Indução da lactação em mulheres nuligestas: relato de experiência / Inducción de la lactancia en mujeres nuligestas: informe de experiencia / Lactation induction in women who never got pregnant: experience report

Resumo Objetivo relatar a experiência de indução da lactação em nuligestas realizada por enfermeira consultora em aleitamento. Método relato de experiência. O processo de indução láctea foi realizado com três mulheres por motivo de gestação em útero de substituição e relacionamento homoafetivo. Resultados todas perceberam o aumento de tamanho e a sensibilidade nas mamas, bem como apresentaram secreção láctea. No entanto, a continuidade da amamentação foi diferenciada entre elas. A primeira não recebeu apoio de profissionais de saúde no contexto de pós-parto hospitalar, nem em casa, e não deu continuidade à amamentação. A segunda recebeu apoio da equipe do hospital e da parceira, amamentando por três meses. A terceira, com o apoio da parceira, amamentou por dois meses, mas interrompeu por sentir-se inibida por familiares. Conclusão e implicações para a prática a técnica de indução é capaz de desencadear a produção láctea. Já o processo de amamentação só se estabeleceu mediante a associação com a rede de apoio, o acolhimento, o incentivo da equipe de saúde e o olhar integral à mulher e sua família. Dessa forma, o cuidado de Enfermagem na indução láctea não deve focar apenas no manejo da indução, mas transcender o aspecto técnico, o que se mostra como fundamental para a proteção, o estabelecimento e a continuidade da amamentação.

Resumen Objetivo reportar la experiencia de inducir la lactancia en nuligestas realizada por una consultora de enfermería en lactancia materna. Método relato de experiencia. El proceso de inducción de la leche se realizó con tres mujeres por embarazo en útero de reemplazo y relación homoafectiva. Resultados todas notaron el aumento de tamaño y la sensibilidad en las mamas, además de presentar secreción de leche. Sin embargo, la continuidad de la lactancia materna se diferencia entre ellos. La primera no recibió apoyo de los profesionales de la salud en el contexto posparto hospitalario, ni en el domicilio, y no continuó con la lactancia. La segunda recibió apoyo del personal del hospital y su pareja, amamantando durante tres meses. La tercera, con el apoyo de su pareja, amamantó durante dos meses, pero la interrumpió porque se sentía inhibida por familiares. Conclusión e implicaciones para la práctica la técnica de inducción es capaz de desencadenar la producción de leche. El proceso de lactancia materna, en cambio, solo se estableció a través de la asociación con la red de apoyo, la acogida, el estímulo del equipo de salud y la mirada integral a la mujer y su familia. Así, el cuidado de Enfermería en la inducción de la leche no debe enfocarse solo en el manejo de la inducción, sino trascender el aspecto técnico, que se muestra fundamental para la protección, el establecimiento y la continuidad de la lactancia materna.

Abstract Objective to report the experience of lactation induction in women who never got pregnant by a lactation consultant nurse. Method experience report. The process of lactation induction was performed with three women due to surrogate pregnancy and homosexual relationships. Results all noticed an increase in the size and sensitivity of the breasts, as well as milk secretion. However, the continuity of breastfeeding was different between them. The first did not receive support from health professionals in the postpartum hospital setting, nor at home, and did not continue breastfeeding. The second received support from the hospital staff and her partner, breastfeeding for three months. The third, with the support of her partner, breastfed for two months, but stopped because she felt inhibited by family members. Conclusion and implications for practice the induction technique is capable of triggering milk production. However, the breastfeeding process was only established through the association with the support network, the reception, the encouragement of the health team, and the comprehensive view of the woman and her family. Thus, nursing care in lactation induction should not focus only on the management of induction, but transcend the technical aspect, which is essential for the protection, establishment, and continuity of breastfeeding.

A new clinical presentation: breast implant pneumocapsule and pneumothorax following penetrating chest wall trauma.

Pneumothorax resulting from traumatic thoracic injury is a potentially life-threatening emergency requiring prompt recognition and management with an intercostal drain. A 34-year-old woman was brought into the emergency department after sustaining a stab injury to the right upper outer quadrant of the right breast. She described noticing a jelly-like substance from her wound, on the background of a prior cosmetic breast augmentation. On examination, it was noted that the right breast was significantly swollen. Computed tomography demonstrated a large right sided pneumothorax with associated punctured right breast implant, a 'pneumocapsule' and extensive subcutaneous emphysema of the breast. This case highlights that the fibrous tissue capsule around a breast implant can function as an anatomical space in continuity with the thoracic cavity, masking the diagnosis of pneumothorax in penetrating trauma.

