ABSTRACT
Immediate breast reconstruction in breast cancer patients is universalized and now with a wide variety of methods to choose from, we can select a breast reconstruction method according to the patient's condition. Among these methods, immediate breast reconstruction with TRAM free flap is the most commonly used. Nipple reconstruction is usually performed as a secondary procedure, reconstructed. Nipple is reconstructed with contralateral nipple composite graft or with local flap. Areola is reconstructed with skin graft and tattooing. Therefore, to reconstruct complete breast, two or more staged operations are needed and are troublesome to both the surgeon and the patient. If we could reconstruct breast mound and nipple at same time, we would reduce the operative stages and heighten the patient's satisfaction. The author performed delayed or immediate breast reconstruction with TRAM free flap and nipple reconstruction at the same time. If the TRAM flap was to situate in the whole of the breast or at the center of the breast mound, nipple was reconstructed with a local flap from the TRAM flap. If the TRAM flap was not situated in center of breast mound, nipple was reconstructed with a local flap from remnant breast skin. Immediate nipple reconstructions in breast reconstruction consisted total of 22 cases. Among these, delayed breast reconstruction were 5 cases and immediate breast reconstruction were 17 cases. According to patient's condition and mastectomy method, nipple reconstruction method was selected; nipple reconstruction with contralateral nipple composite graft(3 cases); nipple reconstruction with remnant breast skin(6 cases); nipple reconstruction from flap margin(10 cases); nipple reconstruction with prefabricated nipple on flap(3 cases). Malposition of the reconstructed nipple was the most common and serious complication(6 cases). The other complications were atrophy of the nipple(1 case), and necrosis(1 case). Reconstruction of the breast and nipple at the same time can reduce the need of a secondary operation and use remnant skin or redundant flap tissue maximally. On the other hand, it must be considered that position and shape of nipple could be deformed, because the nipple reconstruction is performed before the shape of reconstructed breast settles completely. Prudent attention is needed, because the danger of complication is higher than delayed nipple reconstruction.
Subject(s)
Female , Humans , Atrophy , Breast Neoplasms , Breast , Free Tissue Flaps , Hand , Mammaplasty , Mastectomy , Nipples , Skin , Tattooing , TransplantsABSTRACT
It is known that E-cadherin, playing a role in the differentiation of the various tissues, is expressed in the early stage of development. In this research, the expression of E-cadherin and the presence of the intracellular E-cadherin mRNA in the developing fetal rat palatine epithelium using immunohistochemistry and in situ RT-PCR are studied. The investigator also performs TUNEL method and TEM technique for detecting the apoptosis in the palatine epithelium. Fetal rats on the 14th, 15th, 16th and 18th day of gestation were used. The results obtained were as follows: Before the fusion of the both palatine shelves, E-cadherin was expressed in the oral part epithelium. After the fusion oral epithelium and original triangular area were reacted strongly. TUNEL positive cells were rarely found on the midline palatine epithelium in fused palatine processes. On the 18th day of gestation, the remodeling time, many apoptotic cells were observed in the original triangular area. It is suggested that E-cadherin plays a role in the fusion of the palatine shelves, especially in the fusion between the oral part and lower part of midline epithelium, and apoptosis plays a major role in the remodeling of the palate.