Bilateral periareolar hyperpigmentation after augmentation mammoplasty: a case report and literature review

Complications arising from breast augmentation procedures are broadly categorized as either surgery-related or prosthesis-related. Many reports have described complications associated with breast augmentation. However, to date, periareolar post-inflammatory hyperpigmentation (PIH) after breast augmentation has not been reported. Herein, we report a case of PIH after augmentation mammoplasty using a silicone implant through the periareolar approach. A 35-year-old woman, who underwent bilateral breast augmentation using a periareolar approach, presented with bilateral periareolar tissue changes, with dark brown, irregular macules appearing 6 weeks postoperatively. Based on clinical symptoms and histological examination, the lesion was diagnosed as PIH. Topical hydroquinone and retinoic acid were applied for 8 weeks after the pigmentation appeared. After 6 months of observation, the pigmentation faded. To summarize, we report a case of pigmentation around the bilateral nipples after periareolar breast augmentation along with a literature review.ope

Treatment strategy for skin and soft tissue infections caused by nontuberculous mycobacteria following various procedures

Background The early diagnosis and treatment of skin and soft tissue infections caused by nontuberculous mycobacteria (NTM) are important, especially as infections with rapidly growing mycobacteria (RGM) are rare and difficult to diagnose and treat. Recently, we identified 22 cases of NTM infections; in this study, we suggest treatment strategies by analyzing the demographic characteristics and treatment progress of these patients. Methods A retrospective study of patients with NTM infections from 2009 to 2019 was conducted. To identify NTM infections, acid-fast bacillus (AFB) staining, Gram staining, polymerase chain reaction (PCR), and cultures of mycobacteria were performed. Empirical treatment with a combination of antibiotics or surgery was performed; species identification and drug susceptibility tests were performed by the Korean National Tuberculosis Association. The final regimen was determined after obtaining the test results. Results The mean incubation time of NTM was 4.32±2.88 weeks. RGM were detected in mycobacterial cultures in 21 of the 22 NTM patients. The results of AFB staining were negative in all patients, although PCR was positive for NTM in one patient. Fourteen patients were hospitalized for treatment with intravenous antibiotics and surgery. Treatment with a combined regimen of oral antibiotics was maintained for a mean of 5.41±1.85 months. Conclusions The unusual clinical manifestations of skin and soft tissue infections caused by NTM make them difficult to diagnose. Suspicion of NTM based on clinical presentation and a detailed examination should be followed by proper treatment involving multiple antibiotics and surgery in these patients.ope

