Background: Acellular dermal matrices (ADMs) have become an essential material for implant-based breast reconstruction. No previous studies have evaluated the effects of sterility of ADM under conditions of radiation. This study compared sterile (irradiated) and aseptic (non-irradiated) ADMs to determine which would better endure radiotherapy. Methods: Eighteen male Balb/C mice were assigned to the control group with no irradiation (group 1) or one of two other groups with a radiation intensity of 10 Gy (group 2) or 20 Gy (group 3). Both sterile and aseptic ADMs were inserted into the back of each mouse. The residual volume of the ADM (measured using three-dimensional photography), cell incorporation, α-smooth muscle actin expression, and connective tissue growth factor expression were evaluated. The thickness and CD3 expression of the skin were measured 4 and 8 weeks after radiation. Results: In groups 2 and 3, irradiated ADMs had a significantly larger residual volume than the non-irradiated ADMs after 8 weeks (P<0.05). No significant differences were found in cell incorporation and the amount of fibrosis between irradiated and non-irradiated ADMs. The skin was significantly thicker in the non-irradiated ADMs than in the irradiated ADMs in group 3 (P<0.05). CD3 staining showed significantly fewer inflammatory cells in the skin of irradiated ADMs than in non-irradiated ADMs in all three groups after 4 and 8 weeks (P<0.05). Conclusions Under radiation exposure, irradiated ADMs were more durable, with less volume decrease and less deposition of collagen fibers and inflammatory reactions in the skin than in non-irradiated ADMs.

Breast reconstruction is achieved through surgical procedures following mastectomy after breast cancer or trauma using implants or autologous tissue to restore the breast morphology. Reconstruction can physically and emotionally restore a patient's self confidence after the loss of a breast. The method of breast reconstruction is determined by several factors, such as the patient's general medical condition, the extent of the mastectomy, and donor site suitability when opting for autologous flap transplantation. Generally, we can classify breast reconstruction procedures into two broad categories: breast implantation after tissue expansion of the skin of the chest, and flaps using autologous tissue. Of the breast reconstruction methods using autologous tissue, the transverse rectus abdominis musculocutaneous free flap is advantageous over the the transverse rectus abdominis musculocutaneous (TRAM) pedicled flap in that it is easy to obtain the desired shape of the breast, the inframammary fold is maintained, and there is decreased donor site morbidity because the rectus abdominis muscle can be utilized sparingly. Moreover, the TRAM free flap can have an abdominoplasty effect in women who have excessive abdominal fat. However, the procedure is time consuming because microanastomosis of the pedicle and recipient vessel is necessary after flap elevation. Although there are several issues, such as the high cost of surgery, which should be resolved, breast reconstruction can provide support to many women who are emotionally and physically distressed due to breast cancer.
Abdominal Fat ; Abdominoplasty ; Breast ; Breast Implantation ; Breast Implants ; Breast Neoplasms ; Female ; Free Tissue Flaps ; Glycosaminoglycans ; Humans ; Mammaplasty ; Mastectomy ; Muscles ; Rectus Abdominis ; Skin ; Surgical Flaps ; Thorax ; Tissue Donors ; Tissue Expansion ; Transplants

Plastic surgeons who perform reconstructive surgery of facial injuries have a dual responsibility: repair of the aesthetic defect and restoration of the function. The third goal is to minimize the period of disability. although emergent situations are limited in facial injuries, I would like to emphasize the advantages of prompt definitive reconstruction of the injuries and the contribution of early operative intervention to the superior aesthetic and functional outcomes. Socioeconomic and psychological factors make it imperative that an aggressive, expedient, and wellplanned surgical program be outlined, operated, and maintained to rehabilitate the patient to return to his or her active and productive life as soon as possible while minimizing aesthetic and functional disabilities. Teaching points: the techniques of extended open reduction and immediate repair or replacement of bone and microvascular tissue transfer of bone or soft tissue have made extensive and challenging injuries manageable. The principle of immediate skeletal stabilization in anatomic position has been enhanced by the use of rigid fixation and the application of craniofacial techniques that is safer and less traumatic for facial bone exposure. In this article, I will present mandibular fracture, orbital wall fracture and maxillar fracture, which are commonly encountered facial bone injuries. We can improve both the functional and aesthetic outcomes of facial fracture treatment when we manage the patients with the current concept of craniofacial techniques based on precise anatomic knowledge.
Facial Bones* ; Facial Injuries ; Humans ; Mandibular Fractures ; Orbit ; Orbital Fractures ; Psychology

