Nursing care regarding the psycho-emotional aspects of women submitted to mastectomy

Breast cancer, or breast neoplasm, is one of the most frequent types of cancer, and one of the most prevalent among women. The diagnosis and specific treatments, such as mastectomy surgery, lead women to experience different feelings, with the most predominant negative thoughts. In this way, the objective of this study is to describe the importance of nursing care in the face of the psycho-emotional aspects of women after mastectomy. This is an integrative literature review study, developed in electronic Medline and Lilacs databases. The following terms were used: Breast neoplasm; Nursing; Emotions; Mastectomy. A total of 2,314 articles were found, of which eight were selected. The results and discussions were divided into two thematic axes: The first deals with the emotions of women after mastectomy, whose feelings arising from the diagnosis of the disease start to affect different areas, such as personality, sexuality, family, and social relationships. Furthermore, the second deals with nursing care after mastectomy, which must be conducted integrally, aiming at restoring physical and emotional health. Nursing is the vehicle capable of planning and collaborating with these women, promoting humanized treatment and assistance, oriented and aimed at a better quality of life, and stimulating self-help, self-esteem, and acceptance of their body.

Algoritmo para la selección de colgajos perforantes perimamarios en reconstrucción inmediata poscirugía conservadora / Algorithm to select chest wall perforator flaps in immediate conservative breast surgery reconstruction

RESUMEN Antecedentes: los colgajos perforantes perimamarios son de gran utilidad en la reconstrucción mamaria inmediata en cirugía conservadora. Objetivo: describir los resultados del empleo de un algoritmo sobre colgajos perforantes perimamarios en la reconstrucción mamaria inmediata después de cirugía conservadora por cáncer de mama. Material y métodos: se llevó a cabo un estudio retrospectivo descriptivo. Se revisaron las historias clínicas de las pacientes operadas entre enero de 2020 y diciembre de 2022 por carcinoma de mama con cirugía conservadora y que requirieron reconstrucción con colgajos perimamarios. Las indicaciones incluyeron déficit de volumen, defecto de contorno y asimetría. Se evaluó el pedículo vascular del colgajo mediante Doppler color en todos los casos, lo que permitió seguir un algoritmo para la selección de la mejor opción de colgajo. Resultados: se realizaron 20 colgajos en 19 pacientes. Promedio de edad: 52 años ± 11 (rango 30-76). No existieron complicaciones intraoperatorias. Una paciente requirió reoperación por compresión del pedículo vascular del colgajo por hematoma, con la pérdida parcial, y otro colgajo sufrió epidermólisis superficial. No hubo pérdidas totales de ningún colgajo. Todas recibieron radioterapia posoperatoria y no experimentaron pérdida de volumen ni retracciones. Con un promedio de seguimiento de 15 meses, las pacientes valoraron los resultados a 6 meses como excelente en 7, bueno en 11 y regular en 2. Conclusión: la selección de colgajos perforantes locales para corregir defectos mamarios después de cirugía conservadora, mediante el examen con Doppler color preoperatorio para la identificación del pedículo vascular y un algoritmo específico, permitió obtener resultados estéticos satisfactorios sin requerir elementos aloplásticos ni revisiones posteriores.

ABSTRACT Background: Chest wall perforator flaps are a good option for immediate breast reconstruction after conservative surgery. Objective: The aim of this study was to describe the clinical results of an algorithm for using chest wall perforator flaps for breast reconstruction after breast-conserving surgery for breast cancer. Material and methods: We conducted a descriptive and retrospective study. The information was retrieved from the medical records of the patients diagnosed with breast cancer who underwent breast-conserving surgery and required reconstruction using chest wall perforator flaps between January 2020 and March 2022. The indications included volume deficit, contour defect and asymmetry. The vascular pedicle of the flap was evaluated by color Doppler ultrasound in all cases, which allowed us to follow an algorithm for selecting the best flap option. Results: Twenty flaps were made in 19 patients. Mean age: 52 years ± 11 (range 30-76). There were no intraoperative complications. One patient required reoperation due to a hematoma with compression of the vascular pedicle of the flap with partial flap loss, and another flap presented superficial epidermolysis. There were no cases of complete flap loss. All the patients underwent postoperative radiation therapy without loss of volume or retractions. Mean follow-up was 15 months. At 6 months, patients rated the results as excellent, good, and fair in 7, 11, and 2 cases, respectively. Conclusion: The selection of local perforator flaps to correct breast defects after conservative surgery, using preoperative color Doppler ultrasound to identify the vascular pedicle and a specific algorithm, allowed us to obtain satisfactory aesthetic results without the need for alloplastic elements or subsequent revisions.

Acantosis nigricans maligna y carcinoma mamario. Presentación de un caso

Las manifestaciones cutáneas de los tumores malignos comprenden un grupo de dermatosis que pueden ser marcadores de la presencia de neoplasias ocultas y permiten su diagnóstico oportuno. El objetivo de este informe es presentar las características clínicas de una acantosis nigricans asociada a carcinoma de mamario. Para ello, se describe el caso clínico de una paciente de 50 años, color de piel negro, asistida en la consulta de Dermatología del Policlínico Universitario Raúl Sánchez, por tener una placa única eritematosa localizada en la mama izquierda, acompañada de dolor, aumento de la temperatura local y máculas hipercrómicas en las axilas; así como adenopatías axilares múltiples. Los exámenes complementarios mostraron la presencia de acantosis nigricans maligna asociada a un carcinoma inflamatorio de la mama izquierda. Fue intervenida quirúrgicamente, con la consiguiente desaparición de las lesiones cutáneas, pero con un pronóstico reservado. La mayoría de los síndromes paraneoplásicos son inespecíficos; existe una necesidad urgente de sospechar una correlación entre los cambios cutáneos y la posibilidad de una neoplasia interna, por lo que es de suma importancia derivar a estos pacientes para su identificación y el diagnóstico precoz de la enfermedad de base. Esto mejoraría el pronóstico y atenuaría en gran medida las consecuencias.

