Nipples are protected by nipple splints after reconstructing or reshaping them using various materials. We have devised a nipple splint using textile-like thermoplastic tape, which is made out of knitted hybrid fabric, is latex-free, and keeps its position well beneath a brassiere with simple taping. Its conformation is readily modifiable according to each patient's breast shape, if it is soaked into hot water. A patient who underwent nipple reconstructive surgery had this thermoplastic cast applied for a month, and the contour of the nipple was well preserved without reports of skin irritation or pressure sores developing on the areola.
Breast ; Humans ; Nipples* ; Pressure Ulcer ; Skin ; Splints* ; Textiles ; Water

Among autologous breast reconstruction techniques, breast reconstruction using the latissimus dorsi musculocutaneous flap is widely used, offering advantages including the relative simplicity of the procedure and the reliable and consistent vascularity of the flap. Accordingly, more than 500 cases have been performed in the past 8 years at Kyungpook National University Medical Center. This study reports on a rare case involving a radial nerve neuropathy complication which was experienced for the first time at the medical center. The current case demonstrates that in addition to common complications, such as seroma of the donor site and scarring, additional intraoperative complications in areas unrelated to the surgical site can occur, including radial nerve neuropathy in the opposite arm.
Academic Medical Centers ; Arm ; Breast* ; Cicatrix ; Female ; Gyeongsangbuk-do ; Humans ; Intraoperative Complications ; Mammaplasty* ; Myocutaneous Flap ; Paralysis* ; Radial Nerve* ; Radial Neuropathy ; Seroma ; Superficial Back Muscles* ; Tissue Donors

Behçet's disease is a systemic chronic disease that occurs in tissues such as eyes, joints, organs and nerves, and it has been noted that symptoms may be observed in a variety of tissues. In previous studies, reports of blepharoptosis observed in patients with Behçet's disease have been rare. We would like to report a case where a patient among those who visited our hospital with blepharoptosis had a history of Behçet's disease. This patient had been diagnosed with Behçet's disease, and complained of bilateral blepharoptosis even at the time of diagnosis. He complained of dysfunctions in vision and hearing, and upon eye examination, an eye movement disorder was found in his left eye. From the symptoms, neuro-Behçet's disease was diagnosed. The oculomotor and levator palpebrae superioris muscles are both controlled by cranial nerve III, which may suggest that Behçet's disease in this patient occurred in cranial nerve III. The patient received an oral steroid, and the symptoms have improved without surgery. Since we could identify the correlation between Behçet's disease and blepharoptosis, we considered that sharing this case and its outcome would be helpful for plastic surgeons who treat eyelids.
Behcet Syndrome ; Blepharoptosis* ; Chronic Disease ; Diagnosis ; Eyelids ; Hearing ; Humans ; Joints ; Muscles ; Ocular Motility Disorders ; Oculomotor Nerve ; Plastics ; Surgeons

Poly-L-lactic acid (PLLA) is a synthetic injectable medical agent for use as an effective soft tissue filler to treat facial fat volume loss, although complications including nodule formation do occur. We describe a case of foreign body granuloma formation in an immunocompetent patient who received PLLA in the periorbital region for soft tissue aesthetic enhancement and treated with surgical intervention by subciliary approach.
Dermal Fillers ; Granuloma, Foreign-Body ; Humans ; Lactic Acid

We present our experience with calvarial bone framework insertion through an intraoral approach for a patient who was at risk for columellar necrosis due to a previous open rhinoplasty. A 58-year-old woman exhibited severe columellar contracture, so that the columellar tissue was too fragile to be touched. We could not incise the columella and insert a new nasal implant through the bilateral rim incision. Moreover, the patient had septal cartilage perforation and collapse. The patient needed columellar support as well as nasal dorsum reconstruction. The authors decided to graft an autogenous L-strut bone framework through an intraoral approach. Two pieces of 5-cm × 1-cm sized split calvarial bone were harvested and trimmed to fit the width and length of the nasal dorsum and columella. The right-angle-shaped bone framework was made with an absorbable plate and screws. Through a gingivobuccal incision, the bone framework graft was inserted and the graft was fixed with absorbable screws. The patient did not experience complications such as skin necrosis or inflammation. A bone framework grafted through an intraoral approach can be a good choice for patients who have experienced scar contracture in the columella, septal cartilage perforation, and collapse.
Cartilage ; Cicatrix* ; Contracture* ; Female ; Humans ; Inflammation ; Middle Aged ; Necrosis ; Oral Surgical Procedures ; Rhinoplasty ; Skin ; Transplants*

