BACKGROUND:The deep inferior epigastric perforator (DIEP) flap is widely used in autologous breast reconstruction, with its success heavily reliant on the vascular anatomy, particularly midline crossing-over vessels that facilitate contralateral flap perfusion. High-frequency ultrasound (HFUS) offers a non-invasive, radiation-free method to visualize small vessels and assess real-time blood flow. This study evaluates the utility of HFUS in detecting midline crossing-over vessels and their correlation with perfusion in DIEP flaps used for unilateral breast reconstruction. METHODS:A prospective study was conducted on 30 women undergoing unilateral DIEP flap breast reconstruction between August 2023 and June 2024. Preoperative HFUS was performed to assess the number, type, and diameter of midline crossing-over vessels. Intraoperative flap perfusion was quantified using indocyanine green (ICG) angiography, measuring the ICG-stained area (%). Spearman's rank correlation and multiple linear regression were used to analyze the relationship between HFUS findings and ICG area. RESULTS:HFUS identified midline crossing-over vessels in all patients but showed no significant correlation with ICG perfusion area (rho = -0.111, p = 0.5576). Multiple linear regression confirmed that HFUS-derived variables (vessel number, arterial presence, diameter) did not predict ICG area (R² = 0.061, p = 0.6416). CONCLUSIONS:HFUS provides detailed anatomical insights into midline crossing-over vessels but lacks correlation with flap perfusion, limiting its predictive value for DIEP flap outcomes. Further studies are needed to explore its association with perfusion-related complications.

Capsule formation in contact with silicone implants may vary according to the administration of systemic immunosuppressive drugs. A total of 18 Sprague-Dawley rats that underwent premuscular plane silicone implant insertion were divided into three groups as follows: Group 1, untreated negative control (n = 6); Group 2, treated with tacrolimus (n = 6); and Group 3, treated with dexamethasone as a positive control (n = 6). At 3 months after surgery, the histology and immunochemistry of the capsule tissues were analyzed. Systemic administration of dexamethasone and tacrolimus successfully reduced capsule thickness and inflammatory marker levels. The aggregation of CD3 (T lymphocytes)- and CD68 (histiocytes)-positive cells around the capsule also reduced. This study aimed to evaluate whether systemic immunosuppression with tacrolimus modulates peri-implant capsule formation and key inflammatory/fibrotic pathways in a rat silicone implant model. We focused on histologic capsule thickness and immunohistochemical markers representing innate/adaptive immune activation and myofibroblast-driven fibrosis as surrogate measures of early periprosthetic tissue remodeling. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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 .

The tumescent technique has traditionally been used in nipple-sparing mastectomy to help dissection and reduce bleeding. However, its necessity in robotic nipple-sparing mastectomy (RNSM) remains unclear due to enhanced visualization offered by robotic systems. This study analyzed the feasibility of omitting tumescent in RNSM by comparing postoperative outcomes and operative times. We retrospectively reviewed 253 patients who underwent unilateral RNSM at Asan Medical Center from October 2020 to November 2023. Outcomes included adverse events classified by Clavien-Dindo system and operative times. Indocyanine green (ICG) fluorescence imaging was used to assess ischemia patterns. The tumescent group (n = 43) exhibited a higher incidence of adverse events (16.3

BACKGROUND:Acellular dermal matrix (ADM) is widely used in implant-based breast reconstruction to enhance support and reduce capsular contracture (CC). Although manual meshing facilitates implant wrapping, excessive meshing enlarges the raw implant surface exposed to surrounding tissues. We hypothesized that the ADM-to-implant surface area ratio (AS ratio) correlates with CC risk. METHODS:This retrospective cohort study included patients who underwent immediate prepectoral implant-based breast reconstruction using the wrap-around technique between January 2020 and July 2023. Logistic regression with Generalized Estimating Equations (GEE) was performed to evaluate the association between the AS ratio and Baker grade III-IV CC incidence. RESULTS:A total of 730 breasts (541 non-irradiated, 189 irradiated) were evaluated. CC occurred in 7.4% of non-irradiated and 23.8% of irradiated breasts. In the multivariable analysis, a higher AS ratio was significantly associated with a lower risk of CC (OR, 0.781; p = 0.013). Radiotherapy remained the strongest risk factor, increasing CC odds 4.10-fold compared with the non-irradiated cohort (p<0.001). CONCLUSIONS:In this cohort of wrap-around implant-based breast reconstruction with smooth implants, a larger ADM surface area relative to implant surface area was associated with a lower risk of CC during the first two years after surgery. Prioritizing maximal ADM coverage and avoiding unnecessary meshing may help reduce CC risk.

