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Breast Reconstruction Using a TRAM Free Flap with a Mini-Abdominoplasty Design and Flap Beveling.

Tae Hoon KIM ; Kyung Won MINN ; Ung Sik JIN

Archives of Aesthetic Plastic Surgery.2015;21(3):109-115. doi:10.14730/aaps.2015.21.3.109

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

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Minimizing the Gap between Expectation and Outcome in Breast Augmentation.

Jin HWANG ; Chul Hwan SEUL

Archives of Aesthetic Plastic Surgery.2015;21(3):96-108. doi:10.14730/aaps.2015.21.3.96

BACKGROUND: Most patients who desire breast augmentation have higher expectations than the outcomes that can be achieved. The purpose of this article is to propose strategies for coping with each patient's expectation, and selecting the most appropriate surgical method. METHODS: Data were retrospectively reviewed for 138 women who underwent breast augmentation between July 1, 2012 and June 30, 2014. The augmentation methods were selected based on the patients' expectations. According to each expectation, we recommended the optimal procedure and material for each patient, and performed the augmentation in accordance with this as much as possible. The patients were asked postoperatively whether they were satisfied with their outcomes. RESULTS: Most patients (85%) were satisfied with their results during the mean postoperative follow-up period of 21.4 +/- 7.6 months (range, 8-32 months). The remaining, dissatisfied patients (15%) accepted their final results after receiving explanations or additional procedures. CONCLUSIONS: We classified common expectations of breast augmentation patients into nine categories. To minimize the gap between expectations and outcomes, we preoperatively provided realistic explanations about the limitations of the chosen materials and surgical methods with each patient. We then performed breast augmentation in consideration of the patient's expectations. Consequently, we were able to appropriately deal with each patient's expectations.
Breast Implantation ; Breast* ; Female ; Follow-Up Studies ; Humans ; Mammaplasty ; Patient Satisfaction ; Retrospective Studies

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Nonexcisional, Minimally Invasive Rejuvenation of the Neck Using Radiofrequency Tissue Tightening (FaceTite(TM)).

Jin Seok KANG ; Seong Eun CHO ; Seung Min NAM ; Eun Soo PARK

Archives of Aesthetic Plastic Surgery.2015;21(3):91-95. doi:10.14730/aaps.2015.21.3.91

BACKGROUND: Noninvasive radiofrequency (RF) and lasers have been used for skin tightening and body contouring since the 1990s. The safety, efficacy, and patient satisfaction with the procedure using a novel RF device (BodyTite(TM); Invasix Ltd, Yokneam Ilit, Israel) were evaluated. METHODS: We retrospectively included 13 patients who were treated with the BodyTite(TM) to rejuvenate neck skin from May 2012 to May 2014. The power of the device was set between 10 and 15 W. The target temperature was set at 38degrees C. Three independent evaluators were asked to grade baseline and 6- to 12-month follow-up photographs using a comprehensive quantitative 4-point laxity grading scale. All patients were asked to rate their satisfaction with the aesthetic outcome and quality of life after treatment. RESULTS: Grading results of baseline and follow-up photographs of patients were statistically significant with an average grade improvement of 1.01 points on the 4 point scale. Using a patient satisfaction scale, patients were also significantly more satisfied (poor, 0%; fair, 15%; good, 46%; and excellent, 39%). There were transient complications, such as minimal erythema, mild edema, and focal hardness, which resolved spontaneously within 1 week. There were no significant adverse effects or complications. CONCLUSIONS: The BodyTite(TM) is a minimally invasive, RF treatment that was demonstrated to improve skin laxity without significant adverse effects or complications. The BodyTite(TM) provides a nonsurgical option for the safe and effective rejuvenation of neck skin under local anesthesia.
Anesthesia, Local ; Edema ; Erythema ; Follow-Up Studies ; Hardness ; Humans ; Neck* ; Patient Satisfaction ; Quality of Life ; Rejuvenation* ; Retrospective Studies ; Skin

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Medial Crease Formation in Unfavorable Subbrow Excision: Medial Crease in Subbrow Excision.

Heeyeon KWON ; Eui Cheol JEONG

Archives of Aesthetic Plastic Surgery.2015;21(3):87-90. doi:10.14730/aaps.2015.21.3.87

BACKGROUND: Various surgical techniques have been developed to address senile upper eyelids. Upper blepharoplasty has limited efficacy in natural periorbital rejuvenation for severe lateral hooding of the upper eyelids, as well as often producing a 'surprised look'. Subbrow excision is a popular method in East Asia for the correction of eyelid drooping, especially on the lateral side as periorbital rejuvenation. However, medial upper eyelid skin redundancy often tends to be undercorrected. Here, we present a few cases of revisional blepharoplasty, especially for medial crease formation, to improve aesthetic results. METHODS: Five patients, for a total of 10 eyelids, who underwent revisional blepharoplasty from January 2011 to January 2015 after a previous subbrow excision, were included. Patients were dissatisfied with uncorrected excessive skin on the medial part of the upper eyelid after a previous subbrow excision; thus, they underwent revisional blepharoplasty for medial crease formation. RESULTS: During the follow-up period, patients were aesthetically satisfied with the postoperative results. No patients suffered from any complications during the follow-up period. CONCLUSIONS: After a previous unfavorable subbrow excision, medial crease formation, via a very minimally invasive technique, could be a favorable option to improve patient satisfaction without postoperative complication or discomfort.
Blepharoplasty ; Eyebrows ; Eyelids ; Far East ; Follow-Up Studies ; Humans ; Patient Satisfaction ; Postoperative Complications ; Rejuvenation ; Skin

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Migration of a Ruptured, Silicone Gel-Filled Breast Implant into Sternal and Abdominal Areas.

