Comparative analysis of the degree of patient satisfaction after breast-conserving surgery with or without oncoplastic surgery: systematic review and meta-analysis.

Introduction: Conservative surgery is the gold standard for the treatment of single and small tumors and, combined with the concept of oncoplastic tumors, brings good aesthetic results while maintaining cancer safety. The objective was to comparatively analyze the degree of satisfaction of patients undergoing breast conserving surgery (BCS), with and without oncoplastic surgery (OPS) using level II OPS techniques. Methods: Review with a search in the databases MEDLINE (by PubMed), EMBASE, Clinical Trials, Scopus, Web of Science, BVS and Oppen gray. The meta-analysis of random effects was performed using the Der Simonian-Laird method considering the odds ratio (OR) with a 95% confidence interval (95% CI). Results: There was no statistically significant difference in the aesthetic outcome between women who underwent OPS and BCS (OR 0.90; 95% CI 0.62-1.30). The staging (OR 1.93; 95% CI 0.97-3.84; I 2 = 15.83%); tumor location [central (OR 1.28; 95% CI 0.06-27.49; I 2 = 17.63%); lower (OR 0.75; 95% CI 0.21-2.65; I 2 = 2.21%); superior (OR 0.67; 95% CI 0.26-1.74; I 2 = 0.00%] and tumor size (OR 8.73; 95% CI -11.82-29.28; I 2 = 93.18%) showed no association with the type of BCS performed, with or without OPS. The degree of satisfaction remains even in cases of extreme oncoplasty. Conclusion: The level of patient satisfaction in relation to BCS was similar to that of the group undergoing OPS, highlighting that OPS allows the patient's satisfaction rate to be maintained even in the case of large or multicentric tumors.

Masculinizing Mammoplasty for Female-to-Male Transgenders: 10 Years' Experience.

BACKGROUND: Masculinizing mammoplasty is a surgical procedure frequently performed in transmale individuals. Despite providing a positive impact for the patient, this surgery has high rates of complications and revisions. In cases requiring a double incision, there are advantages in using an inferior pedicle when possible. METHODS: This was an observational study. Outcomes and complications were analyzed in 104 patients operated on by the author using three techniques: concentric periareolar surgery, double incision with an areola graft, and double incision with an inferior areolar pedicle. The Breast-Q questionnaire adapted for transgender males was applied. RESULTS: The responses of the adapted Breast-Q questionnaires demonstrated high scores regarding quality of life and satisfaction. The rates of complications and surgical revisions were 24.3 and 25.6%, respectively, with no significant difference between the techniques. The most common complication was hematoma (13.6%), which was positively associated with the use of testosterone. Ischemia of the nipple-areola complex was present in 8.7% of the operated breasts. When using the inferior pedicle, areola ischemia occurred more often when the nipple-fold distance was greater than 8 cm. CONCLUSIONS: Quality of life, satisfaction, complications, and revisions were comparable to those observed in the literature. Hematoma was the most frequent complication, and an association with the use of testosterone was observed. When a double incision is indicated, the inferior pedicle is more advantageous than the areola graft; however, it should be used when the distance between the nipple and the inframammary fold is 8 cm or less. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Assessment of Three Breast Volume Measurement Techniques: Single Marking, MRI and Crisalix 3D Software®.

INTRODUCTION: Measuring breast volume is important to obtain satisfactory breast surgery results, and many techniques are used for this purpose. Thus, the aim of the present study was to compare 3 breast volume techniques: Pessoa's single marking technique, magnetic resonance imaging (MRI) and Crisalix 3D software®. METHODS: Fourteen patients indicated for mammoplasty were selected. Three breast volume measurement techniques were compared: Pessoa's single marking technique, MRI and Crisalix 3D software®. The volumes were tabulated and analyzed using R software. RESULTS: Average age was 30.93 ± 10.25 years. The breast volume was 1554.54 ± 512.54 cm3, as measured by the MRI technique (considered the gold standard), 1199.64 ± 403.13 cm3 using Crisalix 3D software® and 1518.04 ± 468.72 cm3 by Pessoa's single marking technique. Comparison between the Crisalix 3D software® and MRI techniques using the pairwise t test demonstrated a statistically significant difference (t = 4.3957, df = 27, p value = 0001543), but no significant difference between the single marking and MRI techniques (t = 1.3841, df = 27, p value = 0.1777). CONCLUSION: When compared to MRI, breast volume measurement using Pessoa's single marking technique showed no statistically significant difference between them. However, the Crisalix 3D® technique exhibited a difference in relation to MRI. Anthropometric measurements are useful in measuring breast volume because they are easy to obtain, practical and inexpensive, and should be part of a plastic surgeon's arsenal. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Mamoplastia redutora: da técnica ao impacto social / Reduction mammoplasty: from technique to social impact / Mamoplastia de reducción: de la técnica al impacto social

As mulheres com tamanhos excessivos das mamas sofrem de patologias definidas como gigantomastia, macromastia ou hipertrofia mamária, isso indica um processo em que os seios são patologicamente aumentados o que gera condições insalubres. Seu tamanho afeta diretamente sua saúde com danos psicológicos e na qualidade de vida. O tratamento inclui a retirada cirúrgica do tecido excedente no processo de melhora da qualidade de vida, visando reduzir os sintomas, melhorar a funcionalidade, o estado psicológico, além um melhoramento estético. Dessa forma, o presente estudo tem como objetivo realizar uma análise desde a técnica da mamoplastia redutora quanto aos seus impactos sociais. Trata-se de uma pesquisa qualitativa como foco a construção teórica e a discussão de questões atuais sobre o tema com base nas evidências das literaturas dos últimos cinco anos. As mulheres com gigantomastia experimentam melhorias na forma e funcionalidade da mama após a mamoplastia redutora. Há evidências substanciais de que esta cirurgia melhora significativamente a qualidade de vida do paciente, visto que há a redução do volume mamário que consequentemente melhora das dores lombares, as mamas ficam esteticamente mais adequadas para uso de roupas íntimas, além de cessar irritações cutâneas e infecções nas áreas das dobras. Muitas pacientes se beneficiam de uma melhor qualidade de vida ao não apresentarem mais esses sintomas listados. Realizar este procedimento tem sido considerado satisfatório pela maioria das pessoas, e com base na análise realizada, a maioria das pacientes priorizam os efeitos estéticos e funcional, além de reduzir o impacto em outras doenças mesmo essa patologia não sendo amplamente disponibilizada pelo SUS. De tal forma, essa direção de pesquisa busca contribuir para o desenvolvimento de pesquisas futuras e em andamento relacionadas a esse tema.

