Usefulness of a Lateral Thoracodorsal Flap after Breast Conserving Surgery in Laterally Located Breast Cancer

양정덕,류동완,이정우,최강영,정호윤,조병채,박호용,변진석 대한성형외과학회 2013 Archives of Plastic Surgery Vol.40 No.4

Background Breast-conserving surgery is widely accepted as an appropriate method in breast cancer, and the lateral thoracodorsal flap provides a simple, reliable technique, especially when a mass is located in the lateral breast. This study describes the usefulness of a lateral thoracodorsal flap after breast conserving surgery in laterally located breast cancer. Methods From September 2008 to February 2013, a lateral thoracodorsal flap was used in 20 patients with laterally located breast cancer treated at our institution. The technique involves a local medially based, wedge shaped, fasciocutaneous transposition flap from the lateral region of the thoracic area. Overall satisfaction and aesthetic satisfaction surveys were conducted with the patients during a 6-month postoperative follow-up period. Aesthetic results in terms of breast shape and symmetry were evaluated by plastic surgeons. Results The average specimen weight was 76.8 g. The locations of the masses were the upper lateral quadrant (n=15), the lower lateral quadrant (n=2), and the central lateral area (n=3). Complications developed in four of the cases, partial flap necrosis in one, wound dehiscence in one, and fat necrosis in two. The majority of the patients were satisfied with their cosmetic outcomes. Conclusions Partial breast reconstruction using a lateral thoracodorsal flap is well matched with breast color and texture, and the surgery is less aggressive than other techniques with few complications. Therefore, the lateral thoracodorsal flap can be a useful, reliable technique in correcting breast deformity after breast conserving surgery, especially in laterally located breast cancer.

Surgical Techniques for Personalized Oncoplastic Surgery in Breast Cancer Patients with Small- to Moderate-Sized Breasts (Part 1): Volume Displacement

양정덕,이정우,조영규,김완욱,황승욱,정진향,박호용 한국유방암학회 2012 Journal of breast cancer Vol.15 No.1

Despite the popularity of breast-conserving surgery (BCS), which constitutes 50-60% of all breast cancer surgeries, discussions regarding cosmetic results after BCS are not specifically conducted. The simple conservation of breast tissue is no longer adequate to qualify for BCS completion. The incorporation of oncological and plastic surgery techniques allows for the complete resection of local disease while achieving superior cosmetic outcome. Oncoplastic BCS can be performed in one of the following two ways: 1) volume displacement techniques and 2) volume replacement techniques. This study reports volume displacement surgical techniques, which allow the use of remaining breast tissue after BCS by glandular reshaping or reduction techniques for better cosmetic results. Thorough understanding of these procedures and careful consideration of the patient’s breast size, tumor location, excised volume, and volume of the remaining breast tissue during the surgery in choosing appropriate patient and surgical techniques will result in good cosmetic results. Surgery of the contralateral breast may be requested to improve symmetry and may take the form of a reduction mammoplasty or mastopexy. The timing of such surgery and the merits of synchronous versus delayed approaches should be discussed in full with the patients. Because Korean women have relatively small breast sizes compared to Western women, it is not very easy to apply the oncoplastic volume displacement technique to cover defects. However, we have performed various types of oncoplastic volume displacement techniques on Korean women, and based on our experience, we report a number of oncoplastic volume displacement techniques that are applicable to Korean women with small- to moderate-sized breasts.

Contralateral Breast Management Related to Breast Reconstruction in Korean Females