Heon YOO ; Seung Jun SHIN ; Myong Chul PARK

Archives of Aesthetic Plastic Surgery.2014;20(3):178-181. doi:10.14730/aaps.2014.20.3.178

A 50-year-old woman visited our hospital for two palpable masses on her sternal and left upper abdominal areas. She had augmentation mammoplasty 12 years prior. Based on the physical examination, the mass in the sternal area was firm, movable, and round. The size of the mass was approximately 3.0x3.0x1.0 cm3. The mass in the upper-left abdomen showed similar characteristics, with a size of approximately 10.0x15.0x1.5 cm3. Ultrasonography revealed a 3.9x1.0x3.4 cm3 hypoechoic lesion in the sternal area. On enhanced-mode computed tomography, a rupture of the left breast implant was noted. Both masses had similar densities as the implant. After rupture of the breast implant, surgery was performed under general anesthesia. Using an inframammary approach, both breast implants and masses were removed using the site of the previous mammoplasty incision. Intraoperative findings revealed that the left breast implant was ruptured and the masses consisted of implant gel components. After surgery, the patient's recovery was uneventful. The patient was discharged without any problem on hospital day 9.
Abdomen ; Anesthesia, General ; Breast Implants* ; Female ; Humans ; Mammaplasty ; Middle Aged ; Physical Examination ; Rupture ; Silicone Gels* ; Ultrasonography

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Prevention of Lower Eyelid Ectropion Using Noninsional Suspension Sutures after Blepharoplasty.

So Min HWANG ; Sang Hwan LEE ; Kyoung Seok OH ; Hyung Do KIM ; Yong Hui JUNG ; Hong Il KIM

Archives of Aesthetic Plastic Surgery.2014;20(3):173-177. doi:10.14730/aaps.2014.20.3.173

Blepharoplasty is one of the most common anti-aging operations. Although rare, complications such as ectropion may occur. Thus, we introduced an operative technique to prevent ectropion of the lower lid after blepharoplasty. From January 2012 to August 2013, we performed a nonincisional suspension suture (NISS) technique for 30 patients who visited our clinic for lower blepharoplasty. These patients had a distance of greater than 7 mm on the distraction test and were suspected of having horizontal lid laxity. We performed a slit incision 3 mm superior to the junction between the lateral epicanthus and the orbital bone during lower blepharoplasty. We passed a 7-0 nylon suture through the subcutaneous layer and the orbicularis oculi muscle. Then, we punctured the tarsal plate at the lateral limbus and fixed it to the lateral orbital rim by puncturing the periosteum. We tied a suspension knot through the slit incision. Thirty patients had satisfactory results without major complications, such as scleral exposure or ectropion. The NISS technique could be an effective method by which to prevent postoperative ectropion in cases with a mild to moderate degree lower lid laxity. The use of a NISS procedure is also a simple surgical technique, which saves time and is minimally invasive.
Blepharoplasty* ; Ectropion* ; Eyelids* ; Humans ; Nylons ; Orbit ; Periosteum ; Surgical Procedures, Minimally Invasive ; Sutures*

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Endoscopic Correction of Inferior Implant Malposition in Augmented Breasts with Electrocauterization.

Han Jo KIM ; Yong Jun JANG ; Seung Yong SONG

Archives of Aesthetic Plastic Surgery.2014;20(3):169-172. doi:10.14730/aaps.2014.20.3.169

Bottoming out is the term used to describe the inferior displacement of a breast implant after breast augmentation that results in increased distance between the nipple areolar complex and the inframammary fold. Conventional techniques for correcting bottoming out involve capsulectomy and capsulorrhaphy via an inframammary fold incision that is prone to cause large scar and increases the patient's burden. However, using an endoscopic approach via the axilla, we are able to correct bottoming out, resulting in a smaller scar and shorter recovery time. In this article, we present a novel and simple method to correct bottoming out using endoscopy and electrocauterization.
Axilla ; Breast Implants ; Breast* ; Cicatrix ; Endoscopy ; Nipples

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Review of Keloid Patients with Clinical Experience.