BACKGROUND:Prepectoral direct-to-implant insertion (DTI) with acellular dermal matrix (ADM) is the currently preferred operation for breast reconstruction. There are different placements of ADM, which are largely classified as wraparound placement or anterior coverage placement. Because there are limited data comparing these two placements, this study aimed to compare the outcomes of these two methods. METHODS:This was a retrospective study of immediate prepectoral DTI breast reconstructions performed by a single surgeon between 2018 and 2020. Patients were classified depending on the ADM placement type used. Surgical outcomes and breast shape changes using nipple position during follow-up were compared. RESULTS:A total of 159 patients were included in the study, with 87 in the wraparound group and 72 in the anterior coverage group. Demographics were similar between the two groups, excluding ADM amount used (154.1 cm 2 versus 137.8 cm 2 ; P = 0.01). There were no significant differences in the overall rate of complications between the two groups, including seroma (6.90% versus 5.56%; P = 1.0), total drainage amount (762.1 mL versus 805.9 mL; P = 0.45), and capsular contracture (4.6% versus 1.39%; P = 0.38). The wraparound group had a significantly longer distance change than that of the anterior coverage group in the sternal notch-to-nipple distance (4.44% versus 2.08%; P = 0.03) and midclavicle-to-nipple distance (4.94% versus 2.64%; P = 0.04). CONCLUSIONS:Wraparound and anterior coverage placement of ADM in prepectoral DTI breast reconstruction showed similar complication rates, including seroma, drainage amount, and capsular contracture. However, wraparound placement can make the breast more ptotic in shape compared with anterior coverage placement. CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, III.

Background:Conventional detergent-based decellularization can disrupt the extracellular matrix (ECM) structure and denature proteins. Supercritical carbon dioxide (scCO 2 ) processing offers a simplified manufacturing process (<2 hours), minimal protein denaturation, and excellent ECM preservation. This study aimed to evaluate the clinical outcomes of scCO 2 processing acellular dermal matrix (ADM) compared with conventional detergent-processed ADM. Methods:This prospective observational study enrolled patients undergoing immediate implant-based breast reconstruction with scCO 2 -processed ADM ( n  = 50) and compared outcomes with a retrospective cohort receiving conventional detergent-processed human ADM ( n  = 50). Patient demographics, comorbidities, and treatment variables were collected. Postoperative complications and BREAST-Q-assessed patient-reported outcomes were analyzed. Results:The groups were comparable in age (45.0 ± 10.4 years vs. 46.8 ± 9.4 years, p  = 0.362), body mass index (median: 21.5 kg/m 2 vs. 22.7 kg/m 2 , p  = 0.558), comorbidities, and oncologic characteristics. Rates of skin necrosis (2% vs. 0%), nipple-areolar complex necrosis (2% vs. 2%), hematoma (4% vs. 4%), seroma (6% vs. 0%), infection (6% vs. 0%), capsular contracture (8% vs. 12%), implant failure (0% vs. 0%), implant change (2% vs. 2%), and reoperation (2% vs. 2%) did not differ significantly between groups. BREAST-Q questionnaires revealed no significant differences in patient-reported outcomes. Conclusion:scCO 2 -processed ADM demonstrated safety and patient-reported outcomes equivalent to established detergent-based ADMs. Given its eco-friendly, protein-preserving manufacturing process, scCO 2 -processed ADM represents a safe and effective alternative for implant-based breast reconstruction. Long-term follow-up studies are warranted.

