PURPOSE: The main problem for reoperation after augmentation mammoplasty is contraction of the capsule surrounding a breast implant and it tends to be recur after second surgery. The author studied that intracapsular injection of triamcinolone could reduce the recurrence of capsular contracture. METHODS: Twenty-six cases of capsular contracture, undertaken at the M.D. Clinic between July 2002 and August 2004, were reviewed. Age, types of previous implant, reoperation methods including triamcinolone injection, and recurrence rates were retrospectively evaluated. RESULTS: Two cases (7.7%) were in their twenties, 14 (53.9%) in their thirties, 7 (26.9%) in their forties and 3 (11.5%) in their fifties. The types of previous implant were as followed: 24 (92.3%) saline, 2 (7.7%) silicone gel, 14 (53.9%) textured type and 12 (46.1%) smooth type. The reoperation methods were as followed: capsulectomy in 4 (15.4%), subpectoral conversion in 1 (3.9%), subpectoral conversion with an intracapsule injection of triamcinolone in 2 (7.7%), capsulotomy in 7 (26.9%) and capsulotomy with an intracapsule injection of triamcinolone in 12 (46.2%). Recurrence occurred in 1 capsulectomy (25%), 1 subpectoral conversion (100%), 0 subpectoral conversion with injection (0%), 4 capsulotomy (57%) and 1 capsulotomy with injection (8.3%). CONCLUSION: The injection of triamcinolone into the capsule following an implant replacement was effective in patients with a capsular contracture after augmentation mammoplasty. It seems to be an effective rational therapy for primary high risk cases with more advanced technique.
Breast Implants ; Contracture* ; Female ; Humans ; Mammaplasty* ; Recurrence ; Reoperation ; Retrospective Studies ; Silicone Gels ; Triamcinolone*

PURPOSE: Augmentation mammoplasty is a procedure that expands the breast tissue and pectoral muscle by insertion of an implant. This procedure induce extreme postoperative pain. The purpose of this study was to determine whether intercostal nerve block (ICNB) could reduce the pain after augmentation mammoplasty. METHODS: Eighty three patients, who underwent augmentation mammoplasty, at the M.D. Clinic between December 2005 and February 2006, were the cases of this study. We injected 0.25% ropivacaine (total 30ml per side) in the ICNB group (n=68) into the 3,4,5 and 6th intercostals spaces following induction of general anesthesia for surgery. The mean arterial pressures and heart rates were measured before and after subpectoral dissection. A numerical rating scale (NRS: 0=no pain, 10= most severe pain) was used to measure the pain postoperative 6, 24, 48 hours, respectively. We statistically compared the ICNB group with the control group (n=15) with using the Mann-Whitney Rank Sum test. RESULTS: The mean arterial pressures and heart rates were more stable during subpectoral dissection in the ICNB group than in the control group (p= 0.142 and p= 0.037). The NRSs were lower throughout the 48 hours of the postoperative period in the ICNB group than in the control group (p<0.001 at 6hr, p=0.017 at 24hr, p=0.054 at 48hr). CONCLUSION: ICNB induced stable vital sign during subpectoral dissection and excellent postoperative pain control during 48 hours postoperatively for those patients undergoing augmentation mammoplasty.
Anesthesia, General ; Arterial Pressure ; Breast ; Female ; Heart Rate ; Humans ; Intercostal Nerves* ; Mammaplasty* ; Pain, Postoperative ; Postoperative Period ; Vital Signs

PURPOSE: Breast augmentation has recently become a common plastic surgical procedure performed in Korea. However, the incidence of re-operation has also increased due to various complications. The purpose of this study is to analyze the complications of primary augmentation mammoplasty and to demonstrate the reasons for re- operations. METHODS: Among augmentation mammoplasty cases operated in M.D. Clinic from Jan. 2002 to Jul. 2003, 42 cases of re-operations were reviewed. Age, interim primary operations, used implants, complications and reasons of re- operations and methods of re-operations were retrospectively evaluated. RESULTS: Patients from half of the cases were in their thirties. Almost halves of the patients were operated again within a year. Common reasons of re-operations were complications in shape and physical texture. For shape problems, they commonly complained of upper fullness or double bubble deformity and asymmetry. The author commonly used a periareolar incision (95.2%) and saline bag implants (81.0%) for re-operations. The usual size of the implant was between 151 and 250 cc. In 7 capsular contracture cases, 3 capsulotomy, 3 capsulectomy and 1 case of subpectoral conversion were performed, of which 1 case in capsulotomy and 1 subpectoral conversion recurred. CONCLUSION: Augmentation mammoplasty is not a simple procedure, making many complications in shape, physical texture, breast functions, and others that is related to breast diseases. For better outcomes in re-operation cases, exact understanding and evaluation of primary complications are essential.
Breast ; Breast Diseases ; Congenital Abnormalities ; Contracture ; Female ; Humans ; Incidence ; Korea ; Mammaplasty* ; Reoperation ; Retrospective Studies

