• Archives of Plastic Surgery
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• 제40권1호
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• pp.19-27
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• 2013

Background Acellular dermal matrix (ADM) allografts and their putative benefits have been increasingly described in prosthesis based breast reconstruction. There have been a myriad of analyses outlining ADM complication profiles, but few large-scale, multi-institutional studies exploring these outcomes. In this study, complication rates of acellular dermis-assisted tissue expander breast reconstruction were compared with traditional submuscular methods by evaluation of the American College of Surgeon's National Surgical Quality Improvement Program (NSQIP) registry. Methods Patients who underwent immediate tissue expander breast reconstruction from 2006-2010 were identified using surgical procedure codes. Two hundred forty tracked variables from over 250 participating sites were extracted for patients undergoing acellular dermis-assisted versus submuscular tissue expander reconstruction. Thirty-day postoperative outcomes and captured risk factors for complications were compared between the two groups. Results A total of 9,159 patients underwent tissue expander breast reconstruction; 1,717 using acellular dermis and 7,442 with submuscular expander placement. Total complications and reconstruction related complications were similar in both cohorts (5.5% vs. 5.3%, P=0.68 and 4.7% vs. 4.3%, P=0.39, respectively). Multivariate logistic regression revealed body mass index and smoking as independent risk factors for reconstructive complications in both cohorts (P<0.01). Conclusions The NSQIP database provides large-scale, multi-institutional, independent outcomes for acellular dermis and submuscular breast reconstruction. Both thirty-day complication profiles and risk factors for post operative morbidity are similar between these two reconstructive approaches.

• Archives of Plastic Surgery
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• 제47권6호
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• pp.551-558
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• 2020

Background Giant congenital melanocytic nevus (GCMN) is a rare disease, for which complete surgical resection is recommended. However, the size of the lesions presents problems for the management of the condition. The most popular approach is to use a tissue expander; however, single-stage expansion in reconstructive surgery for GCMN cannot always address the entire defect. Few reports have compared tissue expansion techniques. The present study compared single and serial expansion to analyze the risk factors for complications and the surgical outcomes of the two techniques. Methods We retrospectively reviewed the medical charts of patients who underwent tissue expander reconstruction between March 2011 and July 2019. Serial expansion was indicated in cases of anatomically obvious defects after the first expansion, limited skin expansion with two more expander insertions, or capsular contracture after removal of the first expander. Results Fifty-five patients (88 cases) were analyzed, of whom 31 underwent serial expansion. The number of expanders inserted was higher in the serial-expansion group (P<0.001). The back and lower extremities were the most common locations for single and serial expansion, respectively (P =0.043). Multivariate analysis showed that sex (odds ratio [OR], 0.257; P=0.015), expander size (OR, 1.016; P=0.015), and inflation volume (OR, 0.987; P=0.015) were risk factors for complications. Conclusions Serial expansion is a good option for GCMN management. We demonstrated that large-sized expanders and large inflation volumes can lead to complications, and therefore require risk-reducing strategies. Nonetheless, serial expansion with proper management is appropriate for certain patients and can provide aesthetically satisfactory outcomes.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제39권1호
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• pp.31-34
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• 2013

In dentistry, tissue expanders have been used to obtain sufficient soft tissue for alveolar bone augmentation in the severely atrophic ridge. Herein, we review two cases of soft tissue augmentation using a self-inflating tissue expander in patients in the Department of Oral and Maxillofacial Surgery at Ewha Womans University Mokdong Hospital for bone graft and implant operations. The results of each patient were presented using pre-operative and post-operative radiographs and clinical exams. The results of our study indicate successful bone graft and implant surgery using a self-inflating tissue expander.

• 대한두개안면성형외과학회지
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• 제21권3호
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• pp.184-187
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• 2020

Scalp reconstruction is challenging because the scalp is inelastic, stiff, and has hair follicles. Tissue expansion offers aesthetically pleasing outcomes with minimal donor-site morbidity. However, in a scarred scalp, the extent of possible dissection for the expander insertion may be limited and surgeons must make use of the limited scalp tissue. We successfully reconstructed scarred scalps using rectangular expanders. This report presents two cases: a 4×3 cm chronic defect with widespread scarring and osteomyelitis and an 11×7.5 cm scar tissue following a skin graft. Tissue expanders were inserted in the subgaleal plane and were inflated by 195 mL and 400 mL over periods of 2 and 3 months, respectively. Subgaleal elevation of a fasciocutaneous flap was achieved with the expanded tissue. The defects were well covered, with good color, texture, and hair-bearing tissue. There were no complications involving the tissue expanders. Rectangular expanders yield more available tissue than round or crescent-shaped expanders. Moreover, since the base of the flap is well defined, the expander can be easily inserted in a limited space. Therefore, rectangular expanders are recommended for the reconstruction of scarred scalps.

• 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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• 제46권4호
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• pp.375-380
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• 2019

Breast tissue expanders (TEs) with magnetic infusion ports are labeled "MR Unsafe." Therefore, patients with these implants are typically prevented from undergoing magnetic resonance imaging (MRI). We report a patient with a total submuscular breast TE who inadvertently underwent an MRI exam. She subsequently developed expander exposure, requiring explantation and autologous reconstruction. The safety profile of TEs with magnetic ports and the use of MRI in patients with these implants is surprisingly controversial. Therefore, we present our case report, a systematic literature review, and propose procedural guidelines to help ensure the safety of patients with TEs with magnetic ports that need to undergo MRI exams.