복잡 유동장에서의 입자 현탁액의 거동: 와류 형성, 유로 막힘, 응집 파괴

학위논문 (박사)-- 서울대학교 대학원 : 공과대학 화학생물공학부, 2018. 2. 이승종.In this thesis, the dynamics of particulate suspensions in complex flow, such as vortex formation, channel clogging, and agglomerate breakup, was studied. Three main goals have been pursued in this thesis. First, the effect of silica particles in poly(ethylene oxide) (PEO) solutions on both rheological properties and vortex dynamics in micro contraction channel flow was investigated. Although the materials used in industry are not merely polymeric solutions or melts but also suspensions consisting of particles as well as polymers, the researches on the interaction between particle-polymer and their vortex behaviors inside the contraction are rare. The effect of silica particle was demonstrated by comparing between PEO solutions and silica/PEO suspensions. The addition of 1.0 wt% silica particles caused the decrease in vortex size and delayed the formation of lip vortex and the proceeding to corner vortex. Then, as the silica concentration increased, the vortex size increased and the flow rate, at which the lip vortex and corner vortex formed, decreased. The vortex behavior inside micro contraction channel was related to the storage modulus than viscosity. The storage modulus also decreased at first and then increased with silica concentration like the vortex size. The decrease in both the vortex size and the storage modulus was arisen from the adsorption of polymers onto the silica particles. Even though 1.0wt% silica particles were added, the storage modulus decreased because the amount of free polymer in the medium significantly decreased. Then, the storage modulus increased because the amount of free polymer was kept nearly constant and the silica concentration increased. The same tendency was observed when the suspension was compensated with the additional polymers corresponding to the amount of adsorbed polymer. In the second part of the study, the clogging mechanism of poly(styrene) particles in the flow through a single micro-pore was investigated. Together with the microscopic observation, the pressure drop was also measured. The pressure drop fluctuated according to the amount of particles deposited inside the channel. When the particles deposited and blocked the channel, the channel was clogged and the pressure drop increased sharply. During the clogging process, the particles were often detached by the flow, and interesting behaviors, such as rolling and stick and detach, were found to be the key factors that determine whether the clogging completely occurs or not. Above a certain flow rate, the channel was not clogged and the pressure drop did not increase further. The particles deposited in the upstream had an influence on the flow path. When the particles were deposited in the upstream, the flow detoured and the vortex was formed. The effect of viscosity was examined by controlling the concentration of glycerol solution. As the viscosity and flow rate increased, the shear stress applied to the particles became larger and it was more difficult for the particles to get accumulated. When the shear stress was high enough, the particles could not withstand the flow and the channel was not clogged. As the last part of the thesis, the deformation and breakup of a single agglomerate exposed to purely planar extensional flow in a cross channel were experimentally observed and investigated. Aggregation was generated by applying shear with destabilized poly(styrene) particles, and the fractal dimension, df, of the agglomerate was 2.25. The aggregation focused on the center of the channel by the sheath flow was rotated while approaching the stagnant point. Then, the aspect ratio increased as it was deformed close to the stagnant point. The probability of breakup and the fragment distribution were dependent upon the viscosity and flow rate, and were superimposed on a master curve as a function of the applied stress. Also, with the increase in stress, the projected area of the fragment which was split by the flow decreased with the power-law relationship and the exponent was in good agreement with the model prediction. This work provides an insight on the effect of the interaction between polymer and particle on the rheological properties and flow field, and it is thought to be helpful for designing various particle suspensions. It is also expected that the mechanism of agglomerate formation and breakup in the flow field will contribute to the control of the size of agglomerate required in many processes.1. Introduction 1 1.1 General introduction 2 1.2 Outline of the thesis 8 2. Experimental section 10 2.1 Channel fabrication 11 2.2 Observation system 11 3. Effect of silica particles on vortex dynamics of poly(ethylene) oxide solutions 14 3.1 Experimental 15 3.1.1 Materials 15 3.1.2 Channel geometry 19 3.1.3 Rheological measurements 21 3.1.4 Dimensionless numbers 21 3.2 Behavior of PEO solution 22 3.3 Behavior of PEO/silica suspension 26 3.3.1 Vortex development 26 3.3.2 Effect of viscoelasticity 30 3.4 Adsorption of polymer 33 4. Clogging mechanism in contraction channel flow 42 4.1 Experimental 43 4.1.1 Materials 43 4.1.2 Channel geometry 44 4.1.3 Differential pressure drop measurement 46 4.1.4 Operation conditions 49 4.2 Clogging mechanism and pressure drop 51 4.3 Effect of shear stress on pressure drop and clogging 62 5. Agglomerate breakup under extensional flow 69 5.1 Experimental 70 5.1.1 Materials 70 5.1.2 Channel geometry 73 5.1.3 Flow characterization 75 5.1.4 Image processing 78 5.2 Behavior of a single agglomerate 80 5.3 Probability of agglomerate breakup 86 5.4 Fragment distribution 88 5.5 Master curves 98 5.6 Model prediction 101 6. Summary 103 References 109 국문 초록 120Docto

A Study on Director's Oversight Liability for Enterprise Risk Management - Focused on Legal Debates under the Delaware Corporate Law in USA-

