Analysis of Patients with Facial Lacerations Repaired in the Emergency Room of a Provincial Hospital

BACKGROUND: Facial laceration is the most common injury encountered in the emergency room in the plastic surgery field, and optimal treatment is important. However, few authors have investigated this injury in all age groups or performed follow-up visit after repair. In the present study, the medical records of patients with lacerations in the facial area and underwent primary repair in an emergency room over a 2-year period were reviewed and analyzed. METHODS: Medical records of 3,234 patients with lacerations in facial area and underwent primary repair in an emergency room between March 2011 and February 2013 were reviewed and identified. RESULTS: All the 3,234 patients were evaluated, whose ratio of men to women was 2.65 to 1. The forehead was the most common region affected and a slip down was the most common mechanism of injury. In terms of monthly distribution, May had the highest percentage. 1,566 patients received follow-up managements, and 58 patients experienced complications. The average days of follow-up were 9.8. CONCLUSIONS: Proportion of male adolescents was significantly higher than in the other groups. Facial lacerations exhibit a 'T-shaped' facial distribution centered about the forehead. Careful management is necessary if a laceration involves or is located in the oral cavity. We were unable to long term follow-up most patients. Thus, it is necessary to encourage patients and give them proper education for follow-up in enough period.

A Case Report of Sweet's Syndrome with Parotitis

Sweet's syndrome is characterized by clinical symptoms, physical features, and pathologic findings which include fever, neutrophilia, tender erythematous skin lesions, and a diffuse infiltrate of mature neutrophils. This is a report of our experience of Sweet's syndrome with parotitis. A 57-year-old man initially presented with tender swelling on the right cheek similar to parotitis. His symptoms relapsed despite the use of an oral antibiotic agent for 3 weeks. He additionally presented with erythematous papules and plaques on the periocular area and dorsum of both hands. Histiopathologic findings on punch biopsy of the right dorsum of the hand showed superficial perivenular histiocytic infiltration without vasculitis. We confirmed this as histiocytoid Sweet's syndrome and used systemic corticosteroid. After initiation of treatment with systemic corticosteroids, there was a prompt recovery from both the dermatosis-releated symptoms and skin lesions. Sweet's syndrome should be considered in patients with therapy-refractory parotitis and unclear infiltrated nodules. We present a confusing case who initially appeared to have parotitis but turned out to have histiocytoid Sweet's syndrome.

Usefulness of V-Y Advancement Flap for Defects after Skin Tumor Excision

BACKGROUND: After skin tumor excision on the face, extremities, or trunk, the choice of treatment for a skin defect is highly variable. Many surgeons prefer to use a local flap rather than a skin graft or free flap for small- or moderately-sized circular defects. We have used unilateral or bilateral V-Y advancement flaps, especially on the face. Here we evaluated the functional and aesthetic results of this technique. METHODS: All of the patients were pathologically diagnosed with squamous cell carcinoma (SCC), basal cell carcinoma (BCC), or malignant melanoma or premalignant lesion (Bowen's disease). Thirty-two patients underwent V-Y advancement flap repair (11 unilateral and 21 bilateral) from January 2007 to June 2011. We analyzed the patients' age and satisfaction, and location and size of defect. The patients were followed up for 6 months or more. RESULTS: There were 22 women and 10 men. The ages ranged from 47 to 93 years with a mean age of 66 years. The causes were SCC in 15 cases, BCC in 13 cases, malignant melanoma in 1 case, Bowen's disease in 2 cases, and another cause in 1 case. The tumor locations were the face in 28 patients, and the scalp, upper limb, and flank each in one patient. All of the flaps survived and the aesthetic results were good. Postoperative recovery was usually rapid, and no complication or tumor recurrence was observed. CONCLUSIONS: The V-Y advancement flap is often used not only for facial circular defects but also for defects of the trunk and extremities. Its advantages are less scarring and superior aesthetic results as compared with other local flap methods, because of less scarification of adjacent tissue and because it is an easy surgical technique.

