1
|
Myung Y, Yun J, Beom J, Hayashi A, Lee WW, Song YS, Park JKH. Evaluating the Surgical Outcome of Lymphovenous Anastomosis in Breast Cancer-Related Lymphedema Using Tc-99m Phytate Lymphoscintigraphy: Preliminary Results. Lymphat Res Biol 2024; 22:124-130. [PMID: 38265788 DOI: 10.1089/lrb.2023.0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Abstract
Background: Breast cancer-related lymphedema (BCRL) remains a significant postcancer treatment challenge with no definitive cure. Recent supermicrosurgical treatments, such as lymphovenous anastomosis (LVA), have shown promise but lack established objective indicators for outcome evaluation. We investigated the utility of Technetium-99m (Tc-99m) lymphoscintigraphy, an imaging technique providing objective information on lymphatic fluid flow, for assessing LVA surgical outcomes. Methods and Results: A retrospective cohort analysis of patients undergoing LVA for BCRL was conducted. Lymphoscintigraphy images pre- and 1-year postsurgery were compared to determine changes in lymphatic fluid flow of 18 patients based on newly defined parameters "uptake ratio" and "washout rates." Statistically significant reduction in the uptake ratio was observed in the forearm at 30 and 60 minutes postinjection phases. In addition, the forearm showed higher washout rate, indicating an improved lymphatic function in the forearm. Conclusion: Tc-99m lymphoscintigraphy can provide valuable objective data for evaluating LVA surgical outcomes in BCRL patients. However, site-specific differences in outcomes highlight the need for individualized surgical planning. Further large-scale studies are necessary to validate these preliminary findings and develop a standardized approach for LVA assessment.
Collapse
Affiliation(s)
- Yujin Myung
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Junseo Yun
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Jaewon Beom
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | | | - Won Woo Lee
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Yoo Sung Song
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Joseph Kyu-Hyung Park
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| |
Collapse
|
2
|
Park JKH, Baek S, Heo CY, Jeong JH, Myung Y. A Novel, Deep Learning-Based, Automatic Photometric Analysis Software for Breast Aesthetic Scoring. Arch Plast Surg 2024; 51:30-35. [PMID: 38425860 PMCID: PMC10901594 DOI: 10.1055/a-2190-5781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/26/2023] [Indexed: 03/02/2024] Open
Abstract
Background Breast aesthetics evaluation often relies on subjective assessments, leading to the need for objective, automated tools. We developed the Seoul Breast Esthetic Scoring Tool (S-BEST), a photometric analysis software that utilizes a DenseNet-264 deep learning model to automatically evaluate breast landmarks and asymmetry indices. Methods S-BEST was trained on a dataset of frontal breast photographs annotated with 30 specific landmarks, divided into an 80-20 training-validation split. The software requires the distances of sternal notch to nipple or nipple-to-nipple as input and performs image preprocessing steps, including ratio correction and 8-bit normalization. Breast asymmetry indices and centimeter-based measurements are provided as the output. The accuracy of S-BEST was validated using a paired t -test and Bland-Altman plots, comparing its measurements to those obtained from physical examinations of 100 females diagnosed with breast cancer. Results S-BEST demonstrated high accuracy in automatic landmark localization, with most distances showing no statistically significant difference compared with physical measurements. However, the nipple to inframammary fold distance showed a significant bias, with a coefficient of determination ranging from 0.3787 to 0.4234 for the left and right sides, respectively. Conclusion S-BEST provides a fast, reliable, and automated approach for breast aesthetic evaluation based on 2D frontal photographs. While limited by its inability to capture volumetric attributes or multiple viewpoints, it serves as an accessible tool for both clinical and research applications.
Collapse
Affiliation(s)
- Joseph Kyu-hyung Park
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnamsi, Gyeonggi-do, Republic of Korea
| | - Seungchul Baek
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnamsi, Gyeonggi-do, Republic of Korea
| | - Chan Yeong Heo
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnamsi, Gyeonggi-do, Republic of Korea
| | - Jae Hoon Jeong
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnamsi, Gyeonggi-do, Republic of Korea
| | - Yujin Myung
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnamsi, Gyeonggi-do, Republic of Korea
| |
Collapse
|
3
|
In SK, Park SW, Myung Y. Effect of Perioperative Prophylactic Intravenous Antibiotic Use in Immediate Implant-Based Breast Reconstruction: A Retrospective Matched Cohort Study. Arch Plast Surg 2024; 51:36-41. [PMID: 38425851 PMCID: PMC10901589 DOI: 10.1055/a-2161-7521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 08/26/2023] [Indexed: 03/02/2024] Open
Abstract
Background Among breast reconstruction methods, implant-based breast reconstruction has become the mainstream. However, periprosthetic infection is still an unresolved problem. Although published articles have revealed that limited use of antibiotics is sufficient to reduce infection rates, the number of surgeons still preferring elongated usage of antibiotics is not less. The aim of our study is to validate the appropriate duration of antibiotic use to reduce infection rate after implant-based breast reconstruction. Methods A retrospective study reviewed medical record of 235 patients (274 implants for reconstruction) who underwent prepectoral direct to implant breast reconstruction using acellular dermal matrix wrapping technique. Infection rates were analyzed for the patients administered postoperative prophylactic antibiotics until drain removal and those who received only perioperative prophylactic antibiotics for 24 hours. Results Of the 274 implants, 98 who were administered prophylactic antibiotics until drain removal had an infection rate of 3.06% (three implants) and 176 who received prophylactic antibiotics no longer than 24 hours postoperatively had an infection rate of 4.49% (eight implants). A total of 11 patients diagnosed with postoperative infection clinically, 8 were salvaged by antibiotic treatment, and 3 had implant removal and replacement with autologous flap. Postoperative antibiotic prophylaxis duration had no statistically significant effects in the risk of infection ( p = 0.549). Conclusion The duration of prophylactic antibiotics after surgery was not related to infection risk. Further study with a large number of patients, randomized control study, and route of antibiotics is needed.
Collapse
Affiliation(s)
- Seok Kyung In
- Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Republic of Korea
| | - Seok Won Park
- Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Republic of Korea
| | - Yujin Myung
- Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Republic of Korea
| |
Collapse
|
4
|
Trinh XT, Chien PN, Long NV, Van Anh LT, Giang NN, Nam SY, Myung Y. Development of predictive models for lymphedema by using blood tests and therapy data. Sci Rep 2023; 13:19720. [PMID: 37957217 PMCID: PMC10643602 DOI: 10.1038/s41598-023-46567-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 11/02/2023] [Indexed: 11/15/2023] Open
Abstract
Lymphedema is a disease that refers to tissue swelling caused by an accumulation of protein-rich fluid that is usually drained through the lymphatic system. Detection of lymphedema is often based on expensive diagnoses such as bioimpedance spectroscopy, shear wave elastography, computed tomography, etc. In current machine learning models for lymphedema prediction, reliance on observable symptoms reported by patients introduces the possibility of errors in patient-input data. Moreover, these symptoms are often absent during the initial stages of lymphedema, creating challenges in its early detection. Identifying lymphedema before these observable symptoms manifest would greatly benefit patients by potentially minimizing the discomfort caused by these symptoms. In this study, we propose to use new data, such as complete blood count, serum, and therapy data, to develop predictive models for lymphedema. This approach aims to compensate for the limitations of using only observable symptoms data. We collected data from 2137 patients, including 356 patients with lymphedema and 1781 patients without lymphedema, with the lymphedema status of each patient confirmed by clinicians. The data for each patient included: (1) a complete blood count (CBC) test, (2) a serum test, and (3) therapy information. We used various machine learning algorithms (i.e. random forest, gradient boosting, decision tree, logistic regression, and artificial neural network) to develop predictive models on the training dataset (i.e. 80% of the data) and evaluated the models on the external validation dataset (i.e. 20% of the data). After selecting the best predictive models, we created a web application to aid medical doctors and clinicians in the rapid screening of lymphedema patients. A dataset of 2137 patients was assembled from Seoul National University Bundang Hospital. Predictive models based on the random forest algorithm exhibited satisfactory performance (balanced accuracy = 87.0 ± 0.7%, sensitivity = 84.3 ± 0.6%, specificity = 89.1 ± 1.5%, precision = 97.4 ± 0.7%, F1 score = 90.4 ± 0.4%, and AUC = 0.931 ± 0.007). We developed a web application to facilitate the swift screening of lymphedema among medical practitioners: https://snubhtxt.shinyapps.io/SNUBH_Lymphedema . Our study introduces a novel tool for the early detection of lymphedema and establishes the foundation for future investigations into predicting different stages of the condition.
