Jeong Yeop Ryu

Background: In postmastectomy radiotherapy, radiation reaches an already-reconstructed breast, and implant-based reconstruction remains feasible in selected patients. Far less studied is reconstruction within a previously irradiated field: after breast-conserving therapy, ipsilateral breast tumor recurrence (IBTR), and salvage mastectomy. We compared implant-based and autologous reconstruction in this setting and propose a hypothesis-generating treatment algorithm. Methods: From 2219 consecutive breast reconstructions (2012–2026), we cross-matched implant-removal, radiotherapy, and local-recurrence registries to identify all immediate total reconstructions of a previously irradiated breast after salvage mastectomy for IBTR (n = 13; 8 implant-based [all stand-alone, without vascularized flap coverage], 5 autologous [all latissimus dorsi-based]). The primary endpoint was reconstruction failure, defined in a modality-neutral manner as definitive loss or abandonment of the reconstruction; implant-based reconstructions of breasts not previously irradiated at the time of reconstruction (n = 689) served as a descriptive institutional reference cohort. Results: Seven of eight implants (87.5%) were removed at 3 to 51 months; the single retained implant has a persistent wound; none achieved complication-free success. Failure modes comprised early envelope necrosis, periprosthetic infection, and late attritional failure; chronic retained-capsule seroma followed removal without capsulectomy. All five autologous reconstructions healed without failure or unplanned reoperation (reconstruction failure, 7/8 [87.5%; 95% CI, 47.3–99.7%] vs. 0/5 [0%; 95% CI, 0–52.2%], p = 0.005; log-rank p = 0.039; median follow-up, 32.0 vs. 10.9 months; failure or major complication, 8/8 vs. 0/5, p = 0.0008). The implant-removal rate also exceeded that of the institutional reference cohort (87.5% vs. 11.2%; unadjusted, descriptive comparison). Conclusions: In this small consecutive series, stand-alone implant-based reconstruction of the previously irradiated breast was associated with a very high failure rate, whereas reconstruction importing well-vascularized autologous tissue healed in every case, a pattern biologically consistent with chronic radiation injury. These findings constitute a strong cautionary signal rather than definitive evidence. Our findings support an autologous-first approach after salvage mastectomy of the irradiated breast; stand-alone implant-based reconstruction should be offered only to carefully selected, fully counseled patients, and the proposed algorithm requires external validation.

Background and Objectives: Reconstructive breast surgery covers a far wider range of operations than the implant-versus-autologous dichotomy: oncoplastic techniques, several pedicled flap designs, and chest wall coverage of defects resisting primary closure are rarely reported together. We described the complete reconstructive spectrum of a single tertiary center over thirteen years and asked whether the reconstructive choice carries prognostic information. Materials and Methods: All reconstructive procedures performed by the breast reconstruction service of a Korean tertiary hospital between December 2012 and July 2026 were reviewed retrospectively. Free-text operative descriptions were mapped onto a 26-category classification, and each patient received a primary technique from her index operation, separated by reconstructive intent: restoration of breast form or coverage of a defect after wide resection. Mortality was ascertained from institutional records; termination of National Health Insurance eligibility was examined separately as a candidate surrogate, with the last institutional attendance retrieved for every patient so flagged. Associations with recorded mortality were assessed by logistic regression. Results: In total, 2216 patients underwent 2523 procedures. The index operation was autologous reconstruction in 907 patients (40.9%), oncoplastic breast-conserving surgery in 623 (28.1%), implant-based reconstruction in 564 (25.5%), and chest wall reconstruction in 14 (0.6%). Autologous reconstruction fell from 67 of 114 index procedures in 2014 to 15 of 160 in 2026, whereas implant-based reconstruction rose from four to 70. Recorded mortality was 1.8% overall and ranged from none after several oncoplastic techniques to 28.6% after chest wall reconstruction. Patients whose eligibility had lapsed resembled survivors rather than the deceased; all 41 had attended in person after reconstruction, at a median of 4.3 years. Conclusions: The reconstructive operation summarizes the oncological situation rather than determining survival independently. Chest wall reconstruction merits reporting apart from breast reconstruction, and lapsed insurance eligibility performed poorly as a surrogate for mortality.