Extended Indications of Bilhaut-Cloquet Procedure for Type III and IV of Duplicated Thumb

PURPOSE: The authors applied Bilhaut-Cloquet procedure to Wassel type III and IV duplicated thumb, which was limited to patients with Wassel type I, II. This procedure was applied in order to improve the growth potential, range of joint motion, joint stability and cosmetic outcome. METHODS: Sixteen patients received Bilhaut-Cloquet procedures to correct duplicated thumbs from May, 2005 to December, 2010. Seven patients were Wassel type III, nine patients were type IV. This procedure was applied not only to balanced type, but also unbalanced type or convergent type. Five patients were balanced type and eleven patients were unbalanced type. Convergent type of Wassel type IV was three. Sex ratio was the same, mean age at the operation was 20.1 months old(8~52 months old). Angular deformity, joint stability and range of joint motion and cosmetic outcome were considered together and estimated in Tada score. Also, postoperative subjective satisfaction score of the parents was evaluated by a 100-points scale. RESULTS: Mean subjective satisfaction scored 75 points at 28 months after the operation. Radiologic study showed bony union of proximal phalangeal bone and stable joint in all patients. Range of motion was mean 20 degrees in interphalangeal joint and mean 73 degrees in metacarpophalangeal joint. Tada score showed 'good' in eleven patients(68.8%), 'fair' in three patients(18.7%) and 'poor' in two patients(12.5%). In seven patients those who were able to follow up for a long term showed no significant difference in length of proximal and distal phalangeal bones compared to the opposite thumb. CONCLUSION: Bilhaut-Cloquet procedure can be applied not only to balanced type of Wassel type III, IV duplicated thumb, but also to unbalanced type or convergent type that focused on functional reconstruction and cosmetic improvement.

Recent Trend of the Reduction Mammaplasty and comparing with Vertical Reduction Method and Inverted T-scar Method

PURPOSE: The goal of reduction mammaplasty is breast with natural cone shape, minimizing scars, well-placed and sensate nipple-areolar area and maintaining breast physiology. In order to satisfy that goal, variable reduction mammaplasty methods are performed, however, two methods such as vertical reduction method and inverted T-scar method are currently most used. We compared indications and advantages of the two methods and set up useful guidlines. METHODS: For 15 years from 1995 to 2010, we experienced 84 patients(162 breasts). We performed vertical reduction method as Lejour's superior pedicle technique(45 patients) and inverted T-scar method as Goldwyn's inferior dermal flap technique(39 patients). We evaluated the result of the operation comparing patient's age, amount of resected tissue, complications and post-operative scars of the two methods. RESULTS: The mean age was 36 years and the vertical reduction group was 3 years younger than inverted T-scar group. The mean breast tissue resection amount per one breast, inverted T-scar group(712 gm) was lagger than vertical reduction group(395 gm). CONCLUSION: There is no ideal method for reduction mammaplasty until now. However, we suggest that guide line, the vertical reduction method is effective for minimal and moderate macromastia in young and middle aged women and inverted T-scar method is appropriate for severe macromastia with ptosis in elderly women. Recently, all procedures tried shorter and smaller scar on the vertical line as small I, J or L shape scar, and inframammary fold as short inverted T-scar.