Collapse
Affiliation(s)
- Xuan-Tung Trinh
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, 13620, Republic of Korea
| | - Pham Ngoc Chien
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, 13620, Republic of Korea
| | - Nguyen-Van Long
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, 13620, Republic of Korea
| | - Le Thi Van Anh
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, 13620, Republic of Korea
| | - Nguyen Ngan Giang
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, 13620, Republic of Korea
- Department of Medical Device Development, College of Medicine, Seoul National University, Seoul, 03080, Republic of Korea
| | - Sun-Young Nam
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, 13620, Republic of Korea.
| | - Yujin Myung
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, 13620, Republic of Korea.
| |
Collapse
|
5
|
Kim JH, Kang J, Najmiddinov B, Kim EK, Myung Y, Heo CY. Nipple Projection Change in Immediate Breast Reconstruction and Use of an Acellular Dermal Matrix Strut for Maintaining Nipple Projection. Plast Reconstr Surg 2023; 152:949-957. [PMID: 36877621 DOI: 10.1097/prs.0000000000010355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Nipple-sparing mastectomy (NSM) has gained popularity as more studies have supported its oncologic safety. Although there have been some studies reporting complications including mastectomy flap and nipple necrosis, there have been few reports discussing the change in nipple projection following NSM. This study aimed to analyze the change in nipple projection after NSM and identify risk factors for nipple depression. In addition, the authors present a new method for maintaining nipple projection. METHODS Patients who underwent NSM between March of 2017 and December of 2020 at the authors' institute were included in this study. The authors measured the preoperative and postoperative nipple projection height and used a nipple projection ratio (NPR) to compare the change in height. Univariate and multivariate analyses were performed to examine the correlation of variables with the NPR. RESULTS A total of 307 patients and 330 breasts were included in this study. There were 13 cases of nipple necrosis. The postoperative nipple height was decreased by 32.8%, which was statistically significant. In multiple linear regression analysis, the use of an acellular dermal matrix strut was positively correlated with the NPR and implant-based reconstruction and postmastectomy radiation therapy were negatively correlated with the NPR. CONCLUSIONS The results of this study demonstrated that the reduction in nipple height after NSM was statistically significant. Surgeons need to be aware of these changes following NSM and explain this possibility to patients who have risk factors. The application of an acellular dermal matrix strut should be considered for the prevention of nipple reduction. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
Collapse
Affiliation(s)
- Jong-Ho Kim
- From the Departments of Plastic and Reconstructive Surgery
| | - Jiwon Kang
- From the Departments of Plastic and Reconstructive Surgery
| | | | - Eun-Kyu Kim
- General Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital
| | - Yujin Myung
- From the Departments of Plastic and Reconstructive Surgery
| | - Chan Yeong Heo
- From the Departments of Plastic and Reconstructive Surgery
| |
Collapse
|
6
|
Park JB, Jang BS, Chang JH, Kim JH, Hong KY, Jin US, Chang H, Myung Y, Jeong JH, Heo CY, Kim IA, Shin KH. Impact of the New ESTRO-ACROP Target Volume Delineation Guideline on Breast-Related Complications after Implant-Based Reconstruction and Postmastectomy Radiotherapy. Int J Radiat Oncol Biol Phys 2023; 117:e198. [PMID: 37784842 DOI: 10.1016/j.ijrobp.2023.06.1070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The European Society for Radiotherapy and Oncology Advisory Committee in Radiation Oncology Practice (ESTRO-ACROP) recently updated a new target volume delineation guideline for postmastectomy radiotherapy (PMRT) after implant-based reconstruction. This study aimed whether this change has impact on breast-related complications. MATERIALS/METHODS We retrospectively reviewed patients who underwent PMRT after mastectomy with tissue expander or permanent implant insertion from 2016 to 2021. In total, 412 patients were included; 277 received RT by the new ESTRO-ACROP target delineation (ESTRO-T), and 135 received RT by conventional target delineation (CONV-T). The primary endpoint was comparison between the target groups of major breast-related complication, including infection, capsular contracture, deformity and necrosis requiring re-operation or re-hospitalization during follow-up after RT or delayed implant replacement. Complications were evaluated according to the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0., and capsular contracture was graded by the Baker Classification. RESULTS The median follow-up was 29.5 months (range, 0.3-76.8). The 1-, 2-, and 3-year incidence rates of major breast-related complication were 5.7%, 10.0%, and 11.6% in the ESTRO-T group, and 8.2%, 13.8%, and 14.7% in the CONV-T groups; it did not show a difference between the groups (P = 0.55). In multivariate analyses, target delineation is not significantly associated with the major complications (hazard ratio [HR] = 0.93; P = 0.83, Table 1). There was no significant difference between the ESTRO-T and CONV-T groups in the incidence of any breast-related complications (3-year cumulative incidence, 37.3% vs. 29.4%, respectively; P = 0.28). Symptomatic RT-induced pneumonitis rates were 2.7% in the ESTRO-T group (7 patients) and 2.2% in the CONV-T group (3 patients). Only one local recurrence event occurred in the ESTRO-T group, which was within the ESTRO-target volume. CONCLUSION Target volume delineation according to the new ESTRO-ACROP guideline did not reduce the risk of major or any breast-related complications. As the dosimetric benefits of heart and lung have been reported, further analyses with long-term follow-up are necessary to evaluate whether it could be connected to better clinical outcomes.
Collapse
Affiliation(s)
- J B Park
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea, Republic of (South) Korea
| | - B S Jang
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea, Republic of (South) Korea
| | - J H Chang
- University of California San Francisco, Department of Radiation Oncology, San Francisco, CA
| | - J H Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea, Republic of (South) Korea
| | - K Y Hong
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul, Korea, Republic of (South) Korea
| | - U S Jin
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Korea, Republic of (South) Korea
| | - H Chang
- 2nd Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul, Korea, Republic of (South) Korea
| | - Y Myung
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, Korea, Republic of (South) Korea
| | - J H Jeong
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, Korea, Republic of (South) Korea
| | - C Y Heo
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea, Republic of (South) Korea
| | - I A Kim
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea, Republic of (South) Korea
| | - K H Shin
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea, Republic of (South) Korea
| |
Collapse
|
7
|
Park JKH, Choi N, Beom J, Lim JY, Kang Y, Nam SY, Myung Y. Utilization of Noncontrast Magnetic Resonance Lymphangiography for Selection of Effective Surgical Method in Breast Cancer-Related Lymphedema. Medicina (Kaunas) 2023; 59:1656. [PMID: 37763775 PMCID: PMC10537151 DOI: 10.3390/medicina59091656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: When considering surgery for patients with breast cancer-related lymphedema (BCRL), it is crucial to determine which surgery will be most effective for the patient and establish the indications for each surgery. Our study retrospectively compared the results of preoperative noncontrast MR lymphangiography (NMRL) performed on the lymphedematous limb of patients before surgery, with the aim of analyzing whether preoperative NMRL can be used as a criterion for determining the type of surgery. Materials and Methods: From January 2020 to June 2022, a total of 138 patients with lymphedema underwent surgery at Seoul National University Bundang Hospital. All patients underwent preoperative NMRL imaging and were classified into stages 1-3 based on the MRI severity index using the authors' previous reference. Three types of surgery, LVA, LVA + liposuction, and LVA + VLNT, were conducted on all patients. The effectiveness of the surgery was evaluated one year postoperatively using the interlimb volume difference before and after surgery, the fluid volume of the edematous limb measured by bioimpedance spectroscopy, and the subjective satisfaction of the patients through the Lymph Q questionnaire. Results: In this study, out of a total of 138 patients, 26 (19%) were MRI stage 1, 62 (45%) were stage 2, and 50 (36%) were stage 3. Of the 83 patients who underwent LVA surgery, the greatest decrease in interlimb volume difference was observed in stage 2 patients, and subjective satisfaction was also the most effective in stage 2. In the case of LVA + liposuction patients, a significant volume decrease and a high satisfaction were observed in stage 3 patients. In the case of LVA + VLNT patients, there was no difference in volume decrease according to the stage, but a greater decrease in body fluid volume was observed as the MRI severity index score increased through BIA. Conclusions: In conclusion, this study demonstrates that NMRL imaging is a useful modality for determining the most effective surgical method and predicting the surgical outcome in patients with lymphedema. This highlights the importance of using NMRL in the treatment planning of lymphedema patients.
