• Archives of Plastic Surgery
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• v.45 no.3
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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 Reconstructive Microsurgery
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• v.8 no.1
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• pp.28-34
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• 1999

The need for reconstruction of large bone, soft tissue defect of mandible has greater emphasis due to development of industry, traumatic accident and increase of tumor. The mandibular reconstruction had greatly progressed through the first and the second World Wars. The Fibular free flap by using microscope was reported in 1970 and many maxillofacial reconstructive surgeons had used. In 1988, Dr. Hidalgo first reported mandibular reconstruction by using fibular free flap. Mandibular reconstruction by using fibular free flap has several advantages. First, it provides up to 25 cm of bone, enough to reconstruct any length of mandible defect. Second, a skin island, based on a septocutaneous blood supply, is available in a size large enough to simultaneously reconstruct internal and external soft tissue defect. Third, The fibular donor site morbidity is low, fourth, it provides a esthetic effect of mandible line. And finally bone viability is good. The Fibular osteocutaneous free flap was performed after COMMANDO operation due to squamous cell cancer in oral cavity (15 cases). Therefore we report out successful operation of the mandible reconstruction by using fibular osteocutaneous free flap.

• Journal of Korean Orthopaedic Sports Medicine
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• v.2 no.1
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• pp.20-27
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• 2003

It is reported that approximately 100,000 anteior cruciate ligament (ACL) reconstructions are performed in the United States each year. Recurrent instability because of graft failure is estimated to occur in from 0.7$\%$ to 8$\%$ of reconstruction. Recently revision ACL reconstruction is likely to become more common as the number of primary reconstructions continues to increase. Arthroscopic revision ACL surgery with adequate graft for failed ACL reconstruction was successful in objectively and subjectively improving stability. However, considering the most common causes of failure after ACL reconstruction were errors in surgical technique, it is important that the primary ACL reconstruction should be performed with correct surgical technique. Therefore author reviewed the causes of failure of reconstruction to prevent the failure of reconstruction and described the surgical technique of revision ACL reconstruction.

• Journal of Mechanical Science and Technology
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• v.17 no.4
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• pp.571-580
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• 2003

Tomography has been investigated to observe bubble behaviors in two-phase flows. A bubbly flow and an annular flow have been reconstructed by tomography methods such as an algebraic reconstruction technique (ART) and a multiplicative algebraic reconstruction technique (MART) . Computer synthesized phantom fields have been used to calculate asymmetric density distributions for limited cases of 3, 5, and 7 projection angles. As a result of comparison of two tomography methods, the MART method has shown a significant improvement in the reconstruction accuracy for analysis of the two-phase flows.

• 대한정형외과스포츠의학회:학술대회논문집
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• 2004.09a
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• pp.15-16
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• 2004

• Journal of Fisheries and Marine Sciences Education
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• v.24 no.1
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• pp.123-135
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• 2012

The purpose of this study is to search for factor of obstructing curriculum reconstruction. we try to reconstruct curriculum for relevance and adequacy of educational content. There are many reasons for refusing mission of curriculum reconstruction. We searched the factor of obstructing curriculum reconstruction by survey and qualitative interview. According to the results of previous research, teachers are felt for strong demand of accountability and rigorous evaluation. In the future, the study of these themes will be approached by grounded theory and qualitative study because of nature of the reconstruction problem. Curriculum reconstruction is searched by teacher in real context of instruction and teaching.

• Archives of Plastic Surgery
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• v.35 no.2
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• pp.193-196
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• 2008

