함몰유두의 치료방침

심형보 大韓成形外科學會誌 2000 Archives of Plastic Surgery Vol.27 No.1

A number of techniques have been introduced for the correction of inverted nipples, many of which are time-consuming, involve extensive incision and dissection around the nipple, or result in undesirable outcomes. Only two surgical methods were performed depending upon the patient's demand for nursing. When a patient desired breast-feeding the modified Teimourian method with pursestring was executed to preserve lactiferous ducts while the modified Hartampf method with purse-string severing the ducts was performed on a patient who did not want breast-feeding. These two methods were both simple and non-invasive. The reinversion rates were compared and analyzed for 73 nipples followed up for between 3 months and 2 years. Eversion was maintained in 89% of nipples. Invaginated nipples showed an increased tendency to reinvert postoperatively compared to umbilicated types(13.6% vs 6.9%). The duct-preserving method also tended to reinvert 3 times more than the duct-dividing method(14.3% vs. 4.2%).

Transaxillary Endoscopic Breast Augmentation

심형보 대한성형외과학회 2014 Archives of Plastic Surgery Vol.41 No.5

The axillary technique is the most popular approach to breast augmentation among Koreanwomen. Transaxillary breast augmentation is now conducted with sharp electrocauterydissection under direct endoscopic vision throughout the entire process. The aims of thismethod are clear: both a bloodless pocket and a sharp non-traumatic dissection. Roundtextured or anatomical cohesive gel implants have been used to make predictable welldefinedinframammary creases because textured surface implants demonstrated a betterstability attributable to tissue adherence compared with smooth surface implants. The axillaryendoscopic technique has greatly evolved, and now the surgical results are comparable tothose with the inframammary approach. The author feels that this technique is an excellentchoice for young patients with an indistinct or absent inframammary fold, who do not wanta scar in the aesthetic unit of their chest.

유관 부분절단과 유방 실질 V-Y 전진피판을 이용한 함몰유두의 교정

심형보,홍윤기 대한미용성형외과학회 2009 Archives of Aesthetic Plastic Surgery Vol.15 No.1

The pathophysiology of the inverted nipple is characterized by less connective tissue beneath the nipple, dense fibrous tissue at nipple-areola junction and shortened fewer functional lactiferous ducts. For grade I and II nipple inversion, the dissection of dense fibrous tissue at nipple-areola junction is sometimes not enough to completely bring out the nipple and also the recurrence rate is high. These findings suggest that the shortened hypoplastic ducts might play a considerable role in grade I and II nipple inversion. The purpose of this study was to prove the effectiveness of partial ductal division and V-Y advancement of glandular tissue to correct the inverted nipple. Through a 3mm slit incision around the nipple base, partial division of lactiferous ducts was performed and V-Y advancement of parenchyma was followed. The extent of ductal division was limited only to the central portion until the nipple protrusion persisted without any support. A deep purse-string with a 4-0 permanent suture reinforced the advancement of glandular tissue to add bulk beneath the nipple, and a superficial purse-string was applied at the subcutaneous layer to avoid instability of the nipple. 168 female patients(309 nipples) underwent this procedure from April 2000 to June 2008. 37 nipples were grade I and 272 nipples were grade II. No major complication occurred. Overall recurrence rate was 4.2%(13/309). Among 17 women who had breast-fed after correction of inverted nipples, 2 women failed to breast- feed. This safe and simple technique can correct almost all pathologic factors of nipple inversion, and it can also be easily applied to reoperation cases.