Collapse
Affiliation(s)
- Joseph Kyu-hyung Park
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam 07061, Republic of Korea; (J.K.-h.P.)
| | - Nakwon Choi
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam 07061, Republic of Korea; (J.K.-h.P.)
| | - Jaewon Beom
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 07061, Republic of Korea
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 07061, Republic of Korea
| | - Yusuhn Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 07061, Republic of Korea
| | - Sun-Young Nam
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam 07061, Republic of Korea; (J.K.-h.P.)
| | - Yujin Myung
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam 07061, Republic of Korea; (J.K.-h.P.)
| |
Collapse
|
8
|
Ha JH, Cheun JH, Jung JJ, Kim HK, Lee HB, Shin HC, Moon HG, Han W, Myung Y, Jeong JH, Heo CY, Chang H, Kim EK, Jin US. Impact of implant surface type on breast cancer relapse after breast reconstruction: propensity score-matched study. Br J Surg 2023; 110:1288-1292. [PMID: 37307506 PMCID: PMC10480036 DOI: 10.1093/bjs/znad147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 02/06/2023] [Accepted: 04/30/2023] [Indexed: 06/14/2023]
Affiliation(s)
- Jeong Hyun Ha
- Interdisciplinary Program of Medical Informatics, Seoul National University
College of Medicine, Seoul, South Korea
- Department of Plastic and Reconstructive Surgery, Seoul National University
Hospital, Seoul, South
Korea
| | - Jong-Ho Cheun
- Department of General Surgery, Seoul Metropolitan Government–Seoul National
University Boramae Medical Centre, Seoul,
South Korea
| | - Ji-Jung Jung
- Department of Surgery, Seoul National University Hospital,
Seoul, South Korea
| | - Hong-Kyu Kim
- Department of Surgery, Seoul National University Hospital,
Seoul, South Korea
| | - Han-Byoel Lee
- Department of Surgery, Seoul National University Hospital,
Seoul, South Korea
- Department of Surgery, Seoul National University College of
Medicine, Seoul, South
Korea
- Cancer Research Institute, Seoul National University,
Seoul, South Korea
- Biomedical Research Institute, Seoul National University
Hospital, Seoul, South
Korea
| | - Hee-Chul Shin
- Department of Surgery, Seoul National University Bundang
Hospital, Seongnam, South
Korea
| | - Hyeong-Gon Moon
- Department of Surgery, Seoul National University Hospital,
Seoul, South Korea
- Genomic Medicine Institute, Medical Research Centre, Seoul National
University College of Medicine, Seoul, South Korea
| | - Wonshik Han
- Department of Surgery, Seoul National University Hospital,
Seoul, South Korea
- Department of Surgery, Seoul National University College of
Medicine, Seoul, South
Korea
- Cancer Research Institute, Seoul National University,
Seoul, South Korea
- Biomedical Research Institute, Seoul National University
Hospital, Seoul, South
Korea
- Genomic Medicine Institute, Medical Research Centre, Seoul National
University College of Medicine, Seoul, South Korea
| | - Yujin Myung
- Department of Plastic and Reconstructive Surgery, Seoul National University
Bundang Hospital, Seongnam, South Korea
| | - Jae Hoon Jeong
- Department of Plastic and Reconstructive Surgery, Seoul National University
Bundang Hospital, Seongnam, South Korea
| | - Chan Yeong Heo
- Department of Plastic and Reconstructive Surgery, Seoul National University
Bundang Hospital, Seongnam, South Korea
- Department of Plastic and Reconstructive Surgery, Seoul National University
College of Medicine, Seoul, South Korea
| | - Hak Chang
- Department of Plastic and Reconstructive Surgery, Seoul National University
Hospital, Seoul, South
Korea
- Department of Plastic and Reconstructive Surgery, Seoul National University
College of Medicine, Seoul, South Korea
| | - Eun-Kyu Kim
- Department of Surgery, Seoul National University Bundang
Hospital, Seongnam, South
Korea
| | - Ung Sik Jin
- Department of Plastic and Reconstructive Surgery, Seoul National University
Hospital, Seoul, South
Korea
- Department of Plastic and Reconstructive Surgery, Seoul National University
College of Medicine, Seoul, South Korea
| |
Collapse
|
9
|
Myung Y, Park JKH, Beom J, Lim JY, Park YS, Ahn SH, Kang E, Shin HC, Kim EK, Nam SY, Heo CY, Jeong JH. Outcome Analysis of Combined Surgical Approaches in Advanced-stage Upper Extremity Breast Cancer-related Lymphedema. Plast Reconstr Surg Glob Open 2023; 11:e5237. [PMID: 37691707 PMCID: PMC10484372 DOI: 10.1097/gox.0000000000005237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/18/2023] [Indexed: 09/12/2023]
Abstract
Background This study aimed to discuss several surgical approaches for advanced-stage breast cancer-related lymphedema and compared their treatment outcomes. Methods The patients who underwent surgery with International Society of Lymphology stage III lymphedema were included in this study. The three surgical methods used here were (1) suction-assisted lipectomy with lymphovenous anastomosis, (2) autologous breast reconstruction with muscle-sparing transverse rectus abdominis muscle flap combined with inguinal lymph node transfer, and (3) vascularized lymph node transfer with free omental flap. Analysis of the postoperative outcomes in the patients was based on the difference in volume between patients pre- and postoperatively, LYMPH-Q questionnaire, and bioelectrical impedance analysis. Results Eighty-seven patients with stage IIb or higher disease underwent surgery. 38 patients underwent suction-assisted lipectomy + lymphovenous anastomosis, 23 underwent autologous breast reconstruction with vascularized lymph node transfer + lymphovenous anastomosis, and 26 underwent right gastroepiploic omental vascularized lymph node transfer with lymphovenous anastomosis. The LYMPH-Q questionnaire, which evaluates patients' subjective satisfaction, showed that the autologous breast reconstruction group showed the greatest improvement, whereas in bioimpedance analysis, the omental flap group demonstrated the greatest postoperative improvement compared with preoperative values. However, suction-assisted lipectomy was considered the most effective surgical method for reducing limb volume in patients with high-stage lymphedema accompanied by fibrosis and volume increase. Conclusions We observed slightly different clinical effects for each surgical method; however, all surgical methods demonstrated a reduction in the degree of edema and an increase in patient satisfaction.
Collapse
Affiliation(s)
- Yujin Myung
- From the Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Joseph Kyu-hyung Park
- From the Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jaewon Beom
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young Suk Park
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang-Hoon Ahn
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eunyoung Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hee-Chul Shin
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eun-Kyu Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sun-Young Nam
- From the Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chan Yeong Heo
- From the Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae Hoon Jeong
- From the Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
10
|
Park JKH, Lee S, Yang EJ, Heo CY, Jeong JH, Myung Y. Outcomes of leaflet-shaped acellular dermal matrix with a thickness-gradient for abdominal fascial defect repair in muscle-sparing TRAM flap-based breast reconstruction. Asian J Surg 2023; 46:3581-3586. [PMID: 37537053 DOI: 10.1016/j.asjsur.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 05/24/2023] [Accepted: 07/09/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Numerous fascial closure techniques have been used to reduce donor site morbidities after transverse rectus abdominis myocutaneous (TRAM) flap harvest. A leaflet-shaped acellular dermal matrix (ADM) with a thickness gradient was designed to cover the defect effectively and to withstand the pressure applied to the lower portion of the defect. The complication and functional recovery rates of the donor site of the custom ADM were compared with those of previous methods of fascial closure (primary closure and polypropylene mesh assisted closure). MATERIALS AND METHODS A retrospective review of patients undergoing immediate or delayed breast reconstruction using muscle-sparing TRAM flaps was performed. Abdominal bulging, hernia, wound dehiscence, infection, seroma, and hematoma rates were compared. The Back Performance Scale measured four months postoperatively was compared to evaluate the donor site's recovery rate. RESULTS A total of 173 patients were analyzed. The three groups did not differ in hernia, wound dehiscence, infection, and hematoma rates. However, the abdominal bulging rate was lower in the primary closure group, while the seroma rate was higher in the mesh group. Functional recovery was the fastest in the custom ADM group. CONCLUSION A thickness-gradient, leaflet-shaped ADM can be effectively used as an onlay graft to cover the abdominal fascial defect, with similar complication rates, while providing a faster recovery of abdominal function.
Collapse
Affiliation(s)
- Joseph Kyu-Hyung Park
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University School of Medicine, South Korea
| | - Seungjun Lee
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University School of Medicine, South Korea
| | - Eun Joo Yang
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University School of Medicine, South Korea
| | - Chan Yeong Heo
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University School of Medicine, South Korea
| | - Jae Hoon Jeong
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University School of Medicine, South Korea
| | - Yujin Myung
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University School of Medicine, South Korea.
| |
Collapse
|
11
|
Kang HJ, Moon SY, Kim BK, Myung Y, Lee JH, Jeong JH. Recellularized lymph node scaffolds with human adipose-derived stem cells enhance lymph node regeneration to improve lymphedema. Sci Rep 2023; 13:5397. [PMID: 37012287 PMCID: PMC10070624 DOI: 10.1038/s41598-023-32473-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/28/2023] [Indexed: 04/05/2023] Open
Abstract
To overcome the limitations of lymphedema treatment, human adipose-derived stem cells (hADSCs) were injected into decellularized lymph nodes to produce a recellularized lymph node-scaffold, and the effect of lymphangiogenesis was investigated in lymphedema animal models. Axillary lymph nodes were harvested from Sprague Dawley rats (7 weeks old, 220-250 g) for decellularization. The decellularized lymph nodes were performed and PKH26-labeled hADSCs (1 × 106/50 µL) were injected in the decellularized lymph node-scaffolds. Forty rats were equally divided into four groups: lymphedema as control group, hADSC group, decellularized lymph node-scaffold group, and recellularized lymph node-scaffold group. The lymphedema model was made by removing inguinal lymph nodes, and hADSCs or scaffolds were transplanted. Histopathological assessments were performed by hematoxylin and eosin and Masson's trichrome staining. Lymphangiogenesis was evaluated by Immunofluorescence staining and western blot. Decellularized lymph nodes showed virtually complete absence of cellular material and maintenance of lymph node architecture. The hADSCs were significantly observed in recellularized lymph node-scaffolds group. The recellularized lymph node-scaffold group was histologically similar to normal lymph nodes. The vascular endothelial growth factor A and lymphatic vessel endothelial hyaluronan receptor 1 (LYVE-1) in immunofluorescence staining were highly expressed in recellularized lymph node-scaffolds group. Also, the expression of LYVE-1 protein significantly increased in recellularized lymph node-scaffold group compared with others. Recellularized lymph node -scaffold had a much better therapeutic effect than stem cells or decellularized lymph node-scaffold alone, and induced stable lymphangiogenesis.