Breast Reconstruction Make Use of Contralateral Breast Tissue after Mastectomy

PURPOSE: Unilateral breast reconstruction after mastectomy confront the challenges of recreating a natural appearing breast mound and achieving symmetricalness of the breasts. If the patient's remaining breast is large compared to reconstructed breast, the most common procedure is reduction mammoplasty of the large breast side. The authors experienced a new method of breast reconstruction using the excess breast tissue from the contralateral breast after breast reduction. METHODS: The excess tissue from the contralateral breast after vertical reduction mammoplasty with superior pedicle and remaining lower breast tissue were transferred to the mastectomy site breast through the subcutaneous tunnel on the chest wall. The main blood supplies of the flap are perforator branches of the 4th, 5th and 6th anterior intercostal artery. After elevating and detaching the flap on the lower lateral area of the breast, the turned over flap is fixed on the upper portion of the chest wall of the mastectomy site. RESULTS: On two cases of the breast reconstructions, remaining excess breast tissue from reduction mammoplasty was transferred to the contralateral breast side as pedicles. Both patient and operator were satisfied with the outcome of the reconstruction as the breasts were symmetrical and in natural shape. CONCLUSION: We have performed unilateral breast reconstruction using the excess breast tissue after reduction mammoplasty of the contralateral breast. As Oriental women's breasts are relatively smaller than those of Caucasian women, delayed breast reconstruction cases of Oriental women with large breasts(macromastia) seem to be ideal for this procedure.

Facial Anthropometry Using 3-D CT Image

The purpose of this study was to analyze the structure form of the head and face using 3-dimensional computerized tomography in Korean adults. We examined CT images of 100 Koreans (50 males and 50 females) between 22 and 46 years of age. The data of the 2-dimensional CT images were sent to the personal computer in the form of DICOM (Digital Image Communication in Medicine) files and transformed to the 3-dimensional CT images using V-worksTM 4.0 program (Cybermed, Korea). The authors could have 50 soft and 50 bony tissue 3-D images of the female patients by changing the contrast from same data. We could also have 50 soft and 50 bony tissue 3-D images of the male patients by the same method. To define the structural elements, we identified the key points of upper face (eurion, frontotemporale), mid face (zygion, malar eminence), and lower face (anterior mandible, posterior mandible) in the soft tissue and skeletal images, respectively. We measured the distance between the key points and evaluated the angular relationships in construction a geometric form corresponding to these points. We were able to get the quantitative data of facial form variants and the characteristics of facial structure of Korean adults. The cranium of the male Korean is wider and higher than that of female. The facial contour is also more projected than female. Application of these concepts to surgery may be helpful in determining the plan of the intervention and evaluation of the results of procedures.

Recurrence Rate after Angle Splitting Ostectomy

For the treatment of the square mandibular angle, the angle splitting ostectomy method is known to have many advantages compared to the conventional angle ostectomy procedure. The splitting method is easy to proceed even for the patients with inverted angle. Better results could be achieved in the lateral profile as well as the anterior view. And this method has less complications such as bleeding, asymmetry and subcondylar fracture. However, there seems to be some doubts about the long-term results because of bone remodeling concept; the new bone could easily grow on the remained cancellous bony surface and prominence could recur on the mandibular angle area. The purpose of this study is to identify the amount of the regrowth on the ostectomized surface. We performed angle contouring surgery in fifty-one patients with wide and squared lower faces for 5 years. Of these patients, we selected 22 patients who fulfilled following categories; (1) those who had angle splitting ostectomy surgery in our institute, (2) those who had preoperative and postoperative CT examinations. The patients were classified into 3 groups. In the group 1, the follow-up CT was checked within 1 month after surgery (n=11). Group 2 included those who had CT examination during 4~6 months after surgery (n=8). In the group 3, the CT was checked more than 1 year after surgery (n=3). We identified one point (Point B) to examine the most possible point on angle of mandible (Point A: a point that 3.5 cm distance from sigmoid notch on parallel line to the posterior border of ramus at sigmoid notch , Point B: a point that 1 cm distance from Point A). We analyzed the preoperative, postoperative thickness of point B using 3 dimensional CT for detecting recurrence rate of cortical bone. The measurement was 8.43 mm before operation, and follow up measurements were 4.92 mm in group 1, 4.84 mm in group 2, and 5.27 mm in group 3, respectively. There was no statistical significant evidence of bony regrowth and recurrence from remaining surface among the groups. In the morphological comparisons, the cortical bone started to appear on the remaining angle in group 2 and covered whole the surface of angle in group 3. We concluded that the surgical procedure of angle splitting ostectomy is a long-term effective and stable method.