14-year-old girl • history of bullying • lack of social support • multiple linear scars on breasts • Dx?

► History of bullying ► Lack of social support ► Multiple linear scars on breasts.

Sports Medicine-Related Breast and Chest Conditions-Update of Current Literature.

ABSTRACT: This article reviews the most up-to-date evidence-based recommendations pertaining to breast and upper chest conditions, specifically for the sports medicine physician. Because of the unique circumstances of the team physician, they can see a wide breadth of pathology. Athletes may not have a primary care physician and may prefer to present to their team physician for breast and upper chest conditions. It is often more comfortable and convenient for athletes to seek treatment in the team setting. Therefore, it is important that the medical professional be aware of not only common pathology but also of that which is rarer. Any delay in evaluation can result in unnecessary morbidity and lead to complications or extended time lost from sport. Consequently, it also is important to facilitate an atmosphere encouraging early presentation and workup.

Breast Hematoma: An Under-Recognized and Under-Reported Female-Specific Traumatic Injury and Its Clinical Significance.

Female-specific traumatic injury patterns have not been well researched and are potentially not well documented. Our aim was to examine the prevalence of breast hematomas (BHs) after blunt chest trauma, and to evaluate if there were risk factors associated with BH requiring intervention. A retrospective review from 2013 to 2018 was performed, identifying female patients ≥18 years sustaining blunt chest trauma. BH was defined as the presence of a collection of blood within the breast parenchyma, and clinically significant breast hematoma (CSBH) as BH requiring blood transfusion, surgical, or interventional radiology intervention. Univariate analysis was performed comparing CSBH with BH in terms of demographics, injury severity, antithrombotic agent use, and body mass index (BMI). Of 871 female patients meeting criteria, 59 (7%) had BH. Of these, 10 (17%) had CSBH (transfusion only, n = 3; angioembolization, n = 4; operation, n = 3). Compared to BH not requiring intervention, CSBH patients were older (mean age, 80 vs 69, P = .006), but had similar rates of motor vehicle crashes (90% vs 78%), seatbelt use (70% vs 71%), antiplatelet use (10% vs 12%), and anticoagulant use (10% vs 6%). Median Injury Severity Scores and median BMI (34 vs 34) were similar between the groups.

Use and perception of breast protective equipment by female contact football players.

OBJECTIVES: Female contact football players sustain contact breast injuries that can negatively affect their sporting performance. This study investigated what female contact football players wear on their breasts during training and competition, and their perceptions on the protection provided by these garments against contact breast injury. DESIGN: A custom-designed survey about breast injuries and prevention strategies was distributed via an online link to coaches and team staff of contact football teams throughout Australia. The fit and features of breast support and/or protection that players wore during training and competition were also directly assessed. METHODS: 207 female Australian Football League (AFL), Rugby League, Rugby Union (XVs) and Rugby 7s players completed the survey. The breast support of 112 of these players was also assessed. RESULTS: Only 17% (n=35) of players reported using breast protective equipment, of which 66% (n=23) perceived it provided protection against contact breast injuries. Reasons reported for not using protective equipment included not knowing it existed (n=79, 53%), it was too uncomfortable/hot (n=50, 24%) and that it did not fit or was restrictive (n=33, 22%). Although most players (n=97, 87%) reported to wear a sports bra, 52% (n=58) wore an ill-fitted bra and only 31% (n=63) perceived it provided any protection against contact breast injuries. CONCLUSIONS: Breast protective equipment is not commonly worn by female contact football players reportedly due to a lack of awareness of its existence, discomfort or poor fit. Although most female contact football players usually wore a sports bra, most players perceived these bras did not provide breast protection.

Arterial contrast extravasation in severe seat belt-related female breast trauma on CT: Conservative management at a level 1 trauma centre.

Seat belt-related female breast trauma (SFBT) is an uncommon cause of haemorrhage following motor vehicle collision. Classification systems have been used to grade the severity of SFBT, ranging from mild class I to severe class IV injuries with evidence of active haemorrhage. In the case of class IV injuries, contrast extravasation represents active haemorrhage, prompting angiographic embolisation or surgery to arrest the bleed. Contrary to the majority of reports published in the literature, our institution has been successful with conservative management of class IV SFBT. None of the patients required specific intervention to control haemorrhage from SFBT.

Reconstruction of Severe Burns to the Breast in Pediatric Patients: A 10-Year Experience.