Peripheral nerve repair remains a major clinical challenge, and novel strategies such as conduit-assisted repair have been developed to improve outcomes. In this study, we fabricated a 3D-printed nerve guidance conduit (NGC) composed of polycaprolactone (PCL), a biocompatible and biodegradable polymer, combined with acellular dermal matrix (ADM) derived from porcine dermis, in order to create a multilayered PCL-ADM NGC with both favorable mechanical properties and biological activity. Twenty rabbits were divided into four groups: a negative control group, a silicone tube repair group, an autologous nerve graft group, and a group treated with the 3D-printed PCL-ADM NGCs. Sciatic nerve regeneration was assessed at 4 and 12 weeks postoperatively using electrophysiological measurements, histological staining, and electron microscopy. The PCL-ADM NGC demonstrated comparable axonal regeneration and functional recovery to autologous grafting, and it significantly outperformed silicone tubes in terms of axonal count and maximal electrophysiological response. Histological and ultrastructural analyses further confirmed that the PCL-ADM NGC facilitated organized regeneration with dense myelinated axons and reduced degenerative changes. The fabricated NGCs exhibited excellent flexibility without compromising lumen diameter, which is critical for adapting to the physiological environment of peripheral nerves. These findings indicate that combining synthetic polymers with biologically derived matrices can enhance the regenerative microenvironment and overcome limitations of traditional synthetic conduits. In conclusion, the 3D-printed PCL-ADM NGC represents a promising alternative to both silicone tube repair and autologous nerve grafting by providing structural support and bioactivity while reducing the need for donor nerve harvesting. Further studies in larger animal models and longer follow-up periods will be required to confirm long-term efficacy and support clinical translation of this technology.

BACKGROUND:Nipple-sparing mastectomy (NSM) with immediate implant-based breast reconstruction provides aesthetic and psychosocial benefits, but nipple-areolar complex (NAC) necrosis remains a significant risk. This study externally validated a previously developed machine learning (ML) model that predicted NAC necrosis with 97% accuracy on institutional data. METHODS:This retrospective cohort study identified an initial 394 patients who underwent NSM with immediate breast reconstruction at Asan Medical Center (January 2021 - August 2022). Though there were 6 incomplete patient profiles, which resulted in 388 cases being used for statistical analysis, as demonstrated in Table 1. Demographic, oncologic, and surgical data were collected, with complications defined as post-operative events occurring within 90 days. A previously validated random forest ML model was applied to predict NAC necrosis. Model performance was assessed using accuracy, area under the receiver operating characteristic curve (AUC-ROC), sensitivity, specificity, and predictive values. RESULTS:Of 388 patients, 19 (4.9%) developed NAC necrosis. Significant risk factors included older age (mean age: 51.3 vs. 46.2 years, p = 0.015), higher BMI (mean BMI: 24.2 vs. 22.4, p = 0.024), active smoking (p = 0.008), and cumulative smoking exposure (mean pack-years: 3.3 vs. 0.2, p < 0.0001). Mastectomy specimen weight was significantly associated with NAC necrosis (mean: 394.2 g vs. 313.4 g, p = 0.021). The ML model achieved a predictive accuracy of 96%, with an AUC-ROC of 0.70 (95% CI: 0.55-0.85), indicating moderate discriminative ability. CONCLUSIONS:The externally validated ML model accurately predicted NAC necrosis in a distinct patient population, demonstrating its potential for personalized risk assessment in NSM candidates. Future validation in diverse populations is needed.

Background:Indocyanine green angiography (ICGA) is widely used to evaluate flap perfusion in reconstructive surgery, but the optimal timing for assessment may differ by flap type. This study compared the perfusion dynamics of perforator and random pattern flaps in a rat model using ICGA. Methods:ICGA dynamics were compared between perforator and random flaps in a rat model. Sixteen Sprague-Dawley rats (275-300 g) were randomly assigned to either a perforator or a random flap group. A 0.25-mg dose of indocyanine green (ICG) was administered via the femoral vein, and fluorescence images were acquired at predefined intervals over 4 minutes. Hypoperfusion was defined as fluorescence intensity below 30% of the peak value. Necrosis was assessed on postoperative day 7. Statistical analyses included the Mann-Whitney U and log-rank tests with Expectation-Maximization Iterative Convex Minorant (EMICM) modeling. Results:In the perforator flap group, the final area of necrosis corresponded to the ICGA-defined perfusion boundary observed between 10 and 50 seconds postinjection. In contrast, necrosis in the random flap group aligned with the ICGA-defined perfusion boundary captured between 30 and 150 seconds. The most accurate time points for necrosis prediction were 50 seconds for perforator flaps and 150 seconds for random flaps, both demonstrating statistical significance (p = 0.0028). Conclusion:ICGA timing requirements differ between flap types. Implementing flap-specific assessment windows may enhance intraoperative interpretation and reduce false-positive findings. These findings support the development of flap-specific ICGA protocols to improve intraoperative decision-making in reconstructive surgery.