The skin manifestations of malignant tumors include a group of dermatoses that can be the sign of the occult neoplasms presence and allow their timely diagnosis. The objective of this report is to present the acanthosis nigricans' clinical characteristics associated with breast carcinoma. The clinical case of a 50-years-old black-skinned patient is described, assisted in the Dermatology consultation of the Raúl Sánchez University Polyclinic, for having a single erythematous plaque located in the left breast, accompanied by pain, increased local temperature and hyperchromic macules in the armpits; as well as multiple axillary lymphadenopathy. Complementary examinations showed the presence of malignant acanthosis nigricans associated with an inflammatory carcinoma of the left breast. She underwent surgery, with the consequent disappearance of the skin lesions, but with a reserved prognosis. Most paraneoplastic syndromes are nonspecific; there is an urgent need to suspect a correlation between skin changes and the possibility of an internal neoplasia, so it is of utmost importance to refer these patients for identification and early diagnosis of the underlying disease. This would improve the prognosis and greatly mitigate the consequences.

Efectos de la mastectomía en los parámetros baropodométricos de pacientes con cáncer de seno / The effect of mastectomy on baropodometric parameters for breast cancer patients / Efeitos da mastectomia nos parâmetros baropodometricos de pacientes com câncer de mama

Objetivo: la mastectomía posterior al cáncer de seno produce diversas alteraciones posturales y biomecánicas en el plano frontal y sagital. Dichos cambios conducen a una cinemática alterada de la columna vertebral, desequilibrio muscular y alteración del soporte del peso del pie. Este estudio pretende describir las alteraciones de la baropodometría después de la mastectomía, con base en análisis baropodométricos de la presión media y la carga estática. Metodología: se realizó un estudio descriptivo correlacional. Las propiedades de carga del pie se identificaron en 17 mujeres mastectomizadas. Se utilizó una placa de presión Ecosanit Foot para medir la carga del pie en posición anatómica y con los pies juntos. Resultados: en el estudio participaron 17 mujeres mastectomizadas con una edad media de 54.16 años. Las pacientes reportaron una presión media significativamente mayor en la posición anatómica del lado dominante mastectomizado en comparación con el lado no dominante mastectomizado (227.2 ± 22.16 vs. 175.6 ± 14.95, p =0.05). No hubo diferencia significativa para la carga estática entre el lado dominante mastectomizado y el lado no dominante mastectomizado en la posición anatómica (52.43±4.069 vs. 49.69 ± 4.094, de forma respectiva). Conclusión: los resultados actuales de nuestro estudio evidenciaron la distribución desequilibrada del peso (vector carga en el pie) en pacientes después de la mastectomía. Por tanto, en este texto se describen las alteraciones posturales, musculares, y el desequilibrio estático y dinámico en pacientes con cáncer de seno.

Objective: mastectomy after breast cancer produces several postural and biomechanical alterations in the frontal and sagittal plane. Such changes lead to disturbed kinematics of the spine, muscle imbalance and altered foot weight bearing. This study aims to describe body balance alterations after mastectomy based on the baropodometric analysis of their mean pressure and static load. Methodology: a descriptive correlational research was carried out. Foot weight-bearing properties were identified in 17 patients who have undergone a mastectomy. An Ecosanit Foot pressure plate was used to measure foot load at anatomical position and keeping the feet together. Results: 17 female patients who had undergo mastectomy with a mean age of 54.16 years took part on the research. Patients who have had a dominant-side mastectomy demonstrated significant greater mean pressure at anatomical position when compared to those patients who have had a non-dominant side mastectomy (227.2 ± 22.16 versus 175.6 ± 14.95, p =0.05). There was no significant difference for static load between the patients who have had a dominant side mastectomy and patients who have had a non dominant side mastectomy at anatomical position (52.43 ± 4.069 versus 49.69 ± 4.094, respectively). Conclusion: the current results of our research showed the unbalanced weight distribution in patients after mastectomy. Consequently, it describes the postural and muscular alterations, and the static and dynamic imbalance in breast cancer patients.

Objetivo: A mastectomia após câncer de mama produz diversas alterações posturais e biomecânicas nos planos frontal e sagital. Tais mudanças levam a alteração da cinemática da coluna, desequilíbrio muscular e alteração do suporte de peso do pé. Este estudo tem como objetivo descrever as alterações baropodométricas após mastectomia, com base em análises baropodométricas de pressão média e carga estática. Metodologia: foi realizado estudo correlacional descritivo. Propriedades de carga nos pés foram identificadas em 17 mulheres mastectomizadas. Uma placa de pressão Ecosanit Foot foi usada para medir a carga do pé em posição anatômica e com os pés juntos. Resultados: participaram do estudo 17 mulheres mastectomizadas com idade média de 54,16 anos. Os pacientes relataram uma pressão média significativamente maior na posição anatômica do lado mastectomizado dominante em comparação ao lado mastectomizado não dominante (227,2 ± 22,16 vs. 175,6 ± 14,95, p =0,05). Não houve diferença significativa para a carga estática entre o lado mastectomizado dominante e o lado mastectomizado não dominante na posição anatômica (52,43 ± 4,069 vs. 49,69 ± 4,094, respectivamente). Conclusão: Os resultados atuais do nosso estudo mostraram distribuição de peso desequilibrada (carga vetorial no pé) em pacientes após mastectomia. Portanto, este texto descreve alterações posturais, musculares e desequilíbrio estático e dinâmico em pacientes com câncer de mama.

