Breast fat grafting and cancer: a systematic review of the science behind enhancements and concerns.

Background: Autologous fat transfer (AFT) is gaining popularity in breast surgery, offering a natural-looking and minimally invasive approach for augmentation, reconstruction, and contouring. However, concerns about its impact on breast cancer necessitate an understanding of the interplay between transplanted adipose-derived stem cells (ADSCs) and the breast tissue microenvironment. Renowned for regeneration, ADSCs raise questions about their role in cancer promotion. This systematic review delves into the complex relationship between AFT and breast cancer, exploring how ADSCs may influence development, growth, and metastasis. Methods: A systematic search of electronic databases, including PubMed, Embase, and BVS was conducted to identify relevant studies. The search strategy employed a combination of keywords, including "breast augmentation", "fat grafting", "breast enhancement", "mammoplasty", "cancer", "neoplasm" and related terms. Two reviewers independently screened titles and abstracts. Full-text articles were then retrieved for further evaluation based on their potential contribution to the review objectives. Results: Two hundred and forty records were identified. Among these, 104 duplicates were removed, resulting in 136 reports available for title and abstract screening. Subsequently, 54 papers were deemed potentially eligible for inclusion, and all reports were retrieved. Conclusions: In vitro studies reveal ADSCs dual role in breast cancer, influencing proliferation, migration, and drug resistance through complex signaling pathways. Animal studies highlight distinct ADSC subpopulations impacting tumor growth via direct interactions and extracellular vesicle cargo. In vivo, ADSC-enriched fat grafting is generally safe, showing no increased cancer recurrence risk compared to other methods. Notably, cases of invasive breast carcinoma warrant special attention. ADSC-enriched fat grafts exhibit potential benefits in graft retention and survival rates. Despite promising evidence, further studies are needed to comprehensively understand the intricate relationship between ADSCs and breast cancer for optimized clinical applications and potential therapeutic innovations.

Use of simulators in video laparoscopic surgery in medical training: a prospective court study with medicine academic at a university in Southern Brazil.

INTRODUCTION: the onset of minimally invasive surgery, such as laparoscopic surgery, was accompanied by an increased frequency of complications, many of which were life-threatening. With the objective of minimizing morbidity and mortality and accelerating the learning curve, video laparoscopic surgery simulators were developed to improve the psychomotor skills required for these procedures. OBJECTIVE: to compare the performance of second year medical students of the Lutheran University of Brazil, in simulated videolaparoscopic surgeries performed at the Realistic Simulation Center of the Faculty of Health Sciences of Porto Alegre. METHOD: prospective cohort study with 16 medical students with no prior experience in video-surgery simulation. The students performed simulated exercises and were evaluated regarding Coordination, Navigation by Instrument and Time in the accomplishment of the procedures. RESULTS: the sample consisted of 69% women and 31% men with a mean age of 23.2 years. The students obtained better results in the second simulation application. The skill in Navigation by Instrument task was the one that showed the best evolution in the studied group. The Total Time in the accomplishment of the procedures was the parameter with greater difference between the successive simulations. CONCLUSION: medical students presented a significant improvement in their performance with the repetition of the simulation exercises, demonstrating that the Laparoscopic Surgery Simulators are a promising tool in medical training and development of surgical skills.

Use of simulators in video laparoscopic surgery in medical training: a prospective court study with medicine academic at a university in Southern Brazil / Uso de simuladores em cirurgia videolaparoscópica na formação médica: estudo prospectivo de coorte com acadêmicos de medicina de uma universidade no Sul do Brasil

ABSTRACT Introduction: the onset of minimally invasive surgery, such as laparoscopic surgery, was accompanied by an increased frequency of complications, many of which were life-threatening. With the objective of minimizing morbidity and mortality and accelerating the learning curve, video laparoscopic surgery simulators were developed to improve the psychomotor skills required for these procedures. Objective: to compare the performance of second year medical students of the Lutheran University of Brazil, in simulated videolaparoscopic surgeries performed at the Realistic Simulation Center of the Faculty of Health Sciences of Porto Alegre. Method: prospective cohort study with 16 medical students with no prior experience in video-surgery simulation. The students performed simulated exercises and were evaluated regarding Coordination, Navigation by Instrument and Time in the accomplishment of the procedures. Results: the sample consisted of 69% women and 31% men with a mean age of 23.2 years. The students obtained better results in the second simulation application. The skill in Navigation by Instrument task was the one that showed the best evolution in the studied group. The Total Time in the accomplishment of the procedures was the parameter with greater difference between the successive simulations. Conclusion: medical students presented a significant improvement in their performance with the repetition of the simulation exercises, demonstrating that the Laparoscopic Surgery Simulators are a promising tool in medical training and development of surgical skills.

RESUMO Introdução: o início da cirurgia minimamente invasiva, como a cirurgia laparoscópica, foi acompanhado por frequência aumentada de complicações, muitas com risco de morte. Com o objetivo de minimizar a morbidade e mortalidade e acelerar a curva de aprendizado, foram desenvolvidos simuladores de cirurgia videolaparoscópica para aprimoramento de habilidades psicomotoras necessárias nestes procedimentos. Objetivo: comparar o desempenho de acadêmicos do segundo ano de medicina da Universidade Luterana do Brasil, na realização de cirurgias videolaparoscópicas simuladas, feitas no Centro de Simulação Realística da Faculdade de Ciências da Saúde de Porto Alegre. Método: estudo prospectivo de coorte com 16 alunos de Medicina sem experiência prévia em simulação de vídeocirurgia. Os alunos realizaram exercícios simulados e foram avaliados quanto a Coordenação, Navegação por Instrumento e Tempo na Realização dos Procedimentos. Resultados: a amostra foi composta por 69% de mulheres e 31% de homens com média de idade de 23,2 anos. Os acadêmicos obtiveram melhora dos resultados na segunda aplicação da simulação. A habilidade na tarefa Navegação por Instrumento foi a que teve melhor evolução no grupo de alunos avaliados. O Tempo Total na realização dos procedimentos foi o parâmetro com maior diferença entre as simulações sucessivas. Conclusão: os acadêmicos de Medicina apresentaram expressiva melhora de desempenhos com a repetição dos exercícios de simulação, demonstrando que os Simuladores de Cirurgia Videolaparoscópica são ferramentas promissoras no treinamento de habilidades cirúrgicas na formação médica.