Sang Gue Kang’s research while affiliated with Soonchunhyang University and other places

Capsular contracture, a significant complication of breast-implant surgery, causes pain and deformation following the formation of a tight capsule around an implant. Current surgical and non-surgical treatment options are invasive, expensive, and typically administered for prolonged periods, potentially leading to side effects. To address these challenges, we developed a novel fish oil-encapsulated, poloxamer-based nanoemulsion gel with omega-3 (ω3) as the primary active component (NE-ω3 gel; N3G). This formulation can be injected during surgery, reducing the need for prolonged administration of medications and minimizing associated side effects. N3G was prepared through a two-step process involving the emulsification of fish oil followed by gelation with poloxamer to create a thermoreversible gel. Dynamic light-scattering analysis confirmed a uniform distribution of nanoemulsion particles, which had a mean diameter of 287 ± 8.599 nm and a PDI of 0.29 ± 0.047. FTIR and DSC analyses validated the encapsulation of fish oil within poloxamer micelles. Drug-release analysis demonstrated that more than 96% of fish oil was released within 10 h. In in vivo experiments, rats (n = 30) were divided into three groups: a negative control group (G1), a positive control group receiving fish oil (G2), and an experimental group with implants coated with N3G (G3). G3 exhibited a 21.2% reduction in capsular thickness compared to G1 and a 5.6% reduction compared to G2. In addition, significant decreases in fibrosis and myofibroblast counts were observed in G3. These results, supported by histological and gene expression analyses, highlight the effectiveness of N3G in reducing inflammation and fibrosis. This study underscores the therapeutic potential of N3G for capsular contracture, based on its persistence, thermoreversibility, and improved dosing and storage characteristics.

Background Adipose tissue-derived stem cells (ASCs) represent a rapidly evolving area of cell-based therapies. ASCs are harvested from the stromal vascular fraction (SVF), a heterogeneous mixture of ASCs and other cell types. Two methods are typically employed to obtain the SVF: enzymatic and mechanical. In this study, we examined the efficacy of ultrasonic cavitation in isolating the SVF from adipose tissue.Methods Human adipose tissue was procured from three patients through an aesthetic liposuction procedure. This tissue was then subjected to either an enzymatic method utilizing type II collagenase or an ultrasonic cavitation method using an Ultra Stemcell device. The cell counts and viability were determined using a cell counter. The immunophenotype of the SVF was analyzed using real-time polymerase chain reaction.Results Compared to the enzymatic method, the total cell count and cell viability of the SVF isolated through ultrasonic cavitation were relatively low. However, no significant difference was observed in the immunophenotype of CD45, CD11b, CD34, and CD105.Conclusions The ultrasonic cavitation method constitutes a clinically practical approach that offers straightforward access in the operative field. This technique is a rapid and cost-effective method for isolating the SVF.

Background We report our experiences with prepectoral placement breast implant sur- gery using Supporix (HansBioMed), a porcine acellular dermal matrix (PADM), for cos- metic and reconstructive indications. The clinical efficiency, safety, and cost-effective- ness of PADM were also discussed. Methods A single-center, retrospective study was designed from December 2017 to De- cember 2019. The participants were Korean women who underwent PADM-assisted prepectoral breast implant surgery performed by two surgeons. All complications were registered and analyzed. A systematic review and meta-analysis of complication rates af- ter PADM-assisted prepectoral breast implant surgery were conducted for comparison with other studies. A subgroup analysis was performed according to the operation type: the cosmetic breast surgery (CBS) group, the immediate implant-based breast recon- struction (IIBR) group, and the delayed implant-based breast reconstruction (DIBR) group. Results Twenty breasts in 16 patients were included in our study (median follow-up pe- riod, 8.25 months). In a systematic review, 20 publications with a total of 2,504 breasts in 1,921 women were quantitively analyzed. The overall complication rates in our study and other studies were 14% and 24% in the total group analysis, 0% and 12% in the CBS group, 62% and 26% in the IIBR group, and 0% and 28% in the DIBR group, respectively. Conclusions Our data support the effectiveness of PADM-assisted prepectoral breast implant surgery, which was comparable to other studies. PADM was effective for re- ducing seroma and hematoma in the revision CBS group and the DIBR group. In the IIBR group, it was helpful in preventing implant loss and explantation.

