group to that occurring after a comparable postoperative period in the control group. Results The fraction of breasts requiring unscheduled surgical reinterventions for complications and the loss of implants did not differ significantly between both groups but significantly more reinterventions were needed among the controls (p = 0.00). The fraction of events after the onset of radiotherapy in the interventional group was higher than the fraction of events after 6.2 weeks in the control group, but not significantly so. Conclusion We found no prove for the alleged increase of short-term complications of adjuvant radiotherapy. Therefore, we advise that these should not be considered valid arguments to advice against [N]SSM/SDTI-IBR.