Immediate Microsurgical Reconstruction of Fingertip Injuries

During the recent 8 years, 45 fingertip injuries were reconstructed with immediate microsurgical free flap in 36 patients. There were 21 patients of pulp reconstruction (great toe pulp flap 8 cases, pulp flap from the second toe 3 cases, innervated arterialized venous flap 5 cases and first web space flap 5 cases) for pulp defect proximal to the most distal palmar crease of the fingers, 5 cases of onychocutaneous flap for thumb nail reconstruction, and 10 cases of partial toe transfer(partial great toe transfer 8 cases and second toe wrap-around procedure 2 cases). Overall survival rate of flap transfer was 97.2%(35/36). The static 2-point discrimination averaged 8 mm in pulp reconstruction of the thumb, 12 mm in index and 16 mm for other fingertip reconstruction. There was 1-2 mm atrophy of the nail width after onychocutaneous flap for thumb nail reconstruction. The subjective satisfaction of self-assessment score on the new fingertip was 85 and 88 of the thumb reconstruction in function and appearance, respectively. The score of the index was higher than that of other fingers. Immediate microsurgical reconstruction of the fingertip injuries provides many advantages over other procedures such as single stage reconstruction, early exercise and shortened convalescent period, and high satisfaction score by self-assessment in both functional and aesthetic aspects. Therefore, immediate microsurgical reconstruction of fingertip injury is a safe and reliable procedure in case of limited indications.

Comparison of Porous Polyethylene Sheet(Medpor(R)) with Titanium Dynamic Mesh in the Treatment of Blow Out Fracture

The records of the patients with orbital wall fracture were reviewed from March 1997 through February 2001 in the department of plastic and reconstructive surgery, Yeungnam university medical center. One hundred thirty nine patients with blow out fracture were repaired by using porous polyethylene(Medpor(R)) or titanium dynamic mesh. Surgical effect of titanium dynamic mesh was evaluated and compared with that of Medpor(R) in the reconstruction of orbital wall fracture after follow up period of six months. The incidence of the orbital wall fracture was more common in men than in women. The traffic accident was most common cause of the fracture and the most common combined fracture was nasal bone fracture. The sites of fractures were the orbital floor in 51 patients, the medial wall in 18 patients, and both the medial wall and floor in 38 patients. Medpor(R) is easy to handle, shape, contour and position. Titanium dynamic mesh is good device in that it has for good structural stability, excellent strength, high biocompatibility and can be fixed easily. In conclusion, Medpor(R) was suitable for local defect in small fracture and titanium dynamic mesh was suitable for large defect in compound fracture

Reconstruction of Alopecia by Scalp Expansion

Tissue expansion has been used for several decades in plastic and reconstructive surgery. Recently tissue expansion of the hair bearing scalp provides an excellent surgical option for the treatment of wide alopecia. During the period 1990 to 2001, 34 patients, 37 cases of wide alopecia with various causes were treated using tissue expansion. Choice of the size, shape, and the numbers of the expander was done by a senior author. The capsule of the expanded tissue remained intact and transposition flaps were use to redistribute expanded scalp. For three patients, serial expansion was performed to completely remove the remaining alopecia. Another patients with male pattern baldness were also successfully treated using tissue expansion technique. In conclusion, tissue expansion for alopecia is a simple, safe, and reliable method and provides excellent aesthetic results. It is the treatment of choice for wide alopecia due to burn, tumor excision, traffic accident and even for male pattern baldness.