Collapse
Affiliation(s)
- Hyo Jin Kang
- Department of Biomedical Laboratory Science, Honam University, Gwangju, 62399, Republic of Korea
| | - Soo Young Moon
- Department of Biomedical Laboratory Science, Honam University, Gwangju, 62399, Republic of Korea
| | - Baek-Kyu Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, 13620, Gyeonggi-do, Republic of Korea
| | - Yujin Myung
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, 13620, Gyeonggi-do, Republic of Korea
| | - Ju-Hee Lee
- College of Korean Medicine, Dongguk University, Goyang, 10326, Gyeonggi-do, Republic of Korea
| | - Jae Hoon Jeong
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, 13620, Gyeonggi-do, Republic of Korea.
| |
Collapse
|
12
|
Myung Y, Park S, Kim BR, Yang EJ, Park JKH, Kang Y. Validation of a Lymphedema Index Score Based on Noncontrast Magnetic Resonance Lymphangiography: Correlation with Clinical Staging and Indocyanine Green Lymphangiography. Lymphat Res Biol 2023; 21:70-77. [PMID: 35501954 DOI: 10.1089/lrb.2021.0092] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: A standardized lymphedema grading system is a prerequisite for accurately and objectively evaluating its severity, both preoperatively and postoperatively. The purpose of this study was to establish a clinically feasible noncontrast magnetic resonance lymphangiography (NMRL) protocol and a standardized scoring system for the evaluation of lymphedema. Methods and Results: From January 2020 to February 2021, 39 patients who had been clinically diagnosed with lymphedema and had undergone NMRL were included. The severity and circumferential extent of lymphedema were assessed using magnetic resonance imaging, and a combined index was devised as the sum of the product of the severity and extent scores determined at four different levels. A magnetic resonance imaging (MRI) stage was allocated based on the combined index score, its correlation with clinical indices was analyzed. The MR and clinical staging showed a percentage agreement of 85.9% and a kappa coefficient of 0.641, indicating moderate agreement (p < 0.001). Both the interlimb volume and interlimb impedance ratios differed significantly between groups (p < 0.001 for both). The correlation analysis revealed a significant correlation between the combined index score and the inter-limb volume ratio (r = 0.70, p < 0.001) and inter-limb impedance ratio at both 1 kHz (r = 0.71, p < 0.001) and 5 kHz (r = 0.71, p < 0.001). The interobserver agreement was moderate for the severity score, extent score, and combined score. Conclusion: The proposed standardized scoring system for evaluating lymphedema based on NMRL can reproducibly determine the severity and extent of lymphedema in both the upper and lower extremities, and correlates strongly with established clinical measures.
Collapse
Affiliation(s)
- Yujin Myung
- Department of Plastic Surgery, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Seokwon Park
- Department of Plastic Surgery, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Bo Ram Kim
- Department of Radiology, and Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Eun Joo Yang
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Joseph Kyu-Hyung Park
- Department of Plastic Surgery, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Yusuhn Kang
- Department of Radiology, and Seoul National University Bundang Hospital, Seongnam-si, South Korea
| |
Collapse
|
13
|
Park JKH, Lee S, Heo CY, Jeong JH, Myung Y. The effect of immediate postoperative intravenous administration of ferric carboxymaltose after autologous free-flap breast reconstruction. Sci Rep 2022; 12:19125. [PMID: 36352090 PMCID: PMC9645745 DOI: 10.1038/s41598-022-23976-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 11/08/2022] [Indexed: 11/10/2022] Open
Abstract
Intravenous ferric carboxymaltose (IV-FCM) can effectively correct perioperative anemia in patients undergoing major surgeries. However, its efficacy and side effects in patients undergoing free flap-based breast reconstruction are yet to be investigated. At our institution, from year 2020, patients with breast cancer undergoing abdominal free flap-based breast reconstruction were injected 500 mg of IV-FCM immediately post-operation. Propensity-matched 82 IV-FCM injected (study group) and 164 historical control group patients were retrospectively analyzed for transfusion rates, changes in hematological parameters, and flap or donor-site related complications. The major and minor complication rates related to the operation site were similar between the two groups. There was no significant difference in the transfusion rate between the two groups (control 29.9% vs. study 32.9%, p = 0.71). However, the total amount of transfusion required was significantly higher in the historical control group (control-53.2% 1 pack, 42.6% 2 packs, 4.3% 3 packs of RBC vs. Study-66.7% 1 pack, 33.3% 2 packs, p = 0.02) than in the study group. Additionally, the historical control group showed a significantly higher drop in red blood cell count, hemoglobin, and hematocrit levels from postoperative days 1-2 and 2-3 compared to the study group. Immediate postoperative use of IV-FCM in free flap-based breast reconstruction was well tolerated by patients and reduced overall transfusion volume.
Collapse
Affiliation(s)
- Joseph Kyu-hyung Park
- grid.412480.b0000 0004 0647 3378Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Seongnam-Si, 463-707 Gyeonggi-Do Korea
| | - Seungjun Lee
- grid.412480.b0000 0004 0647 3378Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Seongnam-Si, 463-707 Gyeonggi-Do Korea
| | - Chan Yeong Heo
- grid.412480.b0000 0004 0647 3378Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Seongnam-Si, 463-707 Gyeonggi-Do Korea
| | - Jae Hoon Jeong
- grid.412480.b0000 0004 0647 3378Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Seongnam-Si, 463-707 Gyeonggi-Do Korea
| | - Yujin Myung
- grid.412480.b0000 0004 0647 3378Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Seongnam-Si, 463-707 Gyeonggi-Do Korea
| |
Collapse
|
14
|
Najmiddinov B, Park JKH, Yoon KH, Myung Y, Koh HW, Lee OH, Hoon JJ, Shin HC, Kim EK, Heo CY. Conventional versus modified nipple sparing mastectomy in immediate breast reconstruction: Complications, aesthetic, and patient-reported outcomes. Front Surg 2022; 9:1001019. [PMID: 36277278 PMCID: PMC9583667 DOI: 10.3389/fsurg.2022.1001019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 08/29/2022] [Indexed: 11/06/2022] Open
Abstract
Background Nipple-sparing mastectomy (NSM) followed by immediate breast reconstruction (IBR) is the optimal surgical treatment for breast cancer. However, investigations are ongoing to improve the surgical technique to achieve better results. This study aimed to evaluate the outcomes of modified NSM (m-NSM), which preserves the anterior lamellar fat layer, in patients who underwent IBR. Methods All patients who underwent modified NSM (m-NSM) or conventional NSM (c-NSM) followed by IBR using autologous tissue or implants were retrospectively reviewed between January 2014 and January 2021. Two mastectomy types were compared in terms of postoperative complications and aesthetic outcomes using panel assessment scores by physicians and reported outcomes using Breast-Q. In addition, postoperative evaluations of the thickness of mastectomy flap was performed using CT scan images. Results A total of 516 patients (580 breasts) with NSM (143 breasts with c-NSM and 437 breasts with m-NSM) followed by IBR were reviewed. The mean ± SD flap thickness was 8.48 ± 1.81 mm in patients who underwent m-NSM, while it was 6.32 ± 1.15 mm in the c-NSM cohort (p = 0.02). The overall major complications rate was lower in the m-NSM group (3.0% vs. 9.0%, p < 0.013). Ischemic complications of the mastectomy flap and nipple-areolar complex (NAC) were more in c-NSM, although the difference was not statistically significant. The mean panel assessment scores were higher in the m-NSM group (3.14 (good) and 2.38 (fair) in the m-NSM and c-NSM groups, respectively; p < 0.001). Moreover, m-NSM was associated with greater improvements in psychosocial (p < 0.001) and sexual (p = 0.007) well-being. Conclusion Preserving the anterior lamellar fat in NSM was associated with thicker mastectomy flap, overall lower rates of complications, including ischemia of the mastectomy flap and nipple-areolar complex, and was associated with better aesthetic outcomes and improved quality of life.