An advantage of breast augmentation with injectable fillers is that the desired size can be determined and achieved under local anesthesia with a short recovery time. How- ever, a high complication rate is a critical disadvantage. Some fillers are challenging to remove, resulting in breast deformity and scarring. Five patients who underwent sur- gery to manage a foreign body in the breasts in 2021 were enrolled in this study. Two had copolyamide filler injections, while the other three had polyacrylamide hydrogel filler injections. A physical examination was performed, and preoperative and intraop- erative photographs were obtained. Two patients underwent subcutaneous mastecto- my because most of the filler had infiltrated into the normal breast tissue. In contrast, the other patients underwent filler removal and debridement because most of the fill- er had remained separate from the normal breast tissue. All patients who had a subcu- taneous mastectomy and one who underwent only filler removal underwent immedi- ate breast reconstruction with cohesive gel implants. The other patients rejected im- mediate reconstruction, and only filler removal was performed. All patients recovered without complications. We propose an algorithm for diagnosis and treatment based on our cases, which we hope can help clinicians manage the complications of filler in- jections for breast augmentation.

Background The latissimus musculocutaneous flap (LD flap) is a useful option for breast reconstruction following mastectomy. It has the advantage of obtaining sufficient tissue padding and natural shape by using autologous tissue. However, with the emergence of the skin-sparing mastectomy technique and artificial dermis matrix, direct-to-implant (DTI) breast reconstruction has become the first choice of surgery. The purpose of this study was to compare the satisfaction levels of patients who underwent DTI and LD flap with implant using patient-reported Breast-Q results. Methods A retrospective study was performed reviewing the records of 49 women who underwent immediate breast reconstruction with DTI or LD flap with implant and responded to the BREAST-Q questionnaire after the operation. The patient-reported breast-Q results were analyzed and correlated to the demographic information and intraoperative information. Results A total of 26 patients who underwent reconstruction with LD flap with implant and 23 patients with DTI were identified and responded to the questionnaire after an average of 32.3 and 10.4 months postoperation, respectively. According to the patient response to the breast-q values, satisfaction with breast was 60.0 and 57.0 points, psychosocial well-being 61.0 and 60.0 points, and sexual well-being 41.0 and 43.0 points in the two groups. Overall, there was no significant difference in the breast-Q score between the two groups. Conclusion Patients who underwent DTI breast reconstruction seemed equally satisfied with the appearance and outcome of their breast reconstruction compared with LD flap with implant. Therefore, it appears that DTI is adequately replacing LD with implant.

Background Currently, the BREAST-Q can effectively measure patient's satisfaction on the quality of life from the patient's perspective in relation to different type of breast reconstruction. However, evaluation of patient satisfaction and cosmetic outcomes in breast reconstruction may have potential to led bias. Methods To maximize the benefits of using BREAST-Q to evaluate clinical outcome, we performed comparative study focused on the correlation between postoperative BREAST-Q and cosmetic outcomes assessed by medical professionals. For the current analysis, we used three postoperative BREAST-Q scales (satisfaction with breast, psychosocial well-being, and sexual well-being). The Ten-Point Scale by Visser et al was applied to provide reproducible grading of the postoperative cosmetic outcomes of the breast. The system includes six subscales that measured overall aesthetic outcome, volume, shape, symmetry, scarring, and nipple-areolar complex. The photographic assessments were made by five medical professionals who were shown photographs on a computer screen in a random order. Obtained data were stored in Excel and evaluated by Spearman's correlations using SPSS Statistics. Results We enrolled 92 women in this study, 10 did not respond to all scales of postoperative BREAST-Q, the remaining 82 women had undergone breast reconstruction. The correlation between BREAST-Q score and aesthetic score measured by Ten-Point Scale for the three BREAST-Q scales all show positive values in Spearman's correlation coefficient. Conclusion A significant correlation without any bias observed was found between the patient's satisfaction measured by BREAST-Q after breast reconstruction and the medical expert's aesthetic evaluation.