Training in oncoplastic surgery for mastologists

SUMMARY OBJECTIVE: The radical change in the treatment of breast cancer has promoted the necessity for more comprehensive training of the professionals involved, ensuring the preservation of oncological safety while also allowing for cosmetic interventions to benefit breast cancer survivors. The aim of this study was to present the methods employed in the training of breast surgeons, highlighting the importance of oncoplasty and breast reconstruction. METHODS: A literature review was conducted in two databases, identifying articles related to medical education in the context of oncoplastic surgery and breast reconstruction. We also assessed the Brazilian experience in oncoplastic centers. RESULTS: The basis for educational discussions was derived from 16 articles. We observed approaches that included hands-on courses utilizing simulator models, porcine models, cadaver labs, and fellowship programs. Positive outcomes were observed in Brazil, a fact based on seven oncoplasty training centers for senior mastologists and five training centers for junior mastologists. From 2009 to 2023, an estimated 452 seniors and 42 juniors received training, representing approximately 30% of mastologists in Brazil who have acquired training and experience in oncoplasty. CONCLUSION: Despite the limited number of publications on training methods, oncoplastic centers have made significant progress in Brazil, establishing a successful model that can be replicated in other countries.

Outcomes after elevation of serratus anterior fascia flap versus serratus muscle flap in direct-to-implant breast reconstruction following mastectomy: a prospective study

Abstract Objective: The purpose of this study was to compare postoperative pain between SF flap and serratus anterior muscle (SM) in direct-to-implant breast reconstruction. Methods: This is a prospective cohort study that included 53 women diagnosed with breast cancer who underwent mastectomy and one-stage implant-based breast reconstruction from January 2020 to March 2021. Twenty-nine patients (54.7%) had SF elevation, and 24 patients (45.3%) underwent SM elevation. We evaluated patient-reported early postoperative pain on the first day after surgery. Also, it was reported that all surgical complications in the first month and patient reported outcomes (PROs) were measured with the BRECON 23 questionnaire. Results: The serratus fascia group used implants with larger volumes, 407.6 ± 98.9 cc (p < 0.01). There was no significant difference between the fascial and muscular groups regarding the postoperative pain score reported by the patients (2 versus 3; p = 0.30). Also, there was no difference between the groups regarding early surgical complications and PROs after breast reconstruction. Conclusion: The use of SF seems to cause less morbidity, which makes the technique an alternative to be considered in breast reconstruction. Although there was no statistical difference in postoperative pain scores between the fascia and serratus muscle groups.

Autogestão ineficaz de linfedema em mulheres mastectomizadas: análise de conceito / Autogestión ineficaz de linfedema en mujeres mastectomizadas: análisis de concepto / Ineffective self-management of lymphedema in mastectomized women: concept analysis

Resumo Objetivo Analisar o conceito de "autogestão ineficaz do linfedema" em mulheres mastectomizadas. Métodos Trata-se de uma análise do conceito proposto por Walker e Avant operacionalizada por meio de uma revisão integrativa da literatura, organizada em oito etapas e baseada nas seguintes questões norteadoras: Qual é a definição de autogestão ineficaz em mulheres mastectomizadas? Quais os antecedentes, atributos e consequências da autogestão ineficaz em mulheres mastectomizadas? Como a autogestão ineficaz de linfedema tem sido definida no contexto de mulheres que passaram por mastectomia? A busca de artigos foi realizada em cinco bases de dados eletrônicas, sem limite de data, no período de julho de 2022 a fevereiro de 2023. Resultados Foram identificados 30 antecedentes e 19 consequentes; os mais frequentes entre eles foram respectivamente os seguintes: falta de apoio familiar/social e diminuição da qualidade de vida. Os atributos definidores mais frequentemente identificados foram os seguintes: edema, inchaço no braço, sensação de peso no membro, dor, dormência e diminuição da função do membro. Foram ainda elaborados os casos modelo e contrário para auxiliar na decisão sobre o uso do conceito. Conclusão Os conceitos resultantes da análise contribuem para clarificar os termos e o desenvolvimento da linguagem na enfermagem, devendo ser validados por juízes e prática clínica para melhor aplicação na oncologia clínica.

Resumen Objetivo Analizar el concepto de "autogestión ineficaz de linfedema" en mujeres mastectomizadas. Métodos Se trata de un análisis del concepto propuesto por Walker y Avant, realizado mediante una revisión integradora de la literatura, organizado en ocho etapas y basado en las siguientes preguntas orientadoras: ¿Cuál es la definición de autogestión ineficaz en mujeres mastectomizadas? ¿Cuáles son los antecedentes, atributos y consecuencias de la autogestión ineficaz en mujeres mastectomizadas? ¿Cómo se define la autogestión ineficaz de linfedema en el contexto de mujeres que pasaron por una mastectomía? La búsqueda de artículos fue realizada en cinco bases de datos electrónicas, sin límite de fecha, en el período de julio de 2022 a febrero de 2023. Resultados Se identificaron 30 antecedentes y 19 consecuentes. El antecedente más frecuente fue falta de apoyo familiar/social y el consecuente, reducción de la calidad de vida. Los atributos definidores identificados más frecuentemente fueron los siguientes: edema, hinchazón en el brazo, sensación de peso en el miembro, dolor, adormecimiento y reducción de la función del miembro. Además, se elaboraron los casos modelo y contrarios para ayudar en la decisión sobre el uso del concepto. Conclusión Los conceptos resultantes del análisis contribuyen a clarificar los términos y el desarrollo del lenguaje en enfermería y deben ser validados por jueces y práctica clínica para una mejor aplicación en la oncología clínica.

Abstract Objective To analyze the concept of "ineffective self-management of lymphedema" in mastectomized women. Methods This is an analysis of the concept proposed by Walker and Avant, operationalized through an integrative literature review, organized into eight stages, and based on the following guiding questions: What is the definition of ineffective self-management in mastectomized women? What are the antecedents, attributes, and consequences of ineffective self-management in mastectomized women? How has ineffective self-management of lymphedema been defined in the context of women who have undergone mastectomy? The search for articles was carried out in five electronic databases, with no date limit, from July 2022 to February 2023. Results Antecedents (30) and consequents (19) were identified. Among them, the most frequent were the following, respectively: lack of family and/or social support and decreased quality of life. The most frequently identified defining attributes were the following: edema, swelling in the arm, feeling of heaviness in the limb, pain, numbness, and reduced function of the limb. Model and contrary cases were also designed to help decide on the use of the concept. Conclusion The concepts resulting from the analysis contribute to clarifying the terms and development of language in nursing, and should be validated by judges and clinical practice for better application in clinical oncology.