Collapse
Affiliation(s)
- Bakhtiyor Najmiddinov
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Joseph Kyu-hyung Park
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kyung-Hwak Yoon
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yujin Myung
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hyoung Won Koh
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ok Hee Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jeong Jae Hoon
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hee Chul Shin
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Eun-Kyu Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea,Correspondence: Eun-Kyu Kim Chan Yeong Heo
| | - Chan Yeong Heo
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea,Correspondence: Eun-Kyu Kim Chan Yeong Heo
| |
Collapse
|
15
|
Lee S, Najmiddinov B, Heo CY, Park JKH, Myung Y. Does Lymphangiogenesis Occur through Incisional Scars? Arch Plast Surg 2022; 49:701-702. [PMID: 36159383 PMCID: PMC9507616 DOI: 10.1055/s-0042-1756504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 07/08/2022] [Indexed: 10/26/2022] Open
Affiliation(s)
- Seungjun Lee
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Bakhtiyor Najmiddinov
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Chan Yeong Heo
- Department of Plastic and Reconstructive Surgery, Seoul National University School of Medicine, Seoul, Republic of Korea
| | - Joseph Kyu-Hyung Park
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Yujin Myung
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| |
Collapse
|
16
|
Kim DY, Lee SJ, Kim EK, Kang E, Heo CY, Jeong JH, Myung Y, Kim IA, Jang BS. Feasibility of anomaly score detected with deep learning in irradiated breast cancer patients with reconstruction. NPJ Digit Med 2022; 5:125. [PMID: 35999451 PMCID: PMC9399246 DOI: 10.1038/s41746-022-00671-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 08/03/2022] [Indexed: 11/23/2022] Open
Abstract
The aim of this study is to evaluate cosmetic outcomes of the reconstructed breast in breast cancer patients, using anomaly score (AS) detected by generative adversarial network (GAN) deep learning algorithm. A total of 251 normal breast images from patients who underwent breast-conserving surgery were used for training anomaly GAN network. GAN-based anomaly detection was used to calculate abnormalities as an AS, followed by standardization by using z-score. Then, we reviewed 61 breast cancer patients who underwent mastectomy followed by reconstruction with autologous tissue or tissue expander. All patients were treated with adjuvant radiation therapy (RT) after reconstruction and computed tomography (CT) was performed at three-time points with a regular follow-up; before RT (Pre-RT), one year after RT (Post-1Y), and two years after RT (Post-2Y). Compared to Pre-RT, Post-1Y and Post-2Y demonstrated higher AS, indicating more abnormal cosmetic outcomes (Pre-RT vs. Post-1Y, P = 0.015 and Pre-RT vs. Post-2Y, P = 0.011). Pre-RT AS was higher in patients having major breast complications (P = 0.016). Patients with autologous reconstruction showed lower AS than those with tissue expander both at Pre-RT (2.00 vs. 4.19, P = 0.008) and Post-2Y (2.89 vs. 5.00, P = 0.010). Linear mixed effect model revealed that days after baseline were associated with increased AS (P = 0.007). Also, tissue expander was associated with steeper rise of AS, compared to autologous tissue (P = 0.015). Fractionation regimen was not associated with the change of AS (P = 0.389). AS detected by deep learning might be feasible in predicting cosmetic outcomes of RT-treated patients with breast reconstruction. AS should be validated in prospective studies.
Collapse
Affiliation(s)
- Dong-Yun Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea.,College of Medicine, Seoul National University, Seoul, Korea
| | - Soo Jin Lee
- College of Medicine, Seoul National University, Seoul, Korea
| | - Eun Kyu Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Eunyoung Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Chan Yeong Heo
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae Hoon Jeong
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yujin Myung
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - In Ah Kim
- College of Medicine, Seoul National University, Seoul, Korea.,Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Bum-Sup Jang
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea. .,College of Medicine, Seoul National University, Seoul, Korea. .,Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Korea.
| |
Collapse
|
17
|
Seo SH, Lee S, Park JKH, Yang EJ, Kim B, Lee JS, Kim MJ, Park SS, Seong MW, Nam SY, Heo CY, Myung Y. Clinical staging and genetic profiling of Korean patients with primary lymphedema using targeted gene sequencing. Sci Rep 2022; 12:13591. [PMID: 35948757 PMCID: PMC9365773 DOI: 10.1038/s41598-022-17958-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 08/03/2022] [Indexed: 11/23/2022] Open
Abstract
Lymphedema is a progressive disease caused by lymphatic flow blockage in the lymphatic pathway. Primary (hereditary) lymphedema is caused by genetic mutations without secondary causes. We performed clinical profiling on Korean primary lymphedema patients based on their phenotypes using lymphoscintigraphy and made genetic diagnoses using a next-generation sequencing panel consisting of 60 genes known to be related to primary lymphedema and vascular anomalies. Of 27 patients included in this study, 14.8% of the patients had lymphedema of the upper extremities, 77.8% had lymphedema of the lower extremities and 7.4% had 4-limbs lymphedema. Based on the International Society of Lymphology staging, 14, 10, and 3 patients had stage 3, 2, and 1 lymphedema, respectively. Only one family was genetically confirmed to harbor likely pathogenic variants in CELSR1. The proband was carrying two likely pathogenic variants in CELSR1, while her symptomatic mother was confirmed to carry only one of the variants. Furthermore, two other variants of uncertain significance in CELSR1 were detected in other patients, making CELSR1 the most commonly altered gene in our study. The clinical and genetic profile of hereditary lymphedema reported here is the first such data series reported for South Korea.
Collapse
Affiliation(s)
- Soo Hyun Seo
- Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Seungjun Lee
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Joseph Kyu-Hyung Park
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Eun Joo Yang
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Boram Kim
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jee-Soo Lee
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Man Jin Kim
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Sung Sup Park
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Moon-Woo Seong
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Sun-Young Nam
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Chan-Yeong Heo
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Yujin Myung
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, South Korea.
| |
Collapse
|
18
|
Kim JH, Lee S, Najmiddinov B, Kim EK, Myung Y, Heo CY. Risk factors for chest wall depression after implant insertion for breast reconstruction: a retrospective quantitative study. Gland Surg 2022; 11:1333-1340. [PMID: 36082096 PMCID: PMC9445711 DOI: 10.21037/gs-22-101] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 06/14/2022] [Indexed: 11/06/2022]
Abstract
Background Methods Results Conclusions
Collapse
Affiliation(s)
- Jong-Ho Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Korea
| | - Seungjun Lee
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Korea
| | - Bakhtiyor Najmiddinov
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Korea
| | - Eun-Kyu Kim
- Department of General Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Korea
| | - Yujin Myung
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Korea
| | - Chan Yeong Heo
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Korea
| |
Collapse
|
19
|
Park JKH, Seo J, Yang EJ, Kang Y, Heo CY, Myung Y. Association of lymphatic flow velocity with surgical outcomes in patients undergoing lymphovenous anastomosis for breast cancer-related lymphedema. Breast Cancer 2022; 29:835-843. [PMID: 35553019 DOI: 10.1007/s12282-022-01363-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/20/2022] [Indexed: 01/09/2023]
Abstract
PURPOSE Lymphovenous anastomosis (LVA) is primarily used for treating early-stage lymphedema. Here, we aimed to investigate the relationship between lymphatic flow velocity and the efficacy of LVA in breast cancer-related lymphedema patients. To this end, we assessed the transit velocity of lymphatic fluid using indocyanine green (ICG) lymphography and radioisotope lymphoscintigraphy. METHODS We retrospectively examined patients diagnosed with breast cancer-related lymphedema who underwent LVA from January to December 2020. Patient data, including demographics, clinical stage, and postoperative surgical outcomes, were collected from electronic medical records. ICG lymphography results and dynamic lymphoscintigrams were analyzed to measure the lymphatic flow velocity and to determine the grade of the limb lymphedemas. RESULTS Eighty patients (all female, mean age of 53.6 years) were included. The lymphatic flow velocity ranged between 0.58 and 21.5 cm/min (average, 7.61 cm/min); 37 (46.3%), 18 (22.5%), 15 (18.8%), and 10 (12.5%) arm lymphedemas were classified as lymphoscintigraphy grade 0, 1, 2, and 3, respectively. A significant association was observed between lymphatic flow velocity and lymphedema grade determined using lymphoscintigraphy and between the amount of volume reduction after LVA and preoperative lymphatic flow velocity (P < 0.05). CONCLUSIONS Our findings suggest that lymphatic flow velocity is positively correlated with surgical outcomes in patients undergoing LVA. Therefore, surgical treatment plans for lymphedema should not be based only on the International Society of Lymphedema stage, because advanced-stage lymphedema patients with high ICG velocities can benefit from LVA alone.