SUMMARY:The 3-dimensional (3D) head-up display (HUD) exoscope is a novel magnification system providing stereoscopic, high-definition visualization without conventional microscope eyepieces that offers potential ergonomic and workflow advantages for microsurgeons. The authors compared the feasibility and outcomes of microsurgical breast reconstruction performed using the 3D HUD exoscope versus a conventional surgical microscope. A retrospective review was conducted of 34 patients (37 flaps) who underwent free flap breast reconstruction between July and September of 2024. Eighteen patients (21 flaps) were treated using the 3D HUD exoscope, and 16 patients (16 flaps) with a conventional microscope. Demographics, operative measures, and outcomes were analyzed. The mean microanastomosis time was similar between the 3D HUD exoscope and microscope groups (28.0 ± 4.1 versus 26.5 ± 11.7 minutes; P = 0.60). All flaps survived with no total flap loss. Venous congestion requiring intervention occurred in 1 flap in the 3D HUD group (4.8%), with no significant difference in revisional surgery rates. The 3D HUD exoscope accommodated both hand-sewn and coupler techniques, enhanced ergonomic positioning, and mitigated operator strain by eliminating the requirement for rigid eyepiece alignment. Its compact, mobile configuration facilitated more efficient setup compared with conventional microscopes. With surgical performance comparable to that of the traditional microscope, the HUD system provides notable advantages in surgeon comfort and team visualization. These findings support its role as a viable alternative for microsurgical breast reconstruction, with potential applicability in supermicrosurgery, telemicrosurgery, and robotic-assisted procedures.

The breast shape changes between reconstructed and native breasts in autologous reconstruction, which is important to achieve symmetry. This study was conducted to clarify chronological changes in the shape and nipple position of the reconstructed breast compared with the contralateral breast in the Asian population.Photographic assessments were conducted at baseline and during annual visits of patients who underwent immediate free flap breast reconstruction following unilateral nipple-sparing mastectomy at our institution between June 2017 and December 2019. Univariate and multivariate analyses were performed to identify factors associated with the change in shape and nipple position. This observation was most marked at 1-year postsurgery.Among the 170 patients (mean age, 48.04 ± 7.55 years), 164 (96.47%) had a deep inferior epigastric perforator flap and 8 (4.71%) required further surgery on the contralateral breast for correction of asymmetry. The chronological changes in the breast shape and nipple position significantly differed between the native and the reconstructed breast, with the latter showing a higher degree of retraction. Grading of breast ptosis (grades 0-2) and exposure to radiotherapy were associated with an increased degree of retraction.Retraction may occur after free flap breast reconstruction, particularly in patients with ptosis or those receiving radiotherapy. These findings support careful planning, including volume adjustment and contralateral procedures. While based on an Asian population, the results may inform surgical decisions in similar patient groups.

Background: Although autologous breast reconstruction using the deep inferior epigastric artery perforator (DIEP) flap is a standard procedure, flap perfusion-associated complications remain a concern. This study aimed to investigate the correlation between blood flow information obtained through color Doppler ultrasonography (CDU) and flap perfusion assessed by indocyanine green (ICG) angiography. Methods: This prospective study included 30 female patients who underwent DIEP flap breast reconstruction between August 2023 and June 2024. Preoperative flow parameters, including arterial peak velocity, arterial volume flow, and venous peak velocity, were measured using CDU. Flap perfusion was evaluated using ICG angiography. Results: The study demonstrated a positive correlation between venous flow and overall flap blood flow. Arterial peak velocity (r = 0.368, p = 0.046), arterial volume flow (r = 0.455, p = 0.011), and venous peak velocity (r = 0.399, p = 0.029) all showed significant associations with ICG-stained area percentages. These findings suggest that venous flow data can provide valuable information for predicting flap viability. Conclusion: This study demonstrates a significant correlation between flow information obtained through CDU and flap perfusion assessed via ICG angiography in patients undergoing DIEP flap breast reconstruction. Both arterial and venous flow data were shown to be crucial for predicting flap viability, with venous flow exhibiting a notable positive correlation with flap blood flow.

