Qual o impacto da capsulectomia nos sintomas sistêmicos atribuídos às próteses mamárias de silicone? Revisão sistemática da literatura / What is the impact of capsulectomy on systemic symptoms attributed to silicone breast implants? Systematic literature review

Introdução: Diversos estudos têm analisado a possível relação entre a prótese mamária de silicone e sintomas sistêmicos. A remoção das próteses de mama com capsulectomia tem sido indicada na tentativa de melhorar esses sintomas. É necessário que o cirurgião tenha dados embasados na literatura para informar ao paciente se há relação entre retirada de prótese de mama com capsulectomia e melhora dos sintomas, qual a taxa de melhora e por quanto tempo se mantém. Método: Foi realizada pesquisa nos bancos de dados virtuais Cochrane Library e PubMed de janeiro de 1990 até abril de 2023. A busca foi realizada pela combinação de termos livres ("breast implant illness", "breast capsulectomy" e "breast implant explantation") e pelo uso de operadores booleanos para descritores Mesh como [autoimmune diseases (MeSH Terms)] e [breast implant (MeSH Terms)]. Resultados: Foram obtidos 1.203 artigos, sendo 14 selecionados para o estudo, consistindo em 7 artigos de coorte retrospectivo, 3 de coorte prospectivo e 4 caso-controle. A taxa de melhora variou entre 50 e 100% dos casos e o tempo de acompanhamento variou entre 2 meses e 2,7 anos. Diversos tipos de capsulectomia foram realizados nos estudos, com taxas semelhantes de melhora. Conclusão: Há evidências de melhora dos sintomas sistêmicos em pacientes com prótese mamária de silicone submetidas a retirada de prótese de mama com capsulectomia. A melhora dos sintomas persistiu durante o período em que as pacientes foram acompanhadas nos estudos. Estudos mais recentes demonstraram que o tipo de capsulectomia não tem influência na melhora dos sintomas sistêmicos.

Introduction: Several studies have analyzed the possible relationship between silicone breast implants and systemic symptoms. Removal of breast implants with capsulectomy has been indicated in an attempt to improve these symptoms. The surgeon must have data based on the literature to inform the patient whether there is a relationship between the removal of a breast prosthesis with capsulectomy and improvement in symptoms, what is the rate of improvement, and how long it lasts. Method: A search was carried out in the Cochrane Library and PubMed virtual databases from January 1990 to April 2023. The search was carried out using a combination of free terms ("breast implant illness", "breast capsulectomy," and "breast implant explantation") and by using Boolean operators for Mesh descriptors such as [autoimmune diseases (MeSH Terms)] and [breast implant (MeSH Terms)]. Results: 1,203 articles were obtained, 14 of which were selected for the study, consisting of 7 retrospective cohort articles, 3 prospective cohort articles, and 4 case-control articles. The improvement rate varied between 50 and 100% of cases, and the follow-up time varied between 2 months and 2.7 years. Several types of capsulectomies were performed in the studies, with similar rates of improvement. Conclusion: There is evidence of improvement in systemic symptoms in patients with silicone breast implants who underwent breast implant removal with capsulectomy. The improvement in symptoms persisted during the period in which the patients were followed in the studies. More recent studies have demonstrated that the type of capsulectomy does not influence the improvement of systemic symptoms.

Mama supranumeraria: resección mediante técnica abierta con dren versus sin dren / Supranumerary breast: resection by open technique with drain vs without drain

Introducción. El tejido mamario accesorio es una anomalía congénita que se presenta en el 2-6 % de la población femenina. En este tejido se pueden desarrollar las mismas patologías que en la mama normal. El manejo curativo es la resección quirúrgica. El objetivo de este estudio fue comparar los resultados de la técnica de resección vía abierta de tejido mamario accesorio con dren vs sin dren. Métodos. Se realizó un estudio observacional tipo cohorte retrospectivo, teniendo en cuenta dos grupos de pacientes con tejido mamario accesorio: a uno de ellos se les realizó resección quirúrgica mediante técnica abierta con dren y al otro grupo sin dren. Además, se incluyó un brazo prospectivo donde se evaluó la calidad de vida y la satisfacción de las pacientes con el resultado posoperatorio mediante el uso de la herramienta Breast-Q. Resultados. Se recolectó la información de 82 pacientes, la mayoría mujeres; 22 se intervinieron con técnica con dren y 60 con técnica sin dren. 13,6 % de los pacientes presentaron complicaciones tempranas, siendo la infección de sitio operatorio la más frecuente (36,4 %). En general, las complicaciones fueron más comunes en el grupo con dren (40,9 % vs 3,4 %), con una diferencia estadísticamente significativa (p=0,000). La calidad de vida fue similar en ambos grupos. Conclusiones. Los pacientes a quienes se les realizó resección de mama supernumeraria y se dejó un sistema de drenaje en el lecho de disección presentaron más complicaciones posoperatorias que las pacientes a quienes no se les dejó dren

Introduction. Accessory breast tissue is a congenital anomaly that occurs in 2-6% of the female population. It can develop the same pathologies that in the normal breast. The curative management of this pathology is surgical resection. The objective of this study was to compare the results of the accessory breast tissue open resection technique with a drain vs without a drain. Methods. An observational retrospective cohort study was conducted considering two groups of patients with accessory breast tissue: one of them underwent surgical resection using an open technique with a drain and the other group without a drain. In addition, a prospective arm where the quality of life and satisfaction of the patients with the postoperative result was evaluated by the Breast-Q tool. Results. Eighty-two patients were included, most of them women; 22 were operated with open technique with drain and 60 without drain. 13.6% of patients presented early complications, with surgical site infection being the most frequent (36.4%) and, in general, complications were more common in the group with drain (40.9% vs 3.4%) with a statistically significant difference (p=0.000). Quality of life was similar in both groups.Conclusions. Patients who undergo supernumerary breast resection and leaving drainage in the dissection bed present more postoperative complications compared to those without drain

Mastalgia and associated breast diseases in a tertiary care center, Tamil Nadu: A cross-sectional study