Women with excessive breast sizes suffer from pathologies defined as gigantomastia, macromastia, or breast hypertrophy, this indicates a process in which the breasts are pathologically enlarged which generates unhealthy conditions. Their size directly affects your health with psychological damage and quality of life. The treatment includes the surgical removal of the excess tissue in the process of improving quality of life, aiming to reduce symptoms, improve functionality, psychological state, and an aesthetic improvement. Thus, the present study aims to carry out an analysis from the technique of reduction mammoplasty as to its social impacts. This is a qualitative research focusing on theoretical construction and discussion of current issues on the subject based on evidence from the literatures of the last five years. Women with gigantomastia experience improvements in breast shape and functionality after reduction mammaplasty. There is substantial evidence that this surgery significantly improves the patient's quality of life, as there is a reduction in breast volume which consequently improves lower back pain, the breasts become more aesthetically pleasing for underwear, and skin irritation and infections in the fold areas cease. Many patients benefit from a better quality of life by no longer experiencing these listed symptoms. Performing this procedure has been considered satisfactory by most people, and based on the analysis performed, most patients prioritize the aesthetic and functional effects, besides reducing the impact on other diseases even though this pathology is not widely available by SUS. In such a way, this research direction seeks to contribute to the development of future and ongoing research related to this theme.

Las mujeres con excesivo tamaño mamario sufren patologías definidas como gigantomastia, macromastia o hipertrofia mamaria, esto indica un proceso en el que las mamas se agrandan patológicamente lo que genera condiciones insalubres. Su tamaño afecta directamente a la salud con daños psicológicos y a la calidad de vida. El tratamiento incluye la extirpación quirúrgica del exceso de tejido en el proceso de mejora de la calidad de vida, con el objetivo de reducir los síntomas, mejorar la funcionalidad, el estado psicológico, y una mejora estética. Así, el presente estudio pretende realizar un análisis a partir de la técnica de mamoplastia de reducción en cuanto a sus impactos sociales. Se trata de una investigación cualitativa centrada en la construcción teórica y la discusión de cuestiones actuales sobre el tema a partir de la evidencia de las literaturas de los últimos cinco años. Las mujeres con gigantomastia experimentan mejoras en la forma y funcionalidad de las mamas después de la mamoplastia de reducción. Existen pruebas sustanciales de que esta cirugía mejora significativamente la calidad de vida de la paciente, ya que se produce una reducción del volumen mamario que, en consecuencia, mejora el dolor lumbar, las mamas resultan más estéticas para la ropa interior y cesan la irritación de la piel y las infecciones en las zonas de los pliegues. Muchas pacientes se benefician de una mejor calidad de vida al dejar de experimentar estos síntomas enumerados. La realización de este procedimiento ha sido considerada satisfactoria por la mayoría de las personas, y con base en el análisis realizado, la mayoría de los pacientes priorizan los efectos estéticos y funcionales, además de reducir el impacto sobre otras enfermedades, aunque esta patología no esté ampliamente disponible por el SUS. De tal forma, esta dirección de investigación busca contribuir para el desarrollo de futuras y actuales investigaciones relacionadas a este tema.

Técnica de mastopexia sem demarcação prévia idealizada pelo Dr. Millan: descrição da técnica e avaliação do nível de satisfação / The mastopexy technique without preoperative markings idealized by Dr. Millan: description of the technique and patient satisfaction evaluation

Introdução: Diferentes técnicas cirúrgicas foram desenvolvidas para a redução do volume glandular e para a correção da ptose mamária com o objetivo de obter resultados eficientes e de qualidade com o menor número de complicações possível. Este artigo descreve a técnica de mastopexia idealizada pelo Dr. Roberto Antonio Barjaz Millan e a avaliação do nível de satisfação das mulheres após o procedimento. Métodos: Trata-se de um estudo transversal, observacional e analítico desenvolvido a partir da análise da técnica de mastopexia na redução mamária e na correção de ptose mamária padronizada pelo Dr. Millan, realizado no Setor de Cirurgia Plástica do Centro Universitário Saúde ABC. Participaram do estudo 20 mulheres com ptose mamária grau II e III, segundo classificação de Regnault, ou hipertrofia mamária, definida pelos critérios de Sacchini et al. e de Franco & Rebello, ainda não submetidas a cirurgia e 20 mulheres previamente submetidas a mastopexia pela técnica de Millan, com idades entre 18 e 60 anos. Para análise do nível de satisfação após o procedimento, foi aplicado o questionário BREAST-Q®. Resultados: Não houve diferenças significantes das mulheres que fizeram a cirurgia (grupo pós-cirúrgico) quando comparadas às que não fizeram cirurgia (grupo controle) em relação às variáveis idade (p=0,357), Índice de Massa Corporal (p=0,695), grau de hipertrofia (p=0,799) e grau de ptose mamária (p=0,391). Em relação às variáveis de satisfação com mamas, psicossocial, sexual, físico, todas as pacientes submetidas a cirurgia apresentaram valores maiores comparados aos valores obtidos nas pacientes do grupo sem cirurgia (p<0,009). Conclusão: A técnica de mastopexia idealizada pelo Dr. Millan apresenta resultados que foram considerados satisfatórios pelas pacientes avaliadas.