Pressure injuries (PIs) are a major clinical burden in patients with multiple comorbidities. The Charlson Comorbidity Index (CCI) is a validated comorbidity measure; however, its quantitative association with PI severity remains poorly characterised. To evaluate the association between CCI scores and PI stage, and to identify individual CCI component diseases independently associated with higher PI stage. This retrospective cohort study included 454 PI patients at a tertiary university hospital (July 2023–December 2025). PI severity was classified into stages 1–4. Both the original and updated CCI were calculated from comorbidities only, without the Charlson age adjustment. Ordinal logistic regression assessed associations between CCI and PI stage, adjusting for age and sex. The median patient age was 73 years (range, 17–95); 63.2% were male. Stage 2 PIs were most prevalent (70.5%). Each 1‐point increase in original CCI was associated with 1.10‐fold higher odds of a more advanced PI stage (95% CI: 1.02–1.20; p = 0.015) after adjusting for age and sex. Among individual CCI components, rheumatic disease (OR = 2.20; 95% CI: 1.04–4.65; p = 0.039) and hemiplegia/paraplegia (OR = 1.72; 95% CI: 1.07–2.77; p = 0.024) were independently associated with higher PI stage; moderate‐to‐severe renal disease showed an association of similar direction that did not reach statistical significance (OR = 1.63; 95% CI: 0.99–2.69; p = 0.056). A higher CCI was associated with higher PI severity in this cohort, although the effect size was modest. In a mutually adjusted multi‐variable model, rheumatic disease and hemiplegia/paraplegia were independently associated with higher PI stage. These associations are observational and require prospective confirmation before any clinical application can be considered.

Background: Phyllodes tumors (PTs) are rare fibroepithelial breast neoplasms spanning a benign-to-malignant spectrum, and the extent of surgery and reconstruction differs markedly by histologic grade. The primary aim of this study was to derive a grade-stratified surgical and reconstructive algorithm. Methods: The charts of patients diagnosed with phyllodes tumor at Kyungpook National University Chilgok Hospital between January 2011 and February 2026 were retrospectively reviewed. Tumors were classified by World Health Organization criteria as benign, borderline, or malignant, and the treatment protocols, extent of surgery, and immediate reconstruction after mastectomy were analyzed. Results: Of 417 patients charted, 401 were confirmed to have phyllodes tumors and 334 carried a definitive histologic grade. Together, they formed the analyzed cohort: 251 benign (75.1%), 55 borderline (16.5%), and 28 malignant (8.4%). Benign tumors were managed predominantly by breast-conserving surgery (BCS). Twenty-six patients formed the surgical cohort, defined by the reconstructive requirement of the resection defect: all total mastectomies (n = 19) together with all breast-conserving resections reconstructed by the plastic surgical team (oncoplastic breast-conserving surgery, n = 7). Reconstruction was performed in 21 (80.8%) with latissimus dorsi-based flaps, local flaps, or direct-to-implant reconstruction. Adjuvant radiotherapy was confined to malignant disease (7 of 15 malignant PTs, 46.7%; p = 0.010). Over a median follow-up of 32.7 months, local recurrence developed in four patients (15.4%) and two malignant tumors were fatal. In an illustrative case of recurrent malignant PT with rib metastasis, a widely opened pleural cavity was sealed with a single sheet of non-fenestrated acellular dermal matrix (ADM), which was found to be fully incorporated and still sealing the pleura at later implant explantation. Conclusions: A grade-stratified strategy (BCS for benign tumors and mastectomy with reconstruction for borderline/malignant disease) balances oncologic safety with aesthetic outcome.

Background/Objectives: Hypoglossal nerve palsy is a rare but disabling complication of general anesthesia, typically associated with tracheal intubation and head and neck surgery. This study evaluated the incidence, clinical characteristics, and potential mechanisms of postoperative tongue deviation after breast reconstruction and other surgeries performed under general anesthesia with orotracheal intubation. Methods: We retrospectively reviewed 240,646 consecutive general anesthetic procedures with orotracheal intubation performed at two tertiary hospitals between September 2011 and October 2025. Eighteen patients who developed new-onset postoperative tongue deviation were identified, and demographic features, surgical department, breast reconstruction status, anesthetic details, patient positioning, laterality of deviation, symptom duration, and recovery outcomes were analyzed. Results: Postoperative tongue deviation was documented in 18 patients, corresponding to an overall incidence of approximately 0.01%, most frequently after breast reconstruction (7/18, 38.9%), followed by vascular (27.8%), head and neck tumor (16.7%), neurosurgical (11.1%), and hepatobiliary–pancreatic surgery (5.6%). All seven breast-reconstruction cases occurred at the breast-cancer center hospital, corresponding to 0.31% of 2256 breast reconstructions. The median age was 58.0 years; 66.7% patients were female. Most patients (77.8%) achieved complete recovery, whereas 16.7% had residual deviation. Conclusions: Postoperative hypoglossal nerve palsy with tongue deviation is an exceptionally rare event after general anesthesia. In our two-center cohort, it was observed most frequently among patients undergoing breast reconstruction at one participating center; this pattern is confounded by institution-specific anesthetic and positioning practices and should not be interpreted as evidence that the procedure itself carries inherent risk. The findings are hypothesis-generating and suggest that prolonged operating time, repeated intraoperative position changes, and specific head-fixation and tube-fixation practices warrant prospective investigation. Meticulous head–neck alignment, careful tube fixation, and a structured postoperative cranial-nerve check (tongue-protrusion and voice-quality assessment in the recovery room and on postoperative day 1) may aid the early detection of this complication.