Background: Mastalgia is the common breast condition among women. Mastalgia has highly variable prevalence which ranges 41–79%. It is more common in age group between 30 and 50 years. Mastalgia is approached according to its classification into three major categories, that is, cyclical pain, non-cyclical pain, and extra mammary pain. Breast pain ranges from mild to severe influencing the lifestyle of women affecting sexual relations, sleep pattern, and decreasing their daily life activities. Aim and Objectives: The aim of the study was to determine the incidence of benign and malignant breast disease in mastalgia. Materials and Methods: This cross-sectional study was conducted in Government Medical College, Sivagangai. Patients complaining of breast pain were examined. The data were compiled in an Excel worksheet, Epiinfo version 7.0 was used to analyze the data. Results: In our study, 100 patients complaining of breast pain were examined ranging from age 18 to 68 years. The mean age of the study population was 37.54 years and standard deviation of 9.077. Among 100 patients with mastalgia only 1 (1.64%) had malignancy which is insignificant and among rest 99 patients with mastalgia, 60.61% had benign breast diseases and 39.39% had no any breast lesions. Benign breast diseases are more commonly found in patients with mastalgia. Conclusion: Women having mastalgia can be reassured and some lifestyle modifications may aid the women. Hence, early detection of any breast disease in women having mastalgia and treating accordingly has considerable importance. Lifestyle modifications are needed in patients with mastalgia and they should come to facility to check and identify the issues and solve soon.

Galactorrhea after breast augmentation: case report and literature review / Galactorreia após mamoplastia de aumento: relato de caso e revisão da literatura

Introduction: Augmentation mammoplasty is one of the most frequently performed surgeries in plastic surgery. Among its rarer occurrences are galactorrhea, spontaneous milk output by the papilla, and galactocele, a collection of milky material in the surgical bed. There is little literature on this extremely rare occurrence, and through this article, we conduct a literature review and report on a case operated in our service. Case Report: We present a case of a 35-year-old patient who underwent breast augmentation surgery via the inframammary fold, with an implant placed in the subglandular plane, which evolved, on the thirtieth postoperative day, with galactorrhea exteriorized through the incision, and we propose a treatment for such intercurrence. Six months after the operation, the breasts were symmetrical, without signs of contracture or additional alterations; the patient was satisfied with the result and without new episodes of galactorrhea or galactocele. Conclusion: Although rare, with an incidence of less than 1%, galactorrhea can occur as a postoperative complication, and knowledge about it, as well as the forms of treatment, will benefit both patient and surgeon.

Introdução: A mamoplastia de aumento é uma das cirurgias mais frequentemente realizadas na cirurgia plástica. Entre suas intercorrências mais raras, está a galactorreia, saída de leite pela papila de forma espontânea, e o galactocele, uma coleção de material leitoso no leito cirúrgico. Pouca literatura existe sobre esta raríssima intercorrência e por meio deste artigo realizamos uma revisão da literatura e relato de um caso operado no nosso serviço. Relato de Caso: Apresentamos um caso de uma paciente de 35 anos que foi submetida a cirurgia de mamoplastia de aumento via sulco inframamário, com implante alocado no plano subglandular, que evoluiu, no trigésimo dia pós-operatório, com galactorreia exteriorizada pela incisão, e propomos um tratamento para tal intercorrência. Com seis meses de pós-operatório, as mamas se encontravam simétricas, sem sinais de contratura ou alterações adicionais, paciente satisfeita com o resultado e sem novos episódios de galactorreia ou galactocele. Conclusão: Embora rara, com uma incidência de menos de 1%, a galactorreia pode ocorrer como intercorrência pós-operatória e o conhecimento desta, bem como as formas de tratamento, irá beneficiar tanto paciente como cirurgião.

Dificuldades enfrentadas pelas consultoras em amamentação no manejo das intercorrências mamárias / Difficulties faced by lactation consultants in the management of breast complications / Dificultades de las asesoras de lactancia en el manejo de las complicaciones mamarias

Introdução: As intercorrências mamárias atuam sobre o físico e emocional das lactantes, sendo necessário intervir com rapidez. Para tanto, as consultoras em amamentação desempenham um papel fundamental nesse processo. Objetivo: analisar as dificuldades enfrentadas pelas consultoras em amamentação no manejo das intercorrências mamárias. Metodologia: Estudo descritivo e exploratório com abordagem qualitativa, realizado com 10 consultoras em amamentação do Estado da Bahia-Brasil. Como instrumento e técnica de coleta de dados, utilizou-se o roteiro de entrevista semiestruturada e a gravação na plataforma digital Google Meet. Procedeu-se a análise dos dados, utilizando análise temática de conteúdo proposta por Bardin. Principais Resultados: Percebeu-se que as dificuldades enfrentadas pelas consultoras em amamentação concentram-se nas esferas: biológicas (dor, desconforto, disfunções orais do bebê), emocionais e sociais (temor, insegurança, impotência associado ao papel mítico do amor maternal), familiares (falta de empatia das mães e avós) e multiprofissionais (dificuldade inter-relacional e comunicacional da equipe de saúde). Conclusão: As consultoras em amamentação reconhecem que existem dificuldades associadas às intercorrências mamárias, mas creditam às suas habilidades e competências o sucesso no manejo.

Introduction: Breast complications affect the physical and emotional aspects of lactating women, and it is necessary to intervene quickly. Therefore, breastfeeding consultants play a key role in this process. Objective: to analyze the difficulties faced by breastfeeding consultants in the management of breast complications. Methodology: Descriptive and exploratory study with a qualitative approach, carried out with 10 breastfeeding consultants in the State of Bahia-Brazil. As an instrument and technique for data collection, a semi-structured interview script and recording on the Google Meet digital platform were used. Data analysis was carried out using thematic content analysis proposed by Bardin. Main Results: It was noticed that the difficulties faced by breastfeeding consultants are concentrated in the spheres: biological (pain, discomfort, baby's oral dysfunctions), emotional and social (fear, insecurity, impotence associated with the mythical role of maternal love), family (lack of empathy on the part of mothers and grandmothers) and multidisciplinary (interrelational and communication difficulties on the part of the health team). Conclusion: Breastfeeding consultants recognize that there are difficulties associated with breast complications, but they credit their skills and competences for successful management.