현대의 주식회사는 복합적인 금융 리스크(complex financial risk)에서부터 중국에서 생산되는 원재료에 관한 품질관리에 이르기까지 다양한 사업의 분야에서 발생하는 수많은 리스크에 직면하고 있다. 따라서 이사회는 현대의 주식회사가 직면하고 있는 리스크의 종류와 규모를 충분히 이해하고 관리할 필요가 있다. 2008년 미국에서 발생한 금융위기는 기본적으로 금융회사가 직면한 리스크를 식별하고 관리하지 못한데서 그 원인을 찾을 수 있다. 다시 말하면 금융회사의 리스크 관리(risk management)의 실패가 그 주된 원인이라고 할 수 있다. 리스크 관리에 대한 새로운 시각이 필요한 이유는 경영환경의 급격한 변화라고 할 수 있다. 기업 경영을 함에 있어 주변 환경의 불확실성 증가, 다시 말하면 기업 경영을 둘러싼 리스크의 종류가 많이 다양해졌고 기술의 발전, 글로벌화, 소비자 보호 정책의 강화 등 복잡해진 환경속에서 내부통제 등 전통적인 리스크 관리 방법으로는 그 달성에 장애가 많아 새로운 리스크 관리의 방안이 현대의 주식회사에 필요하게 되었다. 2008년 금융위기를 초래한 다양한 금융회사의 사업 관행으로 인해 주주, 소비자, 주택소유자, 차주 등은 실질적으로 손해를 입었다. 특히 금융회사의 주주들은 이사를 상대로 감시의무위반을 이유로 한 감독책임을 추궁하는 다수의 주주대표소송을 제기하였다. 그런데 델라웨어주 법원은 주주들의 손을 들어주지 않았다. 그 이유는 델라웨어주 법원이 리스크 감시의무를 사법심사로부터 크게 보호를 받는 주의의무의 재구성으로 보았기 때문이다. 나아가 이사의 감독책임을 추궁하는 주주대표소송에서 주주들이 승소하기 어려운 주된 이유는 델라웨어주 회사법상의 이사의 책임면제조항이 과실 또는 중과실로 인한 이사의 손해배상책임을 면제하여 주고 있을 뿐만 아니라 델라웨어주 법원이 과정 중심의 경영판단원칙의 적용을 고수하고 있기 때문이라고 할 수 있다. 최근에는 리스크 관리가 기업가치의 보호측면이 아닌 기업가치를 창출하는 적극적인 개념으로 그 역할이 바뀌고 있다. 다시 말하면 리스크는 더 이상 개별부문에서만 관리하는 것이 아니라 전사 차원에서 통합적으로 그리고 상시적으로 관리해야 한다는 주장이 늘고 있다. 당연히 이사회는 비즈니스의 결과뿐만 아니라 그 법적인 결과에 대해서도 책임을 부담하여야 하므로, 리스크 관리에 대한 이사의 감시의무와 함께 그 위반의 경우 감독책임을 부담해야 한다. 이러한 이사의 임무를 효과적으로 달성하기 위해선 이사(이사회)가 리스크를 이해·평가·통제할 수 있는 제도적인 장치가 상법상에 필요하다고 생각한다. |Comparing to the past, the competition among companies is getting intense as the market environment changes rapidly. Nowadays, business profits are more dependent on executive’s judgement. Therefore, the corporation expects top management to make a maximum profit and pay careful attention to their duties and liabilities. According to the Delaware General Corporation Law §141(a), the business and affairs of every corporation shall be managed by or under the direction of a board of directors. A director has, therefore, a fiduciary duty to monitor or oversee whether or not officers or employees commit wrongdoing or violate laws and regulations. A breach of the duty to monitor may impose on oversight liability. Under Delaware law, officers, directors and other control persons of corporations owe three primary fiduciary duties, (1) the duty of care, (2) the duty of loyalty and (3) the duty of good faith. By the way, the recent Delaware Supreme Court's decision in Stone v. Ritter was greatly significant. The reason is that a duty of good faith is not an independent fiduciary duty and a duty of loyalty includes the duty to monitor. The Delaware courts also have developed the doctrine of the duty to monitor through a series of derivative suits. Specifically, the Delaware Chancery Court in the Caremark case held that the board of directors should have a responsibility to establish internal control system in the context of oversight. After the subprime mortgage crisis of 2008, shareholder's derivative litigation has gradually increased. The reason is that financial institutions had great loss due to excessive risk-taking. Shareholders blamed the directors for failure to monitor or oversee financial institutions' excessive risk-taking. So, a duty to manage risk has been emphasized under lots of recent derivative suits. But in these cases, the Delaware Court has consistently denied the oversight duty over business risk. For example, the Delaware Court under both the Citigroup derivative litigation and the Goldman Sachs Group derivative litigation held that the oversight duty should not apply to business risk. The reason is that business risk should be protected under the business judgement rule. In addition, the Delaware Court consistently held that the plaintiff should prove director's bad faith with particularity in respect of a breach of oversight duty. In 2008, the Supreme Court of Korea clarified that the representative director as well as each director is under a continuing obligation to establish reasonable systems for information, reporting and internal control and to endeavor to operate those systems in DAEWOO case. Furthermore, the director is responsible for any damages incurred by illegal corporate affairs of other directors or officers resulting from continuing or systematic negligence in monitoring them. The representative director remains subject to such liability regardless of how the internal work or responsibility is divided or delegated within the corporation. Every board of directors has an oversight role of helping to support the creation of value in a corporation and prevent its decline. Traditionally, risk management has palyed a strong supporting role at the board level. Now, The board of directors is increasingly expected to provide oversight of enterprise risk management. In conclusion, it is necessary to consider the duty to manage risk because the enterprise risk management has been greatly significant in every corporation.