• Archives of Plastic Surgery
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• 제37권6호
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• pp.808-814
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• 2010

Purpose: The sunken chest deformity without breast asymmetry is not a rare condition encountered in augmentation mammaplasty. Therefore, failure to recognize the deformity and improper surgical plan will lead to a suboptimal result. The authors review the experience of breast augmentation in simple sunken chest patient based on retrospectively collected data. Methods: From January, 2008 to January, 2009, patients with simple sunken chest underwent endoscopic submuscular augmentation mammaplasty through axilla, using silicone implants. Patient demographics were queried and outcomes were assessed. Results: Eleven patients (22 breasts) were followed up for 8.2 months after surgery. Sunken chests were augmented with implant size of approximately 248.9 cc (range: 213~286 cc) and contralateral chest with 211.4 cc (range: 180~235 cc). Simultaneous camouflaging the chest wall depression with breast augmentation resulted in good aesthetic outcome. All of the patients were satisfied with the surgery. There were no complications among all patients. Conclusion: We have demonstrated proper surgical planning with precise implant selection to optimize results in patients with small breast and simple sunken chest. Even though asymmetry still remains after the operation, it is still considered as acceptable.

• Archives of Plastic Surgery
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• 제46권1호
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• pp.79-83
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• 2019

Robotic surgery facilitates surgical procedures by employing flexible arms with multiple degrees of freedom and providing high-quality 3-dimensional imaging. Robot-assisted nipple-sparing mastectomy with immediate reconstruction is currently performed to avoid breast scars. Four patients with invasive ductal carcinoma underwent robot-assisted nipple-sparing mastectomy and immediate robot-assisted expander insertion. Through a 6-cm incision along the anterior axillary line, sentinel lymph node biopsy and nipple-sparing mastectomy were performed by oncologic surgeons. The pectoralis major muscle was elevated, an acellular dermal matrix (ADM) sling was created with robotic assistance, and an expander was inserted into the subpectoral, sub-ADM pocket. No patients had major complications such as hematoma, seroma, infection, capsular contracture, or nipple-areolar necrosis. The mean operation time for expander insertion was 1 hour and 20 minutes, and it became shorter with more experience. The first patient completed 2-stage prosthetic reconstruction and was highly satisfied with the unnoticeable scar and symmetric reconstruction. We describe several cases of immediate robot-assisted prosthetic breast reconstruction. This procedure is a feasible surgical option for patients who want to conceal surgical scars.

• 생체재료학회지
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• 제22권4호
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• pp.319-327
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• 2018

Background: Silicone implants are biomaterials that are frequently used in the medical industry due to their physiological inertness and low toxicity. However, capsular contracture remains a concern in long-term transplantation. To date, several studies have been conducted to overcome this problem. This review summarizes and explores these trends. Main body: First, we examined the overall foreign body response from initial inflammation to fibrosis capsule formation in detail and introduced various studies to overcome capsular contracture. Secondly, we introduced that the main research approaches are to inhibit fibrosis with anti-inflammatory drugs or antibiotics, to control the topography of the surface of silicone implants, and to administer plasma treatment. Each study examined aspects of the various mechanisms by which capsular contracture could occur, and addressed the effects of inhibiting fibrosis. Conclusion: This review introduces various silicone surface modification methods to date and examines their limitations. This review will help identify new directions in inhibiting the fibrosis of silicone implants.

• Archives of Plastic Surgery
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• 제47권5호
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• pp.419-427
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• 2020

Background This study evaluated the Blossom system, an innovative self-filling, rate-controlled, pressure-responsive saline tissue expander (TE) system. We investigated the feasibility of utilizing this technology to facilitate implant-based and combined flap with implant-based breast reconstruction in comparison to conventional tissue expansion. Methods In this prospective, single-center, single-surgeon pilot study, participants underwent either implant-based breast reconstruction or a combination of autologous flap and implantbased breast reconstruction. Outcome measures included time to full expansion, complications, total expansion volume, and pain scores. Results Fourteen patients (TEs; n=22), were included in this study. The mean time to full expansion was 13.4 days (standard error of the mean [SEM], 1.3 days) in the combination group and 11.7 days (SEM, 1.4 days) in the implant group (P=0.78). The overall major complication rate was 4.5% (n=1). No statistically significant differences were found in the complication rate between the combination group and the implant group. The maximum patient-reported pain scores during the expansion process were low, but were significantly higher in the combination group (mean, 2.00±0.09) than in the implant group (mean, 0.29±0.25; P=0.005). Conclusions The reported average duration for conventional subcutaneous TE expansion is 79.4 days, but this pilot study using the Blossom system achieved an average expansion duration of less than 14 days in both groups. The Blossom system may accommodate single-stage breast reconstruction. The overall complication rate of this study was 4.5%, which is promising compared to the reported complication rates of two-stage breast reconstruction with TEs (20%-45%).

• 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.

