• Archives of Plastic Surgery
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• 제34권5호
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• pp.617-621
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• 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.

• Archives of Reconstructive Microsurgery
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• 제21권1호
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• pp.8-13
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• 2012

Purpose: Purpose: The free deep inferior epigastric artery perforator (DIEP) flap is a popular option for autologous breast reconstruction. However, the anatomy of the deep inferior epigastric artery(DIEA) may vary from one individual to another. Unexpected vascular anomaly can confuse the surgeon and affects on the safety of the free DIEP flap. Materials and Methods: Thirty five consecutive patients who underwent free DIEP/TRAM flap for immediate breast reconstruction between Mar. 2010 and Oct. 2010 were enrolled in this study. Computed tomography angiography (CT angiography) of abdomen was evaluated part of our standard preoperative assessment: atypical patterns of DIEA/DIEP were evaluated by preoperative CT angiography and compared with intraoperative finding. Results: Atypical patterns of DIEA/DIEP which may affect preoperative planning were noted as the following: Circummusclar/subfascial DIEA (n=1), DIEA running underneath rectus muscle (n=8), septocutaneous perforator (n=3), peritoneo-cutaneous perforator (n=1), a large branch going into peritoneum (n=1), and very early division and muscle penetration of DIEA (n=1). Conclusion: Atypical DIEA/DIEP that might change the operation plan is not rare, so the individualized planning based on the preoperative CT angiography is recommended. Preoperative CT angiography could help to select reliable and easy-to-dissect perforator in free DIEP/TRAM breast reconstruction.

• Archives of Plastic Surgery
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• 제37권4호
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• pp.409-414
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• 2010

Purpose: Poland's syndrome encompasses a constellation of congenital chest wall, breast, and upper extremity deformities. We would like to present several techniques, which may be combined if necessary, used to treat the forms involving both the breast and chest wall according to the degree of deformity. Methods: In a retrospective series of 9 patients (3 men and 6 women), we report our experience with reconstructing breast and chest contour deformities associated with Poland syndrome. We recorded their age, gender, the surgical techniques, and the grade in Poland's syndrome according to the classification of Foucras. Results: The breast and chest wall deformities associated with Poland syndrome can be treated in individualized fashion according to the classification of Foucras. In case of 3 male patients with gradeI, II, the latissimus dorsi muscle pedicled flap improved the chest contour deformity. 3 female patients with grade II underwent the latissimus dorsi muscle pedicled flap with breast implant. 2 female patients with gradeIunderwent breast reconstruction with breast implant and fat injection each other. One female patient with severe chest wall deformity (grade III) underwent breast reconstruction using the free TRAM flap. All patients were satisfied with the results without specific complications. Conclusion: The Individualized correction for this syndrome according to the degree of patient's deformity and preference made the overall satisfaction of the patients high.

• Archives of Plastic Surgery
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• 제36권6호
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• pp.750-754
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• 2009

Purpose: The thoracodorsal vessels have been the standard recipient vessels for the majority of surgeons performing free abdominal flap breast reconstructions. Recently, the internal mammary vessels have been recommended as the first - choice recipient vessels for microvascular breast reconstruction. To approach the internal mammary vessel, 3rd or 4th rib cartilage excision is needed, but this method has some demerits - vessel injury, post operative pain and post operative chest hollowness. So, authors propose the approach method to the internal mammary vessel through intercostal space without rib cartilage resection. Methods: From November, 2008 to May, 2009, 13 patients underwent free abdominal flap breast reconstruction with approach to the internal mammary vessel through intercostal space without rib cartilage resection. Results: The mean patient age was 41.8 years, and the mean height was 159.3 cm. 11 patients underwent immediate breast reconstruction. Free DIEP flap reconstruction was performed in 7 patients, Free TRAM flap was performed in 5 patients, and Free SIEA flap was performed in 1 patient. Except 1 case, approach to the internal mammary vessel was took through 3rd intercostal space, and all width of intercostal space exceeded 1 cm. Conclusion: In the authors' experience, use of approach to the internal mammary vessels without rib cartilage resection method is safe and reliable to overcome demerits of rib cartilage resection method.

• Archives of Plastic Surgery
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• 제33권1호
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• pp.101-106
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• 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
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• 제33권4호
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• pp.469-473
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• 2006

Purpose: The transverse rectus abdominis myocutaneous(TRAM) flap has become a reliable method for autogenous breast reconstruction. However, dissection of the tendinous intersections of rectus abdominis is technically difficult. The tendinous intersection has significant vascularity within its fascial layers raising in importance of technique in elevation. If tendinous intersections are damaged during the elevation of the rectus muscle, circulation to TRAM flap can be endangered. The purpose of this study is to evaluate the number of tendinous intersections and to predict anatomical position of the tendinous intersections. Methods: We dissected 182 consecutive TRAM flaps and measured the distance between xiphoid process and each tendinous intersection and evaluated the statistic correlation among the distance, patient's height and position of umbilicus. Results: In this study, in 30.7% of patients, two tendinous intersections were observed in one rectus abdominis muscle, in 67.7% three tendinous intersections, and in 1.6% four tendinous intersections, respectively. But there was no correlation between patient's height and the distance between xiphoid process and each tendinous intersection. Conclusion: It still remains difficult to predict the position of tendinous intersections just by topography before the dissection. Careful and meticulous dissection of the tendinous intersections is still required.