Introduction: Different surgical techniques were developed to reduce glandular volume and correct breast ptosis, with the objective of efficient and quality results for the patients and with the fewest possible complications. This study describes the treatment technique standardized by Dr. Roberto Millan and the level of women's satisfaction after performing the procedure. Methods: This is a cross-sectional, observational and analytical study carried out from the analysis of the breast treatment technique standardized by Dr. Millan performed at the Plastic Surgery Sector of Centro Universitário Saúde ABC. The study included 20 women with grade II and III breast ptosis, according to Regnault's classification, or breast hypertrophy, defined by the criteria of Sacchini et al. and by Franco & Rebello; and 20 women previously submitted to mastopexy or reduction mammoplasty using the Millan technique, aged between 18 and 60 years. The BREAST-Q® questionnaire was applied to analyze the level of satisfaction after the procedure. Results: It is observed that there were no significant differences between women who underwent the surgery Mass group (post-surgical group) when compared to those who did not undergo surgery (control group) concerning age (p=357), (p=0.695), degree of hypertrophy (p=0.799) and degree of breast ptosis (p=0.391). Regarding breast satisfaction, psychosocial, sexual, and physical variables all presented higher values in women with surgery than those without surgery (p<0.009). Conclusion: The breast treatment technique standardized by Dr. Millan presents results that led to patient satisfaction.

Galactorreia pós-mastopexia com prótese: relato de caso / Post-mastopexy galactorrhoea with a prosthesis: a case report

A mastopexia é a cirurgia plástica responsável pela correção da ptose mamária, problema caracterizado pela discrepância entre o volume da mama e sua camada cutânea. As complicações mais relatadas no pós-operatório imediato são deiscência de suturas, seroma, edema e infecção, enquanto outras, como a galactorreia, são consideradas raras. O caso em questão consiste em uma paciente de 52 anos, que realizou a mastopexia bilateral com inclusão de prótese e desenvolveu após 30 dias do procedimento galactorreia com hiperprolactinemia. O diagnóstico foi suspeitado devido ao aumento de volume, associado a dor ou desconforto mamário no pós-operatório, seguido de saída secreção leitosa. A galactocele pósmastopexia com prótese pode ou não estar associada à hiperprolactinemia, porém pouco se sabe sobre a real fisiopatologia do desenvolvimento desse quadro. O tratamento foi feito com cabergolina 0,5mg em duas doses, com melhora do quadro.

Mastopexy is the plastic surgery responsible for correcting breast ptosis, a problem characterized by a discrepancy between the volume of the breast and its skin layer. The complications most commonly reported in the immediate postoperative period are suture dehiscence, seroma, edema and infection, while others such as galactorrhea are considered rare. The case in question consists of a 52-yearold patient who underwent bilateral mastopexy with prosthesis inclusion and developed galactorrhea with hyperprolactinemia 30 days after the procedure. The diagnosis was suspected of increased volume, associated with postoperative breast pain or discomfort, followed by milky discharge. Galactocele after mastopexy with a prosthesis may or may not be associated with hyperprolactinemia, but little is known about the real pathophysiology of the development of this condition. Treatment was done with cabergoline 0.5mg in two doses, improving the condition.

Gigantomastia as a Cause of Pulmonary Hypertension.

Reduction mammaplasty is the gold standard treatment for gigantomastia. We report one female patient with juvenile gigantomastia associated with severe pulmonary hypertension where her pulmonary pressure decreased significantly after the surgery, improving her quality of life. A 22-year-old female patient with gigantomastia since 10 years old, tricuspid regurgitation, and pulmonary thromboembolism antecedent was admitted to the emergency department. Her oxygen saturation was 89%. Acute heart failure management was initiated. An echocardiogram reported left ventricle ejection fraction (LVEF) of 70% with severe right heart dilation, contractile dysfunction, and arterial pulmonary pressure (PASP) of 110 mm Hg. A multidisciplinary team considered gigantomastia could generate a restrictive pattern, so a Thorek reduction mammoplasty with Wise pattern was performed. Presurgical measurements were: sternal notch to nipple-areola complex, right 59 cm, left 56 cm. Three days after surgery, the patient could breathe without oxygen support. In the outpatient follow-up, patient referred reduction of her respiratory symptoms and marked improvement in her quality of life. Six months after surgery, a control echocardiogram showed a LVEF of 62% and PASP of 85 mm Hg. Pulmonary hypertension may be present in patients with gigantomastia. Reduction mammoplasty may be a feasible alternative to improve the cardiac signs and symptoms in patients with medical refractory management.

Técnica de duplo espaço modificada para mastopexia de aumento / Modified double space technique for augmentation mastopexy

Introdução: A mastopexia com prótese continua sendo um desafio para todos os cirurgiões plásticos. Resultados consistentes ainda são difíceis de se obter por muitas razões e alguns autores defendem a cautela devido a complicações. Métodos: Este estudo retrospectivo inclui 92 casos consecutivos mastopexia de aumento em tempo único realizados pelo mesmo cirurgião, entre março de 2012 e outubro de 2019. Resultados: O seguimento médio foi de 14 meses para o grupo de mastopexia de aumento. Três pacientes (3,3%) tiveram contratura capsular grau III. O índice de revisões foi de 25,3%: 7,6% com recidiva da ptose, revisão de cicatrizes em 6,5%, 1,1% de assimetrias. Três pacientes (3,3%) apresentaram ruptura da fixação da alça muscular, quatro pacientes (4,4%) tiveram deformidades dinâmicas. Conclusão: A técnica modificada de duplo espaço apresenta em nossa experiência resultados consistentes a longo prazo, e as taxas de revisão/complicação foram semelhantes a alguns estudos, mas maiores do que outros. Cirurgia prévia da mama, tabagismo, amamentação e cirurgia bariátrica anterior não aumentam as taxas de complicações e revisões. Pode ser uma das opções para a cobertura e suporte dos implantes em procedimentos de mastopexia de aumento.