• Archives of Plastic Surgery
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• 제49권2호
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• pp.158-165
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• 2022

Background Implant-based breast reconstruction has evolved tremendously in the last decades, mainly due to the development of new products and techniques that make the procedure safer and more reliable. The purpose of this study was to compare the outcomes in immediate one-stage breast reconstruction between acellular dermal matrix (ADM) and inferior dermal flap (IDF). Methods We conducted a retrospective comparative study of patients submitted to immediate breast reconstructions with an anatomical implant and ADM or IDF in a single center between 2016 and 2018. Outcomes evaluated included major complications, early complications, reinterventions, readmissions, and reconstruction failure. Simple descriptive statistics and univariate analysis were performed. Results A total of 118 breast reconstructions (85 patients) were included in the analysis. Patients in the IDF group had a higher body mass index (median = 27.0) than patients in the ADM group (median = 24). There were no statistically significant differences among both groups regarding immediate major complication, early complications, readmissions, and reinterventions. Conclusion There are no significant differences in complications between the ADM and IDF approach to immediate implant breast reconstruction. In patients with higher body mass index and large, ptotic breasts, we recommend an immediate implant reconstruction with IDF.

• Archives of Plastic Surgery
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• 제42권3호
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• pp.321-326
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• 2015

Background The acellular dermal matrix (ADM)-assisted breast reconstruction technique is widely known, but discouraging results due to early postoperative complications have been reported. As the literature identifies seroma as the most common issue after breast surgery without identifying its pathogenesis, we aimed to report the trend of postoperative daily serum collection after ADM-assisted breast reconstruction and compare it with data in the literature in order to discover more about this little-known topic. Methods A retrospective study on 28 consecutive patients who received ADM-assisted breast reconstruction between February 2013 and February 2014 was performed. In order to reduce the number of variables that could affect serum production, only one brand of ADM was used and all tissues were handled gently and precisely. The daily drainage volume was recorded per patient during the first four days of hospitalization. Likewise, postoperative complications were noted during routine follow-up. Results In total, five (17.9%) bilateral and 23 (82.1%) unilateral ADM-assisted breast reconstructions (33 implants) were performed. The mean age, body mass index, and length of hospital stay were 53.6 years, $21.3kg/m^2$, and 4.5 days, respectively. One major complication led to implant loss (3.0%), and nine minor complications were successfully treated with ambulatory surgery (27.3%). Serum collection linearly decreased after 24 hours postoperatively. Conclusions Daily drainage decreased following the theoretical decline of acute inflammation. In concordance with the literature, daily serum production may not be related to the use of ADM.

• 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.

• 한국방사선학회논문지
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• 제8권5호
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• pp.217-223
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• 2014

본 연구에서 Phantom에 고 밀도 물질이 삽입 된 CT 영상을 재구성 하여 방사선 치료 계획 시 선량 분포에 대한 평가를 하고자 하였다. Gammex 467 Tissue Characterization Phantom을 사용하여 인체 조직과 유사한 영상을 획득하였고 Titanium을 삽입하여 금속물로 인한 인공허상을 발생시켜 영상을 획득하였다. 획득한 영상은 Metal Artifact Reduction for Orthopedic Implants (O-MAR)를 이용하여 영상을 재구성 하였고 전산화 치료계획 시스템을 이용하여 체적을 분석 하고 선량 분포를 추출하였다. $MapCHECK^{TM}$을 이용하여 선형가속기의 광자선 선량 분포를 측정하여 계획한 선량 분포와 비교 분석 하였다. 비교 분석 결과 Titanium으로 인한 인공허상이 발생 되었을 때 O-MAR를 적용한 체적은 BR-12 Breast는 16.8 % 그리고 LV 1 Liver는 40.2 % 증가하였고 선량 분포는 O-MAR를 적용하기 전의 선량 분포 보다 1.4 에서 1.6 % 높게 나타났다. 결론적으로 금속물로 발생된 인공허상 O-MAR를 적용하여 가능한 제거하고 치료계획에 이용해야 오류를 줄일 수 있을 것으로 사료된다.

• Archives of Plastic Surgery
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• 제33권2호
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• pp.155-160
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• 2006

Although several reports have been introduced about dual plane augmentation mammaplasty, the description of periareolar approach dual plane augmentation mammaplasty was few. This article describes specific characteristics, and different classification and techniques for the periareolar dual plane breast augmentation while postoperative scars resulted from inframammary crease approach caused complaints. A total of 124 patients(248 breasts) had periareolar dual plane augmentation surgery from 1998 to 2004. Anatomic implants were used in 43 cases. Most of the patients were satisfied with the outcomes of periareolar dual plane augmentation. Periareolar dual plane augmentation mammaplasty adjusts implant and tissue relationships to ensure adequate soft-tissue coverage while optimizing implant-breast parenchymal dynamics to offer increased benefits and fewer faults compared to a single pocket location in a wide range of breast types with minimal scars. Two types of dual plane classifications are discussed in this study for the periareolar approach exclusively. The boundaries of retroglandular dissection remain constant, as the costal origin of pectoralis major are divided. Type A dual plane implies that the inferior edge of pectoralis muscle lies below the inferior areolar border, and type B dual plane implies that the inferior edge lies above the superior areolar border.