PURPOSE: Autolougous fat grafting to the breast for cosmetic enlargement remains controversial because the efficacy and the complications due to fat necrosis are unclear. METHODS: Ten cases who underwent autologous fat grafting to the breast for enlargement and visited author's clinic from October 2006 to March 2008 were evaluated retrospectively. Mammography, ultrosonography, culture, cytology, operative findings and results were reviewed for each cases. RESULTS: The study group consisted of 7 cases for additional augmentation mammaplasty, 1 case for breast abscess, 2 cases for breast examination. Two of 7 augmentation cases had multiple palpable masses. One of 2 cases for breast examination had fat grafts 20 months ago and have suffered from painful huge masses especially on exercise. One case with abscess had fat graft 4 months ago and have suffered from painful reddish swelling. On mammography of 9 cases except 1 breast abscess, malignancy could not be excluded in 2 cases because of bizarre forms of multiple microcalcifications. On ultrasonography of 8 cases, there were ill defined hypoechoic masses in 2 cases which needed additional cytology for rule out malignancy. There were implant puncture in all 2 cases with silicone implants, and in case with abscess, there were S. epidermidis in culture. Among 7 augmentation mammaplasty cases, removal of fat necrosis was performed simultaneously in 1 case with severely palpable masses but postoperative seroma formation and capsular contracture occurred. CONCLUSION: Autologous fat grafting for breast augmentation can make masses, abscess and microcalcifications on mammography due to fat necrosis which compromise breast cancer detection. Additional study is necessary to evaluate the efficacy of fat stem cell grafts as an alternative to traditional method.
Abscess ; Breast ; Breast Neoplasms ; Contracture ; Cosmetics ; Fat Necrosis ; Female ; Mammaplasty ; Mammography ; Punctures ; Retrospective Studies ; Seroma ; Silicones ; Stem Cells ; Transplants

PURPOSE: This study was conducted to determine if the body shape of women with small breasts differed from that of women with large breasts. METHODS: Between January 2002 and June 2006, 461 patients with hypomastia and 104 patients with macromastia, who had visited the M.D. Clinic, Seoul, Korea, were evaluated. These two groups were further divided into three groups (Group 1; underweight BMI<18.5, Group 2; normal BMI 18.5-22.9, Group 3; overweight BMI> or =23) according to Body mass index (BMI). RESULTS: The average age of women with hypomastia and macromastia was 32 and 34.5 respectively. The average BMI was 18.88 in the hypomastia group and 22.19 in the macromastia group (p<0.001). In the hypomastia group, the distribution of BMI was as follows: group 1, 44.5% (n=205); group 2, 53.8% (n=248); group 3, 1.7% (n=8). However, in the macromastia group, a higher proportion of overweight individuals were observed, as shown by the following distribution pattern: group 1, 7.7% (n=8); group 2, 71.1% (n=32); group 3, 27.3% (n=3). In the hypomastia group, the proportion of group 3 were 0% in their 20s, 0.9% (n=2) in their 30s, 6% (n=3) in their 40s and 27.3% (n=3) in their 50s, but in the macromastia group, the proportion of group 3 were 17.8% (n=8) in 20s, 32% (n=8) in 30s, 50% (n=12) in 40s and 100% (n=10) in 50s. CONCLUSION: The BMI of women with macromastia was significantly higher than that of women with hypomastia. In addition, although BMI was found to increase as age advanced for both groups, women with macromastia appear to have a strong tendency to become overweight with age.
Body Mass Index ; Breast ; Female ; Humans ; Hypertrophy ; Korea ; Overweight ; Thinness

