• Archives of Plastic Surgery
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• 제37권6호
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• pp.742-748
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• 2010

Purpose: The method of using ultrasound-assisted liposuction and excision of the remaining glandular tissue is the preferred method for treating gynecomastia and is currently used worldwide. Herein, this article described the role of ultrasound-assisted liposuction before a surgical excision in the treatment of gynecomastia. The cosmetic results were objectively evaluated. Methods: 11 patients (22 breasts) underwent ultrasoundassisted liposuction and suction-assisted lipectomy between April 2007 and January 2009. At the end of the liposuction, the remaining glandular tissue was removed through the incision used for liposuction. We evaluated the cosmetic results using ordinary scale methods on the basis of four categories (recurrence, symmetry, contour irregularity, and scar). Results: The volume of aspirates ranged between 50 and 200 cc per breast and the average weight of tissue removed by excision was 65g per breast. No complications were recorded. Regarding the cosmetic evaluation, the recurrence, contour irregularity, and scar were excellent, the symmetry was good, and the overall results represented all those cases were mostly excellent. Conclusion: Ultrasound-assisted liposuction has many advantages in the treatment of gynecomastia. When excising the remaining glandular tissue, bleeding is decreased by the use of a tumescent technique. The glandular tissue is easily mobilized and excised after being "morselized" with ultrasound-assisted liposuction. The glandular tissue is simply dissected via the suction surface. Compared the residual mound of glandular tissue beneath the nipple and areola to the periphery, it facilitates precise control of the excision.

• Archives of Plastic Surgery
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• 제35권2호
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• pp.193-196
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• 2008

Purpose: TRAM flap reconstruction has settled down as a common method for breast reconstruction after mastectomy. There are a few surgical contraindication in TRAM flap surgery. Previous abdominal liposuction has been a relative contraindication in TRAM flap surgery. The authors present 2 patients of successful breast reconstruction using pedicled TRAM flaps, who previously underwent abdominal liposuction. Methods: Case 1: A 48-year-old woman with a right breast cancer visited for mastectomy and breast reconstruction. Her past surgical history was notable for abdominal liposuction 15 years ago. Skin sparing mastectomy and breast reconstruction with a pedicled TRAM flap was performed. Case 2: A 45-year-old woman with a left breast cancer visited us for mastectomy and autologous breast reconstruction. 3 years ago, she had an abdominal liposuction and augmentation mammaplasty in other hospital. Nipple sparing mastectomy and breast reconstruction was done using pedicled TRAM flap. Results: One year after the reconstruction, partial fat necrosis was developed in one case but there was no skin necrosis or donor site complication in both patients. Conclusion: As aesthetic surgery becomes more popular, increasing numbers of patients who have a prior abdominal liposuction history want for autologous tissue breast reconstruction. In these patients, TRAM flap surgery will be also used for breast reconstruction. But, the warning of fat necrosis and the use of preoperative Doppler tracing to evaluate the abdominal perforator may be beneficial to patients who had abdominal liposuction recently.

• Archives of Plastic Surgery
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• 제35권1호
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• pp.42-47
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• 2008

Purpose: Advanced techniques now make it possible to remove considerable amounts of subcutaneous adipose tissue more safely with minimum blood loss. However, few have analyzed the metabolic consequences of liposuction. The purpose of this study was to identify the early effects of the surgical removal of subcutaneous fat on metabolic changes in patients who have undergone liposuction. Methods: Nineteen patients were evaluated from June 2005 to December 2005. Preoperative body weight, serums levels of lipids, apolipoprotein A1, dehydroepiandrosterone(DHEA), uric acid, insulin, and glucose were evaluated. Insulin resistance was determined using the homeostasis model assessment of insulin resistance (HOMA-IR), which is based on fasting glucose and insulin concentrations. All of these data were remeasured in 1 and 4 weeks postoperatively. Tumescent fluid was infiltrated using the superwet technique. The liposuction device used was a $Liposlim^{(R)}$ power-assisted unit. Results: Average volumes of infiltrate and aspirate were 3,268mL and 2,892mL, respectively. Results in 1 week postoperatively demonstrated a significant difference in high-density lipoprotein(HDL) cholesterol, apolipoprotein A1, insulin, and HOMA-IR levels. However, all values were within normal limits and returned to baseline in 4 weeks postoperatively.Conclusion: This study provides little to support the presumed therapeutic effect of liposuction. And, it is unclear whether liposuction can prevent or be used to treat the metabolic complications of obesity. However, the results of the present study lead us to believe that liposuction is a metabolically safe procedure.

