Breast Reduction using Free Nipple Graft

PURPOSE: Free nipple graft reduction mammaplasty is a simple and effective way to reduce huge breasts. However, this technique is frequently criticized for producing poor projection and hypopigmentation of the nipple areola complex(NAC). METHODS: Sixty three patients(126 breasts) underwent the procedure from 1998 to 2005. Authors' method is similar with the modified Gradinger's technique except the keyhole pattern. After skin flap closing, the position of NAC is determined considering symmetry. The NAC is initially harvested and then resection of the breast followed, leaving a deepithelized inferior parenchymal pedicle(5 x 5cm). The upper point of inferior pedicle is sutured to the fascia of the pectoralis to produce the upper bulge. The nipple is replaced as a free and composite graft. RESULTS: An average of 823grams of breast tissue per breast was removed. There was no major complications. All grafted nipples showed long lasting projection. And also, all NAC eventually regained their normal color except for 3 patients who needed medical tattoos. The overall results were good and patient satisfactory score was high. CONCLUSION: This useful technique greatly enhances long lasting projection and recovers nipple color.

Breast Reduction using Free Nipple Graft

PURPOSE: Free nipple graft reduction mammaplasty is a simple and effective way to reduce huge breasts. However, this technique is frequently criticized for producing poor projection and hypopigmentation of the nipple areola complex(NAC). METHODS: Sixty three patients(126 breasts) underwent the procedure from 1998 to 2005. Authors' method is similar with the modified Gradinger's technique except the keyhole pattern. After skin flap closing, the position of NAC is determined considering symmetry. The NAC is initially harvested and then resection of the breast followed, leaving a deepithelized inferior parenchymal pedicle(5 x 5cm). The upper point of inferior pedicle is sutured to the fascia of the pectoralis to produce the upper bulge. The nipple is replaced as a free and composite graft. RESULTS: An average of 823grams of breast tissue per breast was removed. There was no major complications. All grafted nipples showed long lasting projection. And also, all NAC eventually regained their normal color except for 3 patients who needed medical tattoos. The overall results were good and patient satisfactory score was high. CONCLUSION: This useful technique greatly enhances long lasting projection and recovers nipple color.

A New Design of Vertical Reduction Mammaplasty

Although the technique of vertical reduction mammaplasty has gained major popularity, it is difficult to perform and has the steep learning curve. The authors present a modification of the standard Lejour vertical mammaplasty that simplify the design and make it more reliable and easy to perform. We simplified the design by discarding the Mosque dome. From March 2000 to March 2004, we performed this technique for 40 patients with breast hypertrophy. The apex of the design was marked at the anterior projection of the inframammary fold. After resection of the breast tissue, the medial and lateral pillars were approximated. Then a new nipple- areola position was determined at 4.0-5.0cm from a new inframammary fold. The range of resection amount of breast tissues was from 150 to 750 gram. Most of the patients were satisfied with the results. There was no permanent sensory loss and nipple areola skin necrosis. But there was 1 case of hematoma on the first day after the operation. This technique presents several advantages. It allows shaping and projection without compromising the future nipple position and makes it easier to remove an excessive skin around the areolae. And it may be comfortable to adjust the position of the nipple at the end of the procedure. We believe that this modification helps to improve the results of the vertical reduction mammaplasty.

Breast Augmentation using Expandable Implants

Ideal results of augmentation mammaplasty consist of symmetry, natural shape, soft feeling and inconspicuous scar. In addition, patient's preferences about size and shape should be included. Static implants could not perfectly satisfy patients' desires for size and shape, but expandable implants enable to change the volume after the operation. From September 2001 to September 2004, 76 patients(150 breasts) underwent breast augmentation using permanent expandable implant. The procedure was unilateral in 2 women and bilateral in 74 women. Age ranged from 19 to 50 years(mean, 29 years). Fifty nine patients underwent simple augmentation mammaplasty, 7 patients were corrected of their severe asymmetry, 2 patients with the congenital breast deformity underwent mammaplasty using this, and 2 patients who had undergone unilateral mastectomy were reconstructed of their breasts using expandable implant. There were no definite complications such as capsular contracture, implant rupture, asymmetry. And there reported little dissatisfaction about the size. The permanent expandable implants might be good alternatives in cases of ordinary breast augmentation as well as tissue deficient patients, asymmetry, congenital anomaly, and breast reconstruction.