Primary leiomyosarcoma with osteosarcomatous differentiation of the breast

ABSTRACT Primary leiomyosarcoma with osteosarcomatous differentiation of the breast is an uncommon entity. We present the case of a 37-year-old female who presented with a lump in the breast and pulmonary lesions on PET-CT, for which she underwent a toilet mastectomy. Histopathological examination revealed a tumor with cells arranged in sheets. These tumor cells had moderate eosinophilic cytoplasm, highly pleomorphic, irregular hyperchromatic nuclei, coarse chromatin, and prominent nucleoli. Areas with spindle-cell morphology were noted. Osteoid was seen intermingling with the tumor along with numerous osteoclast-like multinucleate giant cells. A wide panel of Immunohistochemistry was applied, and Desmin, h-Caldesmon, SMA, and Vimentin were positive. The patient died 3 months post-surgery and had a recurrence at the surgical site.

Resultados en reconstrucción mamaria inmediata prepectoral con implantes / Result of immediate prepectoral implant-based breast reconstruction

RESUMEN Antecedentes: la reconstrucción mamaria inmediata prepectoral con implantes es la incorporación técnica más reciente al arsenal de reconstrucción mamaria. Esta técnica proporciona un aspecto más natural a la reconstrucción, elimina complicaciones, como la deformidad por animación, y disminuye el dolor posoperatorio. Objetivo: describir los resultados quirúrgicos en una serie de pacientes con reconstrucción mamaria inmediata prepectoral con implantes de silicona. Material y métodos: se realizó un estudio retrospectivo descriptivo; fueron revisadas las historias clínicas y los informes de anatomía patológica de pacientes operadas con la técnica descripta entre marzo de 2018 y diciembre de 2021, por carcinoma invasor, no invasor y sarcoma de mama. Todas fueron evaluadas en el preoperatorio con mamografía digital y presentaban más de 2 cm de cobertura grasa en la mama intervenida. Resultados: se registraron 52 reconstrucciones en 40 pacientes. El promedio de edad fue de 52 años (rango 30-76). En todas se realizó mastectomía con preservación del complejo aréolapezón. Con un promedio de seguimiento de 40 meses, no se registraron complicaciones mayores. No se encontró animación, desplazamiento ni rotación del implante. Se observó contractura capsular grados III y IV después del año de seguimiento en 3 pacientes que realizaron radioterapia posoperatoria. Los resultados estéticos fueron excelentes y buenos en 40 mamas (80,0%), regulares en 8 mamas (12,0%) e insuficientes en 4 mamas (8,0%). Se necesitó revisión quirúrgica posoperatoria inmediata por hematoma en 4 mamas (7,7%). Conclusiones: la reconstrucción inmediata con implantes prepectorales posmastectomía fue una técnica segura y con alto porcentaje de satisfacción.

ABSTRACT Background: Prepectoral implant-based breast reconstruction has recently been added to the armamentarium for breast reconstruction. This technique provides natural-looking breasts, avoids complications, such as animation deformity, and reduces postoperative pain. Objective: The aim of this study was to describe the surgical outcomes in a series of patients undergoing immediate prepectoral breast reconstruction with silicone implants. Material and methods: A descriptive and retrospective study was carried out with review of the medical records and pathology reports of patients who underwent surgery using the described technique for invasive carcinoma, non-invasive carcinoma, and sarcoma of the breast from March 2018 to December 2021. All the patients were evaluated preoperatively with digital mammography and had fat coverage thickness in the operated breast > 2 cm. Results: A total of 52 reconstructions were performed on 40 patients. Mean age was 52 age (range 30- 76). The nipple sparing mastectomy was undertaken in all the cases. There were no major complications during the 40-month average follow-up. None of the patients experienced animation deformity, implant displacement, or rotation. After one year of follow-up, three patients who underwent postmastectomy radiotherapy showed grades III and IV capsular contracture. The aesthetic results were excellent and good in 40 breasts (80.0%), fair in 8 breasts (12.0%) and insufficient in 4 breasts (8.0%). Four breasts (7.7%) required surgical revision in the immediate postoperative period. Conclusions: Immediate prepectoral implant-based breast reconstruction is a feasible technique with enduring results and high level of satisfaction.

Beneficios musculoesqueléticos de la terapia física temprana en pacientes posoperadas de mastectomía / Musculoskeletal benefits of early physical therapy in post-mastectomy patients

Resumen Objetivo: Determinar los beneficios musculoesqueléticos que conlleva la terapia física temprana en pacientes posoperadas de mastectomía. Método: Se comenzó el programa de terapia física, con el consentimiento de pacientes posoperadas de mastectomía en el Hospital Militar de Especialidades de la Mujer y Neonatología, registrando las evaluaciones de amplitud de movilidad y de fuerza muscular, dando inicio con la terapia en las primeras 24 a 48 horas posteriores a la cirugía, con ejercicios isométricos de baja intensidad durante una semana, movilizaciones activas en la segunda y tercera semana y ejercicios isotónicos con movilizaciones activas en la cuarta y quinta semana (grupo en estudio). Asimismo, antes de iniciar con el proyecto de investigación, se identificaron pacientes posoperadas de mastectomía que no se habían sometido a ningún programa de terapia física. (grupo control). Resultados: En el programa de terapia física temprana, se analizaron los datos estadísticos de la muestra, que estuvo integrada por 19 pacientes del grupo en estudio y 9 pacientes del grupo control, en los cuales se obtuvo un promedio de edad de 53.21±11.86 años en el grupo en estudio y 50.44±9.95 años en el grupo control no habiendo diferencia estadísticamente significativa (p=0.26), por lo que respecta a los aspectos demográficos; no se encontraron situaciones que limitaran la investigación; asimismo, se identificó que la cirugía de mayor incidencia fue la mastectomía radical modificada derecha, siendo en consecuencia la lateralidad más frecuente, de igual forma en el análisis de varianza en los resultados de medición en el progreso en la mejoría de arcos de movilidad y de fuerza muscular se obtuvo una diferencia estadísticamente significativa (p< 0.0001), con diferencias positivas en la mejoría de las pacientes del grupo en estudio en comparación con las pacientes del grupo control. Conclusiones: La terapia física temprana en pacientes posoperadas de mastectomía, produce beneficios musculoesqueléticos que ayudan a mejorar la amplitud de los arcos de movilidad del miembro torácico afectado y aumenta la fuerza muscular.