제1장 서론 ------------------------------------------------------ 1 제1절 연구의 목적----------------------------------------------------------1 제2절 연구의 범위 및 방법 -------------------------------------------------3 1. 연구의 범위 ----------------------------------------------------------3 2. 연구의 방법 ----------------------------------------------------------5 제2장 전사적 리스크관리의 기원과 발전 --------------------------------7 제1절 내부통제의 개념의 기원과 발전----------------------------------------7 1. 내부통제 개념의 기원 --------------------------------------------------7 2. 내부통제 개념의 발전 연혁----------------------------------------------8 제2절 COSO보고서상의 내부통제--------------------------------------------15 1. 내부통제의 개념 ------------------------------------------------------15 2. 내부통제의 구성요소---------------------------------------------------15 3. 내부통제의 역할과 책임------------------------------------------------16 제3절 COSO보고서상 전사적 리스크관리와 2017년 개정내용-------------------18 1. 전사적 리스크관리의 의의 ---------------------------------------------18 2. 전사적 리스크관리의 내용 ---------------------------------------------19 3. 전사적 리스크관리의 구성요소 -----------------------------------------20 4. 전사적 리스크관리의 역할과 책임 --------------------------------------22 5. 1992년 내부통제와 2004년 전사적 리스크관리의 비교---------------------23 6. 전사적 리스크관리의 2017년 개정내용-----------------------------------24 제3장 미국 델라웨어주 회사법상 전사적 리스크관리와 이사의 감시의무 ---------------------------------------------------------------------29 제1절 전사적 리스크관리의 입법적 수용-------------------------------------29 1. 기업회계개혁법(Sarbanes-Oxley Act)상의 내부통제------------------------29 2. 모범회사법(Model Business Corporation Act)상의 내부통제-----------------37 3. 뉴욕증권거래소의 상장회사매뉴얼(Listed Company Manual)상의 내부통제---38 4. OECD기업지배구조의 원칙상의 내부통제 --------------------------------39 5. 미국법률협회(ALI)의 기업지배구조의 원칙상의 내부통제-------------------41 6. 금융회사에 대한 감독 메커니즘으로서의 리스크 관리---------------------43 제2절 내부통제에 관한 이사의 감시의무-------------------------------------45 1. 이사의 신인의무(fiduciary duty) 개관------------------------------------45 2. 내부통제에 관한 이사의 감시의무의 이론적 기초-------------------------46 제3절 델라웨어주 판례법의 발전--------------------------------------------48 1. 문제의 소재-----------------------------------------------------------48 2. 판례법의 발전---------------------------------------------------------48 제4절 소결----------------------------------------------------------------57 제4장 이사의 감독책임에 관한 델라웨어주 판례법의 최근 동향 -------60 제1절 이사의 감독책임의 판례법적 기초-------------------------------------60 1. 논의의 배경-----------------------------------------------------------60 2. Stone사건 판결상의 감시의무-------------------------------------------61 3. 이사의 감독책임의 법리------------------------------------------------64 제2절 리스크 관리에 관한 최근 델라웨어주 판례의 분석----------------------66 1. 판례의 분석-----------------------------------------------------------66 2. 판례의 평가-----------------------------------------------------------77 제3절 리스크 관리의무-----------------------------------------------------78 1. 문제의 제기-----------------------------------------------------------78 2. 이사의 감시의무 대상으로서의 리스크 관리------------------------------79 3. 리스크 관리의무의 가능성----------------------------------------------83 제4절 소결----------------------------------------------------------------83 제5장 전사적 리스크관리에 관한 입법론--------------------------------86 제1절 전사적 리스크관리제도의 개관----------------------------------------86 1. 준법지원인제도--------------------------------------------------------86 2. 내부회계관리제도------------------------------------------------------87 3. 금융회사의 준법감시인제도---------------------------------------------88 4. 금융회사의 위험관리체제-----------------------------------------------90 5. 종합적 평가-----------------------------------------------------------92 제2절 전사적 리스크관리와 판례의 발전-------------------------------------93 1. 전사적 리스크관리와 이사의 감시의무-----------------------------------93 2. 판례의 발전-----------------------------------------------------------97 제3절 리스크관리위원회 도입에 관한 입법론--------------------------------102 1. 현행 상법상의 리스크관리의 문제점------------------------------------102 2. 리스크관리위원회 도입 입법안-----------------------------------------111 제4절 소결---------------------------------------------------------------115 제6장 결론 -------------------------------------------------------------117Docto