Patients undergoing autologous breast reconstruction (ABR) are more likely to require perioperative transfusions due to the increased intraoperative bleeding. In addition to the mastectomy site, further incisions and muscle dissection are performed at the donor sites, including the back or abdomen, increasing the possibility of transfusion. The purpose of this study was to evaluate perioperative transfusion rates and risk factors according to the type of ABR through analysis of big data. Patients who underwent total mastectomy for breast cancer between 2014 and 2019 were identified. The patients were divided into mastectomy only and immediate ABR groups. The transfusion rate was 14-fold higher in the immediate ABR group (16.1%) compared to the mastectomy only group (1.2%). The transfusion rate was highest with the pedicled transverse rectus abdominis myocutaneous flap (24.2%). Performance of the operation in medical institutions located in the provinces and coronary artery disease (CAD) were significant risk factors for the need for transfusion. The perioperative transfusion risk among patients undergoing immediate ABR was related to the flap type, location of medical institution, and CAD. Based on the higher transfusion rate in this study (16.1%) compared to previous studies, the risk factors for the need for transfusion should be determined and evidence-based guidelines should be developed to reduce the transfusion rates.

Background In August 2019, the Ministry of Food and Drug Safety and the Korean Soci- ety of Plastic and Reconstructive Surgeons confirmed the first case report of breast im- plant-associated anaplastic large cell lymphoma (BIA-ALCL) in Korea and provided rec- ommendations. This study was conducted to evaluate the impact of the first case re- port of BIA-ALCL on patients and whether the impact could be mitigated through ex- pert recommendations. Methods A retrospective chart review was performed of patients who underwent im- plant-based breast reconstruction using Biocell textured breast implants at Soonchun- hyang University Hospital. After the first case report of BIA-ALCL and informing the pa- tients via text messages, the pattern of outpatient visits and the proportion and indica- tions of outpatient office visitors who received reoperations were analyzed. Results After the first BIA-ALCL case report in Korea, 12 patients underwent reopera- tions due to other complications identified incidentally, while only three patients un- derwent prophylactic surgery. Among the patients who underwent reoperation after the Allergan issues, 76.7% received implant exchange. There was no significant differ- ence in the proportion of reoperation types before and after the Allergan issues and the transmission of text messages (P=0.700). Conclusions Despite the major issues, outpatients were managed successfully accord- ing to our recommendations. The study found a low rate of regular outpatient visits; however, our efforts increased this rate. Therefore, methods for appropriate informa- tion delivery are needed for outpatient visits, as well as a system for regular monitor- ing. As experts, plastic surgeons should provide responsible leadership in this situation to relieve patients’ concerns.

Background: We report our experience with performing prepectoral placement breast implant surgery using Supporix TM (HansBiomed, Korea), a porcine acellular dermal matrix (PADM), for cosmetic and reconstructive indications. The clinical efficiency, safety, and cost-effectiveness of PADM were also discussed. Methods: A single-center, retrospective study was designed from December 2017 to December 2019. The participants were Korean female patients who had PADM-assisted prepectoral breast implant surgery performed by two surgeons (S.G.K. & H.B.S.). All complications were registered and analyzed. A systematic review and meta-analysis of the complication rates after PADM-assisted prepectoral breast implant surgery were conducted for comparison with other studies. Subgroup analysis was performed in three groups according to the operation type: the cosmetic breast surgery (CBS) group, the immediate implant-based breast reconstruction (IIBR) group, and the delayed implant-based breast reconstruction (DIBR) group. Results: A total of 20 breasts in 16 patients were included in our study with a median follow-up period of 8.25 months. In a systematic review, 20 publications with a total of 2,504 breasts in 1,921 females were quantitively analyzed. The overall complication rates in our study and other studies were 14% and 24% in total group analysis, 0% and 12% in the CBS group, 62% and 26% in the IIBR group, and 0% and 28% in the DIBR group, respectively. Conclusion: Our data support the effectiveness of PADM-assisted prepectoral breast implant surgery, which was comparable to other studies. PADM was effective for reducing seroma and hematoma in the revision CBS group and the DIBR group. In the IIBR group, it was helpful in preventing implant loss and explantation.