Periareolar Reductioon Mammoplasty: Inferior Dermal Pedicle VS. Central Parenchymal Pedicle-Experiences of 60 patients

After the introduction of the central parenchymal pedicle by Hester(1985) and the round-block technique by Benelli (1988), several variations of periareolar reduction mammoplasty have been used by many authors. Periareolar reduction mammoplasty is a less aggressive procedure than traditional techniques and it produces less conspicuous periareolar scars while maintaining an acceptable overall result. We experienced 120 cases (60 patients) of periareolar reduction mammoplasty during the period from May 1994 to February 1998. We present the analysis of 60 cases of periareolar reduction mammoplasty. Periareolar reduction mammoplasty utilizing central parenchymal pedicle was performed in the first 40 patients, while a procedure utilizing the inferior dermal pedicle was done in the next 20 cases consecutively. The range of follow-up was from 1 to 5 years. Complications such as nipple areolar complex necrosis and sensory changes were reduced when the inferior dermal pedicle used. There were 5 cases of nipple areolar complex necrosis and sensory changes were reduced when the inferior dermal pedicle used. There were 5 cases of nipple areolar complex necrosis (6.2%), including 1 case of near total necrosis in cases utilizing the central parenchymal pedicle. But in the technique using inferior dermal pedicle, there was no skin flap necrosis. The central parenchymal pedicle technique has several advantages such as a wide operation field permitting complete breast contouring and better mobility of the remaining breast tissue. However, inferior dermal pedicle technique has relative superiority over central parenchymal pedicle technique in terms of anatomical rationale, as well as in the rate of complications without causing limitations in breast mobility for contouring. Such complications as nipple areolar complex necrosis, skin flap necrosis and sensory change of nipple were reduced when the inferior dermal pedicle technique was used. It is much easier to preserve the 4th intercostal nerve to the nipple anatomically. Periareolar reduction mammoplasty utilizing the inferior dermal pedicle is thought to be a reliable, reproducible method.

Microsurgical consideration in the liver transplantation from living related donor

Living-Related-Liver-Transplantation(LRLT) has been established as a reliable method of treatment for patients with end-stage liver disease when the scarcity of cadaveric organ donor was considered. But the hepatic artery is high at risk in thrombosis(HAT) following LRLT. So microsurgical technique was introduced in anastomosis of hepatic artery. This study was aimed at using microsurgical technique in LRLT and presenting some technical details of the procedures. From December 1994 to November 1997, a sereis of 41 LRLTs on patients with end-stage liver disease was performed with follow-up period of 5 to 40 months(mean,15.6 months). Organs were donated by living-related donors(n=36) and living-nonrelated ones(n=5). Hepatic artery was reconstructed with microsurgical technique by plastic surgeon. All hepatic arteries were patent intraoperatively and postoperatively except one case, which had leakage at anastomosed site on the postoperative fourth day.Hepatic artery is high at risk in thrombosis(HAT) following LRLT due to the caliber discrepancy and technical difficulties. To overcome these risks, microsurgical technique was introduced. The technique has greatly reduced arterial complication. However, there are some difficulties in microsurgery of LRLT, which are somewhat different from those in other microsurgery fields: the first difficulty is to obtain a good operative field and a sufficient view through the microscope. The second one is to overcome arterial caliber discrepancy. And the last is to achieve a stable posture in narrow and deep operating field against the respiratory movement and heartbeat.With the persistent team approach of plastic and general surgeons in the field of LRLT, we could have reduced the HAT and have had better outcome after LRLT.