1141_1153 의학강좌_이백권

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1 J KMA Continuing Education Column Recent Knowledge of Breast Reconstruction Paik Kwon Lee, MD Department of Plastic and Reconstruction Surgery, The Catholic University of Korea College of Medicine E mail : pklee@catholic.ac.kr J Korean Med Assoc 2006; 49(12): J KorJ Abstract Breast is one of the most important organ which characterize the femininity and the maternity. As growing not only in numbers of breast cancer patients but also concerns about the quality of life, breast reconstruction after mastectomy turns into hot topics in the area of plastic surgery. Historically, numerous operation techniques have been introduced for breast reconstruction using prosthesis (tissue expander and breast implant) and autologous tissues (various pedicled flaps and free flaps). The most ideal method for breast reconstruction is to make a natural soft breast with less complications and morbidities, and no single technique can be universally accepted in every cases. However, in terms of making a natural, good looking breast autologous tissue is more superior to tissue expander and breast implant in breast reconstruction. Usually a breast reconstruction is performed in 3 stages; 1 st stage is breast mound reconstruction using autologous tissue or tissue expander and implant. 2 nd stage is revision of the reconstructed breast and donor site such as abdomen (scar revision, volume adjustment using suction assisted lipectomy and excision), nipple reconstruction, and surgery of the opposite normal breast (augmentation, mastopexy, or reduction) for maximizing cosmetic results. 3 rd stage is a intradermal tattooing for nipple areolar complex. In this article, various techniques are presented with their indications, methods, advantages and disadvantages. For the choice of best modality, many factors should be considered including an extent of mastectomy, the size and shape of opposite breast, the condition of possible donor sites, postoperative adjuvant therapy (radiation, chemotherapy), patient s age, and patient's preferance. Key words : Breast reconstruction; 3 stages; Autologous tissue 1141

2 Lee PK Expander insertion below pectoralis major muscle(left) and after expansion(right)(23) 1142

3 Recent Knowledge of Breast Reconstruction Varions donor cites for antologous tissue breast reconstruction 1143

4 Lee PK Harvest of latissumus dorsi musculocutanous flap(left) and transposition of flap (right)(23) 1144

5 Recent Knowledge of Breast Reconstruction Harvest and rotation of transverse rectus abdomis musculocutaneous (TRAM) pedicled flap(23) 1145

6 Lee PK Free TRAM flap harvesting and insetting(23) 1146

7 Recent Knowledge of Breast Reconstruction Superficial inferior epigastric artery as a dominant pedicle(d) and flap territory of SIEA(23) Harvest of superior gluteal flap based on superior gluteal artery (14) 1147

8 Lee PK n=lateral cutaneous nerve of thigh; a=lateral circumflex femoral artery; s=sartorius; RF=rectus femoris; VL=vastus lateralis; TFL=tensor fasciae latae Dotted line denotes proposed fat takeout. Solid line with circle denotes proposed skin incision and skin island(16) 1148

9 Recent Knowledge of Breast Reconstruction Deep circumflex iliac artery as a dominant pedicle(d) and flap territory of Rubens flap(23) 1149

10 Lee PK A C (A) preoperative frontal view (B) postoperative 4 years frontal view (C) preoperative lateral view (D) postoperative 4 years lateral view A 59 year old woman had a fascia-sparing free TRAM flap Breast reconstruction on her left breast and periareolar mastopexy on her right breast B D 1150

11 Recent Knowledge of Breast Reconstruction 1. Bae YC, K. S., Kim JH. A study on the perception of breast reconstruction in mastectomized patients and general population in Korea. J Korean Soc Plast Reconstr Surg 1997; 24:

12 Lee PK 2. Becker H. Breast reconstruction using an inflatable breast implant with detachable reservoir. Plast Reconstr Surg 1984; 73: Maxwell GP. Iginio Tansini and the origin of the latissimus dorsi musculocutaneous flap. Plast Reconstr Surg 1980; 65: Schneider WJ, Hill HL Jr, Brown RG. Latissimus dorsi myocutaneous flap for breast reconstruction. Br J Plast Surg 1977; 30: Fujino T, Harashina T, Enomoto K. Primary breast reconstruction after a standard radical mastectomy by a free flap transfer. Case report. Plast Reconstr Surg 1976; 58: Robbins TH. Rectus abdominis myocutaneous flap for breast reconstruction. Aust N Z J Surg 1979; 49: Scheflan M, Hartrampf CR, Black PW. Breast reconstruction with a transverse abdominal island flap. Plast Reconstr Surg 1982; 69: Germann G, Steinau HU. Breast reconstruction with the extended latissimus dorsi flap. Plast Reconstr Surg 1996; 97: Chang DW, Youssef A, Cha S, Reece GP. Autologous breast reconstruction with the extended latissimus dorsi flap. Plast Reconstr Surg 2002; 110: 751-9; discussion Beckenstein MS, Grotting JC. Breast reconstruction with free tissue transfer. Plast Reconstr Surg 2001; 108: ; quiz Arnez ZM, Khan U, Pogorelec D, Planinsek F. Breast reconstruction using the free superficial inferior epigastric artery (SIEA) flap. Br J Plast Surg 1999; 52: Chevray PM. Breast reconstruction with superficial inferior epigastric artery flaps: a prospective comparison with TRAM and DIEP flaps. Plast Reconstr Surg 2004; 114: ; discussion 2004; Ulusal BG, Cheng MH, Wei FC, Ho Asjoe M, Song D. Breast reconstruction using the entire transverse abdominal adipocutaneous flap based on unilateral superficial or deep inferior epigastric vessels. Plast Reconstr Surg 2006; 117: ; discussion Shaw WW. Breast reconstruction by superior gluteal microvascular free flaps without silicone implants. Plast Reconstr Surg 1983; 72: Paletta CE, Bostwick J, 3rd, Nahai F. The inferior gluteal free flap in breast reconstruction. Plast Reconstr Surg 1989; 84: ; discussion Elliott LF, Beegle PH, Hartrampf CR, Jr. The lateral transverse thigh free flap: an alternative for autogenous tissue breast reconstruction. Plast Reconstr Surg 1990; 85: ; discussion Elliott LF, Hartrampf CR, Jr. The Rubens flap. The deep circumflex iliac artery flap. Clin Plast Surg 1998; 25: Allen RJ, Treece P. Deep inferior epigastric perforator flap for breast reconstruction. Ann Plast Surg 1994; 32: DellaCroce FJ, Sullivan SK. Application and refinement of the superior gluteal artery perforator free flap for bilateral simultaneous breast reconstruction. Plast Reconstr Surg 2005; 116: ; discussion Allen RJ, Levine JL, Granzow JW. The in the crease inferior gluteal artery perforator flap for breast reconstruction. Plast Reconstr Surg 2006; 118: Nahabedian MY, Momen B, Galdino G, Manson PN. Breast Reconstruction with the free TRAM or DIEP flap: patient selection, choice of flap, and outcome. Plast Reconstr Surg 2002; 110: ; discussion

13 Recent Knowledge of Breast Reconstruction 22. Granzow JW, Levine JL, Chiu ES, Allen RJ. Breast reconstruction with the deep inferior epigastric perforator flap: history and an update on current technique. J Plast Reconstr Aesthet Surg 2006; 59: Mathes SJ. Plastic surgery. 2nd ed. Philadelphia: Saunders Elsevier, 2005; VI: complications and functional outcomes in free muscle sparing TRAM flap and free DIEP flap breast reconstruction. Plast Reconstr Surg 2006; 117: ; discussion Lee PK, Lim JH, Ahn ST. Oh DY, Rhie JW, Han KT. Nipple reconstruction with dermis(scar tissue) graft and C V flap. J Korean Soc Plast Reconstr Surg 2006; 33: Bajaj AK, Chevray PM, Chang DW. Comparison of donor site Peer Reviewer Commentary 1153

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<342EBEC8BCBABFAD2CB9DAC7E2C1D82E687770> 大韓癩學會誌 : 第 41 卷, 第 1 號 2008 Korean Leprosy Bulletin, Vol. 41, No. 1, June, 2008 마비성 하안검 외반증에 대한 lateral tarsal strip의 재조명 안성열 성형외과의원 1), 제일병원 피부과 2) 안성열 1), 박향준 2) - Abstract - Reappraisal of the