Abstract: Objective: Determine the musculoskeletal benefits of early physical therapy in post-mastectomy patients. Method: The physical therapy program was started, with the consent of post-mastectomy patients at the Military Hospital of Women's Specialties and Neonatology, recording the evaluations of range of mobility and muscle strength, starting the therapy in the first 24 to 48 hours after surgery, with low-intensity isometric exercises for one week, active mobilizations in the second and third week and isotonic exercises with active mobilizations in the fourth and fifth weeks (study group). Likewise, before starting the research project, post-mastectomy patients who had not undergone any physical therapy program were identified. (control group). Results: In the early physical therapy program, the statistical data of the sample were analyzed, which was made up of 19 patients from the study group and 9 patients from the control group, in which an average age of 53.21±11.86 years was obtained. in the study group and 50.44±9.95 years in the control group, with no statistically significant difference (p=0.26), regarding demographic aspects; no situations were found that limited the investigation; Likewise, it was identified that the surgery with the highest incidence was the right modified radical mastectomy, consequently laterality being more frequent, likewise in the analysis of variance in the measurement results in the progress in the improvement of ranges of mobility and of muscle strength, a statistically significant difference was obtained (p< 0.0001), with positive differences in the improvement of the patients in the study group compared to the patients in the control group. Conclusions: Early physical therapy in post-mastectomy patients produces musculoskeletal benefits that help improve the range of motion of the affected thoracic limb and increase muscle strength.

Hipertermia maligna en paciente sometida a mastectomía radical tipo Madden / Malignant hyperthermia in a patient undergoing Madden type radical mastectomy

Resumen: El objetivo del presente estudio es dar a conocer el manejo anestésico que se proporcionó ante un evento crítico hipertermia maligna (HM) en una mastectomía radical Madden programada de manera electiva, la cual fue manejada con lo que se contaba en ese momento por no tener el fármaco específico (dantroleno) para este tipo de evento HM. El cáncer de mama es una enfermedad compleja, es la primera causa de muerte en la mujer a nivel mundial, ocurre en 70% en países desarrollados. México se encuentra en un nivel intermedio, representa un problema de salud con tendencia a la alta debido al envejecimiento de la población y a mayor prevalencia en factores de riesgo. La HM es un trastorno farmacogenético desencadenado por anestésicos que liberan una masiva acumulación de calcio en el sarcoplasma, que conduce a un metabolismo acelerado y a un incremento en la actividad contráctil del musculoesquelético, llevando a un estado hipermetabólico que genera un incremento en la temperatura corporal llegando a tener secuelas importantes y una alta mortalidad. Se trató de paciente femenino 40 años sin antecedentes relevantes para procedimientos anestésicos, se aplicó anestesia general balanceada, a los 60 minutos presentó datos clínicos que nos sugerían hipertermia maligna, fue manejada con los medios disponibles y se obtuvo un resultado favorable desde el punto de vista de morbimortalidad.

Abstract: The objective of the present is to present the anesthetic management that occurred before a critical event malignant hyperthermia HM) in an electively scheduled Madden radical mastectomy and which was managed with what was available at that time for not having the drug specific (dantrolene) for this type of event HM. Breast cancer is a complex disease, being the leading cause of death in women worldwide, with 70% occurring in developed countries. Mexico is at an intermediate level, being a health problem with a tendency to rise due to the aging of the population. population and higher prevalence of risk factors. Malignant hyperthermia (MH) is an anesthetic-triggered pharmacogenetic disorder that triggers a massive accumulation of calcium in the sarcoplasm, leading to accelerated metabolism and increased skeletal muscle contractile activity. Leading to a hypermetabolic state showing an increase in body temperature, leading to significant sequelae and high mortality. It was a 40-year-old female with no relevant history for anesthetic procedures, being managed with balanced general anesthesia at 60 minutes present data clinicians that they suggested malignant hyperthermia, being managed. With the available means, obtaining a favorable result from the point of view of morbidity and mortality.

Perfil das cirurgias oncológicas e reparadoras de mama no norte do Brasil: Análise da última década / Profile of oncological and breast repair surgeries in northern Brazil: Analysis of the last decade

Introdução: O diagnóstico tardio do câncer de mama eleva o número de cirurgias, resultando em alta mortalidade e resultado pouco estético. Assim, é fundamental a instituição de procedimentos de reconstrução mamária. Método: Estudo descritivo, quantitativo e retrospectivo sobre as autorizações de internação hospitalar de pacientes submetidos a procedimentos cirúrgicos de mama em oncologia, no período de 2011 a 2020, cujo dados foram obtidos na plataforma DATASUS. Resultados: 7.529 cirurgias de câncer de mama e 1.949 cirurgias reparadoras foram realizadas na Região Norte. Houve aumento do número de procedimentos ao longo da década. Em todos os estados é possível perceber a diferença no número de municípios de residência, comparado aos municípios de internação. Conclusão: Necessita-se instituir centros de referência oncológica, garantindo tratamento individualizado e a reconstrução mamária.

Introduction: Late breast cancer diagnosis increases the number of surgeries, resulting in high mortality and unsightly results. Therefore, the institution of breast reconstruction procedures is essential. Method: Descriptive, quantitative, and retrospective study on authorizations for hospital admission of patients undergoing breast surgical procedures in oncology from 2011 to 2020, whose data were obtained from the DATASUS platform. Results: 7,529 breast cancer surgeries and 1,949 reconstructive surgeries were performed in the North Region. There was an increase in the number of procedures throughout the decade. In all states, it is possible to notice the difference in the number of municipalities of residence compared to the municipalities of hospitalization. Conclusion: It is necessary to establish oncological reference centers, guaranteeing individualized treatment and breast reconstruction.