Background:. Two types of robotic systems are mainly used in implant-based robot-assisted breast reconstruction (RBR): the single-site approach using the da Vinci Xi system (Xi-RBR), and SP system (SP-RBR). In this study, we aimed to compare Xi-RBR and SP-RBR in prosthetic breast reconstruction. Methods:. A total of 24 patients (27 breasts) and 25 patients (25 breasts) underwent implant-based breast reconstruction from July 2019 to October 2021 with da Vinci Xi and SP, respectively, by a single surgeon. Data were collected through a retrospective chart review regarding patient demographics, surgical factors, and complications. Results:. There were no significant differences in demographics overall. The average operation time of the Xi-RBR group was 85.28 minutes, which was significantly longer than that (72.33 min) of the Xi-RBR group (P = 0.0168). In addition, the size of the acellular dermal matrix used in the SP-RBR group was significantly larger than that used in the Xi-RBR group (P = 0.0041). However, there were no significant differences in surgical complications between the 2 groups. Conclusions:. The da Vinci Xi system is convenient to use, is easy to operate, and has a less steep learning curve. However, the da Vinci SP system, although more difficult to operate, is more appropriate for breast surgery. As there are no significant differences in the surgical outcomes between the systems, we recommend using the da Vinci SP for implant-based breast reconstruction.

Background:Microsurgical breast reconstruction offers superior outcomes after mastectomy, but vascular microanastomosis remains technically demanding. Venous couplers are widely adopted, whereas the use of arterial couplers remains controversial. This study aimed to establish an algorithmic approach for arterial coupler use and compare outcomes with hand-sewn sutures. Methods:A retrospective review was performed on 105 patients undergoing deep inferior epigastric perforator flap breast reconstruction by a single surgeon. Patients were divided into an arterial coupler group (n = 62) and a hand-sewn suture group (n = 43). An intraoperative algorithm guided coupler use, requiring the absence of atherosclerosis, intact intima, and adequate vessel laxity. Demographics, operative details, microanastomosis time, and postoperative outcomes were analyzed. Results:Patients in the coupler group were younger (47.6 ± 8.6 vs. 53.0 ± 7.9 years, p = 0.001) and underwent more robot-assisted procedures (16.1% vs. 2.3%, p = 0.025). Microanastomosis time was significantly shorter with couplers (19.6 ± 8.9 vs. 26.1 ± 6.5 minutes, p < 0.01). Flap survival was comparable between groups (96.8% vs. 100%, p = 0.512). Complication rates, including arterial/venous insufficiency, hematoma, and infection, showed no significant differences. Two coupler failures occurred: One venous congestion and one late thrombosis, both attributed to multifactorial causes rather than device failure. Conclusion:Arterial couplers, when used under strict algorithmic selection criteria, provide reliable outcomes comparable to hand-sewn sutures while significantly reducing operative time. This approach enhances efficiency in microsurgical breast reconstruction and may guide future standardized practice.