Introduction: Mastopexy with prosthesis remains a challenge for all plastic surgeons. Consistent results are still difficult to obtain for many reasons, and some authors advocate caution due to complications. Methods: This retrospective study includes 92 consecutive single-stage augmentation mastopexy cases performed by the same surgeon between March 2012 and October 2019. Results: The median follow-up was 14 months for the augmentation mastopexy group. Three patients (3.3%) had grade III capsular contracture. The revision rate was 25.3%: 7.6% with ptosis recurrence, scar revision in 6.5%, and 1.1% asymmetries. Three patients (3.3%) had ruptured muscle loop fixation, four patients (4.4%) had dynamic deformities. Conclusion: The modified double-space technique in our experience shows consistent long-term results, and revision/complication rates were similar to some studies but higher than others. Prior breast surgery, smoking, breastfeeding, and previous bariatric surgery do not increase rates of complications and revisions. It can be one of the options for covering and supporting implants in augmentation mastopexy procedures.

Plano intramuscular para mamoplastia de aumento com implante de silicone / Intramuscular plane for breast augmentation with a silicone implant

Introdução: O aumento mamário é um procedimento estético frequente na cirurgia plástica, o plano ideal ainda não foi encontrado. Cada loja tem sua indicação, suas vantagens e desvantagens. A técnica da loja intramuscular foi inicialmente descrita para uso em cirurgias de aumento dos glúteos com implantes de silicone, e mais tarde sua segurança foi reforçada com a utilização do método XYZ. O estudo tem a finalidade de apresentar a utilização da técnica intramuscular na mamoplastia de aumento com implante de silicone. Métodos: Este estudo descreve em detalhes a técnica da loja intramuscular na mamoplastia de aumento com implante de silicone, utilizada em 50 pacientes do sexo feminino. Resultados: A técnica intramuscular propicia uma boa definição de contorno estético nos quadrantes mediais das mamas. Tivemos um caso de seroma no pós-operatório, causado por erro técnico na separação dos fascículos. Conclusão: A técnica é segura e apresenta baixa incidência de complicações.

Introduction: Breast augmentation is a frequent aesthetic procedure in plastic surgery; the ideal plane has not yet been found. Each pocket has its indication, its advantages, and disadvantages. The intramuscular pocket technique was initially described for use in buttock augmentation surgeries with silicone implants, and later its safety was reinforced with the use of the XYZ method. This study aims to present the use of the intramuscular technique in breast augmentation with a silicone implant. Methods: This study describes the intramuscular pocket technique in breast augmentation with a silicone implant used in 50 female patients. Results: The intramuscular technique provides a good definition of aesthetic contour in the medial quadrants of the breasts. We had a case of seroma in the postoperative period caused by a technical error in separating the fascicles. Conclusion: The technique is safe and has a low incidence of complications.

Mastopexy with an Implant and the Making of a Horizontal Flap of the Upper Pedicle, Simulating an Internal Bra.

INTRODUCTION: Mastopexy with an implant is undoubtedly one of the most challenging surgeries in cosmetic surgery since it involves two overlapping procedures. The aim of this study was to demonstrate that by using horizontal glandular flaps in the sulcus in mastopexy with implants, it is possible to reduce the number of postoperative complications. METHODS: Sixty-three female breast surgery patients with some degree of flaccidity who underwent surgery from July 2018 to January 2020 were selected. All surgeries were performed in one procedure with an initial resection of the excess skin associated with a horizontal flap of the upper pedicle that promoted the protection of the implants and decreased the surgical wound tension. RESULTS: Forty-seven patients were included in the sample, for a total of 94 breasts. The motivation of the surgery was esthetic in all cases. Related to complications, we had 1 (1.06%) case of seroma, 1 (1.06%) case suffering from areola necrosis, 6 (6.3%) cases with scar revisions, 10 (10.6%) cases with complications in the transition from the "T" and no case of hematoma, infection or extrusion of the implants. The follow-up time was 12 months. CONCLUSION: This technique allows the surgeon to perform a resection of excess skin and place the implants in one procedure, thereby decreasing the tension in the suture line, protecting the implants and forming a protective stabilizing brace in the mammary groove. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Tercer episodio de doble contractura capsular unilateral posterior a mamoplastia de aumento / Third episode of unilateral double capsular contracture after breast augmentation

Resumen La mamoplastia de aumento consiste en insertar una prótesis dentro del tejido mamario con el fin de alterar su tamaño y forma. Actualmente, se utilizan varios tipos de implantes según su forma, tamaño y material, así como diferentes variaciones en la técnica quirúrgica. Se han descrito complicaciones asociadas por ser considerados cuerpos extraños y la más común es la contractura capsular. Se presenta el caso de una paciente de 41 años a quien se le realizó mamoplastia de aumento con implantes de silicona y de forma atípica presentó un episodio de doble contractura capsular que requirió dos intervenciones adicionales por asimetría y dolor cambiando el implante y nuevamente presentando el mismo fenómeno de manera unilateral en la mama izquierda.

Abstract Augmentation mammoplasty consists of inserting a prosthesis into the breast tissue in order to alter its size and shape. Currently, several types of implants are used according to their shape, size and material, as well as different variations in the surgical technique. Associated complications have been described because they are considered foreign bodies and the most common is capsular contracture. We present the case of a 41 year old patient who underwent augmentation mammoplasty with silicone implants and atypically presented an episode of double capsular contracture that required two additional interventions due to asymmetry and pain by changing the implant and again presenting the same phenomenon unilaterally in the left breast.

