Immediate One-Stage Breast Reconstruction Including Nipple-Areolar Complex

As surgical trend for breast cancer changes, the method for breast reconstruction is also changing. Due to improved diagnostic techniques and public awareness, more and more patients with breast cancer are diagnosed at earlier stage and the number of patients who undergo skin sparing mastectomy is also increasing. Skin sparing mastectomy has several advantages for immediate breast reconstruction over modified radical mastectomy. Its preservation of breast skin envelope and inframammary fold made it possible to provide more natural breast mound shape without any evidence of increased local recurrence of malignancy. Furthermore, in case of immediate breast reconstruction after modified radical mastectomy, procedures for nipple-areolar reconstruction was deferred for fear of postoperative deformation and vascular problem of the flap. This interval made patients less satisfied with the result and postoperative adjuvant treatment had to be sometimes postponed. To avoid these limitations, "one-stage" breast reconstruction including nipple-areolar complex was performed after skin sparing mastectomy. From December 1998 to March 2000, a total of 12 patients with breast cancer underwent skin-sparing mastectomies, which were followed by immediate reconstruction using our new technique. After long-term follow-up, no major complication including flap necrosis or asymmetry was found and all patients were satisfied with the results. With careful patient selection and adequate intra-operative flap tailoring, this new technique could offer lots of advantages to both surgeons and patients.

Immediate One-Stage Breast Reconstruction Including Nipple-Areolar Complex

As surgical trend for breast cancer changes, the method for breast reconstruction is also changing. Due to improved diagnostic techniques and public awareness, more and more patients with breast cancer are diagnosed at earlier stage and the number of patients who undergo skin sparing mastectomy is also increasing. Skin sparing mastectomy has several advantages for immediate breast reconstruction over modified radical mastectomy. Its preservation of breast skin envelope and inframammary fold made it possible to provide more natural breast mound shape without any evidence of increased local recurrence of malignancy. Furthermore, in case of immediate breast reconstruction after modified radical mastectomy, procedures for nipple-areolar reconstruction was deferred for fear of postoperative deformation and vascular problem of the flap. This interval made patients less satisfied with the result and postoperative adjuvant treatment had to be sometimes postponed. To avoid these limitations, "one-stage" breast reconstruction including nipple-areolar complex was performed after skin sparing mastectomy. From December 1998 to March 2000, a total of 12 patients with breast cancer underwent skin-sparing mastectomies, which were followed by immediate reconstruction using our new technique. After long-term follow-up, no major complication including flap necrosis or asymmetry was found and all patients were satisfied with the results. With careful patient selection and adequate intra-operative flap tailoring, this new technique could offer lots of advantages to both surgeons and patients.

Accelerated Acute Rejection in Renal Allograft: Analysis of prognostic factors

Accelerated acute rejection(AAR) is a rare condition and has a poor prognosis in graft survival following renal transplantation. To elucidate its characteristics, we analysed 14 cases(5.0%) of AAR among 279 renal transplantation. AAR is defined as a condition in which immediate postoperative urine output is good followed by decreased urine output and increase of serum creatinine level within 7 days after transplantation. The incidence of AAR was more prevalent in cadaveric donors than living donors. One year graft survival was inferior in AAR, namely 8 out 14 cases(57%), than that of the patients without AAR(95.1%). Among the factors affecting graft survival in AAR, age and sex of both donor and recipient, donor condition such as living or cadaveric donor, and preoperative HLA matching had no relevance to a graft survival. Time of onset of AAR has no effect on graft survival either. Postoperative donor lymphocytotoxic test showed positive result in one out of 3 patient despite of all negative findings in the preoperative crossmatching test. Histologic finding such as vasculitis on renal biopsy was related to graft survival. Response of treatment was 55% in initial solumedrol pulse therapy and 20% in secondary OKT3 treatment, with an overall effect of 57%. Rerejection developed in 4 out of 8 cases of graft survival group while all cases showed a good function at post operative two years. Graft survival following AAR remains low and AAR is one of the main cause of graft loss following renal transplantation. To illustrate its characteristics, more clinical analysis are required.