• Journal of Yeungnam Medical Science
• /
• 제36권3호
• /
• pp.201-207
• /
• 2019

Implant-based breast reconstruction is the most commonly used reconstruction technique after mastectomy. This is because skin-sparing mastectomy has become possible with advancements in oncology. In addition, the development of breast implants and the advent of acellular dermal matrices have reduced postoperative complications and resulted in superior cosmetic results. The most frequently performed surgical breast reconstruction procedure for the past 20 years was the insertion of an implant under the pectoralis major muscle by means of the dual plane approach. However, some patients suffered from pain and animation deformity caused by muscle manipulation. Recently, a prepectoral approach has been used to solve the above problems in select patients, and the results are similar to subpectoral results. However, this technique is not always chosen due to the number of considerations for successful surgery. In this article, we will discuss the emergence of prepectoral breast reconstruction, indications and contraindications, surgical procedures, and outcomes.

• 한국방사선학회논문지
• /
• 제14권3호
• /
• pp.253-259
• /
• 2020

유방촬영은 경제적이고 간편하며 미세석회화 검출에 효과적이라는 장점이 있으나, 유방은 감수성이 높은 장기이므로 확률적 영향에 의한 암 발생 위험을 동반한다. 이를 최소화하기 위해 정확한 유방 선량 평가가 필요하나, 현재 유방선량 평가는 일반여성들에게 한정되어 유방성형술 환자에게는 제한적이다. 본 연구는 유방성형환자의 정확한 선량 평가를 위하여 유방 보형물이 삽입된 모의피폭체를 구성하여 관전압에 따른 선량변화를 알아보고자 하였다. 그 결과, 유방 보형물이 있는 경우, 보형물이 없을 때의 선량보다 낮은 결과를 나타내었다. 검사 시 관전압 조건에 따른 선량 분포는 보형물의 유·무와 관계없이 관전압이 높아질수록 선량이 높아지는 양상을 보였다. 추후 본 연구를 통해 유방성형환자의 선량 관리 측면의 진단참고 수준 확립을 위한 기초적인 자료로서 활용 가능할 것으로 사료된다.

• Archives of Plastic Surgery
• /
• 제41권3호
• /
• pp.258-263
• /
• 2014

Background For early breast cancer patients, skin-sparing mastectomy or nipple-sparing mastectomy with sentinel lymph node biopsy has become the mainstream treatment for immediate breast reconstruction in possible cases. However, a few cases of skin necrosis caused by methylene blue dye (MBD) used for sentinel lymph node localization have been reported. Methods Immediate breast reconstruction using a silicone implant was performed on 35 breasts of 34 patients after mastectomy. For sentinel lymph node localization, 1% MBD (3 mL) was injected into the subareolar area. The operation site was inspected in the postoperative evaluation. Results Six cases of immediate breast reconstruction using implants were complicated by methylene blue dye. One case of local infection was improved by conservative treatment. In two cases, partial necrosis and wound dehiscence of the incision areas were observed; thus, debridement and closure were performed. Of the three cases of wide skin necrosis, two cases underwent removal of the dead tissue and implants, followed by primary closure. In the other case, the breast implant was salvaged using latissimus dorsi musculocutaneous flap reconstruction. Conclusions The complications were caused by MBD toxicity, which aggravated blood disturbance and skin tension after implant insertion. When planning immediate breast reconstruction using silicone implants, complications of MBD should be discussed in detail prior to surgery, and appropriate management in the event of complications is required.

• Archives of Plastic Surgery
• /
• 제47권3호
• /
• pp.235-241
• /
• 2020

Background This is the first clinical study conducted among Asian women using breast implants manufactured by an Asian company. Four-year data regarding the safety and efficacy of BellaGel breast implants have already been published, and we now report 6-year data. Methods This study was designed to take place over 10 years. It included 103 patients who underwent breast reconstruction or augmentation using BellaGel breast implants. The rates of implant rupture and capsular contracture were measured and analyzed to evaluate the effectiveness of the breast implant. Results At patients' 6-year postoperative visits, the implant rupture and capsular contracture rates were 1.15% and 2.30%, respectively. The implant rupture rate was 3.77% among reconstruction cases and 0% among augmentation cases. The capsular contracture rate was 5.66% among reconstruction cases and 0.83% among augmentation cases. Conclusions The 6-year data from this planned 10-year study suggest that the BellaGel cohesive silicone gel-filled breast implant is an effective and safe medical device that can be used in breast reconstruction and augmentation.

• 대한방사선기술학회지:방사선기술과학
• /
• 제41권1호
• /
• pp.33-38
• /
• 2018

There are limits to check the lesion as inserting a breast implant patients. So the application of BSGI based on Nuclear Medicine examination has increased. In this study, therefore we confirmed the effect of the image applying to breast implants in Breast Specific Gamma Imaging. We utilized Dilon 6800 BSGI scanner and developed the phantom. The self-development phantom was a rectangular shape of $230{\times}190{\times}80mm$ size and had 5 spheres which consisted of diameters of 10, 13, 17, 22, 28 mm in central part. We injected $^{99m}TcO_4$ into the self-development phantom in the proportion of four to one and made each additional phantom filled with 0.9 % sodium chloride, silicon and paraffin. Each additional phantom was placed between detector and self-development phantom. Each image was acquired five times depending on the type and thickness of the additional phantom. Statistical analysis with SPSS ver.18 was applied. In the test of variation according to the thickness of all additional phantoms, as the phantoms which 0.9% sodium chloride, silicon and paraffin increased, the attenuation variation was higher(P<0.005). There was no significant difference in the attenuation variation and the quality of image for type of the additional phantom. Therefore, if the effect of the image applying to breast implants in Breast Specific Gamma Imaging is confirmed, the higher diagnostic value can be achieved.

