• Archives of Reconstructive Microsurgery
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• 제8권1호
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• pp.84-91
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• 1999

The female breast is a potent symbol of maternity, sexuality, and feminity. Unfortunately, the frequency of breast cancer and mastectomy are increasing in Korea, so the reconstruction of breast becomes a important surgical procedure. The purpose of this study is to analyze the results of breast reconstruction using free TRAM flap and to suggest the operative techniques for more successful results. This study is based on a series of 39 cases of breast reconstruction using free TRAM flap in mastectomized patients. Among these cases, 21 patients underwent immediate reconstruction and 18 patients underwent delayed reconstruction. 2 patients underwent immediate bilateral reconstruction. The postoperative courses of these cases are uneventful. Breast reconstruction following mastectomy is one of the most challenging problems in plastic surgery. Nowadays the free TRAM flap is accepted as an excellent method of autogenous tissue breast reconstruction. We conclude that this technique has advantages as follows. The free TRAM flap has not associated with the complications of implant-based reconstruction. It provides sufficient volume for ptotic and natural breast, easily concealed donor site, and secondary aesthetic benefit of abdominoplasty. Unlike conventional pedicled TRAM flap, it has superiority in blood supply, and can make liberal setting of flap and sparing of rectus muscle. So it can provide more satisfaction about the final result of breast reconstruction.

• Archives of Plastic Surgery
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• 제51권1호
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• pp.52-61
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• 2024

Background Although prepectoral implant-based breast reconstruction has recently gained popularity, dual-plane reconstruction is still a better option for patients with poor-quality mastectomy skin flaps. However, shoulder morbidity is aggravated by subpectoral reconstruction, especially in irradiated patients. This study aimed to demonstrate shoulder exercise improvement in subpectoral reconstruction by delayed prepectoral conversion with an acellular dermal matrix (ADM) inlay graft technique at the time of expander-to-implant exchange after irradiation. Methods Patients with breast cancer treated for expander-to-implant exchange after subpectoral expander insertion and subsequent radiotherapy between January 2021 and June 2022 were enrolled. An ADM inlay graft was inserted between the pectoralis major muscle and the previously inserted ADM. The ADM was sutured partially overlapping the pectoralis muscle from the medial side with the transition part, to the muscle border at the lateral side. Perioperative shoulder joint active range-of-motion (ROM) for forward flexion, abduction, and external rotation was also evaluated. Results A total of 35 patients were enrolled in the study. Active shoulder ROM significantly improved from 163 degrees preoperatively to 176 degrees postoperatively in forward flexion, 153 to 175 degrees in abduction, and 69 to 84 degrees in external rotation. There was no difference in patient satisfaction regarding the final outcome between the conventional prepectoral reconstruction group and the study group. Conclusion Shoulder exercises in irradiated patients who underwent subpectoral reconstruction were improved by delayed prepectoral conversion using an ADM inlay graft. It is recommended that subpectoral reconstruction not be ruled out due to concerns regarding muscle contracture and shoulder morbidity in radiation-planned patients with poor mastectomy skin flaps.

• 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.

• 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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• 제38권4호
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• pp.531-534
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• 2011

Purpose: The rectus abdominis myocutaneous flap is currently the most commonly used donor site of immediate and delayed breast reconstruction surgery, for its versatility and ease of handling, as well as sufficient blood supply. Despite many advantages of rectus abdominis flap, morbidity of donor site is considered as inevitable shortcoming. The authors recently faced a devastating complication, small bowel obstruction that led to strangulation, after delayed breast reconstruction with free transverses rectus abdominis myocutaneous (TRAM) flap. And we would like to report it, because abdominal pain after TRAM flap is a common symptom and can be overlooked easily. Methods: A 56-year-old female patient who had history of receiving total abdominal hysterectomy 20 years ago underwent delayed breast reconstruction with TRAM flap transfer. She complained abdominal discomfort and pain from third postoperative day, postoperative small bowel obstruction that arose from strangulated bowel and prompt emergency operation was done. Results: After resection of the strangulated bowel and reanastomosis, quickly her symptoms were relieved, and there were no further problems during her hospital stay. 7 days after her emergency operation she was discharged. Conclusion: In patients with previous abdominal surgical history, prolonged ileus can lead to bowel strangulation, so surgeons should always consider the possibility, and must be aware of abdominal symptoms in patients who receive free TRAM flap operations.