양정덕,이정훈,정호윤,조병채,박호용,정진향 한국유방암학회 2010 Journal of breast cancer Vol.13 No.2

Purpose: The final purpose of post mastectomy reconstruction is a balanced, symmetrical, pleasing appearance for both breasts. However, in cases where women have an unattractive breast, which may be small, ptotic or huge, remodeling of the contralateral breast may be desirable. Surgical options available for the contralateral breast included breast augmentation using implants, mastopexy, and reduction mammoplasty. Methods: All patients who underwent unilateral breast reconstruction at Kyungpook National University Hospital from September of 2006 to February of 2008 were included in this study. The methods of reconstruction included transverse rectus abdominis musculocutaneous flap, latissimus dorsi flap, and the use of implants. Contralateral procedures to achieve symmetry included augmentation,mastopexy, and reduction. Results: A total of 57 patients were evaluated, including 45 immediate, and 12 delayed reconstructions. Twenty-six of these patients underwent contralateral breast management (augmentation [12], mastopexy [11], and reduction [3]). The average age was 44.9 years and the mean follow up interval was 13 months. Most of the patients were satisfied with the symmetry, clothed appearance, nude appearance, aesthetics, and consistency. Sixtysix percent (8 of 12) of delayed reconstruction patients had a symmetry procedure performed on the opposite breast, compared with 40 percent (18 of 45) of the immediate-reconstruction patients. No complications were observed on the contralateral breasts undergoing symmetrization. Conclusion: Contralateral management in breast reconstruction can provide symmetry with the reconstructed breast contour and aesthetically satisfactory results in a safe manner. Immediate symmetrization procedure also can avoid secondary operations and offer psychological benefits without delaying adjuvant therapy.

Usefulness of Oncoplastic Volume Replacement Techniques after Breast Conserving Surgery in Small to Moderate-sized Breasts

양정덕,Min Chul Kim,이정우,Young Kyoo Cho,최강영,정호윤,조병채,박호용 대한성형외과학회 2012 Archives of Plastic Surgery Vol.39 No.5

Background In Korean women, many of whom have small to moderate-sized breasts, it is difficult to cover a partial breast defect using oncoplastic volume displacement techniques after removal of an adequate volume of tissue during oncologic surgery. In such cases,oncoplastic volume replacement techniques are more useful. Methods From January 2007 to December 2011, 104 women underwent a total of 107 breastconserving surgeries with various kinds of oncoplastic volume replacement techniques. We used latissimus dorsi (LD) myocutaneous flap for cases in which the resection mass was greater than 150 g. In case with a resection mass less than 150 g, we used regional flaps such as a lateral thoracodorsal flap, a thoracoepigastric flap, or perforator flaps such as an intercostal artery perforator (ICAP) flap or a thoracodorsal artery perforator (TDAP) flap. Results The mean age was 46.1 years, and the average follow-up interval was 10.3 months. The patients underwent oncoplastic volume replacement techniques with a lateral thoracodorsal flap (n=9), thoracoepigastric flap (n=7), ICAP flap (n=25), TDAP flap (n=12), and LD flap (n=54). There was one case of congestion in an LD flap, and two cases of fat necrosis in an ICAP flap. Most of the patients were satisfied with the cosmetic results. Conclusions Oncoplastic volume replacement techniques can be reliable and useful for the correction of breast deformity after breast-conserving surgery, especially in patients with small to moderate-sized breasts.

Our Experiences in Nipple Reconstruction Using the Hammond flap

양정덕,류정엽,류동완,권오현,배성건,이정우,최강영,정호윤,조병채 대한성형외과학회 2014 Archives of Plastic Surgery Vol.41 No.5

Background: Nipple reconstruction following breast mound reconstruction is the final step inbreast reconstruction. Although nipple reconstruction is a simple surgery, the psychologicalaspects of nipple reconstruction are thought to be important. Nipple projection is a key factorin determining patient satisfaction with the surgery. In the present study, the Hammond flaptechnique was introduced for nipple reconstruction. Methods: Twenty-six patients who had undergonebreast reconstruction from February 2008to March 2012 were enrolled in this prospectivestudy. All patients were evaluated based onpreoperative photos, and their nipple diametersand heights were measured. Postoperativeevaluation was conducted 3, 6, 9, and 12 months following nipple reconstruction. Aquestionnaire on patient satisfaction with the nipple reconstruction was administered 12months after nipple reconstruction. Moreover, the same plastic surgeon scored nippleprojection and overall cosmetic result of the new nipple. Results: The mean projection was 4.4 mm (range, 3–6 mm), and it well matched the contralateralnipple. Twelve months following nipple reconstruction, the mean reduction rate inthe nipple projection was 43.6%. Patients were satisfied or very satisfied with the nippleprojection and the overall cosmetic result in 80.7% cases. Conclusions: In the present study, compared with other techniques, the use of the Hammondflap technique in nipple reconstruction showed competitive results with regard to nippleprojection and patient satisfaction.