• Archives of Plastic Surgery
• /
• 제47권5호
• /
• pp.478-482
• /
• 2020

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) has received increasing interest among plastic surgeons as a long-term complication of breast augmentation. Although the prognosis is usually good, mortality is a possible outcome. Most of the cases reported in the past two decades have been from the United States, Europe, and Australia, whereas cases of BIA-ALCL in Asia remain rare. Herein, we describe the first known case of BIA-ALCL in Thailand, in which a 32-year-old woman developed BIA-ALCL 3 years after breast augmentation using textured implants. The patient underwent bilateral removal of the implants and ipsilateral total capsulectomy. This case report-the first of its kind from Thailand-should increase awareness of BIA-ALCL among plastic surgeons in Asia. The true incidence of BIA-ALCL in Asia may be underreported.

• Archives of Plastic Surgery
• /
• 제46권4호
• /
• pp.375-380
• /
• 2019

Breast tissue expanders (TEs) with magnetic infusion ports are labeled "MR Unsafe." Therefore, patients with these implants are typically prevented from undergoing magnetic resonance imaging (MRI). We report a patient with a total submuscular breast TE who inadvertently underwent an MRI exam. She subsequently developed expander exposure, requiring explantation and autologous reconstruction. The safety profile of TEs with magnetic ports and the use of MRI in patients with these implants is surprisingly controversial. Therefore, we present our case report, a systematic literature review, and propose procedural guidelines to help ensure the safety of patients with TEs with magnetic ports that need to undergo MRI exams.

• Archives of Plastic Surgery
• /
• 제50권2호
• /
• pp.156-159
• /
• 2023

Breast implants whether used for cosmetic or reconstructive purposes can be placed in pockets either above or below the pectoralis major muscle, depending on clinical circumstances such as subcutaneous tissue volume, history of radiation, and patient preference. Likewise, cardiac implantable electronic devices (CIEDs) can be placed above or below the pectoralis major muscle. When a patient has both devices, knowledge of the pocket location is important for procedural planning and for durability of device placement and performance. Here, we report a patient who previously failed subcutaneous CIED placement due to incision manipulation with prior threatened device exposure requiring plane change to subpectoral pocket. Her course was complicated by submuscular migration of the CIED into her breast implant periprosthetic pocket. With subcutaneous plane change being inadvisable due to patient noncompliance, soft tissue support of subpectoral CIED placement with an acellular biologic matrix (ABM) was performed. Similar to soft tissue support used for breast implants, submuscular CIED neo-pocket creation with ABM was performed with durable CIED device positioning confirmed at 9 months postprocedure.

• Archives of Plastic Surgery
• /
• 제37권6호
• /
• pp.749-757
• /
• 2010

Purpose: Since skin sparing mastectomy removes the mammary gland and the nipple-areolar complex preserving all mammary skin, it makes the widespread use of implants in immediate reconstruction. This article reports our experience in immediate breast reconstruction after skin sparing mastectomy by using the silicone implants in patients especially who have small to moderate sized and minimal ptotic breast. Methods: From September of 2007 to July of 2009, we performed breast reconstruction for 44 breasts of 40 women with silicone implant after mastectomy. Tumors were divided into 5 malignant types (21 IDC, 18 DCIS, 2 ILC, 2 phylloides tumor, 1 mucinous carcinoma). The implant is placed in a submuscular pocket or in a submuscularsubfascial pocket depending upon the condition of the muscles and skin flaps after mastectomy. Results: The mean age was 47 years and the average follow-up period was 11 months. Cosmetic outcome was assessed by evaluation of photographs and assessment of breast volume and shape, breast symmetry, and overall outcome. About 80% of each of these parameters was scored as good or excellent. Breast complication was developed in a total of 6 cases including 2 capsular contracture, 2 partial skin necrosis due to blue dye injection and 2 implant infection. Conclusion: The use of definitive implants in a skin sparing mastectomy is a one-stage immediate breast reconstruction with low morbidity and acceptable result. This method is considered reliable with favorable aesthetic result.

• Archives of Plastic Surgery
• /
• 제46권4호
• /
• pp.386-389
• /
• 2019

The development of breast implant technology continues to evolve over time, but changes in breast shape after implantation have not been fully elucidated. Thus, we performed computerized finite element analysis in order to better understand the trajectory of changes and stress variation after breast implantation. The finite element analysis of changes in breast shape involved two components: a static analysis of the position where the implant is inserted, and a dynamic analysis of the downward pressure applied in the direction of gravity during physical activity. Through this finite element analysis, in terms of extrinsic changes, it was found that the dimensions of the breast implant and the position of the top-point did not directly correspond to the trajectory of changes in the breast after implantation. In addition, in terms of internal changes, static and dynamic analysis showed that implants with a lower top-point led to an increased amount of stress applied to the lower thorax. The maximum stress values were 1.6 to 2 times larger in the dynamic analysis than in the static analysis. This finding has important implications for plastic surgeons who are concerned with long-term changes or side effects, such as bottoming-out, after anatomic implant placement.