Introducción: Las complicaciones mamarias afectan a los aspectos físicos y emocionales de las mujeres lactantes, por lo que es necesario intervenir rápidamente. Por ello, las asesoras de lactancia desempeñan un papel fundamental en este proceso. Objetivo: analizar las dificultades a las que se enfrentan las asesoras de lactancia en el manejo de las complicaciones mamarias. Metodología: Estudio descriptivo y exploratorio con abordaje cualitativo, realizado con 10 consultoras de lactancia en el Estado de Bahia- Brasil. Como instrumento y técnica de recolección de datos se utilizó un guión de entrevista semiestructurada y grabación en la plataforma digital Google Meet. El análisis de los datos se realizó mediante el análisis temático de contenido propuesto por Bardin. Principales resultados: Se constató que las dificultades enfrentadas por las consultantes de lactancia se concentran en las esferas: biológica (dolor, malestar, disfunciones bucales del bebé), emocional y social (miedo, inseguridad, impotencia asociada al papel mítico del amor materno), familiar (falta de empatía por parte de las madres y abuelas) y multidisciplinar (dificultades interrelacionales y de comunicación por parte del equipo de salud). Conclusiones: Las consultoras de lactancia reconocen que existen dificultades asociadas a las complicaciones mamarias, pero acreditan sus habilidades y competencias para un manejo exitoso.

Explante de prótese mamária de silicone: reconstrução da mama pela técnica dos retalhos cruzados / Silicone breast prosthesis explant: breast reconstruction using the crossed flap technique

Introdução: Em 1963 Cronin e Gerow introduziram o uso do implante de silicone e seu uso aumentou exponencialmente. Contudo, complicações relacionadas aos implantes surgiram ao longo do tempo. O conjunto de situações adversas ao uso dos implantes de silicone, alimentado pelo crescimento das mídias sociais, culminou em um aumento da retirada definitiva do implante. Muitos casos de explante têm o pedículo inferior comprometido pela lesão dos vasos perfurantes e a técnica dos retalhos cruzados é uma alternativa para a reconstrução das mamas explantadas. Métodos: Foram realizados explantes de silicone com reconstrução imediata da mama sem o uso de um novo implante, motivados por indicação médica ou por desejo próprio do paciente. A técnica dos retalhos cruzados foi utilizada em todos os casos. Ela se vale do cruzamento de retalhos parenquimatosos de pedículo superior, um medial e outro lateral, conforme descrito por Sperli. Resultados: Foram operados 10 casos de 2004 a 2021. O tempo de uso das próteses variou de 3 a 19 anos e a principal motivação para o explante foi contratura capsular. Nenhum caso de necrose foi observado. Conclusões: A técnica dos retalhos cruzados é uma alternativa útil e segura para as cirurgias de reconstrução da mama após explante definitivo.

Introduction: In 1963 Cronin and Gerow introduced the use of the silicone implant and its use increased exponentially. However, complications related to implants emerged over time. The set of adverse situations to the use of silicone implants fueled by the growth of social media culminated in an increase in the permanent removal of the implant. Many cases of explants have the inferior pedicle compromised by injury to the perforating vessels, and the crossed flap technique is an alternative for the reconstruction of explanted breasts. Methods: Silicone explants were performed with immediate breast reconstruction without the use of a new implant, motivated by medical indication or the patients own desire. The crossed flap technique was used in all cases. It uses the crossing of parenchymal patches of the superior pedicle, one medial and one lateral, as described by Sperli. Results: 10 cases were operated from 2004 to 2021. The time of use of the prostheses ranged from 3 to 19 years and the main motivation for the explant was capsular contracture. No cases of necrosis were observed. Conclusions: The crossed flap technique is a useful and safe alternative for breast reconstruction surgeries after definitive explantation.

Presentación clínica y hallazgos radiográficos de pacientes con diagnóstico histopatológico de mastitis granulomatosa idiopática / Clinical presentation and radiological findings of patients with histopathological diagnosis of idiopathic granulomatous mastitis

INTRODUCCIÓN. La mastitis granulomatosa idiopática es una patología inflamatoria benigna de mama con clínica y hallazgos imagenológicos no específicos; usualmente confundida con cáncer de mama. El síntoma más frecuente es una masa mamaria palpable. El diagnóstico es histopatológico. OBJETIVO. Describir el perfil demográfico, presentación clínica y hallazgos radiográficos de pacientes con diagnóstico histopatológico de mastitis granulomatosa idiopática. MATERIALES Y MÉTODOS. Estudio observacional, descriptivo, retrospectivo. Población de 1130 y muestra de 49 datos de historias clínicas electrónicas de pacientes con diagnóstico histológico de mastitis granulomatosa idiopática con el código CIE10 N61x Trastornos Inflamatorios de la mama, atendidas en la Unidad Técnica de Imagenología del Hospital de Especialidades Carlos Andrade Marín en la ciudad de Quito entre enero 2019 hasta diciembre 2021. El criterio de inclusión fue la confirmación histopatológica de mastitis granulomatosa idiopática. Los criterios de exclusión: antecedentes de neoplasia maligna de mama, antecedentes de HIV, patología inflamatoria sistémica como granulomatosis de Wegener, sarcoidosis, infecciones granulomatosas crónicas como tuberculosis, brucelosis, histoplasmosis, sífilis y reacciones a cuerpos extraños como material de implantes mamarios. Se analizaron datos demográficos, presentación clínica, hallazgos mamográficos, ecográficos y la categorización BIRADS. Se efectuó un análisis univarial; para las variables cualitativas se realizó frecuencias y porcentajes; para las variables cuantitativas se realizó medidas de tendencia central. La información recolectada fue analizada en el programa estadístico International Business Machines Statistical Package for the Social Sciences. RESULTADOS La mediana de la edad fue 36 años. El 94,00% de pacientes tenían por lo menos un hijo; 77,50% presentaron con una masa palpable; 55,10% se acompañaron de signos inflamatorios; 16,00% asociaron fístulas y 24,40% presentaron secreción. Solo 1 caso presentó afectación bilateral. CONCLUSIÓN En este estudio, la mastitis granulomatosa idiopática afecta a mujeres en edad reproductiva sin antecedentes de malignidad quienes presentan una masa mamaria palpable que puede estar acompañada de signos inflamatorios, colecciones y fístulas. La realización de una biopsia core eco guiada, para confirmar su diagnóstico.

