• Archives of Plastic Surgery
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• 제45권2호
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• pp.177-179
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• 2018

We present a case report of a patient who experienced a late, spontaneous breast hematoma 26 years after primary breast augmentation. Late hematomas are a rare complication of breast augmentation with uncertain etiology. In this case, there was no trauma, calcifications, or implant rupture. We believe the patient's hematoma was secondary to erosion of a capsular vessel due to capsular contracture.

• Asian Pacific Journal of Cancer Prevention
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• 제16권6호
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• pp.2531-2535
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• 2015

Background: Breast cancer diagnosed in young women may be more aggressive, with higher rates of local and distant recurrence compared to the disease in older women. Epidemiologic evidence suggests that Korean women have a lower incidence of breast cancer than women in the United States, but that they present at a younger age than their American counterparts. We sought to compare risk factors and management of young women with breast cancer in Boston, Massachusetts (US) with those in Seoul, South Korea (KR). Materials and Methods: A retrospective review was performed of consecutive patients less than 35 years old with a diagnosis of breast cancer at academic cancer centers in the US and KR from 2000-2005. Patient data were obtained by chart review. Demographic, tumor and treatment characteristics were compared utilizing Pearson's chisquare or Wilcoxon rank-sum tests where appropriate. All differences were assessed as significant at the 0.05 level. Results: 205 patients from the US and 309 from KR were analyzed. Patients in US were more likely to have hormone receptor positive breast cancer, while patients in KR had a higher rate of triple negative lesions. Patients in US had a higher mean body mass index and more often reported use of birth control pills, while those in the KR were less likely to have a sentinel node procedure performed or to receive post mastectomy radiation. Conclusions: Patients under 35 diagnosed with breast cancer in the US and KR differ with respect to demographics, tumor characteristics and management. Although rates of breast conservation and mastectomy were similar, US patients were more likely to receive post mastectomy radiation. The lower use of sentinel node biopsy is explained by the later adoption of the technique in KR. Further evaluation is necessary to evaluate recurrence rates and survival in the setting of differing disease subtypes in these patients.

• Archives of Plastic Surgery
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• 제49권5호
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• pp.580-586
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• 2022

Background Appropriate position of the nipple-areolar complex (NAC) is crucial following nipple-sparing mastectomy (NSM). The prevention of NAC malposition in two-stage implant-based breast reconstruction has not been well described, and the efficacy of the techniques has not been evaluated. This study aimed to evaluate the efficacy of our technique to prevent NAC malposition in patients who underwent implant-based breast reconstruction after NSM. Methods Patients who underwent two-stage implant-based breast reconstruction with NSM between January 2012 and December 2019 were included. We used a surgical technique to fix the NAC to the rigid base, assuming a pocket-like appearance, with pectoralis major muscle and lateral adipofascial flap at the time of tissue expander (TE) insertion. Patients were classified into two groups based on the performance of the technique for the prevention of NAC malposition. Results In 35 patients who underwent implant-based breast reconstruction after NSM, the clavicle-to-nipple distance ratio was 96.0±5.0% in those who underwent NAC fixation and 86.1±11.5% in those who did not undergo NAC fixation. Conclusions Using our technique, NAC malposition could be prevented in two-stage implant-based breast reconstruction. NAC fixation during TE insertion was found to be extremely effective. This procedure successfully prevented NAC malposition without the formation of extra scars.

• Archives of Plastic Surgery
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• 제47권2호
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• pp.160-164
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• 2020

Background Implant-based dual-plane augmentation mammoplasty requires accurate separation of the pectoralis major muscle (PMM) at its origins. The authors identified the PMM origins during breast reconstruction surgery with the goal of providing additional information on subpectoral implant insertion for reconstructive or aesthetic purposes. Methods This study was conducted on 67 patients who underwent breast reconstruction surgery at the breast center of our hospital between November 2016 and June 2018. In total, 34 left and 39 right hemithoraces were examined. The left and right hemithoraces were each divided into 15 zones to determine the percentage of PMM attachments in each zone. The distribution of PMM origins in each zone was examined to identify any statistically significant differences. Results There were no statistically significant differences in the origins of the PMM between the right and left hemithoraces. The percentage of attachments increased moving from the fourth to the sixth rib and from the lateral to the medial aspect. Conclusions The anatomical findings of this study could be used as a reference for accurate dissection of the origins of the PMM for the preparation of the subpectoral pocket for subpectoral implant placement.