Purpose: TRAM flap reconstruction has settled down as a common method for breast reconstruction after mastectomy. There are a few surgical contraindication in TRAM flap surgery. Previous abdominal liposuction has been a relative contraindication in TRAM flap surgery. The authors present 2 patients of successful breast reconstruction using pedicled TRAM flaps, who previously underwent abdominal liposuction. Methods: Case 1: A 48-year-old woman with a right breast cancer visited for mastectomy and breast reconstruction. Her past surgical history was notable for abdominal liposuction 15 years ago. Skin sparing mastectomy and breast reconstruction with a pedicled TRAM flap was performed. Case 2: A 45-year-old woman with a left breast cancer visited us for mastectomy and autologous breast reconstruction. 3 years ago, she had an abdominal liposuction and augmentation mammaplasty in other hospital. Nipple sparing mastectomy and breast reconstruction was done using pedicled TRAM flap. Results: One year after the reconstruction, partial fat necrosis was developed in one case but there was no skin necrosis or donor site complication in both patients. Conclusion: As aesthetic surgery becomes more popular, increasing numbers of patients who have a prior abdominal liposuction history want for autologous tissue breast reconstruction. In these patients, TRAM flap surgery will be also used for breast reconstruction. But, the warning of fat necrosis and the use of preoperative Doppler tracing to evaluate the abdominal perforator may be beneficial to patients who had abdominal liposuction recently.

• Archives of Plastic Surgery
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• v.36 no.1
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• pp.75-79
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• 2009

Purpose: The transverse rectus abdominis musculocutaneous(TRAM) flap is the most commonly used autogenous tissue flap for breast reconstruction. Postoperatively, partial flap loss or fat necrosis are relatively common and it may result in a smaller breast volume with marked contour irregularities. These defects are not easy to reconstruct with local tissue rearrangement or with breast implants. The current authors present the results of 2 patients who underwent Latissimus dorsi(LD) flap reconstruction to correct partial flap or fat necrosis that developed after TRAM flap breast reconstruction. Method: Case1: A 50 - year - old woman with left breast cancer visited for breast reconstruction after radical mastectomy. Initially, breast reconstruction with pedicled TRAM was performed. Postoperatively partial flap necrosis was developed. Secondary breast reconstruction using LD flap was done. Case2: A 51 - year - old woman with left breast cancer visited for breast reconstruction after radical mastectomy. Initially, breast reconstruction with pedicled TRAM was performed. Postoperatively fat necrosis was developed. Secondary breast reconstruction using LD flap was done. Results: Secondary breast reconstruction using LD flap survived completely and produce successful reconstruction. There was no significant complication in both patients. Conclusion: LD flap provides sufficient, vascularized skin and soft tissue. The flap can be molded easily to replace deficient tissue in all areas of the breast. These attributes make it an ideal candidate for salvage of the partially failed TRAM flap breast reconstructio.

• Archives of Plastic Surgery
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• v.39 no.3
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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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• v.47 no.2
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• pp.118-125
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• 2020

Since April 2015, post-mastectomy breast reconstruction has been covered by the Korean National Health Insurance Service (NHIS). The frequency of these procedures has increased very rapidly. We analyzed data obtained from the Big Data Hub of the Health Insurance Review and Assessment Service (HIRA) and determined annual changes in the number of breast reconstruction procedures and related trends in Korea. We evaluated the numbers of mastectomy and breast reconstruction procedures performed between April 2015 and December 2018 using data from the HIRA Big Data Hub. We determined annual changes in the numbers of total, autologous, and implant breast reconstructions after NHIS coverage commenced. Data were analyzed using Microsoft Excel. The post-mastectomy breast reconstruction rate increased from 19.4% in 2015 to 53.4% in 2018. In 2015, implant reconstruction was performed in 1,366 cases and autologous reconstruction in 905 (60.1% and 39.8%, respectively); these figures increased to 3,703 and 1,570 (70.2% and 29.7%, respectively) in 2018. Free tissue transfer and deep inferior epigastric perforator flap creation were the most common autologous reconstruction procedures. For implant-based reconstructions, the rates of directto-implant and tissue-expander breast reconstructions (first stage) were similar in 2018. This study summarizes breast reconstruction trends in Korea after NHIS coverage was expanded in 2015. A significant increase over time in the post-mastectomy breast reconstruction rate was evident, with a trend toward implant-based reconstruction. Analysis of data from the HIRA Big Data Hub can be used to predict breast reconstruction trends and convey precise information to patients and physicians.