INTRODUCTION. Idiopathic granulomatous mastitis is a benign inflammatory breast pathology with nonspecific clinical and imaging findings; usually mistaken for breast cancer. The most frequent symptom is a palpable breast mass. The diagnosis is histopathologic. OBJECTIVE. To describe the demographic profile, clinical presentation and radiographic findings of patients with histopathologic diagnosis of idiopathic granulomatous mastitis. MATERIALS AND METHODS. Observational, descriptive, retrospective study. Population of 1130 and sample of 49 data from electronic medical records of patients with histological diagnosis of idiopathic granulomatous mastitis with ICD10 code N61x Inflammatory disorders of the breast, attended at the Technical Imaging Unit of the Carlos Andrade Marín Specialties Hospital in the city of Quito between January 2019 and December 2021. The inclusion criterion was histopathological confirmation of idiopathic granulomatous mastitis. Exclusion criteria: history of malignant breast neoplasia, history of HIV, systemic inflammatory pathology such as Wegener's granulomatosis, sarcoidosis, chronic granulomatous infections such as tuberculosis, brucellosis, histoplasmosis, syphilis and reactions to foreign bodies such as breast implant material. Demographic data, clinical presentation, mammographic and ultrasound findings and BIRADS categorization were analyzed. Univariate analysis was performed; frequencies and percentages were used for qualitative variables; measures of central tendency were used for quantitative variables. RESULTS. The median age was 36 years. 94,00% of patients had at least one child; 77,50% presented with a palpable mass; 55,10% were accompanied by inflammatory signs; 16,00% were associated with fistulas and 24,40% presented with discharge. Only 1 case presented bilateral involvement. CONCLUSION. In this study, idiopathic granulomatous mastitis affects women of reproductive age with no history of malignancy who present with a palpable breast mass that may be accompanied by inflammatory signs, collections and fistulas. The performance of an echo-guided core biopsy to confirm the diagnosis.

A crescente demanda pelo explante de silicone mamário: um novo cenário para cirurgia de mamas / Growing demand for silicone breast explants: a new scenario for breast surgery

Introdução: A remoção de implantes mamários de silicone é uma cirurgia com crescente notoriedade. O avanço nos estudos sobre o linfoma BIA-ALCL (Breast Implant Associated Anaplastic Large Cell Lymphoma) e patologias inflamatórias/autoimunes relacionadas aos implantes, como a síndrome de ASIA (Autoimmune Syndrome Induced by Adjuvants), tem gerado desconforto em muitas pacientes, que optam pela sua retirada. Essa demanda traz ao cirurgião um cenário muitas vezes desafiador, no qual é preciso devolver às mamas um formato anatômico e esteticamente agradável após a retirada desse material. O objetivo é demonstrar estratégias cirúrgicas para o explante mamário de silicone. Métodos: Foram avaliadas 20 pacientes submetidas ao explante mamário, entre setembro de 2020 e março de 2021, incluindo explantes simples e associados à mastopexia. A indicação cirúrgica foi a demanda explícita das pacientes, motivadas por queixas como receio de patologias associadas, descontentamento estético, desconforto nas mamas, sintomas sistêmicos, desejo de não ter mais implantes, contratura capsular, rotação ou ruptura dos mesmos. As técnicas cirúrgicas são descritas. Resultados: Foi realizado o explante simples em 7 pacientes e em 13 foi feito o explante com mastopexia. Em 17 pacientes foi associada a lipoenxertia. A capsulectomia foi executada em todos os casos. Nas mastopexias, usamos o retalho dermoglandular de pedículo inferior para preservação de tecido mamário, associando também a lipoenxertia. Conclusão: As técnicas descritas conseguem devolver às mamas formato satisfatório, com baixas taxas de complicação e bom nível de aceitação das pacientes. Apesar das patologias relacionadas aos implantes de silicone até o momento mostrarem-se estatisticamente raras, é fundamental que estejamos atentos a sintomas e capacitados para oferecer opções cirúrgicas para o explante.

Introduction: Breast implants explantation surgery has been increasing in notoriety. Advances in studies on lymphomas BIA-ALCL (Breast Implant Associated Anaplastic Large Cell Lymphoma) and inflammatory/autoimmune pathologies related to the implants, like ASIA (Autoimmune Syndrome Induced by Adjuvants), has generated discomfort in many patients that choose to remove it. This type of demand, where it is necessary to return the breasts to an anatomical and aesthetically pleasing shape after the removal of the implants, might be a challenge for surgeons. The objective is to demonstrate surgical strategies for breast silicone explantation. Methods: Twenty patients who underwent the breast explantation surgery between September 2020 and March 2021 were evaluated. The surgical indication was always the patients demand, motivated by fear of associated pathologies, aesthetic dissatisfaction, discomfort in the breasts, systemic symptoms, desire to have no more breast implant, capsular contracture, rotation or rupture of the implant. Surgical techniques are described. Results: The simple explant was performed in 7 patients, and in 13 the explant was performed with mastopexy. In 17 patients, fat grafting was associated. Capsulectomy was performed in all cases. In mastopexies, we used the inferior dermoglandular flap to preserve breast tissue, also associating fat grafting. Conclusion: Techniques described are able to return the breasts to a satisfactory shape, with low complication rates and good levels of patient acceptance. Despite the pathologies related to silicone implants so far show themselves statistically rare, it is essential that we are attentive to symptoms and trained to provide surgical strategy for the explant.

Breast Implant Illness: onde estamos e para onde vamos? / Breast Implant Illness: where are we and where are we going?