BACKGROUND: The brow lift plays an essential role in upper face rejuvenation. The authors designed a new brow lift technique, the endoscope-assisted trichophytic anterior hairline brow lift. It combines the advantages of an endoscopic approach and an anterior hairline approach. This technique was applied to 13 patients with aesthetically excellent results. METHODS: A trichophytic incision line was designed within the fine hairs of the entire anterior hairline and the incision was extended to the temporal hair-bearing scalp. After the incision, most of the procedures were conducted in a similar way to the conventional endoscopic brow lift. Without direct visualization, the dissection was extended down onto the root of the nose and the forehead. An endoscope was used from 2 cm above the supraorbital notch to avoid supraorbital nerve injury. Scars were assessed with the Stony Brook Scar Evaluation Scale (SBSES) at the time the sutures were removed. The visual analogue scale (VAS) score was checked at postoperative 1-year follow-up. The surgical outcomes for brow position and subjective satisfaction were rated with the Global Aesthetic Improvement Scale (GAIS) at postoperative 1-month follow-up. The dermatome of the deep branch of the supraorbital nerve, especially around the hairline, was checked with a two-point discrimination test. RESULTS: From October 2012 through August 2015, 13 endoscope-assisted trichophytic anterior hairline brow lifts were performed. The GAIS score was 1.62 on average. The VAS score was 2.09 on average. No permanent nerve damage has been reported except for 2 cases of temporary paresthesia. These fully recovered at 1-month follow-up. CONCLUSIONS: Based on our results, we think our technique could be a safe and effective treatment option for brow ptosis patients with a high hairline.
Cicatrix ; Discrimination (Psychology) ; Endoscopes ; Follow-Up Studies ; Forehead ; Hair ; Humans ; Nose ; Paresthesia ; Rejuvenation ; Rhytidoplasty ; Scalp ; Sutures

BACKGROUND: Vertical reduction mammaplasty has been criticized for its inability to address larger cases of mammary hypertrophy, with a relatively high frequency of sensory loss reported. This article describes our single-institution experience with modified vertical reduction mammaplasty for varying degrees of breast reduction. METHODS: Thirty-three patients underwent breast reduction using the modified vertical reduction mammaplasty technique with a superomedial dermoglandular pedicle and modifications involving breast parenchyma excision. The degree of sensory preservation in the nipple-areola complex (NAC) was compared with preoperative sensation using an ordinal scale (0, insensate; 10, unchanged). Postoperative outcomes were evaluated through a photogrammetric analysis. Satisfaction with postoperative outcomes was assessed using a telephone questionnaire survey (1, very poor; 5, very good). RESULTS: The modified vertical mammaplasty technique allowed for reductions of up to 1,800 g per side. The mean resection weight was 459.24 g per breast (range, 76-1,800 g). Of the 59 operations, 9 involved complications without significant morbidity. The sensibility of the NAC recovered in most patients by 5 months after the operation. The mean satisfaction score was 3.4, which was between 'no change' and 'satisfied.' CONCLUSIONS: Modified vertical reduction mammaplasty allows a single surgeon to address varying degrees of breast hypertrophy.
Breast ; Female ; Humans ; Hypertrophy ; Mammaplasty* ; Nipples ; Sensation ; Telephone