Background/Objectives: Microtia, a congenital ear malformation ranging from mild anomalies to anotia, imposes a psychosocial burden, yet its link to pediatric psychiatric disorders in population-based settings is understudied. Methods: This study included 6048 patients with microtia and a control cohort of 120,960 age- and sex-matched participants from the Korean National Health Insurance database. The incidence of overall psychiatric disorder events was compared between the microtia and control cohorts. Results: Compared with the control cohort, the incidence rate ratio (IRR) in patients with microtia was 1.16 (95% CI, 1.05–1.29) for overall psychiatric disorders, 5.35 (95% CI, 4.56–6.27) for hyperkinetic disorder (HKD), and 9.67 (95% CI, 5.49–17.03) for autism. After adjusting for age group, sex, and socioeconomic status, microtia was associated with an increased risk of overall psychiatric disorders, HKD, and autism. Subgroup analyses revealed an elevated risk of overall psychiatric disorders among individuals aged 5 to 14 years, males, and those with low or high socioeconomic status. Ear reconstruction surgery was associated with a lower risk of HKD among patients aged 10 to 14 years, females, and those with low socioeconomic status. The observed association between ear reconstruction surgery and lower HKD risk in these specific subgroups warrants further investigation using study designs capable of establishing causal inference. Conclusions: Microtia is associated with an increased risk of psychiatric disorders in pediatric and adolescent populations, with particularly pronounced risks for HKD and childhood autism. These findings underscore the importance of early psychiatric screening in children with microtia.

Background: Emerging evidence suggests that impairment of the glymphatic–lymphatic pathway contributes to neurodegeneration. However, it remains unclear whether individuals with limb lymphedema experience an increased long-term risk of dementia and whether surgical restoration of lymphatic drainage through lymphovenous anastomosis (LVA) modifies this risk. This nationwide cohort study aimed to examine the incidence of dementia subtypes among patients with lymphedema and to evaluate whether LVA is related to subsequent dementia risk.Methods: Using the Korean National Health Insurance Service database (2010–2023), we identified 51 554 adults with lymphedema and matched them 1:10 by age and sex to controls. Dementia was defined by using diagnostic codes combined with at least two prescriptions for dementia medications. Multivariable Cox proportional hazards models adjusted for demographic and socioeconomic factors were used to estimate dementia risk associated with lymphedema. Among patients with lymphedema, a separate Cox model evaluated dementia risk according to LVA.Findings: Lymphedema was associated with a significantly higher incidence and adjusted risk of all dementia subtypes: Alzheimer’s disease (HR 8.04), vascular dementia (HR 9.33), and other dementias (HR 8.82). The risk was particularly pronounced among individuals younger than 70 years. Among patients with lymphedema, LVA was linked to a marked reduction in dementia risk across all categories (HR 0.08–0.18), consistent across different age and sex groups.Interpretation: Peripheral lymphedema is associated with a significantly increased long-term risk of dementia, whereas LVA is associated with reduced dementia incidence. These results suggest that peripheral lymphatic dysfunction may serve as a systemic marker of cognitive vulnerability and that lymphatic restoration may have preventive implications for dementia. Funding: None Copyrights: This is an open access article under the CC BY license

Ryu JY, et al. J Korean Med Sci. 2026 Dec;41:e320. https://doi.org/10.3346/jkms.2026.41.e320

Background/Objectives: Considering the increasing importance placed on the quality of life among those who survive cancer, breast reconstruction is no longer limited to only compensating for breast loss; achieving the patient’s preferences is now considered. However, the optimal surgical approach (subpectoral plane vs. prepectoral plane) in single-stage direct-to-implant breast reconstruction (DTIBR) has not been established. The aim of this study was to summarize the principles for selecting between the subpectoral and prepectoral planes in DTIBR. Methods: In this retrospective study, we evaluated 543 patients with breast cancer who underwent DTIBR between March 2018 and October 2025. Postmastectomy reconstruction was performed in the subpectoral plane when the defect showed greater breast height than width, whereas the prepectoral plane was used when breast width exceeded height. Complications requiring reoperation were analyzed. Patient satisfaction was evaluated based on overall satisfaction, esthetic outcome, physical symptoms, psychosocial impact, and decision satisfaction using a visual analog scale. Results: The subpectoral dual-plane approach was most commonly used between 2018 and 2019, while the prepectoral plane became predominant after 2020. Overall, 83 (14.4%) patients developed major complications. The overall satisfaction score was 4.1 ± 0.80 in the subpectoral group and 4.35 ± 0.70 in the prepectoral group, showing a statistically significant difference (p value = 0.012). Conclusions: The subpectoral and prepectoral planes have distinct advantages and limitations. Ultimately, the reconstructive surgeon should determine the most appropriate option in DTIBR. Selecting the surgical plane based on the postmastectomy defect reduces complications while improving patient satisfaction.

Jeong Yeop Ryu. Anti-aging (Journal of Asia Pacific Anti-Aging) 2025;3:10-5. https://doi.org/10.70966/anti-aging.25.0006