Mamoplastia de reducción oncoplástica en paciente con cancer de seno y macromastia: reporte de caso / Oncoplastic reduction mammoplasty in patients with breast cancer and macromasty: review of the literature and case report

Resumen El cáncer de mama es la patología maligna más frecuente en la población femenina, su tratamiento ha evolucionado progresivamente en dirección a la conservación del seno a través del desarrollo de la cirugía Oncoplástica de seno, que consiste en manejo conservador con mastectomía parcial y reconstrucción inmediata. Las pacientes que presentan de manera concomitante cáncer de seno y macromastia, representan un reto mayor en el tratamiento debido a la dificultad de generar simetría con el seno contralateral y que además presentan sintomatología específica relacionada con la macromastia que disminuye su calidad de vida. El objetivo de este artículo es reportar el caso de una paciente que se maneja de manera exitosa y simultánea el cáncer de seno y macromastia, mediante cirugía oncoplástica de seno derecho y en el mismo tiempo quirúrgico, mamoplastia de reducción bilateral, obteniendo adecuado control oncológico y mejoría significativa en su calidad de vida medida por cuestionario BREAST-Q. MÉD.UIS.2021;34(3): 93-101.

Summary Breast cancer is the most frequent malignant pathology in the female population. Its treatment has progressively evolved in the direction of breast conservation through the development of oncoplastic breast surgery, which consists of conservative management with partial mastectomy and immediate reconstruction. Patients who present breast cancer concomitantly with macromastia, represent a greater challenge in treatment due to the difficulty of generating symmetry with the contralateral breast; they also present specific symptoms related to macromastia that diminishes their quality of life. The objective of this article, is to report the case of a patient with breast cancer and macromastia, who is successfully and simultaneously managed with oncoplastic surgery of the right breast and bilateral reduction mammoplasty, obtaining adequate oncological control and significant improvement in her quality of life measured by BREAST-Q questionnaire. MÉD.UIS.2021;34(3): 93-101.

Mastoplastia de aumento primária em serviço de residência médica de cirurgia plástica / Primary augmentation mammoplasty in a plastic surgery residency service

■ RESUMO Introdução: A mastoplastia de aumento primária é uma das principais cirurgias estéticas na rotina do cirurgião plástico. As várias técnicas de realização exigem estudo constante e formação ampla dos médicos residentes da especialidade. Métodos: Revisão de prontuários das pacientes submetidas a mastoplastias de aumento primária no Hospital das Clínicas da Faculdade de Medicina de Botucatu no período de 2017 a 2020. Resultados: 120 cirurgias foram realizadas no período analisado. Houve predomínio de implantes de projeção alta (75%) e em plano subfascial (67,5%). Houve ausência de complicações maiores, com grande parte das pacientes (75%) não apresentando nenhuma complicação menor (p<0,001). Conclusão: A mastoplastia de aumento é uma cirurgia segura quando realizada seguindo os cuidados técnicos adequados e sob supervisão, sendo um procedimento importante na formação do cirurgião plástico.

■ ABSTRACT Introduction: Primary augmentation mammoplasty is one of the main cosmetic surgeries in the plastic surgeon's routine. The various performance techniques require constant study and extensive training of the specialty's resident physicians. Methods: Review medical records of patients who underwent primary augmentation mammoplasty at the Hospital das Clínicas of the Faculdade de Medicina de Botucatu from 2017 to 2020. Results: 120 surgeries were performed during the period analyzed. There was a predominance of high-projection (75%) and subfascial (67.5%) implants. There were no major complications, with most patients (75%) not having any minor complications (p<0.001). Conclusion: Augmentation mammoplasty is a safe surgery when performed following proper technical care and under supervision.

Mamoplastia com técnica em "D" espelhado e lipoaspiração assistida por laser / Mammoplasty with mirrored "D" technique and laser-assisted liposuction

■ RESUMO Introdução: A mamoplastia é um procedimento estético e funcional, considerada uma cirurgia árdua, com o objetivo de melhorar as mamas na sua forma com o mínimo de cicatriz aparente e reposicionar o complexo areolopapilar. Não existe um procedimento padrão e a escolha de uma técnica depende de distintos fatores, o que justifica a diversidade de técnicas descritas. Apresentaremos a técnica em "D" espelhado, de uma maneira ampla em distintos cenários (anatômicos), junto à lipoaspiração assistida por laser com marcação padrão, o que facilita o procedimento cirúrgico com uma simetria final e manutenção de resultados estéticos, corrigindo as recidivas. Métodos: Técnica realizada em 46 pacientes, do sexo feminino, sem exclusão de raça, entre 20 a 66 anos, operadas pelos autores entre janeiro de 2017 a março 2020, no Hospital Antoninho da Rocha Marmo - São José dos Campos - Brasil. Trabalho retrospectivo com aplicação do questionário validado Breast-Q® para avaliar o grado de satisfação. Resultados: Não teve revisão cirúrgica, sem infecção pós-operatória ou necrose da placa areolopapilar, 5 casos de epidermólise da placa areolopapilar tratados com flavonoides e castanha da índia (linfa cream®), sem sequelas. Ressecção do parênquima de 80 a 1.100g média 477,1g. LAL entre 150 a 790ml, média 438,6ml. A cicatriz vertical final média 6,7cm, estável após 2 anos, com avaliação Breast-Q® de muito satisfeito (86%). Conclusão: Consideramos a técnica em "D" espelhado e lipoaspiração assistida por laser uma boa opção cirúrgica pela sistematização e versatilidade em diferentes cenários de mamoplastia, mantendo formato coniforme com cicatriz menor e manutenção dos resultados validados.