Collapse
Affiliation(s)
- Joseph Kyu-Hyung Park
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, South Korea
| | - Junggyo Seo
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, South Korea
| | - Eun Joo Yang
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, South Korea
| | - Yusuhn Kang
- Department of Diagnostic Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, South Korea
| | - Chan Yeong Heo
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, South Korea
| | - Yujin Myung
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, South Korea.
| |
Collapse
|
20
|
Kim D, Lee S, Kim E, Kang E, Myung Y, Heo C, Kim I, Jang B. PO-1215 Feasibility of anomaly score detected with deep learning in irradiated breast with reconstruction. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03179-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
21
|
Park JKH, Park S, Heo CY, Jeong JH, Yun B, Myung Y. The Safety of Operating on Breasts With a History of Prior Reduction Mammoplasty: Dynamic Magnetic Resonance Imaging Analysis of Angiogenesis. Aesthet Surg J 2022; 42:NP151-NP158. [PMID: 34415292 DOI: 10.1093/asj/sjab318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The vascularity of the nipple-areolar complex (NAC) is altered after reduction mammoplasty, increasing the risk of complications after repeat reduction or nipple-sparing mastectomy. OBJECTIVES The aim of this study was to evaluate angiogenesis of the NAC via serial analysis of magnetic resonance images. METHODS Magnetic resonance images of breasts after reduction mammoplasty were analyzed for 35 patients (39 breasts) from 3-dimensional reconstructions of maximum-intensity projection images. All veins terminating at the NAC were classified as internal mammary, anterior intercostal, or lateral thoracic in origin. The vein with the largest diameter was considered the dominant vein. Images were classified based on the time since reduction: <6 months, 6 to 12 months, 12 to 24 months, >2 years. RESULTS The average number of veins increased over time: 1.17 (<6 months), 1.56 (6-12 months), 1.64 (12-24 months), 1.73 (>2 years). Within 6 months, the pedicle was the only vein. Veins from other sources began to appear at 6 to 12 months. In most patients, at least 2 veins were available after 1 year. After 1 year, the internal mammary vein was the most common dominant vein regardless of the pedicle used. CONCLUSIONS Repeat reduction mammoplasty or nipple-sparing mastectomy should be performed ≥1 year following the initial procedure. After 1 year, the superior or superomedial pedicle may represent the safest option when the previous pedicle is unknown.
Collapse
Affiliation(s)
- Joseph Kyu-hyung Park
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea
| | - Seokwon Park
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea
| | - Chan Yeong Heo
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, South Korea
| | - Jae Hoon Jeong
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, South Korea
| | - Bola Yun
- Department of Diagnostic Radiology, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, South Korea
| | - Yujin Myung
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, South Korea
| |
Collapse
|
22
|
Park JKH, Myung Y. Treatment of delayed venous congestion of the nipple-areolar complex after reduction mammoplasty. Arch Aesthetic Plast Surg 2021. [DOI: 10.14730/aaps.2020.02369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
23
|
Lee SW, Heo JW, Myung Y, Kim KK, Jin US. A Revision Mandibuloplasty: Causes, Indications, Surgical Methods and Treatment Outcomes. Aesthetic Plast Surg 2019; 43:726-732. [PMID: 30805687 DOI: 10.1007/s00266-019-01333-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 12/27/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND This paper aims to propose a classification system to categorize patients undergoing revision mandibuloplasty according to their dissatisfaction types. This paper also introduces various appropriate revision techniques and evaluates their outcomes. Through this classification system and suggested surgical techniques, surgeons can settle the disappointments experienced by patients after their primary mandibuloplasty, by realizing more natural-looking results. METHODS The study subjects consisted of 184 patients who underwent a revision mandibuloplasty from October 2010 to March 2016, conducted by a single surgeon at a single institution. The authors were able to classify the dissatisfaction into two primary types-(1) lack of an overall slender frontal facial contour and (2) unnatural and asymmetrical overall facial appearance due to over- or inaccurate resection of the bone. A self-evaluation of patient's subjective satisfaction based on the scale from 1 to 5, both after the primary operation and after revision surgery, was compared. RESULTS Dissatisfaction type I accounted for 145 patients (78.8 percent). The number of patients classified into dissatisfaction type II was 39 (21.2 percent). Of the patients categorized into type I, those undergoing revision surgeries due to an under-corrected mandibular tubercle and parasymphysis showed the most remarkable improvement in self-satisfaction score after reoperation-from 2.3 to 4.0. CONCLUSION To realize a natural-looking outcome in facial look through mandibular contouring, it is important not only to carefully consider the ratio and shape essential for an optimal slender facial contour, but also to minimize unnecessary resection of the bone. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
Affiliation(s)
| | - Jae-Woo Heo
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Yujin Myung
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ki-Kap Kim
- DA Plastic Surgery, Seoul, Republic of Korea
| | - Ung Sik Jin
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea.
| |
Collapse
|
24
|
Hwang I, Myung Y, Park S. Levator Pull-Out Suture Technique for Immediate Postoperative Correction of Eyelid Asymmetry After Ptosis Surgery in Asians. Aesthetic Plast Surg 2019; 43:388-394. [PMID: 30483936 DOI: 10.1007/s00266-018-1276-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/10/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Postoperative eyelid asymmetry is the most common complaint of patients after undergoing blepharoplasty and ptosis correction surgery. Calibrating eyelid asymmetry during ptosis correction surgery is still difficult for surgeons despite the development of innovative procedures. Our levator pull-out suture technique for correcting postoperative eyelid asymmetry after ptosis surgery is introduced. METHODS A total of 330 patients who underwent ptosis correction surgery with upper blepharoplasty from 2016 to 2017 were enrolled in our study. All surgeries were performed using the levator pull-out suture technique, and the postoperative eyelid asymmetry was corrected in the outpatient clinic at 2-3 days after the operation. Patient satisfaction was evaluated preoperatively and at 1 week and 2 months postoperatively using a questionnaire. Visual acuity, marginal reflex distance 1 (MRD1), and vertical palpebral fissure length asymmetry were measured preoperatively and compared to values taken postoperatively. RESULTS Patient satisfaction regarding asymmetry increased from 2.7/5 (preoperatively) to 4.1/5 points (postoperatively). MRD1 and vertical palpebral fissure length increased from 1.1/1.2 and 6.8/6.8 mm (preoperatively), respectively, to 2.8/2.9 and 8.5/8.6 mm (postoperatively), respectively. The asymmetry of MRD1 and vertical palpebral fissure length before and after surgery were corrected from 0.45/1.81 to 0.01/0.19 mm (p < 0.01). CONCLUSION Our innovative surgical method of using the levator pull-out suture technique is relatively simple and allows for finer suture adjustments postoperatively to effectively correct eyelid asymmetry, with satisfactory results. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
Affiliation(s)
- Inseok Hwang
- Department of Plastic Surgery, ID Hospital, 142 Dosan dae-ro, Gangnam-gu, Seoul, 06039, Korea
| | - Yujin Myung
- Department of Plastic Surgery, ID Hospital, 142 Dosan dae-ro, Gangnam-gu, Seoul, 06039, Korea
| | - Sanghoon Park
- Department of Plastic Surgery, ID Hospital, 142 Dosan dae-ro, Gangnam-gu, Seoul, 06039, Korea.
| |
Collapse
|
25
|
Myung Y, Choi B, Yim SJ, Yun BL, Kwon H, Pak CS, Heo C, Jeong JH. The originating pattern of deep inferior epigastric artery: anatomical study and surgical considerations. Surg Radiol Anat 2018; 40:873-879. [PMID: 29926133 DOI: 10.1007/s00276-018-2055-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 06/14/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE Studies focusing on the originating patterns of the deep inferior epigastric artery (DIEA) have not been conducted. Here, we analyzed the vascular anatomy of the DIEA with computed tomographic angiography (CTA) to provide assistance during proximal pedicle dissection of a DIEA-based flap. METHODS We conducted a retrospective study on patients who had undergone breast reconstruction with the transverse rectus abdominis musculocutaneous flap and the deep inferior epigastric perforator flap from March 2006 to October 2016. Preoperative three-dimensional computed tomographic angiograms of the abdominal wall (hemi-abdominal walls) were employed in this study, and three independent surgeons reviewed all CTA images. The originating angles and the distance from the originating point to the DIEA turning point were analyzed. Moreover, we assessed the relationship between the measured values and patients' characteristics, such as abdominal surgery history. RESULTS CTA data of 184 patients and 368 hemiabdomens were reviewed and analyzed. Most of the DIEAs originated from the external iliac artery in the medial direction, proceeded caudally, and curved in a cephalic direction. The average descending length was 11.29 mm. As the DIEA origin angle decreased (toward the caudal direction), the distance of the initial descent increased (r = 0.382, p < 0.01). In addition, the descending length was significantly larger (p < 0.01) in the operation group (12.22 mm) than in the non-operation group (9.86 mm). CONCLUSIONS Surgeons should consider DIEA-originating patterns to ensure safe pedicle dissection during flap elevation.