BACKGROUND: The purpose of this study was to examine the effects of a single administration of vascular endothelial growth factor (VEGF) in promoting the angiogenesis and thereby reducing the formation of capsular contracture. METHODS: We treated 24 female Sprague-Dawley rats with (1) 5 mM Tris Buffer and 150 mM NaCl 0.1 cc, (2) VEGF 15 µg/0.1 cc, (3) VEGF 150 µg/0.1 cc during placement of the implant, or (4) VEGF 150 µg/0.1 cc and VEGF 300 µg/0.2 cc. We histopathologically measured the thickness of the capsule and the number of blood vessels. RESULTS: All experimental groups had a significant difference in the thickness of the capsule compared to the control group (P<0.001). There was no significant difference between experimental group 2 and experimental group 3. The number of blood vessels formed around the capsule was significantly greater in all the experimental groups compared with the control group (P<0.05). There was no significant difference between the experimental groups. There was a significant negative correlation between the thickness of the capsule and the number of blood vessels (Spearman's correlation coefficient, 0.2732; P<0.0001). CONCLUSIONS: A single administration of VEGF reduced formation of the capsule and increased the vascularity around the implant, supporting the hypothesis that prevention of tissue ischemia can be a treatment strategy for capsular contracture.
Animals ; Blood Vessels ; Breast Implants ; Contracture ; Female ; Humans ; Ischemia ; Rats* ; Rats, Sprague-Dawley ; Silicon* ; Silicones* ; Tromethamine ; Vascular Endothelial Growth Factor A*

BACKGROUND: Numerous techniques have emerged for nipple-areolar complex (NAC) over the years. Scar-based modified C-V flap technique is a new method for creating NAC, surgeons can accomplish nipple reconstruction and scar revision simultaneously. This article described the modified C-V flap technique for nipple reconstruction. This modified method is simple and reliable with good outcome. METHODS: To evaluate the effectiveness of our technique, we reviewed 21 patients who underwent nipple reconstruction using the scar-based modified C-V flap technique. For scar-based modified C-V flap, a C flap was designed to match the contralateral nipple in width while a V flap including scar after mastectomy was designed. The flap pedicle was centrally located. The V flap was then fixed surrounding the central part with a proper shape and volume considering the distal part of the flap that had poor vascularization. RESULTS: The average age of the 21 patients was 48.4 years. The average length of follow up was 7.4 months. Complication rate was 19.0% including projection loss in 2 cases, tip necrosis in 1 case, postoperative infection in 1 case, and wound dehiscence in 1 case. Re-operations were performed for 2 cases of projection loss, 1 case of partial flap necrosis, and 1 case of wound dehiscence. CONCLUSIONS: The scar-based modified C-V flap technique is a simple and reliable method for nipple reconstruction with aesthetic outcome. Patients who have undergone this surgical technique tend to have great satisfaction with the results.
Cicatrix ; Female ; Follow-Up Studies ; Humans ; Mammaplasty ; Mastectomy ; Methods ; Necrosis ; Nipples* ; Reconstructive Surgical Procedures ; Surgeons ; Wounds and Injuries

BACKGROUND: Asians tend to have bulbous, wide, and thick-skinned noses, leading to limitations in tip augmentation. Therefore, following various tip plasty procedures, the use of a dermal graft or a fat graft may be considered for additional augmentation. For definition of the Asian nasal tip, thick fibroareolar and subcutaneous tissues are resected. However, these previously discarded tissues may be a useful material for tip augmentation. Hence, we would like to propose the fibroareolar tissue wrap-around flap as an adjuvant augmentation procedure. METHODS: Tip plasty procedures, including various suture techniques and cartilage grafts, were performed. Near the scroll area, the fibroareolar tissues above both lower lateral cartilages were dissected in the supraperichondrial plane. Caudally based fibroareolar tissue flaps were elevated around the nasal tip. The tip portion of the alar cartilage framework was covered with the flaps. The flaps were fixed to the middle or medial crura of the lower lateral cartilages. RESULTS: A total of 13 patients underwent the fibroareolar tissue wrap-around flap procedure for nasal tip plasty. No complaints were reported at follow-up by 12 patients. No cases of major infection, hematoma, or vascular compromise occurred. CONCLUSIONS: The fibroareolar tissue wrap-around flap offers several advantages for tip plasty in Asians, including additional tip projection, soft tissue volume reduction, redraping, and a naturally soft nasal tip, and likely aids in preserving the volume of other cartilage grafts. Therefore, this fibroareolar tissue wrap-around flap is worth considering as a useful adjuvant option for tip plasty in rhinoplasty in Asian patients.
Asian Continental Ancestry Group* ; Cartilage ; Follow-Up Studies ; Hematoma ; Humans ; Nose ; Rhinoplasty* ; Subcutaneous Tissue ; Surgical Flaps ; Suture Techniques ; Transplants