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.
Breast Neoplasms ; Breast* ; Female ; Humans ; Insurance ; Korea ; Mammaplasty* ; Mastectomy ; Mastectomy, Simple ; National Health Programs* ; Seoul

Breast implant insertion is one of the most commonly used methods for breast reconstruction after total mastectomy. However, infection is a common postoperative complication of implant insertion. In most cases, these infections can be managed with antibiotics and supportive therapy. However, severe septic conditions, such as toxic shock syndrome (TSS), can sometimes occur. TSS is an extremely rare but life-threatening complication, for which early diagnosis and proper management play a crucial role in determining patients’ outcome. Although only 16 cases of TSS after breast implant insertion have been reported in the literature, most of those cases involved a serious clinical course. The reason for the seriousness of the clinical course of TSS in these cases is that the initial impression and presentation of these patients are nonspecific, and patients can easily be misdiagnosed as having a simple upper respiratory infection, causing the underlying condition to be neglected. Herein, we present two patients who were diagnosed with TSS after receiving breast reconstruction surgery via a silicone implant after total mastectomy. Both patients were misdiagnosed at the initial examination since they showed no local infectious signs on the postoperative wound.

Papillary carcinoma is the most common malignant tumor of the thyroid gland, and it only infrequently invades the upper aerodigestive tract. When such invasion does occur, it is a source of significant morbidity as well as mortality. Although most thyroid tumors first clinically manifest as a neck mass, there have been few reports of patients whose initial compliant was a disturbance of the aerodigestive tract. The patient in our present study had no significant past medical history, and esophagoscopy and biopsy revealed papillary adenocarcinoma. We report here on a case of thyroid papillary carcinoma that was diagnosed by esophagoscopic biopsy.
Adenocarcinoma, Papillary ; Biopsy ; Carcinoma, Papillary ; Esophagoscopy ; Humans ; Neck ; Thyroid Gland

Gigantomastia is a rare condition characterized by excessive hypertrophy of the connective tissue of the breast, which can cause physical and emotional distress. Surgical intervention is crucial for improving patients’ quality of life; however, it is challenging to balance minimizing the risk of recurrence and maximizing favorable aesthetic outcomes. This study documents the successful management of three rare cases of bilateral gigantomastia resulting from benign tumors. These cases included rapidly growing bilateral diffuse tumorous pseudoangiomatous stromal hyperplasia (PASH) and bilateral juvenile giant fibroadenoma, with no long-term recurrence observed. We discuss the diagnostic challenges and management considerations for gigantomastia, with a focus on reviewing PASH and its differential diagnosis. The findings offer valuable insights into the successful management of diverse gigantomastia cases caused by benign tumors, potentially aiding clinicians in making more informed decisions regarding optimal patient care.

PURPOSE: In cases of breast reconstruction with a free transverse rectus abdominis musculocutaneous(TRAM) flap after skin-sparing mastectomy with nipple-areolar complex(NAC) removal, the flat contour of the flap's skin paddle can easily look unnatural and dissatisfying. Reconstructed NAC on the flap surface lacks the elevated contour that the normal areola possesses, resulting in an unnatural final result. Therefore, we would like to introduce a novel method to improve this problem and report the satisfactory results we obtained. METHODS: Operations were conducted on 19 patients who underwent immediate breast reconstruction with a free TRAM flap and skin-sparing mastectomy from January 2009 to January 2010, with a mean follow-up of nine months. While the TRAM free flap was being inset, a purse-string suture was carried out on the dermal layer of skin flap to create a slight protrusion with Gore-Tex(R) sutures. RESULTS: The elevated mound surrounding the NAC was well maintained for an average follow-up period of nine months. Nipple projection was also well maintained. There was no complaint about breast contour or nipple height reduction. In addition, there was no reported incidence of other complications. CONCLUSION: The purse-string suture technique presents a more natural breast silhouette around the NAC and helps to maintain nipple projection. Furthermore, it does not require any supplementary incisions or complicated skills. There has been no report of additional complications using this technique.
Breast ; Female ; Follow-Up Studies ; Free Tissue Flaps ; Humans ; Incidence ; Mammaplasty ; Mastectomy ; Nipples ; Rectus Abdominis ; Skin ; Suture Techniques ; Sutures