Apesar dos mais de 60 anos de história, dezenas de estudos e grandes amostras populacionais, nos últimos anos diversos pacientes têm retornado ao consultório do cirurgião plástico. Apresentam dúvidas a respeito do silicone, algumas devido aos relatos recentes de BIA-ALCL (Anaplastic Large Cell Lymphoma), mas a grande maioria pela possibilidade de sintomas sistêmicos relacionados aos implantes e que despertam o desejo da sua remoção. Procedimento conhecido como explante. Este fenômeno, cujas dúvidas são inúmeras e as respostas mínimas, é conhecido na literatura mundial como Breast Implant Illness (BII). Na Internet e redes sociais, centenas de sinais e sintomas têm sido relacionados às próteses de silicone, usualmente inespecíficos. Os sintomas mais comuns referidos pelas pacientes são fadiga crônica, artralgia, confusão mental, mialgia, perda de memória, dificuldade de concentração e olhos secos. Até o momento, não existem testes diagnósticos para BII, nenhum método baseado em evidência científica para diferenciá-la de outras condições e há muito pouco conhecimento a respeito do seu início, curso, fatores de risco, causas e manejo adequado. A opção pela retirada dos implantes vem crescendo vertiginosamente nos últimos anos, sendo uma das dez cirurgias mais realizadas nos Estados Unidos no ano passado. A literatura mostra taxas de melhora dos sintomas variáveis após o explante e as pacientes mostram-se, via de regra, satisfeitas com seu resultado estético e apresentam níveis de ansiedade e estresse menores após o procedimento. São necessários estudos prospectivos, randomizados bem desenhados correlacionando períodos distintos das pacientes, desde o pré-operatório do implante até o pós-explante.

Despite more than 60 years of history, numerous studies and large population samples, in recent years, several patients have returned to the plastic surgeons office. They have doubts about the silicone, some due to the recent reports of BIAALCL, but the vast majority due to the possibility of systemic symptoms related to the implants and which arouse the desire for its removal. Procedure known as explant. This phenomenon, whose doubts are numerous and the responses are minimal, is known in the world literature as Breast Implant Illness (BII). On the Internet and social networks, hundreds of signs and symptoms have been related to silicone implants, usually nonspecific. The most common symptoms reported by patients are chronic fatigue, arthralgia, mental confusion, myalgia, memory loss, difficulty concentrating and dry eyes. So far, there are no diagnostic tests for BII, no method based on scientific evidence to differentiate it from other conditions, and there is very little knowledge about its onset, course, risk factors, causes and proper management. The option for removing the implants has been growing dramatically in recent years, being one of the ten most performed surgeries in the United States last year. The literature shows variable improvement rates after the explantation and the patients are, as a rule, satisfied with their aesthetic result and have lower levels of anxiety and stress after the procedure. Prospective, well-designed randomized studies correlating different periods are necessary, from the preoperative period of the implant until after the explantation.

Underestimation Rate in the Percutaneous Diagnosis of Radial Scar/Complex Sclerosing Lesion of the Breast: Systematic Review / Taxa de subestimação no diagnóstico percutâneo de cicatriz radiada/lesão esclerosante complexa da mama: Revisão sistemática

Abstract Objective To evaluate the underestimation rate in breast surgical biopsy after the diagnosis of radial scar/complex sclerosing lesion through percutaneous biopsy. Data Sources A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. The PubMed, SciELO, Cochrane, and Embase databases were consulted, with searches conducted through November 2020, using specific keywords (radial scar OR complex sclerosing lesion, breast cancer, anatomopathological percutaneous biopsy AND/OR surgical biopsy). Data collection Study selection was conducted by two researchers experienced in preparing systematic reviews. The eight selected articles were fully read, and a comparative analysis was performed. Study selection A total of 584 studies was extracted, 8 of which were selected. One of them included women who had undergone a percutaneous biopsy with a histological diagnosis of radial scar/complex sclerosing lesion and subsequently underwent surgical excision; the results were used to assess the underestimation rate of atypical and malignant lesions. Data synthesis The overall underestimation rate in the 8 studies ranged from 1.3 to 40% and the invasive lesion underestimation rate varied from 0 to 10.5%. Conclusion The histopathological diagnosis of a radial scar/complex sclerosing lesion on the breast is not definitive, and it may underestimate atypical andmalignant lesions, which require a different treatment, making surgical excision an important step in diagnostic evaluation.

Resumo Objetivo Avaliar o grau de discordância entre biópsia percutânea e cirúrgica da mama em pacientes com diagnóstico de cicatriz radiada/lesão esclerosante complexa (CR/LEC) por meio de uma revisão sistemática. Fontes dos dados Foi realizada uma revisão sistemática segundo as recomendações do Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA, na sigla em inglês). As bases de dados primárias consultadas foram PubMed, SciELO, Cochrane e Embase, combuscas conduzidas até novembro de 2020, utilizando palavras chaves específicas (cicatriz radiada OU lesão esclerosante complexa, câncer de mama, anatomopatológico de biópsia percutânea E/OU biópsia cirúrgica). Seleção dos estudos A busca dos artigos resultou em um total de 584 estudos, sendo 8 selecionados, os quais incluíam mulheres submetidas a biópsia com diagnóstico histológico de CR/LEC e posteriormente submetidas a exérese cirúrgica para avaliar como desfecho o grau de subestimação de lesões atípicas e malignas. Coleta de dados A seleção dos estudos foi conduzida por dois pesquisadores, com experiência na elaboração de revisão sistemática. Os oito artigos selecionados foram lidos na íntegra e submetidos a uma análise comparativa. Síntese dos dados Cicatrizes radiadas/lesões esclerosante complexas foram associadas com lesões atípicas e malignas após a exérese cirúrgica. O grau de subestimação geral foi calculado pela porcentagem de lesões atípicas e malignas no anatomopatológico após a exérese cirúrgica dentre o total de CR/LEC diagnosticadas, enquanto o grau de subestimação de lesões invasoras foi calculado considerando-se apenas os carcinomas invasivos. O grau de subestimação geral dos estudos selecionados variou de 1,3 a 40%, e o de lesões invasoras de 0 a 10,5%. Conclusão O diagnóstico histopatológico de CR/LEC na mama não é definitivo, podendo subestimar lesões atípicas e malignas, cujo tratamento é distinto, tornando a exérese cirúrgica etapa fundamental na investigação diagnóstica.