Post mastectomy pain syndrome at an Indian tertiary cancer centre and its impact on quality of life

Background: Literature on Post mastectomy pain in the Indian population is scarce. Most literature is from the West. The current study aimed to identify the incidence of post?mastectomy pain syndrome (PMPS), pain severity, and its impact on quality of life in Indian patients. Method: Prospective observational study of 120 women undergoing mastectomy between March and December 2017, followed until 6 months after surgery. The Brief Pain Inventory (BPI) questionnaire and the quality of life questionnaire (QLQ) by the European Organization for Research and Treatment of Cancer (EORTC) and known as (EORTC?QLQ 30) were used to identify the impact on function and quality of life. Results: A 35.8% PMPS incidence was identified at 6 months after mastectomy. Pain was located in the anterior chest wall (41.8%), axilla (32.6%), and medial upper arm (25.6%). Most (48.8%) patients described it as dull aching and of mild intensity (55.8%). No significant association of age, BMI, surgery, Intercostobrachial nerve (ICBN) dissection, postoperative pain severity, pain history {dysmenorrhea, headache}, and postoperative radiotherapy with PMPS was found. Pain interfered with daily activities and quality of life in those with PMPS, as deduced from BPI and EORTC?QLQ. Conclusion: PMPS is very much a problem affecting the quality of life in our set of patients. Most women tried to cope and accept the pain as part of the treatment process. This shows the need for creating awareness about PMPS among healthcare providers and patients alike. Early identification and treatment of post mastectomy pain should be an essential aspect of patient care

Sentinel lymph node biopsy after nipple?sparing mastectomy in early postoperative period: Is it feasible?

Background: Axillary lymph node status is one of the most important prognostic factors for breast cancer. Sentinel lymph node biopsy (SLNB) after mastectomy is highly controversial. There is not enough data about SLNB in the early period after nipple?sparing mastectomy (NSM). This study investigated the feasibility of SLNB in the early postoperative period of NSM. Materials and Methods: Patients who were operated on for breast cancer in Acibadem Maslak Hospital between 2009 and 2018 were searched retrospectively. Results of SLNB as the second session in patients whose final pathology report revealed breast carcinoma after contralateral/bilateral prophylactic mastectomy and mastectomy for benign lesions were evaluated. Results: In the early period (median 14 days) after NSM, SLNB was performed by intradermal radioisotope injection in five patients with occult breast cancer in contralateral/bilateral prophylactic mastectomy and in one patient with preoperatively suspicious mass which yielded breast cancer at final pathology. In five (80%) patients, SLNB was performed, whereas in one patient axillary lymph node dissection (ALND) was performed due to the undetectability of SLN. In one patient, micrometastasis was observed, whereas no metastasis was observed in other patients including the one who underwent ALND. No complication due to SLNB was detected. No recurrence and distant metastasis were detected in a mean follow?up of 42.82 (19�) months. While SLNB did not change the treatment of patients with contralateral occult carcinoma, other patients had hormonal therapy due to negative SLNB. Conclusion: SLNB in the early postoperative period of NSM can be performed by intradermal radioisotope injection. However, further studies are needed to determine the feasibility of SLNB in the early postoperative period of NSM

Role of methylprednisolone in the prevention of seroma formation after mastectomy: A randomized controlled trial

Background: Seroma formation after mastectomy with axillary dissection is a major source of morbidity and results in a significant delay in starting the adjuvant treatment. Many different strategies, including the usage of steroids, have been tried to reduce the incidence of seroma with varying outcomes. This study aimed to assess the effect of a single dose of intracavitary methylprednisolone (MP) on seroma formation in patients undergoing total mastectomy with axillary lymph node dissection (ALND). Methods: A randomized controlled trial was conducted at our institute, from January 2018 till June 2019. In the intervention group of 36 patients, 80 mg of MP solution was injected into the wound on post operative day 1. The drain was clamped for 8 hours and then released. In the control group of 36 patients, saline was administered and the drain output was compared between the groups. Results: The mean drain volume in the intervention group was 409.08 mL and in the control group it was 566.97 mL (P < 0.005). The mean drain removal time was 7.86 days and 10.33 days in the intervention and control group, respectively (P < 0.0004). Conclusion: A single dose of intracavitary MP significantly reduced seroma formation and facilitated early removal of drain in patients undergoing total mastectomy with ALND.

Prevalencia de complicaciones en pacientes mastectomizadas por cáncer de mama

Introducción: la mujer de hoy exige una cirugía lo más efectiva, segura y estética posible. Objetivo: determinar la prevalencia de las complicaciones posquirúrgicas en pacientes mastectomizadas por cáncer de mama. Materiales y métodos: se realizó un estudio cuantitativo, observacional y descriptivo en un universo de 137 pacientes sometidas a mastectomía, por cáncer de mama comprobado histológicamente, en 2019, en los hospitales General Provincial Carlos Manuel de Céspedes y Clínico Quirúrgico Docente Celia Sánchez Manduley, de Granma. Se evaluaron las variables edad, extensión de la mastectomía, lateralidad, aparición de complicaciones, tipo de complicación, estadio tumoral y diagnóstico histológico. Resultados: la media de edad de las pacientes mastectomizadas fue de 56,53 años, y la mastectomía radical modificada fue el proceder quirúrgico más realizado (76 mamas). La incidencia de complicaciones fue del 52,17 % (1,24 % intraoperatoria), siendo la complicación de mayor prevalencia el linfedema (29,63 %). En relación con el tipo histológico, el carcinoma ductal infiltrante sin especificar (77,54 %) fue el más frecuente, y con los estadios tumorales, el IIIB (22,46 %) y el IV (22,46 %) fueron los de mayor prevalencia. La incidencia de las complicaciones aumentó en la medida en que se elevó el estadio tumoral. Conclusiones: la incidencia de las complicaciones posquirúrgicas en la mastectomía fue elevada, relacionándose con el estadio tumoral.