• Archives of Reconstructive Microsurgery
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• 제7권2호
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• pp.114-121
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• 1998

The purpose of this study is to investigate the appropriate management of severe radionecrotic wounds of the anterior chest wall associated with infection of the soft tissues and ribs and exposure of vital structures(heart and lung), and present our strategies for reconstruction of these complicated patients. 9 patients have undergone radical debridement and immediate microsurgical reconstruction for severe radionecrotic wounds of the anterior chest wall over last 7 years. All patients had extensive osteomyelitis of the ribs or sternum, and chronic infection or cutaneous fistulae. 2 patients had pericardial effusions due to longstanding inflammation, and 6 patients had pleural effusions. 2 patients had ipsilateral lung collapse. 10 free flaps were performed for coverage of the huge defects. One patient required 2 free flaps to control the inflammation. 8 free TRAM flaps were used for coverage of the defects and in addition, the rectus abdominis muscle was packed into any deep cavity. 1 patients underwent latissimus dorsi muscle free flap because of previous abdominal surgery. After extensive debridement of the infected, radionecrotic wounds, all 10 free flaps were successful. All the extensive radionecrotic defects of the anterior chest wall were completely healed. Free flaps successfully covered the exposed vital structures of the heart and lungs. Patients with severe radionecrotic defects of the anterior chest wall after ablative breast cancer surgery and radiotherapy were successfully treated by radical debridement and immediate free flap surgery. The TRAM flap together with the rectus muscle is the treatment of choice for these huge defects. The latissimus dorsi muscle flap was the second choice in patients with previous abdominal surgery. The recipient vessel should be carefully selected because of possible radiation damage and inflammation.

• Archives of Reconstructive Microsurgery
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• 제17권2호
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• pp.94-100
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• 2008

In the past decade, there has been increasing breast reconstructions after mastectomy, and the abdomen has been the gold standard for donor site. TRAM (transverse rectus abdominis myocutaneous), MSTRAM (muscle sparing transverse rectus abdominis myocutaneous), DIEP (deep inferior epigastric artery perforator), SIEA (superficial inferior epigastric artery) flap has been widely used nowadays. Among them, DIEP free flap spares the whole rectus abdominis muscle and anterior rectus sheath resulting in decreased donor site morbidity. Between March of 2006 and February of 2008, six patients had undergone immediate breast reconstructions using DIEP free flap. The mean age of patients was 48.5 years. All patients had unilateral breast reconstructions. We dissected two perforators which were included in the unilateral pedicle. Thoracodorsal artery and its venae comitantes were chosen as recipient vessels. For venous anastomosis, we used the GEM Microvascular Anastomotic Coupler System (Synovis Micro Companies Alliance, Inc., Birmingham, Ala.) in four cases. All flaps were survived completely except one who showed fatty abdomen in old age. She showed repetitive vascular spasm intraoperatively. None of the patients had abdominal hernia, bulge or weakness. We believe that DIEP free flap provides a reliable method for autologous breast reconstruction if the patients are selected appropriately and performed by a skillful surgeon.

• Archives of Plastic Surgery
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• 제36권2호
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• pp.140-146
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• 2009

Purpose: Autologous breast reconstruction with abdominal tissue is one of the best options after mastectomy. In a free transverse rectus abdominis myocutaneous(TRAM) or deep inferior epigastric artery perforator(DIEP) flap, a preoperative evaluation of the precise location of perforating vessels and vascular run - off systems is required. The objective of this report is to demonstrate the usefulness of multidetector computed tomography(MDCT) in the preoperative planning of patients undergoing breast reconstruction with abdominal flap. Methods: From June 2006 to January 2008, 28 patients underwent MDCT evaluation before breast reconstruction. All subjects were females with an age range of 30 to 55 years. The CT scan was performed using a 64 - slice MDCT scanner(Brilliance 64; Philips Medical Systems, Best, Netherlands). Results: One perforator or two major perforators were marked on image in good relation with a hand - held Doppler examination and intraoperative findings. All vascular run - off systems were cleared before operation. Conclusion: Preoperative evaluation of perforator arteries with MDCT angiography is beneficial in patients undergoing breast reconstruction. This technique provides a noninvasive approach of the vascular anatomy of the entire anterior abdominal wall.

• Archives of Plastic Surgery
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• 제41권2호
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• pp.158-162
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• 2014

Background Loss of nipple projection is a common problem following nipple reconstruction. The aim of this study was to demonstrate that the use of a tightly rolled dermal graft is effective in the long-term maintenance of nipple projection. Methods Nipple reconstruction was performed using the C-V flap technique. A dermal graft was harvested from the dog-ear portion of previous scars. The graft was rolled tightly into a compact cylinder and used to augment the nipple reconstruction. Postoperatively, stacked Allevyn dressing was used for protecting the nipple from compression for a minimum of two months. Nipple projection was measured at the time of surgery and at 12 months postoperatively. Results Forty nipple reconstructions were performed using this technique. There were 19 transverse rectus abdominis musculocutaneous (TRAM) flaps, 10 latissimus dorsi (LD) flaps, and 11 tissue-expanded breast mounds. At one year, the mean projection was 0.80 cm (range, 0.62-1.22 cm). The twelve-month average maintenance of nipple projection was 70.2% for the TRAM flap group, 76.3% for the LD flap group, and 61.8% for the tissue-expanded group. In two patients with previous irradiation of the reconstructed breasts, relatively poor maintenance of nipple projection was noted (45.7%). No complications were noted, and all of the donor sites healed well primarily. Conclusions Our results demonstrated that the use of a C-V flap with a tightly rolled dermal graft for nipple reconstruction improves the long-term maintenance of nipple projection. Its advantages include reproducibility, technical simplicity, cost-effectiveness, and minimal donor site morbidity.