Comparison Analysis of 3D CT and Cephalometrics in Craniofacial Measurements

The cephalometry can not always to evaluate accurate the real human skull. The reconstructed 3 dimensional image of CT(Computed Tomogram) is more popular method of human skull evaluation. The purpose of this study was to evaluate the difference between the measurements with the cephalometry and that with the 3 dimensional image of CT. Fifteen patients who visited yeungnam university hospital(from Nov. 1999 to Feb. 2000) underwent computed tomography and cephalometry. The average age was a 32-years-old. We measured the midface height(ANS-N, SE-PNS, ANS-SD), the total face height (Me-N, Me-ANS, ANS-UIE, Me-LIE, Me-ID), the midface horizontal(ANS-PNS, PNS-A, PNS-UIE), and the lower face horizontal(Go-Pog, Go-B, Go-LIE). After the acquisition of measurements using 3 dimensional CT and cephalometry statistical analysis was done with paired t-test(p< 0.05). Measured data of the midface height, the total face height and the midface horizontal showed no difference between the length at the cephalometry and that of reconstructed 3 dimensional image of CT, but the lower face horizontal showed statistically significant difference between the two. Both cephalometry and 3 dimensional CT image were accurate method for the measurement of midface height, total facial height and midface horizontal. However for the measurement of lower face horizontal, 3 dimensional CT seems to be a more accurate and reliable method.

A Clinical Study of Subcutaneous Mastectomy with Immediate Reconstruction as Treatment for Early Breast Carcinoma

Immediate breast reconstruction following subcutaneous mastectomy for early breast carcinoma remains controversial. According to the recent reports however, it has become a recommendable option for the care of breast cancer patients whether it involves prosthetic implantation or myocutaneous flap procedure. Many technical problems have been introduced to reconstruct the breast; choice of incision, volume estimation, mobility of skin flap including nipple-areolar complex, irregularity of flap thickness, location of inframammary fold and choice of implant type. We have experienced 43 cases of immediate breast reconstruction by using tissue expander, breast implant and transverse rectus abdominis musculocutaneous(TRAM) flap after subcutaneous mastectomy. We believe that immediate breast reconstruction with autogenous tissue is very satisfactory in aesthetic, economic aspects, whereas reconstruction with prosthetic implantation is a convenient method but prone to unsatisfactory long-term results.

Clinical Application of Reduction Mammaplasty with Various Methods

Breast has been considered as the symbol of the female. Ideal size of the breast was related to the age and culture. The goal of reduction mammaplasty is breast with natural cone shape, minimizing scars, well-placed and sensate nipple-areolar area and maintaining breast physiology. The ideal breast reduction should create beautiful breast with limited scars. We performed 37 cases of reduction mammaplasty. The techniques used were inferior dermal flap technique for 16 cases, vertical reduction mammaplasty for 18 cases, and periareolar round block technique for 3 cases. We compared advantages and disadvantages of the techniques and set up useful guide-lines to match the technique with the problem of each individual. The guidelines are as follow: 1. Inferior dermal pedicle technique is suitable for moderate to severe macromastia with ptosis. 2. Vertical reduction technique is effective for moderate macromastia in young women. 3. Periareolar round block technique is effective for mild to moderate macromastia in young women.

Reconstruction of Craniofacial Bone Defect with Titanium Dynamic Mesh

Reconstructing craniofacial bone defect is mainly done by autogenous bone graft and alloplastic implant insertion. Autogenous bone graft has the advantage of supplying the similar tissue to the bone defect area. But, due to several problems arose by using autogenous bone graft, the clinical use of the alloplastic implant has been increased. Among the various implants, titanium mesh has many advantages in chemical and physical properties. We have treated 26 patients with craniofacial bone defects (9 cases of cranium, 17 cases of orbital bone, and 9 cases of maxilla) using the titanium dynamic mesh (Howmedica Leibinger Inc.) and autogenous bone graft together in last two years. We followed up the patients for 3 to 18 months (mean, 8.2 months) and got satisfactory results with low complication rates. We found that the titanium dynamic mesh could be used successfully as an alternative substitute in reconstruction of the small to medium-sized defects in the craniofacial area. To maximize the success, certain surgical techniques had to be used. These techniques are as follow: 1.It required expertise to produce complex 3-dimensional contours of the craniofacial bone (frontal eminence, orbital margin etc.) with hand forming techniques. 2.In cranioplasty, at least 4 points fixation and enough soft tissue coverage were necessary. 3.In orbital wall reconstruction, mesh was inserted with the margins rested on the firm surrounding bone after meticulous trimming and molding to minimize complication such as enophthalmos. 4.In maxillary sinus reconstruction, attention was needed to prevent of soft tissue prolapse into the sinus and to aerate of the sinus. In conclusion, the excellent biocompatibility of titanium and easy application of the titanium dynamic mesh are outstanding characteristics in three-dimensional reconstruction of craniofacial bone defect with minimal morbidity and complications.