Treatment of Aplasia Cutis Congenita on Scalp using Hyalomatix(R): A Case Report.

PURPOSE: Aplasia Cutis Congenita(ACC) is a rare disease characterized by the focal defect of the skin at birth, frequently involving scalp, but it may affect any region of the body. There are no etiology known but some conditions such as intrauterine vascular ischemia, amniotic adherences and viral infections are associated. The ideal treatment for the ACC is not known. Superficial and relatively small sized defects(<3x5cm) may heal spontaneously and large defects related with risks of infection and bleeding may require aggressive surgical treatment. Hyalomatrix(R) is a bilayer of an esterified hyaluronan scaffold beneath a silicone membrane. It has been used as a temporary dermal substitute to cover deep thickness skin defect and has physiological functions derive from the structural role in extracellular matrix and interaction with cell surface receptor. This material has been used for the wound bed pre-treatment for skin graft to follow and especially in uncooperative patient, like a newborn, this could be a efficient and aseptic way of promoting granulation without daily irritative wound care. For this reason, using Hyalomatrix(R) for the treatment of ACC was preferred in this paper. METHODS: We report a case of a newborn with ACC of the vertex scalp and non-ossified partial skull defect. The large sized skin and skull defect(6x6cm) was found with intact dura mater. No other complications such as bleeding or abnormal neurologic sign were accompanied. Escharectomy was performed and Hyalomatrix(R) was applied for the protection and the induction of acute wound healing for 3 months before the split-thickness skin graft. During the 3 months period, the dressing was renewed in aseptic technique for every 3 weeks. The skin graft was achieved on the healthy granulation bed. RESULTS: The operative procedure was uneventful without necessity of blood transfusion. Postoperative physical examination revealed no additional abnormalities. Regular wound management was performed in out-patient clinic and the grafted skin was taken completely. No other problems developed during follow-up. CONCLUSION: Hyalomatrix(R) provides protective and favorable environment for wound healing. The combination of the use of Hyalomatrix(R) and the skin graft will be a good alternative for the ACC patients with relatively large defect on vertexope

Treatment of a massive keloid on posterior auricular area and ear after correction of microtia

ope

A Case report of Isolated Inguinal Tuberculous Lymphadenitis

PURPOSE: Tuberculous lymphadenitis constitutes about 30% of all types of extrapulmonary tuberculosis. Cervical lymphadenitis is the commonest form (70%), followed by axillary and inguinal. But inguinal tuberculous lymphadenitis is rare form. Especially isolated inguinal tuberculous lymphadenitis was seldom reported. In Korea, that case was not reported. This case emphasizes the need for awareness of tuberculosis as a possible cause of isolated inguinal adenitis. METHODS: We experienced one case of isolated inguinal tuberculous lymphadenitis. We analyzed clinical features, preoperative assessments and method of treatments. RESULTS: A 37-year-old female patient presented with a painless swelling in the left inguinal region of 12 month's duration. There was no history of urethral discharge, dysuria, genital sores, unprotected sexual contacts or trauma. Examination revealed enlarged left inguinal lymph nodes, 2 x 1 cm, non-tender and firm mass. The external iliac, popliteal, right inguinal and other groups of lymph nodes were normal. Serologic tests, urinary tests and chest radiologic test were normal. The excision of mass was performed under the general anesthesia. A excisional biopsy showed chronic granulomatous inflammation with caseous necrosis, consistent with tuberculosis. After excision, the primary repair was done and completely healed on postoperative 25 days. CONCLUSION: The isolated inguinal tuberculous lymphadenitis was rare form of inguinal suppurative mass. Although medical management is the principal mode of therapy of tuberculous adenitis and surgery is rarely necessary, we didn't consider the possibility of tuberculous lymphadenitis in our case. A high index of suspicion is essential for a diagnosis of isolated inguinal tuberculous lymphadenitis. Our case emphasizes this importance and illustrates the need for awareness of tuberculosis as a possible cause of isolated inguinal adope