• Archives of Plastic Surgery
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• 제36권4호
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• pp.503-506
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• 2009

Purpose: Unilateral breast reconstruction after mastectomy confront the challenges of recreating a natural appearing breast mound and achieving symmetricalness of the breasts. If the patient's remaining breast is large compared to reconstructed breast, the most common procedure is reduction mammoplasty of the large breast side. The authors experienced a new method of breast reconstruction using the excess breast tissue from the contralateral breast after breast reduction. Methods: The excess tissue from the contralateral breast after vertical reduction mammoplasty with superior pedicle and remaining lower breast tissue were transferred to the mastectomy site breast through the subcutaneous tunnel on the chest wall. The main blood supplies of the flap are perforator branches of the 4th, 5th and 6th anterior intercostal artery. After elevating and detaching the flap on the lower lateral area of the breast, the turn overed flap is fixed on the upper portion of the chest wall of the mastectomy site. Results: On two cases of the breast reconstructions, remaining excess breast tissue from reduction mammoplasty was transferred to the contralateral breast side as pedicles. Both patient and operator were satisfied with the outcome of the reconstruction as the breasts were symmetrical and natural shape. Conclusion: We have performed unilateral breast reconstruction using the excess breast tissue after reduction mammoplasty of the contralateral breast. As Oriental women's breasts are relatively smaller than that of Caucasian women, delayed breast reconstruction cases of Oriental women with large breasts(macromastia) seem to be ideal for this procedure.

• Archives of Plastic Surgery
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• 제50권4호
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• pp.361-369
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• 2023

The latissimus dorsi (LD) flap is a reliable option for breast reconstruction. This is particularly true in patients with contraindications to abdominally based autologous breast reconstruction. A systematic review of patient satisfaction and health related quality of life following LD breast reconstruction using the BREAST-Q survey was conducted. The scope of the review was to determine the degree of patient satisfaction following the procedure and to examine how patient satisfaction from the pedicled LD flap compares to other breast reconstructive procedures. A literature search on BREAST-Q in LD flap reconstruction was performed. Only articles written in English and in published peer-reviewed journals were included. Studies with less than 20 patients in their sample and those with a follow-up period of less than 1 year were excluded. Five articles representing 331 patients were reviewed, including one case-control study and four retrospective cohort studies. Level of evidence was either III (4) or IV (1). The average age was 53 with average body mass index of 25. Most reconstructions were delayed (67%) and unilateral (88%), and most patients required radiation (79%). The average length of follow-up was 36 months, and the response rate was 75%. Overall, patients who underwent LD flap reconstruction reported favorable outcomes in satisfaction domains and quality of life domains with few complications. A meta-analysis also demonstrated higher satisfaction in LD flap without implants compared with LD flap with implants. Patient-reported outcomes following LD breast reconstruction compare favorably with other techniques of breast reconstruction.

• Archives of Plastic Surgery
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• 제35권3호
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• pp.279-282
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• 2008

Purpose: It is known that the chronic absence of unilateral breast can cause spine curvature. The artificial breast manufactures take up the position of that possibility. This study was designed to evaluate the influence of the mastectomy on the spine and appearance of scoliosis among women who wanted delayed breast reconstruction. ted delayed breast reconstruction. Methods: The study population consisted of 47 women who underwent delayed breast reconstruction at our Department of Plastic Surgery from April 2001 to May 2007. The whole spine anteroposterior and lateral X-ray was taken to evaluate the Cobb's angle. As a general rule a Cobb angle of 10 is regarded as a minimum angulation to define scoliosis. We evaluated Cobb's angle and drew a correlation between the duration of the mastectomy state and the weight of the mastectomy specimen. Results: There were no family history of scoliosis, and no numbness or weakness in the upper or lower extremities. They had normal reflex and experienced no tenderness of the perispinal area. The Spearman Correlation Coefficient between Cobb's angle and the period that took time from the mastectomy to the X-rays and analysis between Cobb's angle and specimen weight was 0.032 and-0.115. there were no correlation between Cobb's angle and time, or between Cobb's angle and specimen weight. Conclusion: lthough the patients attribute their back pain and distorted posture to having received an one-sided mastectomy, it is unlikely that one-sided mastectomy causes spinal deformity and scoliosis.

• 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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• 제49권3호
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• pp.324-331
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• 2022

Prior abdominal liposuction can be viewed as a relative or absolute contraindication to abdominally based autologous breast reconstruction given concerns for damaged perforators and scarring complicating intraoperative dissection. This systematic review aims to explore the outcomes of abdominally based breast reconstruction in patients with a history of abdominal liposuction. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-guided literature search was conducted using PubMed, Scopus, and Web of Science from the earliest available date through June 2020. Deep inferior epigastric perforator, muscle-sparing transverse rectus abdominis musculocutaneous (TRAM), superficial inferior epigastric artery, and pedicled TRAM flaps were included for evaluation. Complications included total or partial flap loss, fat necrosis, seroma, delayed wound healing, and donor site complications. After inclusion criteria were applied, 336 non-duplicate articles were screened, yielding 11 for final review, representing 55 flaps in 43 patients. There was no instance of total flap loss, eight (14.5%) flaps developed partial loss or fat necrosis, three (5.4%) flaps had delayed wound healing, and two (4.6%) patients had donor site complications. Most authors (8/11) utilized some type of preoperative imaging. Doppler ultrasonography was the most used modality, and these patients had the lowest rate of partial flap loss or flap fat necrosis (8%), followed by those without any preoperative imaging (10%). In conclusion, this review supports that patients undergoing abdominally based autologous breast reconstruction with a history of abdominal liposuction are not at an increased risk of flap or donor site complications. Although preoperative imaging was common, it did not reliably decrease complications. Further prospective studies are needed to address the role of imaging in improving outcomes.