• Archives of Plastic Surgery
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• 제37권1호
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• pp.83-86
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• 2010

Purpose: Authors present the case of 2 patients who underwent extended Latissimus dorsi myocutaneous flap to reconstruct postburn breast deformity. Methods: A 39-year-old woman and 18-year-old woman with postburn breast deformity visited for reconstruction. The nipples were preserved but normal breast development did not occur due to scar contracture. Burn scar contracture was released by excision of the restricting burn scar and breast mound was reconstructed with extended Latissimus dorsi myocutaneous flap. Additional contracture release with multiple z-plasty was performed at the axillae and medial portion of breast. Results: Postburn breast reconstruction using Latissimus dorsi myocutaneous flap showed natural shaped breast mound and inframammary fold. There was no significant complication in both cases. Conclusion: Latissimus dorsi myocutaneous flap provide sufficient skin and soft tissue and it could be an effective method for reconstruction of postburn breast deformity.

• Archives of Plastic Surgery
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• 제36권6호
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• pp.784-787
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• 2009

Purpose: Reduction mammaplasty is one of the most commonly performed operations in plastic surgery. Although secondary surgery is occasionally required for minor aesthetic problems or for treatment of the complications of the primary surgery, there are no clear operative guidelines of management. We report here two cases of secondary reduction mammaplasty using differrent pedicle from the initial ones. Methods: One case of secondary reduction mammaplasty were performed using medial pedicle after central (19 years) pedicle reduction mammaplasty because of subsequent breast ptosis and asymmetry. The other case were performed using medial pedicle after superior (4 years) pedicle reduction mammaplasty with contralateral immediate breast reconstruction with TRAM flap because of subsequent breast ptosis and asymmetry. Care was taken to include sufficient width of pedicle and adequate soft tissue attachment beneath the nipple - areolar complex. Results: There was no significant complication such as nipple - areolar necrosis or fat necrosis. The results were well maintained throughout the follow - up period. Conclusion: Medial pedicle reduction mammaplasty can be safely performed after central or superior pedicle reduction mammaplasty when sufficient width of pedicle and adequate soft tissue attachment beneath the nipple - areolar complex are maintained.

• Archives of Plastic Surgery
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• 제36권6호
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• pp.767-772
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• 2009

Purpose: Among reasons for reoperations in augmentation mammoplasty, palpable implant, due to thin skin is relatively common, but not easy to correct, especially if thin skin area is wide. The capsule around the implant is a physiologic response to foreign body, naturally formed, and suitable for use as a flap because of its high vascularity. Authors report that capsular flap is very effective and successful method for correction of implant palpability in secondary breast augmentation. Methods: From September 2007 to September 2008, the capular flaps were performed on 5 patients having palpable and wrinkling breast implants due to very thin skin among the cases on whom secondary augmentation mammaplasty had been performed. After the capsular flap was elevated according to thin skin area, the capsular flap was turned down or over to cover the thin skin area and made the thin skin area thick. Results: Post - implant palpable breast wrinkling had been successfully corrected by capsular flaps and breast implants were not palpable any more during the follow - up period(average 9.2 months). All patients who suffered from deformed breast were satisfied. Conclusion: Authors suggest that the capsular flap is a ideal, effective and useful method in management of implant palpability.

• Archives of Plastic Surgery
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• 제34권1호
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• pp.88-92
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• 2007

Purpose: Free nipple graft reduction mammaplasty is a simple and effective way to reduce huge breasts. However, this technique is frequently criticized for producing poor projection and hypopigmentation of the nipple areola complex(NAC). Methods: Sixty three patients(126 breasts) underwent the procedure from 1998 to 2005. Authors' method is similar with the modified Gradinger's technique except the keyhole pattern. After skin flap closing, the position of NAC is determined considering symmetry. The NAC is initially harvested and then resection of the breast followed, leaving a deepithelized inferior parenchymal pedicle($5{\times}5cm$). The upper point of inferior pedicle is sutured to the fascia of the pectoralis to produce the upper bulge. The nipple is replaced as a free and composite graft. Results: An average of 823grams of breast tissue per breast was removed. There was no major complications. All grafted nipples showed long lasting projection. And also, all NAC eventually regained their normal color except for 3 patients who needed medical tattoos. The overall results were good and patient satisfactory score was high. Conclusion: This useful technique greatly enhances long lasting projection and recovers nipple color.