Background The importance of adequate wound closure in plastic surgery cannot be overstated. With the goals of shortening the operative time and improving outcomes, various methods and devices have been introduced to enhance the speed and quality of wound closure. To simplify dermal closure with favorable outcomes, several studies have compared results between the INSORB dermal stapler and conventional dermal sutures. We hypothesized that the dermal stapler would yield satisfactory scar formation without increasing complication rates over the long term.Methods This retrospective study included patients who had undergone breast reconstruction with a deep inferior epigastric perforator (DIEP) free flap between October 2019 and May 2020 at a single center. Postoperative photographs of the patients’ abdominal scars were assessed at a minimum of 248 days by three blinded attending plastic surgeons using the Vancouver Scar Scale.Results A total of 108 patients who underwent DIEP-free flap reconstruction after mastectomy were included in this study. Among them, 68 patients (group 1) underwent dermal closure with the INSORB dermal stapler, while 40 patients (group 2) underwent conventional dermal sutures. No significant differences were observed between the two groups in terms of vascularity, pigmentation, pliability, scar height, or overall scar assessment. Additionally, there was no significant difference in complication rates between the two groups.Conclusions The INSORB dermal stapler is a valuable tool that can reduce operative time while delivering satisfactory outcomes. When used appropriately with proper training, it can mitigate perioperative complications and alleviate the surgical burden for the surgeon.

Purpose: Tumescent in nipple -sparing mastectomy (NSM) has been reported to increase the risk of necrosis by impairing blood flow to the skin flap and nipple-areolar complex. At our institution, we introduced a tumescent -free robotic NSM using the da Vinci single -port system (Intuitive Surgical, Inc.). Methods: We conducted a retrospective analysis of patients who underwent tumescent -free robotic NSM between October 2020 and March 2023 at Asan Medical Center (Seoul, Korea). Clinicopathological characteristics, adverse events, and operative time were evaluated. Results: During the study period, 118 patients underwent tumescent -free robotic NSM. Thirty-one patients (26.3%) experienced an adverse event. Five patients (4.2%) were classified as grade III based on the Clavien-Dindo classification and required surgery. The mean total operative time was 467 minutes for autologous tissue reconstruction (n = 49) and 252 minutes for implants (n = 69). No correlation was found between the cumulative number of surgical cases and the breast operative time (P = 0.30, 0.52, 0.59 for surgeons A, B, C) for the 3 surgeons. However, a significant linear relationship (P < 0.001) was observed, with the operative time increasing by 13 minutes for every 100-g increase in specimen weight. Conclusion: Tumescent -free robotic NSM is a safe procedure with a feasible operative time and few adverse events. [Ann Surg Treat Res 2024;107(1):8-15]

BACKGROUND:In this study, the authors compared conventional and robot-assisted mastectomy and breast reconstruction. To the authors' knowledge, this study is the first to report the results of robot-assisted mastectomy and breast reconstruction and provide a comparison of patient-reported outcomes. METHOD:This retrospective study included 473 breasts of 423 patients who underwent conventional mastectomy and breast reconstruction and 164 breasts of 153 patients who underwent robot-assisted mastectomy and breast reconstruction from July of 2019 to October of 2021. Demographic and oncologic data, reconstructive outcomes, and patient-reported outcomes (BREAST-Q) were evaluated. The results of implant-based and autologous breast reconstruction were evaluated separately. RESULTS:Skin necrosis requiring surgical débridement occurred significantly more frequently in the conventional group (8.0%) than in the robot-assisted group (2.0%) in implant-based reconstruction ( P = 0.035). At 6 to 12 months, patients who underwent robot-assisted breast reconstruction showed a higher Sexual Well-being score for implant-based reconstruction and a higher Physical Well-being score for autologous breast reconstruction than conventional breast reconstruction according to the BREAST-Q questionnaire. CONCLUSIONS:Robot-assisted mastectomy and breast reconstruction was associated with less skin necrosis and better patient-reported outcomes (Sexual Well-being for implant-based reconstruction and Physical Well-being for autologous breast reconstruction) than the conventional option. Robotic surgery could be a good option for mastectomy and breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, III.

