Immediate Breast Reconstruction Using Bilateral Free TRAM Flap after Removal of Paraffinoma

ABSTRACT

Injection of liquid Paraffin wax was a form of breast augmentation practiced in Korea and many Asian countries for decades. Paraffin makes chorionic foreign body granulomas and brings mass formation, discolorization, deformity of surrounding tissue and in severe cases, necrosis of mammary tissue and skin. Author has experienced 45 year old female with previous bilateral Paraffin injection by unqualified physician. In initial physical examination revealed diffuse, hard and mobile masses in both breasts with overlying skin change, inflammation and discolorization. Mammography showed diffuse, markedly dense breast due to foreign body granulomas on both breasts. Because of skin invasion of the paraffinoma, especially on the breast of right side, modified radical mastectomy was performed rather than skin-sparing mastectomy and reconstructed with bilateral TRAM flap immediately. After 3 month, author reconstructed nipple with MDOT(Modified Double Opposing Tab) Flap, and after 1 year, reconstructed nipple-areola complex with tattooing. This paper represent our experience with bilateral paraffinoma and reconstruction of bilateral TRAM flap after modified radical mastectomy.