Ultrasonic dissection versus electrocautery for immediate prosthetic breast reconstruction

Background: Ultrasonic dissection devices cause less thermal damage to the surrounding tissue than monopolar electrosurgical devices. We compared the effects of using an ultrasonic dissection device or an electrocautery device during prosthetic breast reconstruction on seroma development and short-term postoperative complications. Methods: We retrospectively reviewed the medical records of patients who underwent implant-based reconstruction following mastectomy between March 2017 and September 2018. Mastectomy was performed by general surgeons and reconstruction by plastic surgeons. From March 2017 to January 2018, a monopolar electrosurgical device was used, and an ultrasonic dissection device was used thereafter. The other surgical. Methods: were the same in both groups. Results: The incidence of seroma was lower in the ultrasonic dissection device group than in the electrocautery group (11 [17.2%] vs. 18 [31.0%]; P=0.090). The duration of surgery, total drainage volume, duration of drainage, overall complication rate, surgical site infection rate, and flap necrosis rate were comparable between the groups. Multivariate analysis revealed that the risk of seroma development was significantly lower in the ultrasonic dissection device group than in the electrocautery group (odds ratio for electrocautery, 3.252; 95% confidence interval, 1.242-8.516; P=0.016). Conclusions: The findings of this study suggest that the incidence of seroma can be reduced slightly by using an ultrasonic dissection device for prosthesis-based breast reconstruction. However, further randomized controlled studies are required to verify our. Results: and to assess the cost-effectiveness of this technique.ope

Correction of Dark Coloration of the Lower Eyelid Skin with Nanofat Grafting

Background : A number of factors can cause dark circles around the eyes including excessive pigmentation, thin and translucent lower eyelid skin overlying the orbicularis oculi muscle, and shadowing due to skin laxity and tear trough. Autologous fat graft is an effective method for the treatment of lower lid dark circles, but irregularities caused by leaving visible lumps of the fat can occur. Tonnard et al. suggested 'nanofat' grafting and introduced its characteristics and clinical applications. The authors used their nanofat grafting to correct lower eyelid dark circles. Methods : Nanofat grafting was performed in 19 patients for dark lower eyelids. The grafts were injected into subdermal layer using blunt cannula. Microfat grafting with nasojugal fold was performed to all the patients. Among them, 18 patients received transconjunctival fat removal at the same time. Results : All the patients showed much improvement from preoperative dark coloration. There were no visible lumps of fat, contour irregularities, or fat necrosis. Postoperative edema and ecchymosis were minimal. Conclusions : Nanofat grafting methods provide a good alternative for correcting dark circles by augmenting thin skin with lower complications. This simple, cost effective procedure is suitable for correction of dark circles and various skin rejuvenation purposes.ope

Comparison of complications according to incision types in nipple-sparing mastectomy and immediate reconstruction

Background: Nipple-sparing mastectomy (NSM), followed by immediate reconstruction (IR) of the breast, has become a preferred surgical procedure with good cosmesis results and patient satisfaction. However, nipple-areolar complex (NAC) ischemia and necrosis remain major problems after NSM and IR. Methods: We retrospectively analyzed patients who underwent NSM and IR at Gangnam Severance Hospital from January 2009 to June 2018. We compared the patient characteristics and complication rate among three different incisions (inframammary fold [IMF], radial, periareolar). Additionally, we identified the risk factors of NAC necrosis. Results: Data from 290 eligible breasts in 275 patients were analyzed. Patients with IMF incision had relatively lower breast weights. The overall complication rate was the highest with periareolar incision and the lowest with IMF incision (42.6% vs. 18.8%, p < 0.001). The rate of NAC ischemia or necrosis was significantly different among the three incisions (9.7%, 17.0%, and 31.1% in IMF, radial, and periareolar, respectively; p < 0.001). Moreover, surgical treatments were more frequently needed in patients with periareolar incision. Periareolar incision, short distance from the tumor to the nipple base, and large breast weight were independent risk factors of NAC ischemia or necrosis in multivariable analysis. Conclusions: Compared with IMF incision, periareolar incision was associated with higher incidences of surgical complications and NAC necrosis. Careful consideration is needed when planning NSM in patients with a large breast volume or a tumor close to the nipple.ope