Nipple Reconstruction Using Various Local Flaps

The existence of numerous methods of nipple reconstruction in the literature is indicative of the difficulties encountered while duplicating a normal nipple. We have performed breast reconstruction with free TRAM flap for last 10 years, and after the breast mound reconstruction we have performed nipple reconstruction with three different methods -star flap, double opposing tab flap, and C-V flap. We compared the final outcomes of these three reconstruction methods. From March 1992 to February 2001, we experienced the 82 cases of the breast reconstruction with free TRAM and the nipples were reconstructed in 54 cases by the same surgeon. 9 cases were reconstructed with star flaps, 19 cases were reconstructed with double opposing tab flaps and 26 cases were reconstructed with C-V flaps. We compared the results of the difference of the nipple projection and the patients' satisfaction in 2 weeks and 12 months after the operation. In 12 months after the operation, the average projection of the nipple was 4.2 mm in star flap, 4.5 mm in double opposing tab flap and 6.5 mm in C-V flap. The average reduction rate of the nipple projection was 46.6%, 57.4% and 32.5% respectively in 1 year after the operation. We considered that the star flap often showed the partial necrosis on the sharp tip of the flap and the contracture of the scar tissue. We assumed that double opposing tab flap showed the good projection initially. However, as time goes, it showed a widening shape on the base of nipple and disfiguring mound of breast because of high tension in the closure. The C - V flap showed round tip and less disfiguring mound of breast because of less tension and less spreading, so it shows the least reduction rate of nipple projection. We concluded that the reconstructed nipple with C-V flap showed the least reduction of nipple projection and the most satisfactory result among these 3 methods. We recommend that the nipple should be reconstructed initially much larger than the opposite nipple considering about one-third reduction rate 1 year after the surgery.

Secondary Touch Surgery Following Breast Reconstruction with Free TRAM Flap

It is very difficult to reconstruct perfectly symmetrical breast in one stage operation. Therefore, it is not uncommon that the surgeons perform secondary touch surgery following breast reconstruction to get more satisfactory results. The purpose of this article is to recognize various morphologic problems which could be occurred following breast reconstruction and to present the secondary touch surgery which can solve this problem for more symmetrical and natural breast reconstruction. From August 1995 to August 2001, breast reconstruction with free TRAM flap had been performed in 53 patients. Among them, 26 patients underwent secondary touch surgery. The patient's age ranged between 26 and 56 years with a mean of 41.3 years. The average time of the operation after breast mound reconstruction was 8.9 months. The nipple-areolar reconstruction was performed at the same time in all cases. There were liposuction in 9 cases, fat mobilization in 7 cases, correction of inframammary fold in 5 cases, scar revision in 11 cases, augmentation mammoplasty for normal side in 3 cases, reduction mammoplasty for normal side in 1 case, and mastopexy in 6 cases. In addition, adjuvant surgeries were performed coincidentally such as abdominal liposuction, and facial resurfacing. The result was effective. The author could make a more symmetrical and natural breast after secondary touch surgery. The advantage of this surgery is to reconstruct a more symmetrical and natural breast by a relatively simple procedure with concomitant nipple-areolar reconstruction

Secondary Reconstruction for Head and Neck Cancer Patient

The purpose of secondary reconstruction for head and neck cancer patient is to manage complications and to improve functional and aesthetic defects following previous surgery. The complications following primary treament of tumor include radionecrosis in bones and soft tissue following radiotherapy, formation of orocutaneous fistula, dehiscence of wounds, secondary infection in wounds, and total or partial necrosis in transferred flaps. Following the resection of tumor some functional deficiencies appear such as dyspnea, swallowing and chewing difficulty due to strictures of reconstructed aerodigestive tract and bulkness of flap. In addition, we performed adjuvant surgery for aesthetic improvement or prosthetic appliance after head and neck reconstruction. We have experienced secondary reconstructions in 29 patients who underwent previous surgical resection for head and neck cancer from June 1988 to March 2000. Ages ranged from 36 to 77 with an average of 58.3. We have performed free flaps in 21 cases, skin grafts in 3 cases, local or regional flaps in 2 cases, and other adjuvant procedure in 4 cases. Secondary reconstructions were successful in all cases. The complicated wounds and fistulae were healed completely, the aerodigastric tract with the stricture was reconstructed with healthy tissue and respiration and swallowing functions were recovered. Aesthetic improvement and prosthetic appliance were also achieved through secondary adjuvant treatment. In conclusion, the successful secondary reconstruction for head and neck cancer needs a careful preoperative planning and therapeutic strategy. We believe that secondary reconstruction for head and neck reconstruction is very important for these cancer patients even though primary resection had been successfully performed for cancer removal, because it can provide better quality of life and sometimes save the patient's life itself.