Introduction: today's woman demands the most effective, secure and esthetic surgery possible. Objective: to determine the prevalence of post-surgery complications in patients mastectomized by breast cancer Materials and methods: a quantitative, observational and descriptive study was carried out in a universe of 137 patients who underwent a mastectomy by histologically proven breast cancer, in 2019, in the General Provincial Hospital Carlos Manuel de Cespedes and in the Clinical Surgical Teaching Hospital Celia Sanchez Manduley, of Granma. The variables age, extension of mastectomy, laterality, appearance of complications; type of complication, tumoral stage and histologic diagnosis were evaluated. Results: the mean age of mastectomized patients was 56.53 years, and modified radical mastectomy was the most performed procedure (76 mammae). The incidence of complications was 52.17% (1.24% intra-operatory), being lymphedema (29.63%) the most prevalent complication. In relation to the histologic type, unspecified infiltrating ductal carcinoma (77.54%) was the most frequent one, and tumoral stages IIIB (22.46%) and IV (22.46%) were the most prevalent. The incidence of complications increased as the tumor stage increased. Conclusions: the incidence of postsurgical complications in mastectomy was high, in relation with the tumor stage.

An economic model to assess the value of triclosan-coated sutures in reducing the risk of surgical site infection in a mastectomy in India

Background: The comparison of triclosan-coated sutures (TCS) was made with conventional nonantimicrobial-coated sutures (NCS) to reduce surgical site infection (SSI). This study demonstrates the efficacy and economic outcome of TCS versus NCS for SSIs in mastectomy in India. Methods: In this retrospective analysis, 100 patients were included for both conditions桾CS and NCS梖rom a private and public hospital in India. A systematic literature search of available evidence for both SSI incidences and TCS efficacy data in India were gathered. We collected cost data from a private and public hospital, respectively, for mastectomy in India. The cost-effectiveness of TCS in comparison with the conventional NCS was calculated using a decision-tree deterministic model. We performed a one-way sensitivity analysis to compare TCS with NCS. Results: Cost savings with the use of TCS increased with an increase in SSI incidence and an increase in efficacy for mastectomies in both public and private hospitals. We found a base cost saving of Indian rupees (INR) 27,299 at a private hospital and INR 2,958 at a public hospital for mastectomies. The incremental cost of TCS suture was 0.01% in a private hospital whereas 0.17% in a public hospital. Conclusion: The use of TCS resulted in reduced SSI incidence and cost savings for mastectomy in India.

Diagnósticos de enfermagem baseados na repercussão do câncer mamário e mastectomia / Nursing diagnoses based on breast cancer repercussion and mastectomy / Diagnósticos de enfermería basados en repercusión y mastectomía del cáncer de mama

Objetivo: Descrever diagnósticos de Enfermagem baseados nos discursos de mulheres sobre a repercussão do câncer mamário e mastectomia. Métodos: Trata-se de pesquisa descritiva, com abordagem qualitativa, realizada em uma Organização Não Governamental (ONG) no município de João Pessoa, Paraíba, Brasil. O universo amostral foi composto por todas as 15 mulheres mastectomizadas durante os meses de setembro e outubro de 2017. Essas mulheres responderam um roteiro de entrevista semiestruturada. A análise dos dados qualitativos foi norteada pela Técnica de Análise de Conteúdo proposta por Bardin. Após a delimitação das categorias, foram construídos diagnósticos de Enfermagem por meio da Classificação Internacional da Prática de Enfermagem (CIPE)®. Resultados: Foram identificadas três categorias temáticas: Sentimentos experenciados após diagnóstico de câncer e realização da mastectomia; Modificações biológicas e psicológicas após a mastectomia; Resiliência diante do sofrimento. Os diagnósticos de Enfermagem elencados foram: angústia, bem-estar prejudicado, bem-estar espiritual prejudicado, autoestima alterada, autoimagem alterada, capacidade de autocuidado prejudicada, dificuldades diárias, distúrbio da identidade pessoal, insatisfação com a vida e o corpo. Conclusão: é necessário enfatizar o cuidado no momento de verbalizar o diagnóstico, a escuta diante do outro e a percepção das mulheres diante do processo de adoecimento. (AU)

Objective: To describe nursing diagnoses based on women's discourse on the repercussions of breast cancer and mastectomy. Methods: This is a descriptive research, with a qualitative approach, carried out in a Non-Governmental Organization (NGO) in the city of João Pessoa, Paraíba, Brazil. The sample universe was composed of all 15 women undergoing mastectomy during the months of September and October 2017. These women answered a semi-structured interview script. The analysis of qualitative data was guided by the Content Analysis Technique proposed by Bardin. After delimiting the categories, Nursing diagnoses were constructed using the International Classification of Nursing Practice (ICNP) ®. Results: Three thematic categories were identified: Feelings experienced after cancer diagnosis and mastectomy; Biological and psychological changes after mastectomy; Resilience in the face of suffering. The nursing diagnoses listed were anguish, impaired well-being, impaired spiritual well-being, impaired self-esteem, impaired self-image, impaired self-care capacity, daily difficulties, personal identity disorder, dissatisfaction with life and body. Conclusion: it is necessary to emphasize care when verbalizing the diagnosis, listening to the other and the women's perception of the illness process. (AU)