Young Hoo JOH ; Seung Jun SHIN ; Myong Chul PARK ; Dong Ha PARK

Archives of Aesthetic Plastic Surgery.2014;20(3):165-168. doi:10.14730/aaps.2014.20.3.165

BACKGROUND: Keloid management can be difficult and frustrating, and the mechanisms underlying keloid formation are only partially understood. Despite many studies of the pathogenesis and cause, little is known of the predisposing factors or the diathesis. Therefore, we evaluated patients with keloid for 13 years clinical experience, with the goal of considering the causative factors and physical disposition of keloid. METHODS: We evaluated 107 patients (38 males, 69 females; median age 22.31 years, range 7-58 years) who visited the department of plastic and reconstructive surgery from March 1998 to December 2010. The patients' chart and clinical photo were reviewed for the study. RESULTS: Etiologies were an intended wound like piercing or surgical wound (n=39), avulsion flap injury (n=30), laceration (n=29) and burn (n=9). The location were the head and neck (n=38), trunk (n=23), upper extremity (n=21), lower extremity (n=16) and face (n=9). Patients with more than overweight (>23 kg/m2, Body mass index) were 84 in 107 patients (78.5%) with keloids. CONCLUSIONS: In the care of the keloids, patient information, particularly sex, age and body mass index, it may be useful indicators for expecting prognosis of the patients and treating with proper management. Particularly, large-scale accurate follow-up observations on obese patients will be critical.
Body Mass Index ; Burns ; Causality ; Disease Susceptibility ; Epidemiology ; Female ; Head ; Humans ; Keloid* ; Lacerations ; Lower Extremity ; Male ; Neck ; Overweight ; Prognosis ; Upper Extremity ; Wounds and Injuries

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Combined, Minimally Invasive, Thread-based Facelift.

Hyun Ho HAN ; Ji Min KIM ; Nam Ho KIM ; Ro Hyuk PARK ; Jong Beum PARK ; Tae Joo AHN

Archives of Aesthetic Plastic Surgery.2014;20(3):160-164. doi:10.14730/aaps.2014.20.3.160

BACKGROUND: As society changes, patients have high expectations of plastic surgery and rapid recovery after surgery. A thread-based facelift meets these requirements and is growing in popularity. METHODS: Former thread lifts were either floating or fixed types. The authors used both types. Using a vertical line from the lateral orbital rim as the center, the anterior face was lifted with floating-type threads and the lateral face was lifted with fixed-type threads. The Blue RoseTM thread was used for the combined-type facelift, as it is stronger than other threads. Improvements were measured using the Global Aesthetic Improvement Scale (GAIS). RESULTS: Eighteen patients out of 28 were followed over 3 months. Five patients (28%) reported a GAIS score of 2, 10 patients (55%) had a GAIS score of 3, 2 patients (11%) had a GAIS score of 4, and one patient was unsatisfied with the surgical results. Results showed improvements in 83% of the patients. CONCLUSIONS: The combined, minimally invasive, thread-based facelift has some benefits. First, the functional anatomy of the face is considered. Second, the pulling force of the threads is stronger than formerly used threads. Third, especially in Asian patients, the postoperative broadening of the malar area can be minimized. Thus, a combined thread lift using Blue Rose threads can provide a natural-looking and strong facelift.
Asian Continental Ancestry Group ; Humans ; Orbit ; Rejuvenation ; Rhytidoplasty* ; Surgery, Plastic ; Surgical Procedures, Minimally Invasive

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Efficacy of Lateral Canthoplasty Combined with Transconjuctival Lower Blepharoplasty in Young Asian Patients.

Joo Youn KIM ; Jung Il KIM ; Hyun Gon CHOI ; Ki Il UHM ; Dong Hyeok SHIN

Archives of Aesthetic Plastic Surgery.2014;20(3):155-159. doi:10.14730/aaps.2014.20.3.155

BACKGROUND: The lower eyelid bag associated with an old and tired appearance is not a rare aesthetic problem in young Asian people who have short palpebral fissures and an up-slanting appearance. Many patients want to make their eyes larger, brighter and more youthful at the same time. The purpose of the current study was to determine the feasibility of lateral canthoplasty combined with transconjunctival lower blepharoplasty in minimizing complications and maximizing aesthetic results. METHODS: From June 2011 to May 2014, 59 patients underwent inferior orbital fat removal and orbital septal resets through transconjunctival approaches and lateral canthoplasty. Simple inferolateral canthotomy incisions were used to provide a sufficient operative field for manipulation of the orbital septum, to lengthen the horizontal palpebral fissures and to lower the lateral canthal angle. Patients were evaluated to identify the presence of postoperative complications and to assess the need for additional operations. RESULTS: Most of the patients were satisfied with the aesthetic results during the 2-12-month postoperative follow-up period. There were no recurrences of lower eyelid bulging, postoperative asymmetry, or wound-related complications. Three cases of entropion and two cases of roundness of the lateral canthal angle occurred following the primary operation. However, there were no further complications after secondary operations to correct the tarsal-periosteal fixation position. CONCLUSIONS: Lateral canthoplasty combined with transconjunctival lower blepharoplasty using simple lateral canthotomy is a safe and effective method for maximizing aesthetic results in young Asian patients.
Adipose Tissue ; Adolescent ; Asian Continental Ancestry Group* ; Blepharoplasty* ; Entropion ; Eyelids ; Follow-Up Studies ; Humans ; Orbit ; Postoperative Complications ; Recurrence

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