내시경을 이용한 겨드랑이 절개 여성형 유방증의 교정

심형보,홍윤기 대한미용성형외과학회 2008 Archives of Aesthetic Plastic Surgery Vol.14 No.2

Various approaches for gynecomastia correction have been described to remove glandular tissue. In recent years, standard and ultrasound-assisted liposuction became popular methods. However, these methods cannot meet all their needs in some patients who do not want to have scars on their breast’s esthetic units and are known to have a tendency to form keloid. The purpose of this study is to introduce the usefulness of endoscope-assisted transaxillary removal of breast tissue in selected patients. Through a stab incision in the axilla, the entire surgical area was infiltrated using the tumescent technique. Ultrasound- assisted liposuction(UAL) was initially performed, followed by power-assisted liposuction(PAL). Then, the endoscope was introduced through a 3cm axillary incision, and endoscopic electrocautery dissection of glandular tissue was performed under direct vision throughout the procedures. Adjuvant subcutaneous dissection around areola was done via 1cm subareolar incision. Twelve male patients(22 breasts), whose age ranged from 19 to 38 years, underwent this technique from April 2007 to July 2008. Follow-up ranged from 2 to 16 months with a mean of 9 months. Average volume of aspirate was 290mL, and mean amount of glandular tissue removed was 35g. No major complications occurred. The resulting scar in the axilla was inconspicuous, and patients were satisfied with postoperative breast contour. These results show that the combined use of an endoscope with the subareolar technique enables an effective treatment of gynecomastia and provides a smooth masculine breast contour without stigma of breast surgery.

구형구축의 치료: 유륜절개 이중평면 전환술

심형보,위형곤 대한성형외과학회 2008 Archives of Plastic Surgery Vol.35 No.1

Purpose: The capsular contracture has been the most common complication of augmentation with breast implant, a side effect quite difficult to treat. The latest trends in the correction of capsular contracture include total capsulectomy or conversion of implant pocket. In this study, in an attempt to correct capsular contracture, the authors performed reoperation which involved capsulectomy through peri-areolar approach and dual- plane conversion. The authors hereby report the clinical results of such correction of capsular contracture and examine the efficacy. Methods: The authors selected 46 patients who were admitted to the clinic from January 2004 to January 2007 (37 months), and performed dual-plane conversion through solely peri-areolar approach. Two types of operation were done: dual-plane conversion from subglandular plane or from submuscular plane.Results: The average follow-up time after conversion to the dual-plane position was 10 months. During the follow-up period, 83.1% of patients recovered from capsular contracture and were Baker class I, and in 10.9% the condition had relapsed into Baker class II or III contracture.Conclusion: This study has proven the effectiveness of the dual-plane conversion operation for correcting established capsular contracture after previous augmentation mammaplasty. In this study, all cases of dual-plane conversion operation was performed through peri-areolar approach, which can prevent the occurrence of visible scar on inframammary fold.

PVP 결합제를 이용한 지르코니아/알루미나 복합분말의 분무건조

심형보,문주호,김대준,Shim, Hyung-Bo,Moon, Joo-Ho,Kim, Dae-Joon 한국세라믹학회 2002 한국세라믹학회지 Vol.39 No.5

지르코니아/알루미나 복합분말의 분무건조로 제조된 과립들의 형상과 성형시 과립 경계면 파괴에 분말의 분산 정도, 결합제의 종류, 그리고 고형분말 함량이 미치는 영향을 관찰하였다. 구형의 과립은 복합분말 슬러리가 완전 분산이 되지 않고 약간의 floc을 형성하고 결합제로서 Polyvinyl Pyrrolidone(PVP)을 사용했을 때 얻어졌다. PVP를 결합제로 사용하고 분말함량이 32.5 vol%인 슬러리로 분무건조한 분말은 성형시 과립경계면이 파괴되어 소결밀도는 99.7%이었고 굴곡강도는 850Mpa이었다. Zirconia/alumina mixture powder was spray-dried various degree of dispersion, type of dispersants and powder content in the slurry. The quality of the granule was determined by observation of the granule shapes after spray drying and fracture of intergranular boundaries during pressing. Defect-free granules were obtained from the powders that formed weak flocs in the slurry. The granules, spray-dried from the slurry containing 32.5 vol% powder mixture and PVP as binder, were fractured completely during shaping and the sintered specimens showed a density of 99.7% and a flexural strength of 850 MPa.

