Quality of breast reconstruction service at a university hospital as assessed by the patients

Purpose: To evaluate the quality of breast reconstruction service at a university hospital, as assessed by the patients. Methods: This cross-sectional study enrolled adult women who underwent immediate or delayed breast reconstruction by any technique performed at a university hospital between 1 and 24 months before the assessment. The Brazilian version of the Health Service Quality Scale (HSQS) was self-applied to the participants. The HSQS produces percentage scores, which are expressed in values ranging from 0 to 10 for each domain of the scale, and into an overall percentage quality score. The management team was asked to establish a minimum satisfactory score for the breast reconstruction service. Results: Ninety patients were included. The management team considered 8.00 the minimum satisfactory score for the service. The overall percentage score was 93.3%. Only one domain, 'Support,' had an average score lower than that considered satisfactory (7.22 ± 3.0); while the others had higher scores. The domain that scored highest was 'Qualification' (9.94 ± 0.3), followed by 'Result' (9.86 ± 0.4). There was a positive correlation between 'type of oncologic surgery' and 'intentions of loyalty to the service' (ρ = 0.272; p = 0.009) and a negative correlation between 'education' and 'quality of the environment' (ρ = ­0.218; p = 0.039). The higher the patient's level of education, the higher the score attributed to 'relationship' (ρ = 0.261; p = 0.013) and the lower the score of 'aesthetics and functionality' (ρ = ­0.237; p = 0.024). Conclusion: The quality of the breast reconstruction service was considered satisfactory, but there is a demand for structural improvements, better interpersonal relationships, and a stronger support network for patients.

Comparative clinical evaluation of breast augmentation using silicone foam coated implants and textured implants

Purpose To evaluate whether silicone foam implants have a different evolution pattern compared to conventional texture implants. Methods Fifty-eight female patients underwent surgery. They were divided into two groups (silicone foam Lifesil® and microtexturized silicone Lifesil®). The evolution was analyzed in postoperative consultations, with physical examination, photographic documentation and filling in a satisfaction questionnaire, in the postoperative period of one month, four months, one year and then annually, up to a maximum of 3 years of follow-up. Results There were no statistically significant differences in presence of rippling, stretch marks, breast ptosis, capsular contracture and quality of scars. There was a higher rate of patients who were very satisfied with the outcome 360 days after surgery in the group receiving silicone foam implants (p = 0.036). Conclusion In short time, silicone foam envelope implants proved to be as reliable as textured silicone envelope implants, making them an option for augmentation mammoplasty.(AU)

Histological evaluation of capsules formed by silicon implants coated with polyurethane foam and with a textured surface in rats

PURPOSE:To assess the capsules formed by silicone implants coated with polyurethane foam and with a textured surface.METHODS:Sixty-four Wistar albinus rats were divided into two groups of 32 each using polyurethane foam and textured surface. The capsules around the implants were analyzed for 30, 50, 70 and 90 days. Were analyzed the following parameters: foreign body reaction, granulation tissue, presence of myofibroblasts, neoangiogenesis, presence of synovial metaplasia, capsular thickness, total area and collagen percentage of type I and III, in capsules formed around silicone implants in both groups.RESULTS:The foreign body reaction was only present in the four polyurethane subgroups. The formation of granulation tissue and the presence of myofibroblasts were higher in the four polyurethane subgroups. Regarding to neoangiogenesis and synovial metaplasia, there was no statistical difference between the groups. Polyurethane group presented (all subgroups) a greater capsule thickness, a smaller total area and collagen percentage of type I and a higher percentage area of type III, with statistical difference.CONCLUSION:The use of polyurethane-coated implants should be stimulated by the long-term results in a more stable capsule and a lower incidence of capsular contracture, despite developing a more intense and delayed inflammatory reaction in relation to implants with textured surface.(AU)

Photographs for anthropometric measurements of the breast region. Are there limitations?