Aumento mamario mediante prótesis

Introducción: La apariencia, tamaño, forma y simetría de la glándula mamaria juegan un papel importante en la sexualidad de la mujer y tienen un profundo efecto en su bienestar biopsicosocial. Objetivo: Caracterizar el aumento mamario mediante implantes protésicos. Métodos: Se realizó un estudio descriptivo, prospectivo de corte longitudinal para determinar el comportamiento del aumento mamario mediante implantes protésicos en pacientes con alteraciones mamarias que acudieron a la consulta de Cirugía Plástica del Hospital Universitario Manuel Ascunce Domenech de la provincia Camagüey en el período comprendido desde septiembre de 2017 hasta junio de 2020. Se estudiaron 35 pacientes en quienes se analizaron las variables: edad, enfermedad mamaria a corregir con los implantes, volumen de los implantes, vía de acceso de colocación del implante, localización del bolsillo mamario y complicaciones con el proceder. Resultados: Del total de las pacientes estudiadas, la hipotrofia mamaria estuvo presente en 25 féminas, predominando en las edades entre 30 a 49 años en el 68,56 % de las mismas. En doce de las pacientes que se utilizó la vía subareolar para la colocación del implante, los mismos presentaban volúmenes entre 351 y 400 mililitros. La vía de acceso menos utilizada para la colocación del implante fue la vía axilar, en una paciente y esta a su vez utilizando un bolsillo mamario retromuscular. La dehiscencia de la herida fue la complicación predominante. Conclusiones: La cirugía de aumento mamario mediante material aloplástico es un proceder frecuente que es utilizado para corregir diferentes defectos mamarios en la especialidad de Cirugía Plástica, con diversidad de técnicas y escasas complicaciones.

Introduction: Appearance, size, form and symmetry of the mammary gland play an important role in the sexuality of the woman and have a deep effect in her biopsychosocial well-being. Objective: To characterize breast augmentation using prosthetic implants. Methods: A descriptive, prospective longitudinal study was carried out to determine the behavior of breast augmentation through prosthetic implants in patients with breast disorders that attended to the consultation of Plastic Surgery of the Universitary Hospital Manuel Ascunce Domenech in Camagüey's province, from September, 2017 to June, 2020. 35 patients were studied and the following variableswere analyzed: age, breast disease to be corrected with implants, implant volume, access route for implant placement, location of the breast pocket and complications with the procedure. Results: Of all the patients studied, mammary hypotrophy was present in 25 females, predominating in the ages between 30 and 49 years in 68.56% of them. In twelve of the patients who used the subareolar route for implant placement, they presented volumes between 351 and 400 milliliters. The least used access route for implant placement was the axillary route, in one patient and this in turn used a retromuscular breast pocket. Wound dehiscence was the predominant complication. Conclusions: Breast augmentation surgery using alloplastic material is a frequent procedure that is used to correct different breast defects in the specialty of Plastic Surgery, with a variety of techniques and few complications.

Dermatosis en la región mamaria: estudio retrospectivo de 171 pacientes atendidas en el Hospital General Dr. Manuel Gea González / Skin diseases of the breast: A retrospective study of 171 patients at "Dr. Manuel Gea González" General Hospital

Resumen OBJETIVO: Describir las dermatosis de la región mamaria que para su diagnóstico durante la consulta dermatológica ameritaron estudio histopatológico. MATERIALES Y MÉTODOS: Estudio retrospectivo llevado a cabo con base en los expedientes electrónicos de pacientes atendidas en el servicio de Dermatopatología entre 1992 y 2021. Los términos de búsqueda fueron: "mama", "seno", "areola" y "pezón". RESULTADOS: Se reunieron 171 reportes histopatológicos. El diagnóstico clínico de envío más común en mujeres fue la infiltración cutánea por cáncer de mama y en hombres el pezón supernumerario. Las dermatosis más frecuentes pertenecieron al grupo de tumoraciones benignas (78 de 171), seguidas de las dermatosis inflamatorias no infecciosas (48 de 171), en tercer lugar las neoplasias malignas (39 de 171) y 6 de 171 correspondieron a dermatosis inflamatorias infecciosas. CONCLUSIONES: Las enfermedades cutáneas de la mama tienen diversas manifestaciones clínicas que, en ocasiones, ameritan un estudio histopatológico, sobre todo para un diagnóstico oportuno de neoplasias malignas.

Abstract OBJECTIVE: Describe dermatoses of the mammary region that warranted histopathological diagnosis in dermatologic consults. MATERIALS AND METHODS: The Hospital "Dr. Manuel Gea Gonzalez" Dermatopathology Department record database was reviewed in the 1992 to 2021 period, using the search engine terms "breast," "mammary," "nipple," and "areola." Lesions were classified as benign, malignant, infectious and noninfectious inflammatory tumors. RESULTS: 171 histopathological reports were reviewed. There was a female predominance in histopathological studies (153/171). The most frequent clinical diagnosis for referral in female patients was breast cancer with cutaneous infiltration; supernumerary nipple was the most frequent clinical diagnosis for male patients. The most frequent dermatoses belonged to the benign tumor category (78/171), followed by noninfectious inflammatory dermatoses (48/171). Malignant neoplasms were in third place (39/171), and 3.5% of dermatoses were infectious inflammatory dermatoses. CONCLUSIONS: Cutaneous mammary disease has diverse clinical presentations that might occasionally warrant histopathological studies, mainly for the early diagnosis of malignant neoplasms.