• Archives of Plastic Surgery
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• 제38권5호
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• pp.559-566
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• 2011

Purpose: The use of tissue expander/implant in breast reconstruction using tissue expander-implant is one of the most common surgical procedures. The use of AlloDerm as a sling to reestablish the lower pole of the pectoralis major muscle results a decrease in morbidity compared with more invasive procedures. However the use of AlloDerm is more expensive than other options. We decided to compare AlloDerm with Permacol, which has been safely used in human body reconstruction and is less costly than AlloDerm. Methods: After mastectomy, the inferolateral origin of the pectoralis major muscle was elevated. Either AlloDerm or Permacol was sutured to the chest wall at the level of the previously marked inframammary fold. The lower border of the pectoralis major muscle and the upper portion of the crescent-shaped piece of either AlloDerm or Permacol was sutured together using a tension free technique, and a tissue expander was subsequently inserted into the subpectoral-subAlloDerm (or Permacol) dual pocket. Results: AlloDerm was used in twenty-one patients (28 breasts) and Permacol was used in six patients (11 breasts) for tissue expander-implant breast reconstruction. During the mean follow-up period of 17 months (8~25 months). Two infections (7%) occurred in AlloDerm cases and four infections (36%) occurred in Permacol cases. Conclusion: This study is the first comparison of tissue expander/implant breast reconstruction using AlloDerm and Permacol. The use of Permacol resulted in more postoperative infection compared with the use of AlloDerm. This report is still limited with the small number of cases studied.

• Archives of Plastic Surgery
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• 제45권5호
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• pp.484-489
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• 2018

Large and ptotic breast reconstruction in patients who are not candidates for a transverse rectus abdominalis myocutaneous flap and revision surgery for the contralateral breast remains challenging. We developed a novel breast reconstruction technique using a latissimus dorsi myocutaneous (LD m-c) flap set at the posterior aspect of the reconstructed breast, combined with an anatomical silicone breast implant (SBI), following tissue expander surgery. We performed the proposed technique in four patients, in whom the weight of the resected tissue during mastectomy was >500 g and the depth of the inframammary fold (IMF) was >3 cm. After over-expansion of the lower portion of the skin envelope by a tissue expander, the LD m-c flap was transferred to cover the lower portion of the breast defect and to achieve a ptotic contour, with the skin paddle set at the posterior aspect of the reconstructed breast. An SBI was then placed in the rest of the breast defect after setting the LD m-c flap. No major complications were observed during the follow-up period. The proposed technique resulted in symmetrical and aesthetically satisfactory breasts with deep IMFs, which allowed proper fitting of the brassiere, following large and ptotic breast reconstruction.

• 대한두개안면성형외과학회지
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• 제20권6호
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• pp.408-411
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• 2019

Hairless scalp areas can occur due to trauma, tumors, or congenital disease. This aesthetically unpleasing condition can lead to psychosocial distress, and thin skin flaps may be prone to scarring. Treating the hairless scalp by simple excision is challenging because of skin tension. Tissue expanders are a good option for hairless scalp resurfacing. However, a single expansion may be inadequate to cover the entire defect. This report describes good results obtained using a serial resurfacing method involving re-expansion of the flap with a tissue expander to treat two patients with large lesions: one due to aplasia cutis congenital and another who underwent dermatofibrosarcoma protuberance resection. The results suggest that scalp resurfacing by serial tissue expansion using a tissue expander can be used for extensive lesions.

• Archives of Plastic Surgery
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• 제34권3호
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• pp.346-351
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• 2007

Purpose: As a rare congenital anomaly, Poland's syndrome has been known to show hypoplasia in breast and nipple, absence of pectoralis major muscle, and aplasia or deformity of rib or costal cartilage which has been reported to be more common in male. However, most patients who are seeking operation are female patients having one-side deformity. In the field of plastic surgery, the major surgical indications could be asymmetric chest wall depression in man or breast hypoplasia in woman. There are many reconstruction options according to the degree of patient's deformity: a prosthetic implant, breast implant with or without tissue expander, latissimus dorsi musculocutaneous pedicled flap with or without implant and/or tissue expander, and free tissue transfer with or without tissue expander. Methods: The authors have treated 4 patients(2 male, 2 female) who had a diagnosis of Poland's syndrome. According to the degree of patient's deformity, all patients underwent correction of breast asymmetry and unilateral anterior thoracic hypoplasia with one-staged or two-staged reconstruction. Results: All patents were satisfied with the results and there occurred no specific complications. Conclusion: The authors propose the treatment plan for patient with Poland's syndrome, according to the degree of patient's deformity. In case of male patient with mild deformity, the prosthetic implant or latissimus dorsi musculocutaneous pedicled flap will simulate the missing pectoralis and improve the contour deformity. In case of female patient with moderate to severe breast asymmetry and upward displaced nipple areolar complex (NAC), NAC can be lowered with tissue expander, breast can be enlarged with autologous free flaps or latissimus dorsi musculocutaneous pedicled flap with implant.