조직확장술을 거치지 않고 유방보형물을 대흉근-전거근 포켓에 삽입한 즉시 유방재건술

Immediate Breast Reconstruction Placing the Breast Implant under the Pectoralis Major-Serratus Anterior Pocket without Tissue Expansion

  • 김훈 (울산대학교 의과대학 서울아산병원 성형외과학교실) ;
  • 엄진섭 (울산대학교 의과대학 서울아산병원 성형외과학교실) ;
  • 안세현 (울산대학교 의과대학 서울아산병원 일반외과학교실) ;
  • 손병호 (울산대학교 의과대학 서울아산병원 일반외과학교실) ;
  • 이택종 (울산대학교 의과대학 서울아산병원 성형외과학교실)
  • Kim, Hoon (Departments of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine) ;
  • Eom, Jin Sub (Departments of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine) ;
  • Ahn, Sei Hyun (Departments of General Surgery, Asan Medical Center, University of Ulsan, College of Medicine) ;
  • Son, Byung Ho (Departments of General Surgery, Asan Medical Center, University of Ulsan, College of Medicine) ;
  • Lee, Taik Jong (Departments of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine)
  • 투고 : 2007.04.16
  • 발행 : 2007.09.10

초록

Purpose: Although the autogenous tissue transfer has been the mainstay of the breast reconstruction, concern for the donor site morbidity can lead to the superseded method using tissue expander with implant or permanent expander-implant. However, the additional procedure of tissue expansion possibly cause discomfort and raise the cost. We tried to verify the efficacy of using the saline-filled breast implant by itself for the safe and convenient immediate breast reconstruction modality if the patients have small, round and non-ptotic breasts and the sufficient breast skin can be saved with mastectomy. Methods: From July 2002 to July 2005, 29 breasts of 26 patients were restored only with the saline-filled breast implant immediately after the skin sparing or nipple-areolar skin sparing mastectomy in Asan Medical Center. A pocket with pectoralis major and serratus anterior muscle was created and the implant was covered with this muscle pocket. Simultaneous contralateral augmentation was performed in patients whose mastectomy specimen weighed less than 100g. Results: Using only the saline-filled breast implant resulted in the successful reconstruction with few complications including partial necrosis of nipple areolar skin (five cases, 17.2%), capsular contracture (three cases, 10.3%), hematoma (one case, 3.4%), depigmentation of areolar skin (one case, 3.4%), hypertrophic scar (one case, 3.4%), which were all healed by conservative management. There were no significant complications such as implant exposure and subsequent removal. Conclusion: Immediate breast reconstruction only with the saline-filled breast implant can be a satisfactory alternative option for the patients whose breast is small, round and non-ptotic, especially when the nipple-areolar skin of the breast is preserved in the mastectomy.

키워드

참고문헌

  1. Han SH, Cho JH, Ahn SH: Immediate breast reconstruction after mastectomy. J Korean Soc Plast Reconstr Surg 22: 843, 1995
  2. Choi BC, Kim SE, Woo SH, Jeong JH, Seul JH: Immediate breast reconstruction after mastectomy for breast cancer. J Korean Soc Plast Reconstr Surg 24: 748, 1997
  3. Jung WS, Park HS, Kim YW: A comparison of permanent expander-implant in immediate and delayed breast reconstruction after modified radical mastectomy. J Korean Soc Plast Reconstr Surg 30: 735, 2003
  4. Ko PM, Park WJ, Kim JJ, Joon BJ, Lee JS, Shin MS: Breast reconstruction with an anatomical expander and implant: our clinical experience. J Korean Soc Plast Reconstr Surg 26: 407, 1999
  5. Spear SL, Majidian A: Immediate breast reconstruction in two stages using textured, integrated-valve tissue expanders and breast implants: a retrospective review of 171 consecutive breast reconstructions from 1989 to 1996. Plast Reconstr Surg 101: 53, 1998 https://doi.org/10.1097/00006534-199801000-00010
  6. Gui CP, Tan SM, Faliakou EC, Choy C, A'Hern R, Ward A: Immediate breast reconstruction using biodimensional anatomical permanent expander implants: a prospective analysis of outcome and patient satisfaction. Plast Reconstr Surg 111: 125, 2003 https://doi.org/10.1097/00006534-200301000-00021
  7. Salgarello M, Farallo E: Immediate breast reconstruction with definitive anatomical implants after skin-sparing mastectomy. Br J Plast Surg 58: 216, 2005 https://doi.org/10.1016/j.bjps.2004.06.033
  8. Salgarello M, Seccia A, Eugenio F: Immediate breast reconstruction with anatomical permanent expandable implants after skin-sparing mastectomy: aesthetic and technical refinements. Ann Plast Surg 52: 358, 2004 https://doi.org/10.1097/01.sap.0000105914.69611.c7
  9. Woerdeman LA, Hage JJ, Smeulders MJ, Rutgers EJ, van der Horst CM: Skin-sparing mastectomy and immediate breast reconstruction by use of implants: an assessment of risk factors for complications and cancer control in 120 patients. Plast Reconstr Surg 118: 321, 2006 https://doi.org/10.1097/01.prs.0000234049.91710.ba
  10. Shaikh-Naidu N, Preminger BA, Rogers K, Messina P, Gayle LB: Determinants of aesthetic satisfaction following TRAM and implant breast reconstruction. Ann Plast Surg 52: 465, 2004 https://doi.org/10.1097/01.sap.0000123901.06133.b7
  11. Spear SL, Onyewu C: Staged breast reconstruction with saline-filled implants in the irradiated breast: recent trends and therapeutic implications. Plast Reconstr Surg 105: 930, 2000 https://doi.org/10.1097/00006534-200003000-00016
  12. Cordeiro PG, Pusic AL, Disa JJ, McCormick B, VanZee K: Irradiation after immediate tissue expander/implant breast reconstruction: outcomes, complications, aesthetic results, and satisfaction among 156 patients. Plast Reconstr Surg 113: 877, 2004 https://doi.org/10.1097/01.PRS.0000105689.84930.E5
  13. Andrade WN, Baxter N, Semple JL: Clinical determinants of patient satisfaction with breast reconstruction. Plast Reconstr Surg 107: 46, 2001 https://doi.org/10.1097/00006534-200101000-00008
  14. Tzafetta K, Ahmed O, Bahia H, Jerwood D, Ramakrishnan V: Evaluation of the factors related to postmastectomy breast reconstruction. Plast Reeonstr Surg 107: 1694, 2001 https://doi.org/10.1097/00006534-200106000-00009
  15. Salhab M, Al Sarakbi W, Joseph A, Sheards S, Travers J, Mokbel K: Skin-sparing mastectomy and immediate breast reconstruction: patient satisfaction and clinical outcome. Int J Clin Oncol 11: 51, 2006 https://doi.org/10.1007/s10147-005-0538-1