Evaluation of breast pathologies in puerperal women assisted at a philanthropic hospital in Presidente Prudente (SP), Brazil: longitudinal cohort

Breast milk is the main source of nourishment for the healthy growth and development of newborns up do six months, and after that, it serves as a supplement up to two years. The act of breastfeeding, in addition to being an important means of forming an affective bond between the mother and infant, also promotes maternal, social and environmental benefits. Although its importance has been proven, it is known that there are several reasons that lead to the early interruption of breastfeeding, including breast complications. Our aim was to determine the incidence of complications related to breastfeeding in puerperal women seen at Hospital Regional, a philanthropic hospital in Presidente Prudente (SP) and the possible factors that led to their appearance as well. Methods: A quantitative-qualitative longitudinal study was carried out with puerperal women cared for at Hospital Regional of Presidente Prudente. A structured interview was administered in three stages: the first during the puerperal women's hospitalization and the others, through telephone contact at respectively 30 and 90 days after delivery, to monitor breastfeeding. Results: Of the total number of patients interviewed, 24.3% had some breast complications resulting from breastfeeding. Still in the immediate postpartum period at 30 days, this proportion reached 42.23%, decreasing at 90 days to 17.47%. Furthermore, of the puerperal women that showed any complication, 74% of them were single, 54% had brown skin color, 42.9% had completed high school and 52% were primiparous. Moreover, the patients who had a Cesarean section (53,8%) showed more complications than the ones who had natural childbirth (35,1%).

Application of three-dimensional shear wave elastography in the differential diagnosis of benign and malignant breast masses / 中华超声影像学杂志

Objective:To evaluate the application value of three-dimensional shear wave elastography(3D-SWE) with quantitative parameters and qualitative analysis of stiff rim sign in differentiating benign and malignant breast masses.Methods:One hundred and seventeen female patients (121 breast masses) admitted to the First Affiliated Hospital of Soochow University from January 2020 to February 2021 were examined by conventional ultrasound, two-dimensional shear wave elastography (2D-SWE) and 3D-SWE. Surgical or puncture pathology were used as the gold standard, the ROC curves of 2D-SWE and 3D-SWE were drawn to obtain the optimal qualitative and quantitative indicators. Afterwards, BI-RADS category was adjusted according to the optimal indicators, which could be used to evaluate the diagnostic value in differentiating benign and malignant breast masses.Results:The area under ROC curve (AUC) of BI-RADS category was 0.846, the sensitivity and specificity were 89.6% and 79.6%, respectively. The AUC value of mass-to-fat elasticity ratio(Eratio) of coronal plane was 0.869, which was the highest among all quantitative parameters and was significantly higher than that of 2D-SWE ( P<0.05). In addition, the AUC value of stiff rim sign of coronal plane was significantly higher than those of 2D-SWE, sagittal plane and transverse plane (All P<0.05). The AUC of combination of stiff rim sign of coronal plane and conventional US was 0.901, which was significantly higher than that using conventional ultrasound alone( P<0.05). Conclusions:Compared with 2D-SWE, Eratio and stiff rim sign of coronal plane of 3D-SWE yield better diagnostic efficiency.Adjusting stiff rim sign coronal plane to BI-RADS category can effectively improve the diagnostic efficiency.

Application value of artificial intelligence model based on deep learning in Breast Ultrasound Imaging Reporting and Data System: breast nodules classification / 肿瘤研究与临床

Objective:To explore the application value of artificial intelligence (AI) model based on deep learning in breast nodules classification of Breast Imaging Reporting and Data System of ultrasound (BI-RADS-US).Methods:The ultrasound images of 2 426 breast nodules from 1 558 female patients with breast diseases at Beijing Tongren Hospital, Capital Medical University between December 2006 and December 2019 were collected . The image data sets were divided into training (63%), verification (7%), and test (30%) subsets for the construction of AI model. The diagnostic efficiencies of AI model, doctors' arbitration results and doctors' diagnosis with or without AI model assistance were analyzed by using receiver operating characteristic (ROC) curve. The Cohen weighted Kappa statistic was used to compare the consistency of BI-RADS-US classification among 5 ultrasound doctors' diagnosis with or without AI model assistance. And the changes of BI-RADS-US classification were analyzed before and after each doctor adopted AI model assistance.Results:The differences in diagnostic efficiencies of AI model, doctors' arbitration results and doctors' diagnosis with or without AI model assistance were statistically significant (all P > 0.05). The consistency among 5 ultrasound doctors was improved due to AI model assistance and Kappa value was increased from 0.433 (category 3), 0.600 (category 4a), 0.614 (category 4b), 0.570 (category 4c) and 0.495 (category 5) to 0.812, 0.704, 0.823, 0.690 and 0.509 (all P < 0.05), respectively. The upgrade and downgrade of BI-RADS-US classification occurred in 5 doctors after the classification of AI model assistance. Downgrade from category 4 to 3 in benign nodules of 56.6% (47/76) and upgrade from category 4 to 5 in malignant nodules of 69.4% (34/49) were mostly observed. Conclusions:AI-assisted BI-RADS-US classification can effectively improve the consistency of classification among the doctors without reducing the diagnostic efficiency. AI model shows clinical values in reducing unnecessary biopsy of partial benign lesions and increasing diagnostic accuracy of partial malignant lesions through the adjustment of breast nodule classification.

Sarcoma mamário múltiplo de alto grau: relato de caso / High-degree multiple breast sarcoma: case report

O Sarcoma Mamário tem origem no mesênquima e é um tipo raro de tumor. Caracteriza-se por uma massa palpável, mole e de crescimento rápido. O diagnóstico precoce é dificilmente estabelecido, devido à característica de crescimento do tumor e à dificuldade de classificação histopatológica, o que leva a maioria dos pacientes a apresentar um mau prognóstico. O caso relatado apresenta uma mulher de 44 anos, sem fatores de risco para câncer de mama, diagnosticada com SM múltiplo ipsilateral. O diagnóstico foi estabelecido através de exames de imagens e biópsia. A paciente foi submetida à mastectomia, e a equipe multidisciplinar optou por continuar seu tratamento com quimioterapia e radioterapia adjuvantes, que mostraram resultados satisfatórios.

Mammary Sarcoma originates in the mesenchyme and is a rare type of tumor. It is characterized by a palpable, soft and rapidly growing mass. Early diagnosis is difficult to establish, due to the tumor growth characteristic and the difficulty of histopathological classification, which leads most patients to have a poor prognosis. The case reported presents a 44-year-old woman, without risk factors for breast cancer, diagnosed with ipsilateral multiple MS. Diagnosis was established through imaging and biopsy. The patient underwent mastectomy, and the multidisciplinary team chose to continue her treatment with adjuvant chemotherapy and radiotherapy, which showed satisfactory results.