BACKGROUND:Several alternative flaps have been introduced and used for autologous breast reconstruction. However, as body fat distribution is different among patients, the donor of choice for sufficient breast projection varies between patients.METHODS:Patients who underwent autologous breast reconstruction from Jan 2018 to Sep 2022 were included. Age, body mass index (BMI), smoking history and hypertension, and diabetes occurrence were collected as baseline demographic data. Breast projection with five types of flap thickness was measured based on computed tomography angiography. Analysis was performed for five major autologous flaps for breast reconstruction.RESULTS:A total of 563 patients were included in the study. The mean age of the patients was 47.4 ± 7.9 (standard deviation; SD) years. The mean BMI of the patients was 24.0 ± 3.4 kg/m2. Only the correlation between flap thickness to breast projection ratio and age in the PAP flap illustrated statistical significance (p = .039), but the correlation coefficient was quite low (r = -0.087). Slim patients who had lower BMIs (under 25 kg/m2) had significantly higher sufficient flap thickness for breast reconstruction than patients with higher BMIs over 25 kg/m2 in the profunda artery perforator (PAP) flap (p < .001), the lumbar artery perforator (LAP) flap (p < .001), and the superior gluteal artery perforator (SGAP) flap (p < .001).CONCLUSIONS:The deep inferior epigastric perforator flap provided sufficient thickness and was not usually affected by age and BMI. The PAP, LAP, and SGAP flaps tended to maintain the thickness of the flap even when BMI decreased, so they are advantageous for reconstruction in slim patients. This study contributes evidence in consideration of flap selection in autologous breast reconstruction.

Background:Although dual-plane subpectoral breast reconstruction has been widely implemented in implant-based breast reconstruction, animation deformities remain an issue. Recent advances in skin flap circulation detection have increased the use of prepectoral reconstruction. A partial muscle-splitting subpectoral plane was introduced to decrease the visibility of the implant edge. However, there is yet to be a direct comparison of these methods for optimal results, including changes in implant position after reconstruction. This study aims to compare the incidence of complications such as rippling, animation deformity, implant upward migration between the dual-plane, the partial muscle splitting subpectoral and the prepectoral reconstruction group. In addition, multivariate analysis was conducted to identify the risk factors of complications. Methods:We retrospectively investigated 349 patients who underwent unilateral direct-to-implant breast reconstruction from January 2017 to October 2020. Implants were inserted into the dual-plane subpectoral (P2) or partial muscle-splitting subpectoral (P1, the muscle slightly covering the upper edge of the implant) or the prepectoral pocket (P0). Postoperative outcomes and at least 2 years of follow-up complications were compared. Results:There was no significant difference in rippling (P=0.62) or visible implant edges on the upper pole (P=0.62) among the three groups. In contrast, the P0 group had a lower incidence of seroma (P=0.008), animation deformity (P<0.001), breast pain (P=0.002), and upward implant migration (P0: 1.09%, P1: 4.68%, P2: 38.37%, P<0.001). According to the multivariate analysis, P2 resulted in a greater risk of seroma (odds ratio: 4.223, P=0.002) and implant upward migration (odds ratio: 74.292, P<0.001) than did P0. Conclusions:P0 and P1 showed better postoperative outcomes than P2. Additionally, P0 had less implant migration than P1. Even though P1 minimally dissects the muscle, the location of the implant may change. Considering that muscle contraction can deteriorate symmetry and aesthetic results, the P0 method may be the most favorable.

Background With the increasing number of internet users, search engines have become a widely used source of health-related information. However, evaluating the quality of medical information obtained through search engines can be challenging. This study aimed to evaluate the quality of search results related to breast implants obtained from major domestic websites in Korea using systematic evaluation standards.Methods Two main primary search terms (“gaseum” [breast] implant and “yubang” [breast] implant), along with 15 adjunct search terms, were combined and searched in Google, Naver, and Daum. The top 20 websites were evaluated and classified according to their type and provider. They were scored using the Korean Medical Association’s Internet Health Information Certification Standards. The proportion of significant websites, their categorical distribution, and the quality of information scores were then compared.Results Google yielded the highest number of appropriate results, with statistical significance. Blogs (36.4%) and news (34.8%) were the most common types of search results, while healthcare provider groups (49.5%) constituted the most common provider subgroup. Only 1.9% of the search results were from public organizations. Google had a significantly higher average quality score (14.04) than Naver (13.22), and Daum (12.45) (P<0.05).Conclusions Although almost half of the search results were provided by medical personnel, their average quality score (13.16) was below the overall average (13.36) and far below the 21 points of the journal/abstract category. The findings highlight the need for healthcare providers to provide high-quality medical information, and for users to develop high-level digital health literacy.