A Study on the Perception of Breast Reconstruction in Breast Reconstructed Patients after Mastectomy in Korea

The incidence of breast cancer and the number of patients who underwent mastectomy has been constantly increased. However, only a few of them consider breast reconstruction in Korea. The breast is a symbolic organ of women, which affects individual social and psychologic activities. Therefore the final goal of breast cancer treatment is not just the eradication of cancer, but the reconstruction of the lost breast. The purpose of this study is to evaluate the understanding of breast reconstruction in women who underwent breast reconstruction after mastectomy. This retrospective study includes 88 female patients who had breast reconstruction at Yeungnam University Hospital between April 1996 and September 1999. Various methods of breast reconstruction including nipple-areolar reconstruction were applied according to the patients' condition. Among the 88 cases, only 62 patients answered our questionnaire. The age of the patients ranged from 23 to 50 years. Our questionnaire includes questions about the factors which influenced decision of breast reconstruction, the level of satisfaction, and the reasons for breast reconstruction. According to the answers, most Korean women consider the breast as female symbol. They get most of the information about breast reconstruction from the general surgeon. Patients who underwent reconstruction with autogenous tissue were more satisfied than those with breast implants. In conclusion, the majority of Korean breast cancer patients are devoid of information about breast reconstruction. In order to provide adequate information to the patients, plastic surgeons should provide more detailed information about breast reconstruction to general surgeon, and make efforts for public education by mass media. It should be equally emphasized that the final step of breast cancer treatment is the restoration of the lost breast.

The Bone Forming Effect of Sodium Fluoride During The Distraction Osteogenesis on Membranous Bone: An Experimental Study in the Mandibles of Rabbits

The purpose of this study was to improve bone formation and shorten the period involved in distraction osteogenesis using sodium fluoride (NaF). This has been used in managing osteoporosis for several decades. This study was carried out on 40 New Zealand white rabbits. Twenty animals were used for a control group (no medication) and 20 for the experimental group. NaF 1 mg/kg/day was administered to each experimental animal via drinking water beginning 4 weeks prior to surgery and continued until sacrifice for examination. A distraction device was applied to the left mandible along a plane perpendicular to the direction of osteotomy. After a 5-day latent period, the mandibles were lengthened at 1 mm per 24 hours for 10 days. Five rabbits from each group were sacrificed on the 1st day, 2nd week, 4th week and 8th week of the consolidation period. After lengthening, all the rabbits developed a severe cross-bite. By the 4th week, cortical continuity was seen. Bone densities at the site of bony lengthening were measured by quantitative computer tomography (QCT) and dual X-ray absorptiometry (DXA). The results were as follows: the measurements of the experimental group were significantly higher than of the control group by the 1st day of the consolidation period (p>0.05) and insignificantly higher after the 2nd week. Histologically, in the experimental group, there were more osteoblasts, increased and thickened trabeculae and more mature lamellar bones than in the control group. This study showed that osteogenesis of the experimental group was significantly higher during and immediately after distraction. Our study suggested that the use of NaF could improve bone formation and decrease the period of distraction osteogenesis if a safe dose and method of fluoride administration can be determined for growing humans.