• Archives of Plastic Surgery
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• 제49권2호
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• pp.166-173
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• 2022

The introduction of acellular dermal matrix (ADM) to breast reconstruction has allowed surgeons to reexplore the prepectoral implant placement technique in postmastectomy breast reconstruction. Our institution adopted a novel approach using meshed ADM to lessen the financial burden of increased ADM utilization with the prepectoral breast reconstruction. This is a retrospective, single-center review of two-stage prepectoral breast reconstruction using meshed human-derived ADM for anterior prosthesis coverage. Patient demographics, oncologic data, perioperative characteristics, and complications were examined and reported as means with standard deviations. Cost-saving with the meshed technique was evaluated. Forty-eight patients (72 breasts) with a mean age of 48.5 ± 15.0 years (range 26-70 years) were included in the study. The mean follow-up time was 13.2 ± 4.4 months (range 4.1-25.8 months). Nineteen breasts (24.6%) experienced complications, with seromas being the most common complication (12.5%, n = 9). Expander removal and reoperation occurred at a rate of 8.3 and 9.7%, respectively. The average time to drain removal was 18.8 ± 6.6 days (range 8-32 days). Meshed ADM provided an average cost savings of $6,601 for unilateral and $13,202 for bilateral reconstructions. Our study found that human-derived meshed ADM can be safely used in two-staged prepectoral tissue expander-based breast reconstruction and can result in significant cost savings.

• Archives of Plastic Surgery
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• 제40권3호
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• pp.244-246
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• 2013

Lipomas are benign mesenchymal tumors that develop in areas of abundant adipose tissue. Due to the fatty composition of the breast, difficulties in diagnosis, treatment, and reconstruction are often encountered. We report a case of a 55-year-old female with a giant tumor of the right breast that comprised most of its mass, causing breast asymmetry. A thorough preoperative evaluation, followed by an uneventful difficult surgical resection and reconstruction, resulted in diagnosis of a benign lipoma. The case prompted this report because of its challenging size, location, diagnosis, and reconstructive solution.

• Archives of Plastic Surgery
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• 제34권5호
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• pp.622-627
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• 2007

Purpose: Although the autogenous tissue transfer has been the mainstay of the breast reconstruction, concern for the donor site morbidity can lead to the superseded method using tissue expander with implant or permanent expander-implant. However, the additional procedure of tissue expansion possibly cause discomfort and raise the cost. We tried to verify the efficacy of using the saline-filled breast implant by itself for the safe and convenient immediate breast reconstruction modality if the patients have small, round and non-ptotic breasts and the sufficient breast skin can be saved with mastectomy. Methods: From July 2002 to July 2005, 29 breasts of 26 patients were restored only with the saline-filled breast implant immediately after the skin sparing or nipple-areolar skin sparing mastectomy in Asan Medical Center. A pocket with pectoralis major and serratus anterior muscle was created and the implant was covered with this muscle pocket. Simultaneous contralateral augmentation was performed in patients whose mastectomy specimen weighed less than 100g. Results: Using only the saline-filled breast implant resulted in the successful reconstruction with few complications including partial necrosis of nipple areolar skin (five cases, 17.2%), capsular contracture (three cases, 10.3%), hematoma (one case, 3.4%), depigmentation of areolar skin (one case, 3.4%), hypertrophic scar (one case, 3.4%), which were all healed by conservative management. There were no significant complications such as implant exposure and subsequent removal. Conclusion: Immediate breast reconstruction only with the saline-filled breast implant can be a satisfactory alternative option for the patients whose breast is small, round and non-ptotic, especially when the nipple-areolar skin of the breast is preserved in the mastectomy.