Collapse
Affiliation(s)
- Yujin Myung
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi, 13620, Republic of Korea
| | - Bomi Choi
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi, 13620, Republic of Korea
| | - Sang Jun Yim
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi, 13620, Republic of Korea
| | - Bo La Yun
- Department of Diagnostic Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Heeyeon Kwon
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi, 13620, Republic of Korea
| | - Chang Sik Pak
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi, 13620, Republic of Korea
| | - Chanyeong Heo
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi, 13620, Republic of Korea
| | - Jae Hoon Jeong
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi, 13620, Republic of Korea.
| |
Collapse
|
26
|
Pak C, Yim S, Kwon H, Myung Y, Kim BK, Heo CY, Jeong JH. A Novel Method for Lower Blepharoplasty: Repositioning of the Orbital Septum Using Inverted T-Shaped Plication. Aesthet Surg J 2018; 38:707-713. [PMID: 29566215 DOI: 10.1093/asj/sjy010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Numerous techniques have been used for lower blepharoplasty. The techniques can be classified into four principles: excision of excess fat, septal reset, orbital fat repositioning, and reinforcement of the attenuated orbital septum. OBJECTIVES We modified the conventional approach of septal reinforcement to utilize an inverted T-shaped plication with preservation of the orbital fat, repositioning the septum below the arcus marginalis to refine tear-trough deformity. METHODS From April 2010 to September 2015, 93 individuals underwent bilateral lower blepharoplasty. Retrospective chart reviews were performed, and the results and complications during the follow-up period were recorded and photographed. RESULTS The patients comprised 76 women and 17 men. Thirteen, 33, and 47 patients exhibited mild, moderate, and severe fat herniation, respectively, accompanied by tear-trough deformity. A total of 70 and 23 patients underwent lower blepharoplasty via subciliary and transconjunctival approaches, respectively. We performed inverted T-shaped plication of the orbital septum in mild and moderate cases and X-shaped plication in severe cases, and in moderate and severe cases, we performed septal repositioning simultaneously. The mean follow-up period was 25 months. When immediate mild lid retraction or lid malposition was observed, it recovered without specific treatment within 1 to 2 weeks. No permanent lid malposition or ectropion was observed in any of the patients. CONCLUSIONS Septal plication with inverted T-shape or X-shape can minimize the downward forces that affect postoperative eyelid malposition and ectropion. Further, these procedures provide sufficiently strong reinforcement of the orbital septum to restore infraorbital fat herniation. LEVEL OF EVIDENCE 4
Collapse
Affiliation(s)
- Changsik Pak
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Sangjun Yim
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Heeyeon Kwon
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Yujin Myung
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Baek-Kyu Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Chan-Yeong Heo
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Jae Hoon Jeong
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
| |
Collapse
|
27
|
Myung Y, Choi B, Kwon H, Heo CY, Kim EK, Kang E, Jeong JH, Yang EJ. Quantitative analysis of shoulder function and strength after breast reconstruction: A retrospective cohort study. Medicine (Baltimore) 2018; 97:e10979. [PMID: 29901587 PMCID: PMC6023658 DOI: 10.1097/md.0000000000010979] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Immediate breast reconstruction (IBR) after mastectomy has been proven to affect patient quality of life, psychological well-being, and functional capacities. In the present study, we aimed to investigate the effect of breast reconstruction on postoperative shoulder function and muscle performance by evaluating isokinetic muscle performance tests.A retrospective chart review to collect data on shoulder function analysis with isokinetic muscle performance testing was performed among patients who received mastectomy with IBR from July 2013 to March 2015. Patients were categorized into 4 groups: a control group that underwent mastectomy without reconstruction, a tissue expander/implant insertion group, a pedicled latissimus dorsi (LD) flap group, and a free transverse rectus abdominis muscle (TRAM) flap group.Analysis of the groups at 1 to 3, 4 to 6, 7 to 9, 10 to 12, and 13 to 15 months postoperatively showed significant shoulder function improvement in the tissue expander/implant and TRAM groups as measured by linear regression analysis. Compared with the control group, patients who received immediate reconstruction with tissue expander/implant insertion or a TRAM flap showed statistically significant improvement in shoulder function after mastectomy.IBR with a TRAM flap or tissue expander/implant insertion were more beneficial for shoulder rehabilitation and for regaining function compared to mastectomy alone and breast reconstruction with a LD flap.
Collapse
Affiliation(s)
- Yujin Myung
- Department of Plastic and Reconstructive Surgery
| | - Bomi Choi
- Department of Plastic and Reconstructive Surgery
| | - Heeyeon Kwon
- Department of Plastic and Reconstructive Surgery
| | | | | | | | | | - Eun Joo Yang
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| |
Collapse
|
28
|
Myung Y, Son Y, Nam TH, Kang E, Kim EK, Kim IA, Eom KY, Heo CY, Jeong JH. Objective assessment of flap volume changes and aesthetic results after adjuvant radiation therapy in patients undergoing immediate autologous breast reconstruction. PLoS One 2018; 13:e0197615. [PMID: 29782518 PMCID: PMC5962051 DOI: 10.1371/journal.pone.0197615] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 05/05/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The use of immediate breast reconstruction and adjuvant radiation therapy is increasing in breast cancer patients. This study aimed to analyze the aesthetic outcome and changes in flap volume in patients with breast cancer undergoing radiation therapy of the surgical site after immediate autologous tissue reconstruction. METHODS Immediate abdominal free flap breast reconstruction following unilateral mastectomy was performed in 42 patients; 21 patients received adjuvant radiation (study group) and 21 patients did not (control group). To compare flap volume, three-dimensional computed tomography (CT) was performed before and after radiation. Also, aesthetic analysis was performed in both groups to evaluate shape changes. RESULTS There was a 12.3% flap volume reduction after the completion of radiation in the experimental group that was significantly greater than the 2.6% volume reduction observed in the non-radiation group (P<0.01). There was no significant difference in the short- and long-term aesthetic results between the groups. CONCLUSIONS When performing immediate autologous breast reconstruction, 14% volume overcorrection is recommended for patients in whom adjuvant radiation therapy is anticipated to improve aesthetic outcomes.
Collapse
Affiliation(s)
- Yujin Myung
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Yousung Son
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Tae-hyun Nam
- Department of Diagnostic Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Eunyoung Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Eun-Kyu Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - In Ah Kim
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Keun-Yong Eom
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Chan Yeong Heo
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jae Hoon Jeong
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- * E-mail:
| |
Collapse
|
29
|
Baek RM, Myung Y, Park I, Pak CS, Kim BK, Lâm VN, Jeong JH. A new all-purpose bilateral cleft lip repair: Bilateral cheiloplasty suitable for most conditions. J Plast Reconstr Aesthet Surg 2018; 71:537-545. [DOI: 10.1016/j.bjps.2017.09.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Revised: 09/11/2017] [Accepted: 09/13/2017] [Indexed: 10/18/2022]
|
30
|
Myung Y, Ahn T, Kim BK, Jeong JH, Baek RM. Clinical Significance of the Levator Veli Palatini Muscle in Velocardiofacial Syndrome Patients. Cleft Palate Craniofac J 2017; 55:521-527. [DOI: 10.1177/1055665617732786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Anatomical variation and deficits of velocardiofacial syndrome patients are related to unsatisfactory treatment results in surgical correction of speech abnormalities. The main purpose of the article is to investigate the clinical significance of thinned levator veli palatini muscle in VCFS patients. Methods: The authors reviewed medical records of all children with velocardiofacial syndrome who received pharyngeal flap surgery between March 2007 and September 2015. Data including thickness of levator veli palatini in magnetic resonance examination; preoperative velopharyngeal gap size from nasoendoscopy; and preoperative and postoperative speech outcomes were collected. Results: Total of 36 velocardiofacial syndrome patients with preoperative objective data and postoperative speech outcomes were identified. Preoperative velopharyngeal gap showed significant correlation with thickness of levator veli palatini (correlation coefficient: 0.297/0.397, P = .02/.03) and gap size showed correlation with postoperative speech improvement (0.347/0.413, P = .04/.02). However, muscle thickness showed no correlation with speech outcomes (0.046/0.037, P = .77/.86). Conclusion: Thinned levator veli palatini muscle in velocardiofacial syndrome patients are related to widened velopharyngeal gap and production of hypernasal speech, and can give negative impact on postoperative surgical outcome of pharyngeal flap surgery.