VARIOUS METHODS OF NIPPLE AREOLAR RECONSTRUCTION

As the breast is a symbol of feminity, so nipple areolar complex is a crucial aesthetic unit of the breast. Symmertrical and appropriate nipple areolar complex completes the breast reconstruction. Throughout the history of breast reconstruction, various methods of nipple areolar reconstruction have been developed. Composite graft and several local flap methods have been used for reconstruction of nipples. Skin grafts from contralateral areolar or inguinal area and tattooing methods have been introduced for areolar reconstruction. Among 85 patients of breast reconstruction during recent three years, we experienced only 14 cases of nipple areolar reconstruction. This fact is partly from conservative attitude of Korean women to breast reconstruction and also from the long time-period needed to accomplish an acceptable breast mound. For nipple reconstrction, we performed eight H-shape local flaps, three fish tail shape local flaps, and three composite grafts. For reconstruction of areola, full thickness skin graft was used in 13 cases(10 from inguinal area, 3 from contralateral areola) and tattooing was used in a case. We experienced necrosis of reconstruction nipple in two cases(one in fish tail shape local flap cases and one in composite graft cases). There was no other remarkable complication. Among the three methods of nipple reconstruction. H-shape local flap method was a reliable one which provides stable nipple projection as well as simplicity. In most cases areola was successefully reconstructed with full thickness skin graft and if the size of contralateral areola is large enough to share, contralateral areolar sharing seems to be the best choice. In conclusion, the combination of a H-shape local flap and a full thickness skin graft from the inguinal area provides a satisfactory projection of the nipple and pigmentation of the nipple and pigmentation of the areola comparable to the other side.

Problems of Augmentation Mammoplasty with Saline-Filled Prosthesis

No abstract available.

Subcutaneous Mastectomy with Immediate Reconstruction as Treatment for Early Breast Carcinomas

BACKGROUND: Breast-conservation surgery is now widely used, but is inappropriate in some patients with high risk of recurrence and in patients who refuse radiation therapy. A number of women who undergo a mastectomy in these circumstances request reconstruction. Recently, subcutaneous mastectomies have been performed through an inframammary incision or incision down the lateral side of the breast. The purpose of the present study was to determine the cosmetic results and the complications after a subcutaneous mastectomy using a newly designed skin incision and immediate reconstruction. METHODS: Subcutaneous mastectomies with immediate reconstruction were performed in 17 patients with early breast cancer from June 1997 to November 1998. The inclusion criteria for this procedure were a peripherally located tumor, a size smaller than the T2 size, clinically negative axillary lymph nodes, and a grossly normal nipple and areolar area. A radial skin incision from the lateral edge of the areolar or an incision down the lateral side of the breast with or without an axillary incision was performed, depending on the location of the tumor. If two or more metastatic nodes among 5 or 6 nodes were confirmed by frozen biopsy, we planned a delayed reconstruction. To avoid nipple-areolar recurrence, we performed a frozen biopsy of the resection margin. RESULTS: The mean age of the patients was 38, and the majority of tumors were invasive ductal tumors (9 cases) and DCIS tumors (5 cases). All of the tumor sizes were less than 3 cm (T1: 10 cases, T2: 7 cases). All of the tumors were stage 0 to stage 2 at the time of operation. Thirteen permanent saline-filled protheses, two tissue expanders, one conventional flap, and one free TRAM flap were used for reconstruction. Immediate postoperative complications were 4 case of transient ischemic necrosis of the nipple- areolar area, one case of complete necrosis of the nipple-areolar area, and three case of transient focal skin necrosis. Three of these patients had both transient ischemic necrosis of the skin and the nipple- areolar area. Loss of touch sensation in the central portion of breast occurred in all cases. The majorcosmetic problems were 4 cases of asymmetric breasts and 2 cases of nipple displacement, which was more common in patients with a ptotic breast and in patients who had received a skin incision through the lateral edge of the breast. Excellent or good cosmetic results were obtained in 75% of the patients. There was no local recurrence, but the follow up was short term (mean follow-up period: 12 months). A radial skin incision, with or without axillary incision, was more cosmetic and more easily and completely dissected the breast parenchymal tissue than a lateral incision of the breast was. CONCLUSION: These results support the use of this technique in the treatment of early breast cancer.