• Archives of Plastic Surgery
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• 제34권1호
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• pp.105-110
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• 2007

Purpose: The major drawback of submuscular augmentation of the ptotic breast is a "double-bubble" deformity. If a traditional mastopexy is added to correct the ptosis, there would be additional scars. This article describes simultaneous periareolar mastopexy with dual plane or subfascial breast augmentations. Methods: A series of 81 patients with grade I or II ptosis underwent the procedure from 1999 to 2005. Out of these, dual plane augmentation was done in 71 cases and subfascial plane in 10. After periareolar skin excision, an incision is made perpendicularly down to the fascia of pectoralis. At the lower pole, all breast implants are inserted into the subfascial plane. In case of upper pole thickness of above 20 mm, we inserted the implant into the subfascial plane, whereas below 20 mm, we inserted that into the submuscular plane. Results: No major complications were noted and patients' satisfactory score was high. This technique avoids the "double-bubble" deformity and leaves a minimal periareolar scar. Conclusion: Simultaneous periareolar mastopexy/breast augmentation is useful for correction of the ptotic breast, increasing the volume of breast and providing the natural breast shape with minimal scars. We consider that subfascial plane augmentation with periareolar mastopexy to be an alternative for cases with breast upper pole thickness of at least above 20 mm.

• Archives of Plastic Surgery
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• 제34권1호
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• pp.134-136
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• 2007

Purpose: Erysipelas is a bacterial infection of the dermis and hypodermis, mostly of streptococcal origin, and erysipelas of upper extremity following breast cancer treatment has never been reported in the Korean literature. Methods: 39-year-old female presented to our hospital complaining of fever and painful swelling of her left upper extremity. She had a history of breast cancer and was treated with breast conserving surgery with axillary lymph node dissection, chemotherapy, and radiation. On physical examination, her left upper extremity showed vesicle, bullae, local heatness and erythema with well-defined margin. With these distinctive features of a skin lesion, we gave a diagnosis of erysipelas and started treatment with intravenous antibiotics. Results: Resolution of the signs and symptoms of erysipelas occurred after 7 days of treatment. Conclusion: The diagnosis of erysipelas with distinctive feature of skin lesion is essential and we emphasize that the prevention of any trauma are very important in these patients for prophylactic measures.

• Archives of Plastic Surgery
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• 제38권4호
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• pp.539-542
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• 2011

Purpose: Despite the increasing number of patients with HIV (human immunodeficiency virus) infection, surgical experience with these patients remains limited in aesthetic and reconstructive surgery. The authors performed breast reconsruction with free TRAM (Transverse Rectus Abdominis Muculocutaneous) flap in HIV infected patient firstly in Korea. Methods: A 53-years-old female with HIV positive underwent delayed breast reconstruction with free TRAM flap and 6 months lateral nipple reconstruction was performed. All procedures were performed according to the HIV infection control guidelines provided by the Korea Centers for Disease Control and Prevention. Results: There were no complications such as infection, hematoma and flap loss and symmetry of breast was achieved. Conclusion: When the operation is performed in line with the guidelines of HIV infection control, breast reconstruction with free flap is possible and can obtain successful results.

• Archives of Plastic Surgery
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• 제38권4호
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• pp.527-530
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• 2011

Purpose: Liver transplantation is a groundbreaking section in the field of surgery. Nowadays over 90% of success rate is accomplished and life expectancy of the patients has been elongated. Patients are now seeking for surgical procedures including cosmetic plastic surgery. But these patients take immunosuppressive medication and steroids, which can increase the risk of wound infection, and delay wound healing. By reviewing the case of a 21-year-old liver transplant recipient who underwent mastopexy due to breast ptosis, we discussed about the matters we should consider when performing surgery in liver transplantation recipients. Methods: The patient was a 21-year-old female who received liver transplantation from her father. She was exposed to massive amount of steroids and immunosuppressants, which led to breast ptosis. The vertical and short horizontal incision mastopexy using a medial-based pedicle was done, 29 months after the liver transplantation. Results: On postoperative day 1, she was discharged. On day 10, sutures were removed and taping was applied. There was no sign of wound infection, wound dehiscence, hematoma or bleeding. The patient was followed up at 3, 6 and 9 months after the operation. Mild recurrence of the glandular ptosis was observed but revision was not required. Conclusion: We were able to successfully operate without any complications in the liver transplant recipient. With special attention and consideration, cosmetic plastic surgery can be safely performed in organ transplantation recipients.

• Archives of Plastic Surgery
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• 제37권6호
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• pp.732-735
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• 2010

Purpose: In performing breast reconstruction, making symmetrical breast is still a challenge. A precise estimate of the volume of the breast specimen is necessary to reconstruct a symmetrical and aesthetically pleasing breast. This study aims at finding out the relationship with breast tissue density and body mass index designed to apply for breast reconstruction. Methods: By using the Archimedes' principle, the authors calculated the volume of the breast specimen and drew a correlation between the density of breast specimen and BMI. From October 2002 to November 2004, this method was used on 197 patients to predict breast volume for TRAM flap reconstruction. Results: The mean density was 0.9954g/cc and had no correlation with BMI (p-value=0.069). There was no difference between denstiy of breast tissue after skin spared mastectomy and that of breast tissue after nipple spared mastectomy. Conclusion: These data will be helpful to predict the needed volume for breast reconstruction.

• 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.