Feasibility of the Use of RapiGraft and Skin Grafting in Reconstructive Surgery

양정덕,조인국,권준현,이정우,최강영,정호윤,조병채 대한성형외과학회 2016 Archives of Plastic Surgery Vol.43 No.5

Background Skin grafting is a relatively simple and thus widely used procedure. However, the elastic and structural quality of grafted skin is poor. Recently, various dermal substitutes have been developed to overcome this disadvantage of split-thickness skin grafts. The present study aims to determine the feasibility of RapiGraft as a new dermal substitute. Methods This prospective study included 20 patients with partial- or full-thickness skin defects; the patients were enrolled between January 2013 and March 2014. After skin defect debridement, the wound was divided into two parts by an imaginary line. Split-thickness skin grafting alone was performed on one side (group A), and RapiGraft and split-thickness skin grafting were used on the other side (group B). All patients were evaluated using photographs and self-questionnaires. The Manchester scar scale (MSS), a chromameter, and a durometer were used for the scar evaluation. The average follow-up period was 6 months. Results The skin graft take rates were 93% in group A and 89% in group B, a non-significant difference (P=0.082). Statistically, group B had significantly lower MSS, vascularity, and pigmentation results than group A (P<0.05 for all). However, the groups did not differ significantly in pliability (P=0.155). Conclusions The present study indicates that a simultaneous application of RapiGraft and a split-thickness skin graft is safe and yields improved results. Therefore, we conclude that the use of RapiGraft along with skin grafting will be beneficial for patients requiring reconstructive surgery.

Aesthetic Scar-Less Mastectomy and Breast Reconstruction

양정덕,이지연,이준석,김은규,박찬섭,박호용 한국유방암학회 2021 Journal of breast cancer Vol.24 No.1

Surgical approaches in breast cancer have been changing to ensure both oncologic safety and cosmetic results. Although the concept of “oncoplastic breast surgery” has been accepted for decades, breast and plastic surgeons have been striving to develop more advanced surgical skills that ensure non-inferior oncologic outcomes with better cosmetic outcomes. Endoscopic or robotic devices, which are currently available only for chest or abdominal surgeries, could be used for breast surgery to ensure better cosmetic outcomes. The authors refer to this surgical concept as “aesthetic scar-less breast surgery and reconstruction,” a term that encompasses the consequential concepts rather than naming it with simple technical words such as endoscopy-assisted or robot-assisted surgery. The “scar-less” term simply means leaving less of a scar, and better results can be expected by designing incisions on invisible areas. Herein, we summarize our experiences with various techniques of “aesthetic scar-less” surgery and review the existing literature on this topic.

유전자 재조합으로 만든 T-CAM(Tetra Cell Adhesion Molecule)이 창상치유에 미치는 효과

양정덕,박재우,이신일,정재영,정호윤,조병채,백봉수,김인산 대한성형외과학회 2003 Archives of Plastic Surgery Vol.30 No.4

T-CAM(Tetra cell adhesion molecule) is new recombinant mixture of fibronectin and βig-h3. Fibronectin and βig-h3 are extracellular matrix protein involved in each phase of wound healing and sum of these materials may play synergistic effect on the wound healing. In order to evaluate wound healing effect of T-CAM on open wound in rabbit, we made four round full thickness skin defects, 3 cm in diameter, bilaterally on the dorsolateral aspect of New Zealand white rabbit's trunk. We divided the wound into four groups, according to the content of topocally applied onitments: Group A treated with ointment base only; Group B with ointment containing fibronectin 300μg/ml; Group C with ointment containing βig-h3 300μg/ml; Group D with ointment containing T-CAM 300μg/ml. These ointments were applied daily on the wound. We compared each group with gross findings by means of percentage of wound contraction, percentage of wound epithelization and percentage of total wound healed area with surface tracing the remained wound area on the 0, 6,th 12th, 18th day after wound formation and wound biopsy were performed on the 3rd, 6th, 10th, 14th, and 21st day after wound formation.The T-CAM group shows statistically significant (p< 0.05 ANOVA test and Scheffe's test) in wound contraction and total wound healed area than other groups on the 6th day after wound formation, and equally significant on the 12th and 18th day after wound formation except in group C. In histological examination, T-CAM group shows less inflammatory cell infiltration, faster angiogenesis and marked fibroblast proliferation than other groups in early inflammatory period, and more matured, thickened reepithelization and regularly aligned collagen formation on the 14th and 21st day.This study suggest recombinant T-CAM shows synergistic effect on wound healing, and is expected as new potent material for treatment of wound healing.