Objetivo: Describir los diagnósticos de enfermería basados en el discurso de las mujeres sobre las repercusiones del cáncer de mama y la mastectomía. Métodos: Se trata de una investigación descriptiva, con enfoque cualitativo, realizada en una Organización No Gubernamental (ONG) en la ciudad de João Pessoa, Paraíba, Brasil. El universo muestral estuvo compuesto por las 15 mujeres sometidas a mastectomía durante los meses de septiembre y octubre de 2017. Estas mujeres respondieron un guión de entrevista semiestructurado. El análisis de datos cualitativos fue guiado por la Técnica de Análisis de Contenido propuesta por Bardin. Después de delimitar las categorías, los diagnósticos de enfermería se construyeron utilizando la Clasificación Internacional de la Práctica de Enfermería (CIPE) ®. Resultados: Se identificaron tres categorías temáticas: sentimientos experimentados después del diagnóstico de cáncer y mastectomía; Cambios biológicos y psicológicos después de la mastectomía; Resiliencia ante el sufrimiento. Los diagnósticos de enfermería enumerados fueron angustia, deterioro del bienestar, deterioro del bienestar espiritual, deterioro de la autoestima, deterioro de la autoimagen, deterioro de la capacidad de autocuidado, dificultades diarias, trastorno de la identidad personal, insatisfacción con la vida y el cuerpo. Conclusion: es necesario enfatizar el cuidado al verbalizar el diagnóstico, escuchar al otro y la percepción de la mujer sobre el proceso de la enfermedad. (AU)

Significance of target volume delineation of tumor bed according to metal clips or seroma in determing tumor bed position during radiotherapy after breast-conserving surgery for breast cancer / 肿瘤研究与临床

Objective:To investigate the differences between the mental clips placed intraoperatively and the tumor bed's target volume delineation of seroma based on CT scanning during radiotherapy for breast cancer patients who received breast-conserving surgery in the persuit of a better solution to determine the tumor bed position.Methods:The clinical data of 13 patients with early breast cancer who received postoperative radiotherapy after breast-conserving surgery at Beijing Shijingshan Hospital and Beijing Shijitan Hospital of Capital Medical University from December 2020 to January 2022 were retrospectively analyzed. They all had surgical clips implanted during the surgery. The following methods were used to delineate the target volume of tumor bed, including gross target volume delineation of tumor bed based on the mental clips (GTVtb-Clip), the tumor bed's gross target volume delineation of seroma based on CT scanning (GTVtb-Seroma), and the combination of both (GTVtb-C+S). The volume, diameter on three coordinate axis, neutral point displacement and conformability of these delineation methods were compared.Results:The volume of GTVtb-Clip, GTVtb-Seroma and GTVtb-C+S was (25±10) cm 3, (38±17) cm 3, (49±20) cm 3, and the differences were statistically significant (all P<0.05). The diameter on X axis was (4.7±1.2) cm, (5.3±1.4) cm, (5.7±1.6) cm, respectively in GTVtb-Clip, GTVtb-Seroma and GTVtb-C+S; the diameter on Y axis was (4.6±1.7) cm, (5.0±1.6) cm, (5.7±1.7) cm, respectively in GTVtb-Clip, GTVtb-Seroma and GTVtb-C+S; the diameter on Z axis was (4.4±1.5) cm, (5.2±1.4) cm, (5.6±1.4) cm in GTVtb-Clip, GTVtb-Seroma and GTVtb-C+S. The differences in the diameter of GTVtb-Clip and GTVtb-C+S on X,Y, Z axis were statistically significant (all P<0.05); the differences in the diameter of GTVtb-Seroma and GTVtb-C+S on X, Z axis were statistically significant (all P<0.05); the difference in the diameter of GTVtb-Clip and GTVtb-Seroma on X axis was statistically significant ( P<0.05) .Neutral point displacement was (5.8±1.6) cm, (5.5±1.9) cm, (6.0±1.7) cm, respectively of GTVtb-Clip, GTVtb-Seroma, GTVtb-C+S, and the difference was not statistically significant ( P>0.05). Conformability of GTVtb-Clip and GTVtb-Seroma, GTVtb-Clip and GTVtb-C+S, GTVtb-Seroma and GTVtb-C+S was 0.412±0.112, 0.525±0.095, 0.774±0.112,respectively, and the differences were statistically significant (all P<0.05). Conclusions:During radiotherapy after breast-conserving surgery for breast cancer, compared with the single method, the combination of GTVtb-Clip and GTVtb-Seroma can better cover the real tumor bed, thus reducing the omission of tumor bed and recurrence rate. CT position should better take place at 4 to 8 weeks for patients receiving radiotherapy after breast-conserving surgery, and target volume of tumor bed will be delineated based on the postoperative changes of both mental clips and seroma.

Optimization strategies of anesthesia for modified radical mastectomy: pecto-intercostal fascial block-pectoral nerve block type Ⅱ-general anesthesia / 中华麻醉学杂志

Objective:To evaluate the efficacy of pecto-intercostal fascial block (PIFB)-pectoral nerve block type Ⅱ (PECS Ⅱ block)-general anesthesia for modified radical mastectomy.Methods:Forty-six patients, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, aged 40-65 yr, scheduled for elective modified radical mastectomy, were divided into 2 groups ( n=23 each) using a random number table method: PECS Ⅱ block-general anesthesia group (group P+ G) and PIFB-PECS Ⅱ block-general anesthesia group (group P+ P+ G). The patients received ultrasound-guided PECS Ⅱ block (P+ G group) or PIFB combined with PECS Ⅱ block (P+ P+ G group) in the pre-anesthesia room. Then the patients were admitted to the operating room, and midazolam, propofol, sufentanil and cisatracurium were used for anesthesia induction, and sevoflurane, remifentanil and cisatracurium were used for anesthesia maintenance. The intraoperative consumption of remifentanil, emergence time and extubation time were recorded. Flurbiprofen axetil 50 mg was intravenously injected as rescue analgesic after operation, and visual analog scale score was maintained ≤3 at rest. The requirement for rescue analgesia and occurrence of nausea and vomiting within 24 h after operation were recorded. Results:Compared with group P+ G, the intraoperative consumption of remifentanil was significantly decreased, the emergence time and extubation time were shortened, the rate of rescue analgesia within 24 h after operation was decreased, the time of first rescue analgesia was prolonged ( P<0.05), and no significant change was found in the incidence of nausea and vomiting in group P+ P+ G ( P>0.05). Conclusions:Compared with PECS Ⅱ block-general anesthesia, PIFB-PECS Ⅱ block-general anesthesia can reduce the amount of intraoperative opioids, inhibit postoperative hyperalgesia and promote early postoperative recovery when used for modified radical mastectomy.