The breast and anterior chest are the most commonly burned part of the trunk. Burn injuries to the breast can be associated with pain, asymmetries, and significant social stigma. Burns to the breast bud in the young female may inhibit normal breast development and result in either significant asymmetries or amastia, making the treatment of breast burn injuries challenging. A retrospective chart review was conducted on all female patients under the age of 21 years admitted to our institution for breast burn injuries from January 1, 2008 to December 30, 2018. Patients were included if they had follow-up reconstructive procedures for breast burn injuries many days after their acute-phase treatment. Ninety-six patients aged 1 to 20 years have been admitted to our institution with burned breast injuries. The mean age of this cohort (n = 96) was 6.4 ± 4.8 years with a mean percent TBSA of 36.3 ± 21.4 and a mean time since injury from admission of 2279.1 ± 2284.1 days. Flame burns (66.8 percent) were the most common etiology for breast burn injuries, followed by scald burns (22.8 percent), in this cohort. The mean body mass index was 22.7 ± 6.3 kg/m2. Follow-up for reconstructive procedures was 7.2 ± 5.6 years after injury date. Our institution's 10-year experience of 96 female patients with severe burn injuries has enhanced our understanding of reconstructive techniques. The location, size, anatomic extent, type of deformity, and symmetry must all be assessed before any treatment plans, which may need to include a combination of modalities.

Post-traumatic necrotising fasciitis of the breast: a case study with literature review.

Necrotising fasciitis is a rare infection of the skin and underlying soft tissue. It primarily involves the extremities and rarely the breast. Primary necrotising fasciitis of the breast in a non-lactating, healthy female is rarer still. The authors present the case report of a patient presenting with primary necrotising fasciitis of the breast after sustaining a penetrating injury. The patient was managed successfully with serial debridement and negative pressure wound therapy (NPWT). To our knowledge only 19 such cases have been reported in the indexed literature so far. This is also the eighth case globally of primary necrotising fasciitis of the breast in a non-lactating female without any associated immunosuppression, which is the basis of reporting this case.

Estudo comparativo entre reconstrução imediata com prótese versus abordagem expansor-prótese / Comparative study of immediate implant and expander-implant reconstruction

Introdução: Ao longo dos últimos anos os benefícios das reconstruções imediatas se tornaram cada vez mais documentados na literatura e, hoje, o predomínio é pelas reconstruções imediatas. Nos últimos anos, o número de reconstruções com expansores e próteses tem aumentado. Métodos: Estudo retrospectivo entre 2013 e 2014. Foram incluídas as pacientes submetidas à mastectomia, seguida de reconstrução de mama, e assim separadas em dois grupos: 1 - submetida a reconstrução direta com prótese e 2 - expansor. Diversos dados foram avaliados. Resultados: Foram realizadas 138 reconstruções assim divididos: 57 com prótese e 81 com expansor-prótese. As complicações pós-operatórias não mostraram diferença entre os grupos. Radioterapia não teve influência nas complicações. Pacientes que fizeram reconstrução com prótese realizaram menos cirurgias (1,78 vs 2,54) e menos retornos pós-operatórios (8 vs 11,75). Conclusão: As reconstruções imediatas com prótese ou expansor apresentam baixas e semelhantes taxas de complicações pós-operatórias. Pacientes submetidas às reconstruções com prótese tiveram menor taxa de retorno e número de cirurgias para finalizar a reconstrução.

Introduction: The benefits of immediate reconstruction have been increasingly documented in the literature over the past few years. Today, with some exceptions, immediate reconstruction is the preferred surgical choice for breast cancer patients. In the recent years, the number of reconstructions using expanders and implants has increased. Methods: This retrospective study conducted between 2013 and 2014 included patients undergoing mastectomy followed by breast reconstruction, who were divided into direct implant reconstruction and expander treatment groups. Several variables were evaluated. Results: A total of 138 reconstructions (57 implants and 81 expander-implant) were performed. There were no intergroup differences in postoperative complications. Radiotherapy did not influence complications. Implant reconstruction patients underwent fewer surgeries (1.78 vs 2.54) and had fewer postoperative returns (8 vs 11.75). Conclusion: Immediate implant and expander-implant reconstruction approaches present low and similar postoperative complication rates. Patients undergoing implant reconstruction had a lower return rate and underwent fewer surgeries than those undergoing expander-implant reconstruction.

The Occurrence, Causes and Perceived Performance Effects of Breast Injuries in Elite Female Athletes.