■ ABSTRACT Introduction: Mammoplasty is an aesthetic and functional procedure, considered an arduous surgery, intending to improve the breasts' shape with a minimum of apparent scarring and reposition the nipple-areola complex. There is no standard procedure, and a technique's choice depends on different factors, which justifies the diversity of techniques described. We will present the mirrored "D" technique broadly in different (anatomical) scenarios, together with laser-assisted liposuction with standard marking, which facilitates the surgical procedure with final symmetry and maintenance of aesthetic results, correcting the recurrences. Methods: Technique performed in 46 patients, female, without exclusion of race, between 20 and 66 years old, operated by the authors between January 2017 and March 2020, at the Hospital Antoninho da Rocha Marmo - São José dos Campos - Brazil. Retrospective work with the application of the validated Breast-QTM questionnaire to assess the degree of satisfaction. Results: There was no surgical revision, postoperative infection or necrosis of the papillary areolar plaque, 5 cases of papillary areolar plaque epidermolysis, treated with flavonoids and horse chestnut (linfa creamTM), without sequelae. Parenchyma resection from 80 to 1,100g, average 477.1g. Laser-assisted liposuction between 150 to 790ml, average 438.6ml. The final vertical scar averaged 6.7cm, stable after two years, with Breast-QTM evaluation of very satisfied (86%). Conclusion: We consider the mirrored "D" technique and laser-assisted liposuction a good surgical option due to its systematization and versatility in different mammoplasty scenarios, maintaining a coniform shape with a smaller scar and maintaining the validated results.

Planejamento e marcação simplificados de mastopexia e mamoplastia redutora: o padrão circunvertical "Matryoshka" / Simplified planning and marking of mastopexy and reduction mammoplasty: the circumvertical "Matryoshka" pattern

■ RESUMO Introdução: Como a maioria dos outros procedimentos estéticos, particularmente em órgãos pareados para os quais a simetria é crítica, o resultado bem-sucedido da mastopexia e mamoplastia redutora é amplamente determinado pelo planejamento pré-operatório. Ao considerar cuidadosamente o desenho da ressecção da pele e escolher e desenhar um pedículo apropriado, a necrose da pele, cicatrizes inestéticas e distorção da forma podem ser minimizadas. Métodos: Apresentamos uma técnica original de marcação de pele que combina as vantagens do uso de um template Wise como base para marcação de pele com aquelas do padrão de mamoplastia vertical junto com uma excisão periareolar limitada de pele para encurtar a cicatriz vertical subareolar. Resultados: O design de marcação circunvertical da pele que propomos imita a silhueta de uma boneca russa, a "Matryoshka". Conclusão: Incorporar uma marcação pré-operatória mensurável e com base geométrica certamente oferece um grande grau de controle e consistência.

■ ABSTRACT Introduction: Like most other aesthetic procedures, particularly in paired organs for which symmetry is critical, the successful outcome of mastopexy and reduction mammoplasty is greatly determined by pre-operative planning. By carefully considering the design of the skin resection and choosing and designing an appropriate pedicle, prevention of skin necrosis, unsightly scars, and shape distortion can be minimized. Methods: We present an original skin marking technique that combines the advantages of using a Wise template as the basis for skin marking with those of the vertical mammoplasty pattern together with a limited circumareolar skin excision to shorten the subareolar vertical scar. Results: The circumvertical skin marking design we propose mimics a Russian doll silhouette, the "Matryoshka." Conclusion: Incorporating a geometrically based and measurable pre-operative marking certainly offers a great degree of control and consistency.

Mastectomia masculinizadora para redesignação de gênero de transexuais masculinos / Masculinizing mastectomy for male transsexual's gender reassignment

■ RESUMO Introdução: A mastectomia masculinizadora é geralmente o primeiro, o mais importante e muitas vezes o único procedimento cirúrgico na readequação de gênero em transexuais masculinos. O objetivo é descrever e sistematizar os passos da técnica utilizada pelo autor da mastectomia com dupla incisão associado ao enxerto livre de complexo areolopapilar. Métodos: Revisão retrospectiva de 26 pacientes submetidos a mastectomias masculinizadoras (total de 52 mamas), realizadas pela técnica utilizada pelo autor, entre novembro de 2013 e janeiro de 2018. Resultados: 84,6% dos pacientes sofreram a cirurgia com cicatriz final horizontal no sulco inframamário e 15,4% evoluíram com cicatriz final em "T" invertido. A taxa de complicações maiores foi de 3,8%. Houve uma reoperação (3,8%) no período de acompanhamento. O peso médio das mamas foi de 1.136 gramas, a idade média de 27 anos e 9 meses, índice de massa corporal médio de 26,6kg/m2 e 73% dos pacientes receberam terapia com hormônio masculino previamente à cirurgia. Conclusão: A mastectomia masculinizadora é um procedimento seguro, com boa reprodutibilidade e traz resultados estéticos satisfatórios.

■ ABSTRACT Introduction: Masculinizing mastectomy is generally the first, most important and often the only surgical procedure for gender reassignment in male transsexuals. The objective is to describe and systematize the steps of the technique used by the author of the double-incision mastectomy associated with a free graft from the nipple-areola complex. Methods: Retrospective review of 26 patients who underwent masculinizing mastectomies (total of 52 breasts), performed using the technique used by the author, between November 2013 and January 2018. Results: 84.6% of patients had surgery with a final horizontal scar in the inframammary fold, and 15.4% evolved with a final inverted "T" scar. The rate of major complications was 3.8%. There was one reoperation (3.8%) in the follow-up period. Mean breast weight was 1,136 grams, mean age was 27 years and nine months, mean body mass index was 26.6 kg/m2, and 73% of patients received male hormone therapy before surgery. Conclusion: Mastectomy is a safe procedure, with good reproducibility and brings satisfactory aesthetic results.