PURPOSE: To determine the limitations of the photographs used to obtain the anthropometric measurements of the breast region. METHODS: Five women, between the ages of 18 to 60 years, were evaluated. Photographs of the frontal and left and right profile views of their breasts were taken. Based on the current literature, the most commonly used anthropometric and anatomic landmarks for breast measurement were marked in their different positions. The different points were used to evaluate if the direct anthropometry was possible in a standardized way and determine how the points and the positions can to be used in any breast measurements. RESULTS: There were some limitations to the use of defining points of the breast fold, as well as of its lower portion and lateral extension positions in both profiles. CONCLUSION: The defining points of the breast fold and the profile photographs have some limitations and we suggested how the points and positions can be used for breasts measurements.(AU)

Histology of the rectus abdominis muscle in rats subjected to cranial and caudal devascularization / Histologia do músculo reto do abdome de ratos submetidos à desvascularização cranial e caudal

PURPOSE: To investigate the microscopic changes in the rectus abdominis muscle in rats subjected to five delay procedure. METHODS: 30 male holtzmann rats, weighting between 250 and 350 grams, were used. The animals were divided into five groups (n=6): A - cranial section of the right muscle; B - caudal section of the right muscle; C - craniocaudal section of the right muscle; D - cranial section reflecting the right muscle in the craniocaudal direction; E - caudal section reflecting the right muscle in the caudocranial direction. On the seventh day after surgery, a resection of the cranial and caudal fragments of the right and left muscles, respectively, was performed for microscopic analysis. Histological alterations were quantified and the right and left (control) muscle fragments compared. Fisher's exact test was used for statistical purposes with a significance level of 5 percent. RESULTS: The comparison between right and left muscles showed statistically significant differences in group A - inflammatory infiltrate in the cranial fragment (p=0.015); in group C - inflammatory infiltrate (p=0.000) and necrosis (p=0.015) in the caudal fragment; and in group E - edema in the caudal fragment (p=0.000). No significant alterations were noted in groups B and D. CONCLUSIONS: Irrigation exclusively through the perforating muscle vessels is inappropriate; irrigation exclusively through the cranial pedicle causes milder, insignificant histological alterations, when compared with irrigation exclusively through the caudal pedicle; irrigation exclusively through the caudal pedicle causes more pronounced, but still insignificant, histological alterations when compared with other forms of devascularization.(AU)

OBJETIVO: Investigar as alterações microscópicas no músculo reto do abdome de ratos submetidos a cinco técnicas de autonomização. MÉTODOS: Utilizaram-se 30 ratos machos Holtzmann, pesando entre 250 e 350 gramas. Os animais foram distribuídos em cinco grupos (n=6): A - secção cranial do músculo direito; B - secção caudal do músculo direito; C - secção cranial e caudal do músculo direito; D - secção cranial rebatendo o músculo direito no sentido cranial-caudal; E - secção caudal rebatendo o músculo direito no sentido caudal-cranial. No sétimo dia pós-operatório, ressecou-se um fragmento cranial e caudal dos músculos direito e esquerdo, respectivamente, para estudo microscópico. As alterações histológicas foram quantificadas e comparados os fragmentos dos músculos direito aos do esquerdo (controle). Utilizou-se, para fins estatísticos, o teste exato de Fisher, com nível de significância de 5 por cento. RESULTADOS: A comparação entre os músculos direito e esquerdo demonstrou significância estatística no grupo A - infiltrado inflamatório no fragmento cranial (p=0,015); no grupo C - infiltrado inflamatório (p=0,000) e necrose (p=0,015) no fragmento caudal; e no grupo E - edema no fragmento caudal (p=0,000). Não foram observadas alterações significativas nos grupos B e D. CONCLUSÕES: A irrigação exclusiva pelos vasos musculares perfurantes é inadequada; a irrigação exclusiva pelo pedículo cranial causa alterações histológicas menos acentuadas, não-significantes, em comparação à irrigação exclusiva pelo pedículo caudal; a irrigação exclusiva pelo pedículo caudal causa alterações histológicas mais acentuadas, não-significantes, em comparação com as demais formas de desvascularização.(AU)

Circular local skin flap: a new approach to areola reconstruction / Retalho circular de pele local. Uma nova abordagem para a reconstrução da aréola

PURPOSE: Despite the numerous surgical options available today for nipple-areola reconstruction, the results are often unsatisfactory. The present study proposes a simple and efficient method for areola reconstruction that uses a circular local skin flap. METHODS: We prospectively followed five patients that underwent areola reconstruction using a circular local skin flap. A circle, approximately 5 cm in diameter, was marked on the desired area for the new areola. A thin centripetal undermining of 1.5-2 cm was performed, which created a flap with a central pedicle of approximately 1-2 cm. After hemostasis, the thin flap was fixed in its former position with continuous sutures. RESULTS:The mean procedure time was 20 minutes (± 9). The postoperative results were classified as satisfactory by four of the five patients at six months postoperative. Due to superficial undermining, the resulting scar resembled the appearance of the transition from the mammary skin to the areola. Dermopigmentation was only required in one areola. No complications such as dehiscence, necrosis, hematoma, or infection occurred. CONCLUSION: This technique achieved satisfactory results with low morbidity and few complications, and is thus a potentially promising resource for areola reconstruction.(AU)