Female breasts are vulnerable to direct blows or frictional injuries during sport; however, little research has investigated breast injuries experienced by female athletes. This study aimed to investigate the occurrence, causes and perceived performance effects of breast injuries in elite female athletes across a wide range of sports. A custom-designed survey was distributed to female athletes aged over 18 years who were competing nationally or internationally in their chosen sport. The survey included questions about breast injuries sustained during training and competition and any perceived performance effects of these injuries. 504 elite female athletes from 46 different sports completed the survey. 36% of participants (n = 182) reported experiencing breast injuries and 21% (n = 37) perceived that their breast injury negatively affected their performance. Contact breast injuries were reported by significantly more athletes involved in contact or combat sports and by athletes with larger breasts or a higher body mass index. Frictional breast injuries were reported by significantly more older athletes or those with larger breasts. Less than 10% of participants who experienced breast injuries reported their injury to a coach or medical professional and only half used any prevention strategies. Athletes, coaches and medical professionals associated with women's sport need to be made aware of the occurrence and potential negative effects of breast injuries. It is critical to normalise conversations around breast health so that athletes can be encouraged to report and, when necessary, receive treatment for breast injuries. Further research is also required to better understand factors that affect breast injuries in sport in order to develop evidence-based breast injury prevention strategies.

Breast symptoms in adolescents and young adults presenting to a specialist breast clinic.

BACKGROUND AND OBJECTIVES: While breast cancer is rare in adolescents and young adults (AYAs), breast symptoms are common. The aim of this study was to report breast symptoms that prompted referral of AYAs and to examine diagnoses and treatment. METHOD: A retrospective study of AYAs aged ≤25 years who presented in a specialist breast clinic (2007-18) was conducted. Data regarding presentation, diagnosis and management were collected. RESULTS: One hundred and thirty-four (128 female, six male) AYAs, with a median age of 21 years, attended the breast clinic in the study period. There was one case of breast cancer (incidence 0.8%). In females, the most frequent presenting symptoms were 'lump' (n = 68, 53.1%), 'nipple/areola symptom' (n = 14, 10.9%) and 'discuss risk of breast cancer' (n = 10, 8.3%). In males, 'lump' was the most common presenting symptom (n = 5, 83%) and all were cases of gynaecomastia. DISCUSSION: A range of breast symptoms are found in AYAs and most can be treated conservatively. Awareness of symptoms and their management will help general practitioners treat young people with breast issues.

Trauma on a Recently Augmented Breast as a Trigger for Mondor's Disease.

Mondor's disease is the eponym used to describe a self-limited phlebitis or thrombophlebitis of the superficial veins localized mainly on the thoracoabdominal area of the human body. Its clinical manifestation includes painful superficial cords causing skin retraction. This medical condition could be idiopathic, iatrogenic or a manifestation of underlying pathology such as breast cancer and seems to be more common than has been previously thought. The vast majority of the clinical studies and case reports to date focus on Mondor's disease as a disorder which is more or less directly related to a previous surgical intervention. In this case report, the author discusses the possible role of breast surgery as a predisposing factor only and the trauma on the operated breast as a trigger for onset and earlier manifestation of Mondor's disease. A special emphasis is put on the importance of trauma prevention in breast augmentation surgery, especially when maneuvers like postoperative massages are considered.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Complicações da reconstrução imediata da mama após mastectomia total com uso de prótese cônica e não cônica / Complications of immediate breast reconstruction after total mastectomy using conical and non-conical prostheses

Introdução: No biênio 2016-2017 foram estimados pelo Instituto Nacional do Câncer (INCA) aproximadamente 2.160 casos novos de câncer para o estado do Ceará e 57.960 casos novos para cada 100.000 mulheres no Brasil. A reconstrução mamária com implante de material aloplástico apresenta complicações cirúrgicas precoces e tardias que são direta ou indiretamente relacionadas à técnica cirúrgica utilizada para a realização da mastectomia e a implantação do material sintético. O presente estudo tem por objetivo analisar as complicações encontradas em um grupo de pacientes submetidas à reconstrução mamária imediata com uso de prótese cônica e não cônica. Métodos: Corresponde a um estudo de coorte transversal, retrospectivo, observacional com análise de prontuário de pacientes que foram submetidos à mastectomia total poupadora de pele com reconstrução imediata da mama com o uso de prótese cônica e não cônica, no período de janeiro de 2016 a janeiro de 2018, realizada pelo Serviço de Cirurgia Plástica e Microcirurgia Reconstrutiva do HUWC da Universidade Federal do Ceará. Resultados: As complicações ocorreram em 13 (54,1%). A prótese que apresentou o maior número de complicações foi a de formato cônico, com complicações em 7 (63,6%) pacientes, enquanto somente 6 (46,1%) pacientes com prótese de formato não cônica apresentaram complicações. Conclusão: O nosso estudo mostrou maior frequência de complicações com o uso de próteses cônicas em relação à não cônica devido principalmente à formação de uma área de sofrimento na ponta da prótese cônica que resultou em extrusão das mesmas.