Poland syndrome is a rare anomaly characterized by a unilateral absence of the pectoral muscles, ipsilateral syndactyly and microdactyly. Associated anomalies include defects of the ipsilateral ribs and costal cartilages, and breast parenchyma in women. Herein, a case of a 22 years old woman is reported. She had no right pectoralis major, ipsilateral breast parenchyma and anterior parts of the ipsilateral 2nd, 3rd, 4th and 5th ribs. Under general anesthesia, a tissue expander was placed laterally between the subcutaneous and intercostal tissues and anteriorly to the pleura. A repeated saline injection via the expander connected port induced tissue expansion. The total amount of injected saline was 550 cc, and the expander was replaced with a 300 cc prefilled saline implant. The other breast was augmented by insertion of a 150 cc saline implant for symmetry as this was requested by the patient. There were no specific complications, with the exception of a persisting ipsilateral axillary wrinkle. To remove this wrinkle, a combined latissimus dorsi flap may be helpful.
Anesthesia, General ; Breast* ; Cartilage ; Female ; Humans ; Mammaplasty* ; Muscles ; Pleura ; Poland Syndrome* ; Poland* ; Ribs ; Superficial Back Muscles ; Syndactyly ; Tissue Expansion ; Tissue Expansion Devices ; Young Adult

Purpose: Capsular contracture is a major cause of poor postoperative satisfaction in augmentation mammaplasty. It is unclear whether round or anatomical textured breast implants lead to differences in the rates of capsular contracture. Accordingly, the objective of this study was to compare capsular contracture rates between round and anatomical textured breast implants. Methods: A total of 1,282 cases (2,564 breasts) of augmentation mammaplasty using textured type implants, performed at MD clinic between January 2012 and December 2015, were retrospectively reviewed. A total of 703 cases used round textured implants while 579 used anatomical textured implants. The median follow-up period for the round textured implant group was 9 months, and 7 months for the anatomical textured group. Results The overall capsular contracture rates in the first year was 2.0% in the round textured group and 1.5% in the anatomical textured group (p=0.609). Capsular contracture rates in the first year in those who underwent primary surgery were 1.6% in the round textured group and 1.3% in the anatomical textured group (p=0.187). The rates in those who underwent revision surgery were 5.2% in the round textured group and 2.6% in the anatomical textured group (p=0.178). Conclusion: Although the risk for capsular contracture in the anatomical textured groups appeared to be slightly lower than in the round textured groups, the difference was not significant. Further studies with longer follow-up periods are needed to assess potential differences.

PURPOSE: Breast augmentation with cohesive silicone gel implant has been popular but there remains the risk of implant rupture. We investigated the diagnosis and treatment of cohesive gel implant rupture. METHODS: Ten cases of cohesive gel implant rupture between August 2006 and August 2010 in ooo were reviewed in this study. The diagnostic role of Magnetic resonance imaging (MRI) and ultrasonography (US), and operative findings of cases were studied retrospectively. RESULTS: The mean interval from previous surgery was 14.7 months ranging from 3 to 44 months. Nine cases were visited due to abrupt changes in texture of implants and 1 case for revision of capsular contracture. Seven of 10 cases had capsular contracture, simultaneously. We diagnosed the first case by US and MRI but only US was used in the other 9 cases. US showed discontinuity of the implant membrane and multiple parallel echogenic lines within the implant interior (stepladder sign), and MRI showed the presence of multiple curvilinear low-signal-intensity lines seen within the high-signal-intensity silicone gel (linguine sign). All the ruptured gel remained in place within the capsule and did not migrate into the surrounding area. Surgeries were implant replacement in 3, replacement with capsulectomy in 6 with capsular contracture, and subpectoral conversion with capsulectomy and mastopexy in 1 case. CONCLUSION: US without MRI has asatisfactoryrole in the screening method for detection of cohesive silicone gel implant rupture in symptomatic cases. Ruptured implants were removed and replaced easily due to their highly cohesive nature.
Breast ; Breast Implants ; Contracture ; Hypogonadism ; Magnetic Resonance Imaging ; Mass Screening ; Membranes ; Mitochondrial Diseases ; Ophthalmoplegia ; Rupture ; Silicone Gels