진행성 유방암에서 즉시 유방 및 흉벽 재건술

양정덕,김학태,정호윤,조병채,최강영,이정훈,박호용,이정우 대한성형외과학회 2011 Archives of Plastic Surgery Vol.38 No.5

Purpose: Advanced breast cancer traditionally has been perceived as a contraindication to immediate breast reconstruction, because of concerns regarding adjuvant treatment delays and the cosmetic effects of radiotherapy to breast reconstruction, so delayed reconstruction is usually preferred in advanced breast cancer patients undergoing mastectomy. However, with the improved outcome using multimodality therapy, consisting of perioperative chemotherapy and radiotherapy, immediate breast reconstruction is now being performed as surgical option for selected advanced breast cancer patients. Additionally, advanced breast cancer patients may be needed soft tissue coverage of an extensive skin and soft tussue defect after mastectomy. Current authors have experienced several types of immediate breast and chest wall reconstruction for advanced breast cancer. Methods: From December of 2007 to June of 2009, 14 women performed for immediate breast and chest wall reconstruction for advanced breast cancer. They had been treated with neoadjuvant chemotherapy or chemoradiotherapy followed by modified radical mastectomy or radical mastectomy. Four different techniques were used immediate breast and chest wall reconstruction, which are pedicled TRAM flap(4 cases), extended LD flap with STSG(3 cases), thoracoabdominal flap(4 cases) and thoracoepigastric flap(3 cases). Results: The mean age was 53 years and mean follow up period was 9 months. Patients’ oncologic status ranged stage IIIa to stage IV. Two patients had major complications: partial flap necrosis of TRAM flap and one distal necrosis of thoracoabdominal flap. Three patients with stage IV disease died from metastases. Conclusion: The result of this study suggests that immediate breast and chest wall reconstruction can be considered as surgical option for advanced breast cancer. But we need long term follow up and large prospective studies for recurrence and survival.

과급 횡복직근피판술(Supercharged TRAM)을 이용한 유방재건술

양정덕,송재민,이상윤,정호윤,조병채,박호용,정진향,Yang, Jung-Dug,Song, Jae-Min,Lee, Sang-Yun,Chung, Ho-Yun,Cho, Byung-Chae,Park, Ho-Yong,Jung, Jin-Hyang 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.5

Purpose: When reconstruction for patients who have the large contralateral breast or a following large defect after mastectomy is required, conventional pedicled TRAM flap shows the unpredictable occurrence of fat necrosis and skin flap loss in a relatively high percentage due to insufficient blood supply. In an effort to obtain more stable TRAM flap blood circulation, we have performed a supercharged technique using deep inferior epigastric perforators (DIEP) with conventional pedicled TRAM flap. Methods: From September of 2006 to December of 2008, Fourteen supercharged TRAM flap were performed for breast reconstruction after modified radical mastectomy. The contralateral DIEP was anastomosed to the internal mammary vessels in contralateral pedicled TRAM flap or thoracodorsal vessels in ipsilateral pedicled TRAM flap. Nutrient vessels were selected by Multi-Detector Computed tomography (MD-CT) modalities. For the nutrient vessel, we used deep inferior epigastric vessels (DIEV) of the ipsilateral side in 8 patients, DIEV of the contralateral side in 6 patients. In addition, for the recipient vessel, we used thoracodorsal vessels in 8 patients, internal mammary vessels in 5 patients, intercostals artery perforators in 1 patient. Results: The mean age was 46.8 years and the average follow-up interval was 14 months. There were 11 immediate and 3 delayed breast reconstructions. Fat necrosis incidence rate in supercharged TRAM group was lower than in conventional TRAM flap group. There were no differences of the incidences of abdominal hernia in both groups. Conclusion: The supercharged TRAM flap produces an improvement in vascularity that permits use of all four zones of the flap. The breast reconstruction with supercharged technique is reliable and valuable methods which provide sufficient soft tissue from abdomen without significant complications.