Importância da cirurgia plástica para mulheres mastectomizadas e o papel do Sistema Único de Saúde: revisão integrativa / Importance of plastic surgery for women with mastectomies and the role of Brazilian Unified Health System: integrative review

■ RESUMO Introdução: Os benefícios da realização de reconstrução mamária em pacientes mastectomizadas vão muito além da estética, contribuindo para a saúde emocional, autoestima e vida sexual da mulher. Dessa forma, o presente estudo teve como objetivo abordar a relevância da realização da cirurgia plástica em mulheres mastectomizadas no Brasil, bem como evidenciar os direitos da mulher, dentro do Sistema Único de Saúde, durante o processo. Métodos: Para isso, foi realizada uma revisão integrativa de caráter qualitativo através da coleta de dados nas plataformas SciELO, PubMed e LILACS, além de uma pesquisa complementar no Google Acadêmico. Os artigos incluídos no estudo foram analisados pelo método de conteúdo. Resultados: No total foram incluídos 21 artigos, nos quais observou-se que as mulheres mastectomizadas relatavam sentimentos de medo, vergonha, sofrimento, redução da sexualidade e insatisfação. Também foi observado que esses sentimentos diminuíram após a realização do procedimento estético. Conclusão: Pelo fato de as mamas representarem um símbolo de sensualidade e orgulho feminino, é de extrema importância que o Sistema Único de Saúde, assim como os profissionais da saúde estejam capacitados para acolher e sanar as dúvidas das pacientes, garantindo que não haja negligência no cuidado e proporcionando um tratamento digno.

■ ABSTRACT Introduction: The benefits of performing breast reconstruction in mastectomized patients go far beyond aesthetics, contributing to a woman's emotional health, self-esteem and sex life. Thus, this study aimed to address the relevance of performing plastic surgery in women with mastectomies in Brazil and highlight women's rights within the Brazilian Unified Health System during the process. Methods: For this, an integrative qualitative review was carried out through data collection on the SciELO, PubMed and LILACS platforms, in addition to a complementary search on Google Scholar. The articles included in the study were analyzed using the content method. Results: In total, 21 articles were included, in which it was observed that women with mastectomies reported feelings of fear, shame, suffering, reduced sexuality and dissatisfaction. It was also observed that these feelings decreased after performing the cosmetic procedure. Conclusion: Because the breasts represent a symbol of sensuality and female pride, it is extremely important that the Brazilian Unified Health System, as well as health professionals, are trained to welcome and resolve the patients' doubts, ensuring that there is no negligence in the care and providing a decent treatment.

Oncoplastic Mammoplasty with disguised geometric compensation.

OBJECTIVE: To evaluate the results of a cohort of patients submitted to a new technique of oncoplastic mammoplasty, referred to as Disguised Geometric Compensation Mammoplasty (GCM), which is suitable for tumours involving the glandular tissue in the pillars of the mammoplasty. MATERIALS AND METHODS: Twenty-five breast tumours involving the pillars of the mammoplasty were included, 20 (80.0%) invasive ductal carcinomas, 3 (12.0%) phyllodes tumours, 1 (4.0%) invasive lobular carcinoma, and 1 (4.0%) in situ ductal carcinoma. Preoperative markings followed the "Wise-pattern" technique. The resection of the tumour in the pillar, preserving the overlying skin, was geometrically compensated with a corresponding area coming from the lower poles, which folded over itself and maintained the skin vascularity in the pillar. One patient was converted to classic GCM due to a positive skin margin in the frozen section. Another patient combined a Classic GCM for the inner quadrants and a Disguised GCM for the outer quadrants on the same breast. One patient decided to undergo a bilateral mastectomy after some months because of a BRCA 1 mutation. Immediate fat grafting was done in one case. Approval from the ethics committee: n. 2.322.212. RESULTS: Mean age was 47.0 ± 9.5 years. Mean clinical tumour size was 47.2 ± 22.2mm before chemotherapy and 36.7 ± 22.5mm, after. There were 11 (44.0%) locally advanced and 1 (4.00%) multicentric tumours. Nine (36.0%) were submitted to neoadjuvant chemotherapy. Adjuvant treatment was indicated according to the necessity. Ptosis was corrected in all cases. The aesthetic results were rated as excellent or good in 21 (95.5%) cases, by the Harris scale and the BCCT.core. The BREAST-Q scores for the satisfaction with the breasts and satisfaction with outcomes were 81.5 (±15.0) and 90.4 (±11.7), respectively. Intraoperative frozen sections were done in 12 (48%) cases. There was 1 (4.0%) focus of DCIS in the skin margin treated with radiotherapy. Minor complications occurred in 6 (24.0%) patients. There was 1 (4.0%) local recurrence treated with radical mastectomy, and 1 (4.0%) metastasis after 3 months. No deaths were observed within a mean follow-up time of 16.3 ± 11.4 months. CONCLUSIONS: The disguised geometric compensation mammoplasty allowed breast conservation in situations requiring large resection in the pillars of the mammoplasty, with a high rate of free margins, correction of ptosis, satisfactory symmetry, and few complications.