BACKGROUND: Preoperative volume assessment is useful in breast reconstruction. Magnetic resonance imaging (MRI) and mammography are commonly available to reconstructive surgeons in the care of a patient with breast cancer. This study aimed to verify the accuracy of breast volume measured by MRI, and to identify any factor affecting the relationship between measured breast volume and actual breast weight to derive a new model for accurate breast volume estimation. METHODS: From January 2012 to January 2013, a retrospective review was performed on a total of 101 breasts from 99 patients who had undergone total mastectomy. The mastectomy specimen weight was obtained for each breast. Mammographic and MRI data were used to estimate the volume and density. A standard statistical analysis was performed. RESULTS: The mean mastectomy specimen weight was 340.8 g (range, 95 to 795 g). The mean MRI-estimated volume was 322.2 mL3. When divided into three groups by the "difference percentage value", the underestimated group showed a significantly higher fibroglandular volume, higher percent density, and included significantly more Breast Imaging, Reporting and Data System mammographic density grade 4 breasts than the other groups. We derived a new model considering both fibroglandular tissue volume and fat tissue volume for accurate breast volume estimation. CONCLUSIONS: MRI-based breast volume assessment showed a significant correlation with actual breast weight; however, in the case of dense breasts, the reconstructive surgeon should note that the mastectomy specimen weight tends to overestimate the volume. We suggested a new model for accurate breast volume assessment considering fibroglandular and fat tissue volume.
Breast ; Breast Neoplasms ; Dimensional Measurement Accuracy ; Female ; Humans ; Information Systems ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Mammaplasty ; Mammary Glands, Human ; Mammography ; Mastectomy ; Mastectomy, Simple ; Retrospective Studies

BACKGROUND: One of the most common breast reconstruction techniques that uses autologous tissue is the free muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) flap. However, patients hesitate to choose this method because of the long transverse scar between the anterior superior iliac spines. Furthermore, traditional reconstruction using a free MS-TRAM flap entails donor site morbidities such as pain, hematoma, or seroma. Here, we introduce a mini-abdominoplasty-designed free TRAM flap with flap beveling, which can be a good method for breast reconstruction in Asian patients who have small breasts. METHODS: Breast reconstruction with free MS-TRAM flaps using the mini-abdominoplasty design and flap beveling was performed in 10 patients following mastectomy. Patient age, presurgical brassiere cup size, tumor type, operation type, excised breast weight, elevated flap weight, flap weight used for the breast, recipient vessel, operation time, day that the abdominal drain was removed, and complications associated with both the flap and donor site were documented for all flaps and patients. RESULTS: For all 10 mini-abdominoplasty-designed free TRAM flap procedures, no flap loss or donor site morbidity was noted over a mean follow-up time of 16 months. CONCLUSIONS: The mini-abdominoplasty-designed free TRAM flap can safely and satisfactorily be implanted for the reconstruction of mastectomy defects. It can transfer the lower abdominal skin and subcutaneous tissue for breast reconstruction with minimal donor site scarring and morbidity, especially in Asian patients, who generally have smaller breasts.
Abdominoplasty ; Asian Continental Ancestry Group ; Breast* ; Cicatrix ; Female ; Follow-Up Studies ; Free Tissue Flaps* ; Hematoma ; Humans ; Mammaplasty* ; Mastectomy ; Myocutaneous Flap ; Rectus Abdominis ; Seroma ; Skin ; Spine ; Subcutaneous Tissue ; Tissue Donors