• Archives of Plastic Surgery
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• 제32권4호
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• pp.496-502
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• 2005

This study was performed to compare the effect of external ultrasound assisted PAL(power assisted liposuction) with that of PAL alone. We performed 17 cases of liposuction from January 2003 to June 2003. For comparing both systems, we treated the right side(study group) with external ultrasound assisted PAL and the left side(control group) with PAL alone. To evaluate the difference in results between two groups, we surveyed three objective and four subjective items. Objectives were categorized as "Reduction rate of postoperative swelling", "Efficiency of suction" and "Histologic finding of aspirated fat tissue". Subjectives were also filed as "Degree of postoperative bruising", "Cannula resistance that operator felt", "Degree of postoperative pain" and "Patient's satisfaction". We assessed by questionnaire three times at 1day, 7 days and 30 days after operation. There were statistically significant differences in two of the subjective items; "Degree of postoperative pain at postoperative 1 day" and "Cannula resistance that operator felt". This study concludes that external ultrasound PAL is more effective high mobility of fat tissue and low tension of surrounding tissue. External ultrasound PAL will be more useful in case of large volume liposuction and revision procedures.

• Archives of Plastic Surgery
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• 제36권4호
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• pp.462-468
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• 2009

Purpose: The liposuction has been generalized & undergone in the field of plastic surgery and it has had a great influence on fat graft. But despite of liposuction and fat injection being performed widely, we did not focus on complication associated with donor site. So we reported satisfactory result with the intraoperative sustained limited expansion & direct closure to donor site tissue necrosis after liposuction and analyzed the cause & measures of donor site necrosis with the literature investigation Methods: From November 2007 to June 2008, we treated four cases of tissue necrosis and infection surrounding the thigh and forearm. Necrosis after liposuction was 1 case, donor site necrosis after fat injection were 3 cases and MRSA was detected in 2 cases. first, we debrided the necrotic tissue and treated with potadine gauze soaking dressing & susceptible antibiotics. After confirmation of healthy granulation tissue, we used intraoperative sustained limited expansion and closed directly of defect & observed the results. Results: The patient was displeased and worried with the unexpected damage concerning the donor site and the procedure concerning time and financial exhaustion, but after confirming no contracture of the scar tissues and only a thin or slightly widened line of scar, showed satisfaction. Conclusion: Because it is fastidious to avoid donor site complication after liposuction & fat injection, enough explanation and understanding on possible complication to donor site are necessary and careful surgery procedure & materials are required. But if donor site necrosis were occurred although close consideration of possible causes of necrosis, we should think about not only wound healing process but also the sequela like scar contracture & cosmetic effect and treat the most adequate method to satisfying both concerns.

• Archives of Plastic Surgery
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• 제35권1호
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• pp.62-66
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• 2008

Purpose: Axillary osmidrosis is a distressing disorder characterized by unpleasant odor from axillary area and it is mainly associated with apocrine glands but also associated with eccrine glands. For surgical treatment of osmidrosis, recently ultrasound assisted liposuction(UAL) had been performed for many patients. According to the recent studies about ultrasound assisted liposuction for the treatment of osmidrosis, histologic studies about apocrine gland had been applied for 35 cases, but there were rare mention about eccrine gland and the relationship between two glands. The purpose of this article is to evaluate the effect of ultrasound assisted liposuction for the treatment of axillary osmidrosis on apocrine and eccrine glands. Methods: From January 2004 to January 2007, 35 patients underwent ultrasound assisted liposuction for the treatment of osmidrosis and 5 patients underwent histologic studies. Histologic examinations were performed before and after ultrasound assisted liposuction and each biopsy was performed in central axillary area. The volume ratio of both glands, presence of degeneration were examined. And in aspirates, distribution and density of both glands and their morphological changes were examined. Results: Preoperative biopsy results showed average volume ratio of apocrine glands to eccrine glands was 65 : 35. According to the postoperative biopsy results, the volume of apocrine glands in dermis were significantly reduced and glands were degenerated, but the volume of eccrine glands were slightly reduced and glands were mildly damaged. And the average volume ratio of two glands was 20 : 80. According to biopsy results of aspirates, the volume ratio of two glands was 85 : 15 and apocrine glands had significantly greater proportion. Conclusion: By comparison of each biopsy result, apocrine glands were more significantly reduced and degenerated than eccrine glands in all 5 cases. However, further studies with large sample sizes and close examinations are required.