Tratamento exitoso de pioderma gangrenoso após mamoplastia redutora: relato de caso / Successful treatment of pyoderma gangrenosum after reducing mammoplasty: a case report

RESUMO Introdução: O pioderma gangrenoso é uma doença inflamatória rara caracterizada pela presença de lesões ulceradas. A etiologia é desconhecida, mas aparentemente relaciona-se com fatores imunológicos. Os autores relatam um caso de pioderma gangrenoso no pós-operatório de uma mamoplastia redutora, o tratamento e a importância do diagnóstico precoce para obtenção de um bom resultado estético. Métodos: Trata-se de uma paciente de 18 anos que desenvolveu pioderma gangrenoso após uma mamoplastia redutora. Os sintomas iniciais foram a formação de bolhas de coloração violácea e lesões ulceradas em ambas mamas. Suspeitou-se a doença e a paciente foi tratada prontamente com prednisolona. Foram realizadas culturas, biópsias e exames sanguíneos. Realizou-se terapia hiperbárica e suporte nutricional. Foram realizados curativos diários com fator de crescimento epidérmico. Após 60 dias de acompanhamento foi possível conseguir uma cicatrização adequada da feridas e bons resultados estéticos. Resultados: O diagnóstico precoce associado a uma terapia sistêmica imunossupressora e cuidados locais rigorosos foram fundamentais para a estabilização da doença. A associação com terapia hiperbárica e o suporte nutricional contribuíram para a epitelização das lesões e o controle do quadro clínico. A aproximação das bordas da ferida com sutura subdérmica e posterior sutura intradérmica foram possíveis devido à recuperação da derme e estabilização da doença. Conclusão: O diagnóstico precoce de pioderma gangrenoso é fundamental para conseguir a estabilização da doença. É possível atingir bons resultados estéticos baseados em 4 elementos: corticoide sistêmico precoce, curativos locais diários com fator de crescimento epidérmico, suporte nutricional e terapia hiperbárica.

Abstract Introduction: Pyoderma gangrenosum is a rare inflammatory disease characterized by the presence of ulcerated lesions. The etiology is unknown but apparently relates to immunological factors. The authors report a case of pyoderma gangrenosum in the postoperative period of a reduction mammoplasty, treatment, and the importance of early diagnosis to obtain a good aesthetic result. Methods: This is an 18-year-old patient who developed pyoderma gangrenosum after a reduction mammoplasty. The initial symptoms were the formation of violet blisters and ulcerated lesions in both breasts. The disease was suspected, and the patient was promptly treated with prednisolone. Cultures, biopsies and blood tests were performed. Hyperbaric therapy and nutritional support were performed. Daily dressings with epidermal growth factors were performed. After 60 days of follow-up, it was possible to achieve adequate wound healing and good aesthetic results. Results: Early diagnosis associated with systemic immunosuppressive therapy and rigorous local care were fundamental for disease stabilization. The association with hyperbaric therapy and nutritional support contributed to the lesion's epithelialization and the clinical picture control. The approximation of the wound edges with subdermal suture and the subsequent intradermal suture was possible due to the recovery of the dermis and stabilization of the disease. Conclusion: Early diagnosis of pyoderma gangrenosum is essential to achieve stabilization of the disease. It is possible to achieve good aesthetic results based on four elements: early systemic corticosteroids, daily local dressings with epidermal growth factor, nutritional support, and hyperbaric therapy.

Prevalência de mamoplastia redutora feminina no Brasil de 2015 a 2019 / Prevalence of female reduction mammoplasty in Brazil from 2015 to 2019

RESUMO Introdução: A mamoplastia redutora feminina visa restaurar o volume fisiológico das mamas em casos de hipertrofia mamária, de modo a manter a simetria e com um número mínimo de complicações. Embora tal procedimento seja usual, a literatura carece de dados epidemiológicos e descritivos acerca da cirurgia de redução de mama. Desse modo, esse estudo tem como objetivo descrever a prevalência da mamoplastia redutora no Brasil dos anos de 2015 a 2019; comparar a prevalência de mamoplastia redutora entre as regiões do Brasil de 2015-2018 com a do ano de 2019; e avaliar a relação entre a renda familiar regional e a prevalência da mamoplastia redutora feminina no país de 2015-2019. Métodos: Estudo ecológico de base populacional cujos dados foram coletados por meio do Departamento de Informática do Sistema Único de Saúde e censos demográficos do Instituto Brasileiro de Geografia e Estatística. Foram coletados dados de 2015 a 2019. Resultados: A prevalência de mamoplastia redutora no Brasil no ano de 2019 foi de 0.08%, enquanto que nos anos de 2015 a 2018, essa prevalência foi de 0.07%. Não houve diferença estatisticamente significante quando comparadas as prevalências regionais dos anos de 2015 a 2018 com a prevalência de 2019. As prevalências de mamoplastia redutora nas regiões do Brasil de 2015-2019 apresentaram correlação positiva moderada com renda domiciliar média per capita. Conclusão: A prevalência de mamoplastia redutora feminina no Brasil apresenta uma tendência de estabilidade temporal ao longo dos anos de 2015-2019 e-m âmbito nacional e regional. Sugere-se uma correlação positiva entre a renda familiar per capita regional e a prevalência desse procedimento.

ABSTRACT Introduction: Female reducing mammoplasty aims to restore the physiological volume of the breasts in cases of breast hypertrophy, to maintain symmetry and with a minimum number of complications. Although such a procedure is usual, the literature lacks epidemiological and descriptive data on breast reduction surgery. Thus, this study aims to describe the prevalence of reducing mammoplasty in Brazil from 2015 to 2019; to compare the prevalence of reducing mammoplasty among the regions of Brazil from 2015-2018 with that of 2019, and to evaluate the relationship between regional family income and the prevalence of female reduction mammoplasty in the country of 2015-2019. Methods: Population-based ecological study whose data were collected through Informatics Department of the Unified Health System and Brazilian Institute of Geography and Statistics demographic censuses. Data were collected from 2015 to 2019. Results: The prevalence of reducing mammoplasty in Brazil in 2019 was 0.08%, while from 2015 to 2018, this prevalence was 0.07%. There was no statistically significant difference compared to the regional prevalence from 2015 to 2018 with the prevalence of 2019. The prevalence of reducing mammoplasty in the regions of Brazil from 2015-2019 showed a moderate positive correlation with average household income per capita. Conclusion: The prevalence of female reduction mammoplasty in Brazil shows a trend of temporal stability over the years 2015-2019 at national and regional levels. A positive correlation between regional per capita family income and the prevalence of this procedure is suggested.