Collapse
Affiliation(s)
- Yujin Myung
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Taeseon Ahn
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Baek-kyu Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Jae Hoon Jeong
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Rong-Min Baek
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| |
Collapse
|
31
|
Baek RM, Myung Y. Intraoperative, surgeon-view, high-definition video broadcasting in intraoral surgery. Br J Oral Maxillofac Surg 2017; 55:561-562. [DOI: 10.1016/j.bjoms.2016.11.314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 11/14/2016] [Indexed: 11/27/2022]
|
32
|
Myung Y, Heo CY. Relationship Between Obesity and Surgical Complications After Reduction Mammaplasty: A Systematic Literature Review and Meta-Analysis. Aesthet Surg J 2017; 37:308-315. [PMID: 28207040 DOI: 10.1093/asj/sjw189] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Although many patients who undergo reduction mammaplasty are obese, reports on whether obesity is a risk factor for postoperative complications have been conflicting. Objectives This systematic literature review and meta-analysis aimed to evaluate the relationship between obesity and surgical complications after reduction mammaplasty. Methods The PubMed, Medline, and Embase databases were searched between 1998 and 2016 using the MeSH terms and keywords “reduction mammoplasty (mammaplasty),” “breast reduction,” “obesity,” “body weight,” “body mass index,” and “risk factor.” Results Among 26 studies that reported surgical complication risk and patient body weight, 11 concluded that obesity is not a risk factor and 15 reported that high body mass index increases surgical risk. On comparing obese and non-obese patients, we found that obese patients had a higher relative risk of surgical complications (1.38, 95% confidence interval 1.13-1.69), particularly skin and fat necrosis (2.01, 95% confidence interval 1.54-2.63). The pooled risk further increased with an increase in body mass index, and it was 1.71 for body mass index >35 kg/m2 and 2.05 for body mass index >40 kg/m2. Conclusions Our meta-analysis indicated that the risk of surgical complications and tissue necrosis after reduction mammaplasty is higher in obese patients than in non-obese patients and that the risk gradually increases with an increase in the severity of obesity. The findings of this study could form a basis for preoperative patient education, surgical method selection, and determination of the extent of postoperative care.
Collapse
Affiliation(s)
- Yujin Myung
- From the Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Chan-Yeong Heo
- From the Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
33
|
Myung Y, Yim S, Kim BK. A comparison of axial circumference between superficial circumflex iliac artery perforator flap and other workhorse flaps in dorsal foot reconstruction. J Plast Surg Hand Surg 2017; 51:381-386. [PMID: 28152328 DOI: 10.1080/2000656x.2017.1279621] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Management and reconstruction of dorsal foot defects present various difficulties and challenges. The main purpose of this article is to discuss experiences of using superficial circumflex iliac perforator (SCIP) flap in various defects of the dorsal foot region. METHODS From August 2012 to February 2015, a total of 13 patients - nine males and four females - received a reconstruction operation for dorsal foot defects using SCIP flaps (the SCIP group). The defects were caused by trauma (n = 9), diabetes (n = 3), and malignancy (n = 1). The mean age was 43.07 years, which ranged between 19-70 years. Additionally, 19 other patients, who underwent reconstruction operation of the foot dorsum using ALT and TDAP flaps during the same study period, were recruited for comparison. The axial circumference of the operated foot and unoperated contralateral foot was measured, and the difference were compared between all patients, as well as between the two groups. RESULTS All of the flaps survived after the operation, but secondary procedures were performed in two cases due to partial skin necrosis. The mean follow-up period was 13 months. The mean axial circumference discrepancy of the SCIP group (12.08 ± 2.96 mm) was significantly lower compared with ALT (25.21 ± 3.16 mm) and TDAP (29.88 ± 1.55 mm) groups (p < 0.01). CONCLUSIONS The authors experienced good results with using the SCIP flap in dorsal foot reconstruction. Reconstruction with the SCIP flap can be a good surgical option, with better postoperative symmetry and minimal donor sequelae, compared to conventional workhorse flaps.
Collapse
Affiliation(s)
- Yujin Myung
- a Department of Plastic and Reconstructive Surgery , Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seoul , South Korea
| | - Sangjun Yim
- a Department of Plastic and Reconstructive Surgery , Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seoul , South Korea
| | - Baek-Kyu Kim
- a Department of Plastic and Reconstructive Surgery , Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seoul , South Korea
| |
Collapse
|
34
|
Lee SW, Jeong YW, Myung Y. Revision Surgery for Zygoma Reduction: Causes, Indications, Solutions, and Results from a 5-Year Review of 341 Cases. Aesthetic Plast Surg 2017; 41:161-170. [PMID: 28032152 DOI: 10.1007/s00266-016-0723-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 10/16/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Many patients undergo a revision surgery after malar reduction, which is one of the most popular aesthetic surgeries in Asia. We reviewed the leading causes of revision for malar reduction surgery to establish proper indications for revision, seek adequate surgical strategies, and share the results from revision surgical cases. METHODS A retrospective review was conducted involving 341 patients who underwent malar reduction reoperation between March 2010 and June 2015. Surgical strategies were decided based upon specific problems and complaints from the previous surgery. Facial photographs, cephalography, and computed tomography images were analyzed, and a patient satisfaction survey was conducted before and after the surgery. RESULTS A total of 341 patients (321 women, 20 men; average age, 26.6 years, range 18-40 years) were included. The main causes of reoperations were subjective dissatisfaction and nonunion-related symptoms. Undercorrection of the zygomatic body and arch (n = 175, 51.3%) was the most frequent reason for dissatisfaction. The patients underwent revision surgeries via different techniques and strategies based on previous problems from primary surgery, and postoperative patient satisfaction was high. Complications occurred in 35 patients (10.3%) after revision. CONCLUSIONS Based on the results of this study, patient dissatisfaction with the procedure can be minimized beforehand through accurate goal identification and careful planning. Bone nonunion is usually due to excessive bone resection during zygoma reduction surgery. Careful selection of the reposition site and appropriate fixation based on a thorough understanding of masseter action are essential in ensuring satisfactory outcomes without adverse side effects. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
Affiliation(s)
- Sang Woo Lee
- D.A. Plastic Surgery Clinic, Seoul, Republic of Korea
| | | | - Yujin Myung
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-Si, Gyeong-gi do, 463-707, Republic of Korea.
| |
Collapse
|
35
|
Myung Y, Kwon H, Pak C, Lee H, Jeong JH, Heo CY. Radiographic evaluation of vessel count and density with quantitative magnetic resonance imaging during external breast expansion in Asian women: A prospective clinical trial. J Plast Reconstr Aesthet Surg 2016; 69:1588-1597. [DOI: 10.1016/j.bjps.2016.09.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 08/11/2016] [Accepted: 09/14/2016] [Indexed: 10/20/2022]
|
36
|
Lee SW, Myung Y, Jeong YW. Bone Resection Versus Setback in Reduction Malarplasty: A Quantitative Analysis of the Migration of the Summit of the Zygoma. Aesthetic Plast Surg 2016; 40:349-59. [PMID: 27071384 DOI: 10.1007/s00266-016-0635-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 03/16/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND We hypothesized that the amount of bone resection and setback together controls the effect of reducing the zygomatic body during reduction malarplasty; however, quantitative analyses of this movement are lacking. METHODS A retrospective study of patients who underwent reduction malarplasty between Aug. 2013 and Jan. 2015 was performed. We used 3-dimensional computed tomography (3D CT) scanning to measure movements of the summit of the zygoma (SOZ). We analyzed 394 zygomas in 197 patients. RESULTS The bone resection amount was not significantly correlated with the anteroposterior movement of the SOZ (p = 0.270); in contrast, the setback amount, was significantly correlated with anteroposterior SOZ movement (p < 0.001). The bone resection amount was not correlated with cephalocaudal movement (p = 0.158); however, cephalocaudal movement was significantly correlated with the setback amount (p < 0.001). Both the bone resection amount and the setback amount were correlated with mediolateral movement (p < 0.001). The amount of bone resection determined the mediolateral movement. Both the bone resection amount and the setback amount were correlated with the mean movement distance of the SOZ (p < 0.001). Both the R (2) (0.704 > 0.084) and β (0.839 > 0.290) values indicated that the setback amount made a larger contribution to the SOZ movement distance than did the bone resection amount. CONCLUSIONS Whereas bone resection was the major factor in the medial movement of the SOZ, bone setback was the major factor in the anterior and superior movement of the SOZ and a minor factor in the medial movement. The results indicate that both bone reposition and bone resection are important factors in maximizing surgical results of the reduction malarplasty. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
Affiliation(s)
- Sang Woo Lee
- D.A. Plastic Surgery Clinic, 7, 8, 9 floor, 1303-37, Seocho 4-dong, Seocho-gu, Seoul, 137-855, Republic of Korea
| | - Yujin Myung
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yeon Woo Jeong
- D.A. Plastic Surgery Clinic, 7, 8, 9 floor, 1303-37, Seocho 4-dong, Seocho-gu, Seoul, 137-855, Republic of Korea.
| |
Collapse
|