OBJETIVO: A reconstrução da aréola tem sofrido muitas inovações. Apesar do grande número de opções cirúrgicas, os resultados são muitas vezes insatisfatórios. Este estudo descreve um procedimento simples e eficiente para a reconstrução da aréola com um retalho circular de pele local. MÉTODOS: Os autores avaliaram prospectivamente cinco pacientes submetidas à reconstrução da aréola no período de 2004 a 2005. A reconstrução da aréola foi baseada em um retalho circular de pele local. A técnica inicia com a marcação de um círculo de aproximadamente cinco centímetros de diâmetro no local da nova aréola. Um descolamento centrípeto superficial de 1,5-2 cm é realizado, criando um retalho com pedículo central de aproximadamente 1-2 cm de diâmetro. Após a hemostasia, o fino retalho é suturado em sua antiga posição, com pontos contínuos. RESULTADOS: O procedimento levou em média 20 minutos (± 9). O resultado pós-operatório foi classificado como satisfatório por quatro das cinco pacientes no sexto mês de pós-operatório. Em virtude do descolamento superficial, o aspecto final da cicatriz simulou a transição entre a pele da mama e a aréola. Dermopigmentação foi necessária em apenas uma aréola. Não ocorreram complicações como deiscência, necrose, hematoma ou infecção. CONCLUSÃO: A técnica descrita apresentou resultados satisfatórios com morbidade reduzida e baixos índices de complicações; tornando-se, no arsenal do Cirurgião Plástico, uma alternativa interessante para a reconstrução da aréola.(AU)

Circular local skin flap: a new approach to areola reconstruction / Retalho circular de pele local. Uma nova abordagem para a reconstrução da aréola

PURPOSE: Despite the numerous surgical options available today for nipple-areola reconstruction, the results are often unsatisfactory. The present study proposes a simple and efficient method for areola reconstruction that uses a circular local skin flap. METHODS: We prospectively followed five patients that underwent areola reconstruction using a circular local skin flap. A circle, approximately 5 cm in diameter, was marked on the desired area for the new areola. A thin centripetal undermining of 1.5-2 cm was performed, which created a flap with a central pedicle of approximately 1-2 cm. After hemostasis, the thin flap was fixed in its former position with continuous sutures. RESULTS:The mean procedure time was 20 minutes (± 9). The postoperative results were classified as satisfactory by four of the five patients at six months postoperative. Due to superficial undermining, the resulting scar resembled the appearance of the transition from the mammary skin to the areola. Dermopigmentation was only required in one areola. No complications such as dehiscence, necrosis, hematoma, or infection occurred. CONCLUSION: This technique achieved satisfactory results with low morbidity and few complications, and is thus a potentially promising resource for areola reconstruction.

OBJETIVO: A reconstrução da aréola tem sofrido muitas inovações. Apesar do grande número de opções cirúrgicas, os resultados são muitas vezes insatisfatórios. Este estudo descreve um procedimento simples e eficiente para a reconstrução da aréola com um retalho circular de pele local. MÉTODOS: Os autores avaliaram prospectivamente cinco pacientes submetidas à reconstrução da aréola no período de 2004 a 2005. A reconstrução da aréola foi baseada em um retalho circular de pele local. A técnica inicia com a marcação de um círculo de aproximadamente cinco centímetros de diâmetro no local da nova aréola. Um descolamento centrípeto superficial de 1,5-2 cm é realizado, criando um retalho com pedículo central de aproximadamente 1-2 cm de diâmetro. Após a hemostasia, o fino retalho é suturado em sua antiga posição, com pontos contínuos. RESULTADOS: O procedimento levou em média 20 minutos (± 9). O resultado pós-operatório foi classificado como satisfatório por quatro das cinco pacientes no sexto mês de pós-operatório. Em virtude do descolamento superficial, o aspecto final da cicatriz simulou a transição entre a pele da mama e a aréola. Dermopigmentação foi necessária em apenas uma aréola. Não ocorreram complicações como deiscência, necrose, hematoma ou infecção. CONCLUSÃO: A técnica descrita apresentou resultados satisfatórios com morbidade reduzida e baixos índices de complicações; tornando-se, no arsenal do Cirurgião Plástico, uma alternativa interessante para a reconstrução da aréola.