• Asian Pacific Journal of Cancer Prevention
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• 제14권1호
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• pp.195-200
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• 2013

Secreted protein acidic and rich in cysteines-like protein 1 (SPARCL1), an extracellular matrix glycoprotein, has been implicated in the pathogenesis of several disorders including cancer. However, little is known about the expression and significance of SPARCL1 in human breast cancer. The aim of this study was to determine the expression pattern and clinicopathological significance of SPARCL1 in a Chinese breast cancer cohort. mRNA and protein expression of SPARCL1 in human breast cancer cell lines and breast cancer tissues was detected using the reverse transcription-polymerase chain reaction, real-time quantitative PCR, and Western blotting, respectively. Immunostaining of SPARCL1 in 282 Chinese breast cancer samples was examined and associations with clinicopathological parameters were analyzed. Compared to the positive expression in immortalized human breast epithelial cells, SPARCL1 was nearly absent in human breast cancer cell lines. Similarly, a significantly reduced expression of SPARCL1 was observed in human breast cancer tissues compared to that in normal breast epithelial tissues, for both mRNA and protein levels (P < 0.001). Immunohistochemical analysis showed that strong cytoplasmic immunostaining of SPARCL1 was observed in almost all normal breast samples (43/45) while moderate and strong immunostaining of SPARCL1 was only detected in 191 of 282 (67.7%) breast cancer cases. Moreover, down-regulation of SPARCL1 was significantly correlated with lymphatic metastasis (P = 0.020) and poor grade (P = 0.044). In conclusion, SPARCL1 may be involved in the breast tumorigenesis and serve as a promising target for therapy of breast cancer.

• Archives of Plastic Surgery
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• 제39권3호
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• pp.222-226
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• 2012

Background : Immediate breast reconstruction after mastectomy and delayed breast reconstruction with post-supplementary treatment are the two types of breast reconstruction currently performed when treating breast cancer. Post-mastectomy radiation therapy (PMRT) not only reduces local recurrence but also improves overall survival. However, the complications and survival rates associated with PMRT need to be clear when determining the timing of breast reconstruction. Accordingly, we investigated the optimal timing of breast reconstruction by observing patients who underwent mastectomy followed by PMRT, based on their overall health and aesthetic satisfaction. Methods : We retrospectively reviewed 21 patients who underwent breast reconstruction with PMRT between November 2004 and November 2010. We collected data regarding the various methods of mastectomy, and the modality of adjuvant therapy, such as chemotherapy, hormone therapy, and radiotherapy. Telephone interviews were conducted to study the general and aesthetic satisfaction. Results : Patients who received PMRT after breast reconstruction showed a greater complication rate than those undergoing breast reconstruction after PMRT (P=0.02). Aesthetic satisfaction was significantly higher in the groups undergoing breast reconstruction after PMRT (P=0.03). Patients who underwent breast reconstruction before PMRT developed complications more frequently, but they expressed greater aesthetic satisfaction with the treatment. Conclusions : It is recommended that the complication rates and aesthetic satisfaction after breast reconstruction be carefully considered when determining the optimal timing for radiotherapy.

• Archives of Plastic Surgery
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• 제45권3호
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• pp.239-245
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• 2018

Background Breast reconstruction has become more common as mastectomy has become more frequent. In Korea, the National Health Insurance Service (NHIS) began covering breast reconstruction in April 2015. This study aimed to investigate trends in mastectomy and breast reconstruction over the past 10 years and to evaluate the impact of NHIS coverage on breast reconstruction. Methods Nationwide data regarding mastectomy and breast reconstruction were collected from the Korean Breast Cancer Society registry database. Multiple variables were analyzed in the records of patients who underwent breast reconstruction from January 2005 to March 2017 at a single institution. Results At Seoul National University Hospital, the total number of reconstruction cases increased 13-fold from 2005 to 2016. The proportion of immediate breast reconstruction (IBR) cases out of all cases of total mastectomy increased from 4% in 2005 to 52.0% in 2016. The proportion of delayed breast reconstruction (DBR) cases out of all cases of breast reconstruction and the overall number of DBR cases increased from 8.8% (20 cases) in 2012 to 18.3% (76 cases) in 2016. After NHIS coverage was initiated, the proportions of IBR and DBR showed statistically significant increases (P<0.05). Among the IBR cases, the percentage of prosthesis-based reconstructions increased significantly (P<0.05), but this trend was not found with DBR. Total mastectomy became significantly more common after the expansion of NHIS coverage (P<0.05). Conclusions Over the last decade, there has been an increase in mastectomy and breast reconstruction, and the pace of increase accelerated after the expansion of NHIS coverage. It is expected that breast reconstruction will be a routine option for patients with breast cancer under the NHIS.