내시경을 이용한 겨드랑절개 이중평면 유방확대술

심형보,위형곤,홍윤기 대한성형외과학회 2008 Archives of Plastic Surgery Vol.35 No.5

Purpose: The transaxillary approach for breast augmentation has been advocated for patients and surgeons for several decades. However, this blind technique had many disadvantages including, traumatic dissection, difficult hemostasis, displacement of implants, and ill-defined asymmetrical location of inframammary crease. In the present study, the precise endoscopic electrocautery dissection was applied to eliminate the limits of blunt dissection throughout the procedures. Methods: From December 2006 to December 2007, a total of 103 patients with an average age of 29.5 years underwent endoscopic assisted transaxillary dual plane augmentation mammoplasty. The mean implant size was 243 cc with the range between 150 and 350cc. Through a 4cm axillary incision, electrocautery dissection for submuscular pockets was carried out under the endoscopic control. The costal origin of pectoralis muscle was completely divided to expose subcutaneous tissue and to make type I dual plane. Results: Using the endoscopic dissection, we achieved good aesthetic results including a short recovery period, less morbidity, and symmetrical well-defined inframammary crease. Type I dual plane procedure could support the consistent inframammary fold shape and be applied to most patients without breast ptosis. Minor complications did not occur, however, four major complications of capsular contracture occurred. Received April 27, 2008 Revised May 19, 2008 Accepted May 30, 2008 Address Correspondence: Hyung Bo Sim, M.D., Baram Clinic BBC, Gaonix B/D 2F, 575 Shinsa-dong, Gangnam- gu, Seoul 135-891,Korea.Tel:02)511-8758/Fax:02)540- 8759/E-mail: 123sim@hanafos.com * 본 논문은 2008년 제9차 한-일 성형외과 학술대회에서 구연되었음. Conclusion: In contrast to the era of the blind techniques, endoscopic assisted transaxillary dual plane breast augmentation can now be performed effectively and reproducibly. With Its advantage, the axillary application of endoscopy for augmentation mammaplasty is useful to achieve the optimal cosmetic outcomes.

Sampling Zero란 무엇인가?

심형보 제어로봇시스템학회 2019 제어로봇시스템학회지 Vol.25 No.1

다양한 술식을 이용한 여성형 유방증의 치료: 초음파 지방흡입술과 풀아웃법 또는 유륜절개를 통한 절제술

심형보,윤상엽 대한성형외과학회 2007 Archives of Plastic Surgery Vol.34 No.2

Purpose: Gynecomastia is an abnormal increase in the volume of the male breast. Patients affected by gynecomastia with significant glandular enlargement may respond to suction alone and/or sharp dissection and excision. The purpose of this report is to introduce the indications and results of authors' two techniques.Methods: The diameter of parenchyme was determined by a pinch test after liposuction. For the parenchymal diameter less than 4cm, ultrasound-assisted liposuction was performed, in conjunction with the "pull- out technique" to effectively remove the fibrofatty tissue of the male breast through a single 5-7mm incision. For the parenchymal diameter more than 4cm, ultrasound-assisted liposuction and excision were applied through 2.5cm periareolar approach. Results: A total of 94 patients (185 breasts) underwent the operation from October 2000 to October 2003 and mean follow-up period was 12 months. The volume of aspirates ranged from 50 to 450 cc per breast. There were no major complications such as skin flap necrosis. Five reoperations were performed for 1 hypertrophic scar, 2 under-resected and 2 hematoma cases. The patient's satisfaction was high and most of them were pleased with the shape of the breasts and scars.Conclusion: These procedures can minimize scars and reduce the incidence of contour problem such as saucer deformity, and provides consistent results. Patients can return to full activities in 48 hours. It can be offered as an option for the treatment of gynecomastia.

유륜둘레 절개식 유방축소수술

심형보 대한미용성형외과학회 1996 Archives of Aesthetic Plastic Surgery Vol.2 No.1

Breast reduction surgery has been used for the purpose of obtaining a natural cone shape for the breast, minimizing scars, and maintaining breast physiology. An important factor influencing the selection of the type of procedure was the ease of predicting the eventual size of the breast mound and the final location of the nipple-areolar complex. Several variations of the Round Block periareolar mammaplasty (Benelli) were described, but not enough to solve the problems of mound flattening and early ptosis. The thesis is set forth that: (1) use a circumareolar incision to minimize the scar, (2) adopt the central breast pedicle to preserve the physiology and make significant resection, and (3) introduce the self-implant concept to produce conical shape and prevent early ptosis, also predict the eventual size of breast easily. A personal series of 44 consecutive cases (88 breasts) operated on from 1994 through 1996 is reviewed. The amount excised ranged from 150 g - 1200 g per breast (mean 423 g). The majority of patients were pleased with their breast size, shape and especially scars. There were few complications; one skin flap necrosis (1/88), one partial nipple-areolar necrosis (1/88) and 12 sensory disturbances of nipple-areolar complex (12/88). This series proves that sircumareolar reduction mammaplasty with self-implant technique can be used safely in significant resections for breast hypertrophy, respecting both aesthetic and functional aspects.