Introduction: In the biennium 2016-2017, approximately 2,160 new cancer cases were identified by the Brazilian National Cancer Institute (Instituto Nacional do Câncer; INCA) for the state of Ceará and 57,960 new cases for every 100,000 women in Brazil. Breast reconstruction with alloplastic implants presents early and late surgical complications directly or indirectly related to the surgical technique used to perform mastectomy and implantation of the synthetic material. This study aimed to analyze the complications found in a group of patients submitted for immediate breast reconstruction using conical and non-conical prostheses. Methods: This is a cross-sectional, retrospective, observational cohort study that analyzed the medical records of patients who underwent skin-sparing total mastectomy with immediate breast reconstruction using conical and non-conical prostheses, performed by the Plastic Surgery and Reconstructive Microsurgery Service at the HUWC of the Federal University of Ceará from January 2016 to 2018. Results: A total of 13 (54.1%) patients presented with complications. The conical prostheses showed the highest number of complications, i.e., 7 (63.6%) patients, whereas only 6 (46.1%) patients with non-conical prostheses had complications. Conclusion: Our study showed a higher frequency of complications with the use of conical prostheses when compared to non-conical prostheses, mainly due to the formation of a sore area at the tip of the conical prosthesis that resulted in extrusion.

Reconstrução mamária em decúbito único lateral com retalho miocutâneo do músculo grande dorsal e implante de silicone: sistematização e série de casos / Breast reconstruction with latissimus dorsi myocutaneous flap and silicone implant in the single lateral decubitus position: systematization and case series

Introdução: O câncer de mama é afecção de grande relevância para a saúde pública, sendo que seu tratamento cirúrgico e a reconstrução mamária evoluíram bastante ao longo do tempo. A utilização do retalho miocutâneo do grande dorsal (RMGD) com implante mamário de silicone apresenta-se como um verdadeiro cavalo de batalha ao cirurgião plástico em função de sua confiabilidade anatômica e segurança. Realizar esta cirurgia em decúbito único lateral torna o procedimento mais breve e mantém os resultados da técnica convencional. O objetivo do estudo é apresentar a sistematização desta cirurgia em uma série de casos. Método: Estudo retrospectivo realizado por análise de prontuários e documentação fotográfica de 29 pacientes operadas pelo autor e submetidas à reconstrução mamária com RMGD e implante de silicone em decúbito único lateral. Resultados: Houve um caso de extrusão do implante de silicone por seroma e infecção no sítio receptor (3,5%). Uma paciente cursou com seroma no dorso (3,5%). Um caso de necrose parcial da ilha de pele do retalho (3,5%) e dois casos de sofrimento do envelope cutâneo da mastectomia (7,0%). Uma paciente necessitou retirada do implante de silicone por extensa recidiva local (3,5%). Um caso de contratura capsular Baker III após radioterapia adjuvante (3,5%). Quatro pacientes tiveram suas cicatrizes revisadas (14%). Três pacientes tiveram limitação de movimentos (10,5%). Os resultados mostraram-se compatíveis com os apresentados para a técnica convencional na literatura vigente. Conclusão: A sistematização desta técnica dispensa mudança de decúbito e torna o procedimento mais breve, mantendo sua segurança e confiabilidade.

Introduction: Breast cancer is an important public health condition, and its surgical treatment and the subsequent breast reconstruction has evolved significantly over time. The use of the latissimus dorsi myocutaneous flap (LDMF) with silicone breast implants is a mainstay of plastic surgeons due to the anatomical reliability and safety. Performing this surgery in the single lateral decubitus position makes the procedure shorter and maintains the results of the conventional technique. The objective of this study was to present a systematization of this surgery from a series of cases. Method: Retrospective study using medical records and photographic documentation of 29 patients operated on by the author and submitted to breast reconstruction with a LDMF and silicone implant in a lateral decubitus position. Results: Silicone implant extrusion due to seroma and infection at the receptor site was noted in one patient (3.5%). One patient had a seroma on the back (3.5%); there was one patient with partial necrosis of the skin island of the flap (3.5%), and two patients with mastectomy skin envelope (7.0%). One patient required removal of the silicone implant due to extensive local recurrence (3.5%) while another patient showed Baker III capsular contracture after adjuvant radiotherapy (3.5%). Four patients had scar review (14%), and three patients showed limitation of movement (10.5%). The results were comparable to those reported for the conventional technique. Conclusion: The systematization of this technique requires no change of the decubitus position and makes the procedure shorter, while maintaining safety and reliability.