• Archives of Plastic Surgery
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• 제45권1호
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• pp.14-22
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• 2018

Background Liposuction has become one of the most frequently performed procedures in the field of aesthetic surgery. Fat embolism syndrome after liposuction can easily be overlooked or underestimated; however, occasionally, fulminating fat embolism syndrome can develop and lead to a critical situation within 2-3 days after lipoplasty. Changes over time in the amount of circulating fat particles and the histology of major organs have not yet been studied. Methods This study was conducted using 18 male Sprague-Dawley rats aged 12 weeks and weighing 500-628 g (average, 562 g). Fifteen rats were used as the experimental group and 3 as the control group. Under general anesthesia, tumescent-technique liposuction was performed at the lateral flank areas and abdomen for 1 hour. Blood, lung, and brain tissue specimens were obtained at 1 hour, 1 day, and 2 days after the liposuction procedure. Results The average number of fat particles in the blood samples was 25,960/dL at 1 hour, 111,100/dL at 24 hours, and 21,780/dL at 48 hours. The differences between study groups were statistically significant. Both intravascular and extravascular fat particles with inflammation were seen in all 15 rats, as were inflammatory cell infiltration, hemorrhage, and consolidation with shrinkage of the lung alveoli. Conclusions These results imply that there is a strong possibility of fat embolism syndrome after liposuction in real clinical practice, and the first 24-48 hours after the operation were found to be the most important period for preventing pulmonary embolism and progression to fulminating fat embolism syndrome.

• Archives of Plastic Surgery
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• 제48권6호
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• pp.685-690
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• 2021

Background Human immunodeficiency virus (HIV)-associated lipodystrophy is a known consequence of long-term highly active antiretroviral therapy (HAART). However, a significant number of patients on HAART therapy were left with the stigmata of complications, including fat redistribution. Few studies have described the successful removal of focal areas of lipohypertrophy with successful outcomes. This manuscript reviews the outcomes of excisional lipectomy versus liposuction for HIV-associated cervicodorsal lipodystrophy. Methods We performed a 15-year retrospective review of HIV-positive patients with lipodystrophy. Patients were identified by query of secure operative logs. Data collected included demographics, medications, comorbidities, duration of HIV, surgical intervention type, pertinent laboratory values, and the amount of tissue removed. Results Nine male patients with HIV-associated lipodystrophy underwent a total of 17 procedures. Of the patients who underwent liposuction initially (n=5), 60% (n=3) experienced a recurrence. There were a total of three cases of primary liposuction followed by excisional lipectomy. One hundred percent of these cases were noted to have a recurrence postoperatively, and there was one case of seroma formation. Of the subjects who underwent excisional lipectomy (n=4), there were no documented recurrences; however, one patient's postoperative course was complicated by seroma formation. Conclusions HIV-associated lipodystrophy is a disfiguring complication of HAART therapy with significant morbidity. Given the limitations of liposuction alone as the primary intervention, excisional lipectomy is recommended as the primary treatment. Liposuction may be used for better contouring and for subsequent procedures. While there is a slightly higher risk for complications, adjunctive techniques such as quilting sutures and placement of drains may be used in conjunction with excisional lipectomy.

• Archives of Plastic Surgery
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• 제36권1호
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• pp.51-55
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• 2009

Purpose: Excessive apocrine gland secretion and bacterial decomposition cause axillary osmidrosis, which results in physical discomforts and social problems of patients. Many surgical procedures have been introduced such as skin excision and simple closure, local flap, skin graft, subcutaneous shaving and liposuction method, but the result was not satisfactory to patients and several complications, such as symptom recurrence, hematoma, seroma, delayed wound healing, skin flap necrosis and scarring remain as problems. Methods: For the purpose of reducing these problems, we employed combination treatment of liposuction and rasping method. From January 2006 to February 2008, Total 54 patients were treated with this procedure for bilateral axillary osmidrosis. Results: Follow - up evaluation period was from 2 months to 12 months, and the results were satisfactory. In our method, the length of skin incision is less than 1 cm, so the resultant scar is negligible. Apocrine glands in subcutaneous tissue were mostly removed by liposuction apparatus and remained other glands in subdermal area were mostly removed by rasping. The recurrence rate and postoperative complication were minimal. Conclusion: Our method is very simple, short operation time and excellent results without specific complication.

• 셀메드
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• 제5권3호
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• pp.19.1-19.2
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• 2015

This is a case report involving a novel setting of sonographic scan for thickness of superficial abdominal fat and a non-invasive approach for reduction of the fat thickness. A 38-year-old woman complained of her abdominal contour asymmetry after the laser-assisted liposuction performed two years ago. Compression-free sonographic scanning confirmed that her superficial abdominal fat was thicker in left side than that of right side. After 9 sessions of 40KHz therapeutic ultrasound, the contour asymmetry was reduced.