Pseudoangiomatous stromal hyperplasia of the breast: a rare condition ­ from diagnosis to treatment

Pseudoangiomatous Stromal Hyperplasia (PASH) of the breast is a rare condition that consists of the proliferation of the breast myofibroblastic stromal cells, lining anastomosing vascular slit-like spaces. This condition is not considered a pre-malignant lesion and affects mainly premenopausal women. Its etiology is still uncertain, but its behavior points to a hormonal cause. It has a varied clinical presentation and can be diagnosed as an incidental finding of biopsies or with the manifestation of clinical signs and symptoms. As for the diagnosis, it can be performed with the correlation between clinical data, imaging and histopathological analysis. Due to its rare nature, there are still no prospective studies regarding treatment, but, in most cases, clinical and radiological follow-up is a safe strategy. The aim of this paper is to synthesize the data available in the literature about this condition, which, although benign in nature, can bring important aesthetic, musculoskeletal and psychological repercussions

Metaplastic breast carcinoma with extensive osseous differentiation

Metaplastic breast carcinoma is a rare subtype of invasive breast carcinoma. Metaplastic carcinoma with osseous differentiation is exceptionally uncommon. Because of the heterogenous microscopy of the lesion, various clinical and radiological features are observed, leading to diagnostic difficulty. Herein, we present a case of a 43-year-old female with a recurrent breast lump, who was clinically diagnosed as a phyllodes tumor. However, histopathological examination revealed metaplastic carcinoma with extensive osseous differentiation.

Mastite puerperal complicada em paciente com implante de silicone: Um relato de caso / Puerperal mastitis complicated in patient with silicone implantation: A case report

A mastite é uma patologia relativamente frequente na mulher que amamenta. Surge maioritariamente nas primeiras seis semanas após o parto (prevalência entre 75-95% antes do bebé completar os três meses de vida), podendo, contudo, ocorrer ao longo de todo o período da amamentação. Apresenta-se clinicamente com mastalgia, eritema e edema mamário, linfonodomegalia axilar, febre, calafrios, mal-estar e prostração. Entretanto, o quadro clínico completo pode não estar presente em todos os casos. A técnica incorreta de amamentação provoca as microlesões mamáriasque são fatores associados à mastite, inicialmente, e esta quando não recebe tratamento adequado pode evoluirpara os abscessos mamários, que são caracterizados clinicamente por nodulação palpável ou não, flutuante, parcialmente circunscrita, geralmente no quadrante superior lateral da mama afetada. O microrganismo mais envolvido é o Staphylococcus aureus. O diagnóstico diferencial envolve principalmente outras causas não infecciosas de mastite, por exemplo a granulomatosa com reação a corpo estranho (piercing, implantes de silicone) e também malignidade. A ultrassonografia é um método bastante útil na investigação inicial daqueles quadros com suspeita de desenvolvimento de tal complicação e possibilita de maneira segura o tratamento minimamente invasivo e a obtenção de amostra para analise laboratorial. Isto permite a escolha de antibioticoterapia direcionada para os microorganismos causadores.

Mastitis is a relatively common condition in breastfeeding women. It appears mostly in the first six weeks after delivery (prevalence between 75-95% before the baby is three months old), however, it can occur throughout the entire period of breastfeeding. It may present clinically with mastalgia, erythema and breast edema, axillary lymph node enlargement, fever, chills, malaise and prostration. However, the complete clinical picture may not be present in all cases. The incorrect breastfeeding technique causes breast microlesions which are factors associated with mastitis, initially, and when it does not receive adequate treatment it can evolve for breast abscesses, which are characterized clinically by palpable or not, floating, partially circumscribed nodulation, usually in the upper lateral quadrant of the affected breast. The most involved microorganism is Staphylococcus aureus. The differential diagnosis mainly involves other non-infectious causes of mastitis, for example granulomatous with a foreign body reaction (piercing, silicone implants) and also malignancy. Ultrasonography is a very useful method in the initial investigation of those conditions suspected of developing such a complication, and it safely allows minimally invasive treatment and obtaining a sample for laboratory analysis. This allows the choice of antibiotic therapy directed at the causative microorganisms.

Multimodal ultrasonic diagnosis of breast fibromatosis originating from breast parenchyma / 中国医师杂志

Objective:To analyze the imaging characteristics of invasive fibromatosis from breast parenchyma, and to explore the clinical value of multimodal ultrasound.Methods:The two-dimensional, color Doppler and elastic imaging sonographic manifestations and pathological features of 12 cases of breast invasive fibromatosis included in the Affiliated Hospital of Jining Medical College from October 2015 to October 2020 were studied retrospectively.Results:Two dimensional ultrasound showed that 12 cases of breast invasive fibromatosis grew in parallel, with different sizes, unclear boundary and no complete capsule. The edge morphology of 7 cases (7/12) showed crab foot like changes; The tumor showed solid heterogeneous hypoechoic, punctate hyperechoic in 3 cases (3/12), and echo attenuation behind the tumor in 3 cases (3/12); The blood flow in the tumor was mainly grade 1-2 (9/12). Twelve tumors were examined quantitatively by virtual touch tissue quantifification. The shear wave velocity was (3.08±0.75)m/s. The diagnostic accuracy of multimodal ultrasound in invasive fibromatosis of breast (10/12) was significantly higher than that of conventional ultrasound (3/12, χ 2=8.224, P=0.004). The gross manifestation of the tumor: the section was gray or gray yellow, with unclear boundary and no capsule; Microscopic findings: fascicular fibroblasts and myofibroblasts proliferated, accompanied by varying degrees of glassy degeneration, acellular atypia, nuclear division and necrosis. Conclusions:Conventional ultrasound is difficult to distinguish invasive fibromatosis and malignant tumor of breast, and its ultrasonic manifestations are closely related to pathological features. The combined application of multimodal ultrasound can significantly improve the diagnostic coincidence rate of the disease and has high clinical application value.