Experiencias antes y después de la mamoplastia de reducción en pacientes con macromastia / Experiences before and after reduction mammoplasty in patients with macromastia

Introducción: la hipertrofia mamaria o macromastia es un desarrollo excesivo y desproporcionado de tejido mamario, que suele ir asociada con síntomas físicos y psíquicos que alteran la calidad de vida y pueden ser en ocasiones tremendamente incapacitantes. Prácticamente la única opción terapéutica para estas pacientes es la mamoplastia de reducción, procedimiento quirúrgico que ha demostrado ser muy eficaz para reducir los síntomas. Objetivo: describir y analizar los resultados de la intervención desde el punto de vista de las propias pacientes con macromastia antes y después de la reducción mamaria, a través de los comentarios expresados por ellas mismas. Material y métodos: Estudio prospectivo. Análisis de las características de las pacientes, valoración del cambio en la salud experimentado tras la intervención y las experiencias subjetivas de las mujeres relativas a su macromastia antes y después de la intervención. Resultados: Un total de 121 mujeres intervenidas de macromastia con una edad media de 40,71 años participaron en el estudio. Las pacientes experimentaron un cambio positivo en su estado de salud tras la intervención (p < 0,001). La mayoría de los problemas verbalizados hacían referencia a la dificultad en el vestir y en realizar actividad física, así como la gran mejoría experimentada tras la intervención Conclusión: las experiencias compartidas por las mujeres con macromastia tras la reducción mamaria evidencian una significativa mejoría tanto en su percepción de la salud como en su vida cotidiana, incluyendo el encontrar una ropa adecuada a su gusto y necesidades de actividad física. (AU)

Introduction: Mammary hypertrophy or macromastia is an excessive and disproportionate development of breast tissue, which is usually associated with physical and mental symptoms that alter the quality of life and can sometimes be tremendously disabling. Practically the only therapeutic option for these patients is a reduction mammoplasty, a surgical procedure that has proven to be very effective in reducing symptoms. Objective: To describe and analyze the outcomes of the intervention from the point of view of the patients themselves through the comments expressed by patients with macromastia before and after breast reduction. Material and methods: Prospective study. Analysis of the characteristics of the patients, assessment of the health change experienced after the intervention, and the subjective experiences of the women regarding their macromastia before and after the intervention. Results: A total of 121 women operated on for macromastia with a mean age of 40.71 years participated in the study. The patients experienced a positive change in their health status after the intervention (p < 0.001). Most of the verbalized problems referred to the difficulty in dressing and carrying out physical activity, as well as the great improvement experienced after the intervention. Conclusion: The experiences shared by women with macromastia after breast reduction surgery demonstrate a significant improvement not only in their perception of health but also in their daily life, including finding clothing that is suitable for their preferences and physical activity needs. (AU)

Mastectomía preservadora de piel con colgajo dermograso desepitelizado (técnica de Spira modificada) y reconstrucción mediante implante directo / Nipple sparing mastectomy with a de-epithelialized derma-fat flap (modified Spira technique) and direct-to implant reconstruction

Introducción: La técnica de Spira es un tipo de mastectomía preservadora de piel que permite la reconstrucción inmediata (RMI), ideal en mamas ptósicas. Si bien, persiste controversia sobre resultados oncológicos en el cáncer de mama. El objetivo es analizar complicaciones, secuelas cosméticas, causas de reintervención y resultados oncológicos. Métodos: Estudio observacional retrospectivo de pacientes intervenidas durante 2003-2018 en nuestro centro. La población de estudio la constituyen pacientes con carcinoma de mama o sometidas a mastectomía profiláctica por alto riesgo, en las que se realizó una mastectomía preservadora de piel con colgajo dermograso desepitelizado (técnica de Spira modificada) y reconstrucción mediante implante directo. Se analiza la presencia de complicaciones precoces y tardías, secuelas, recidiva tumoral y supervivencia. Resultados: Se realizaron 247 mastectomías con reconstrucción en 139 pacientes, 216 bilaterales (87,4%) y 31 unilaterales (12,5%); 121 terapéuticas (49%) y 126 profilácticas (51%). La mediana de seguimiento fue de 81 meses. Se observaron complicaciones en un 16,2%; necrosis cutánea en 5,3% y cinco casos de necrosis del CAP (2%). La tasa de reintervención por secuelas cosméticas fue del 17,4% (la más frecuente fue contractura capsular 11,3%) y, de ellas, el 39,3% recibieron RT. La tasa de recidiva fue del 14% (0,8% cutánea, 3,3% locorregional y 9,9% a distancia). Ocho pacientes fallecieron (6,6%). La SLE y SG fue del 92,6% y 93,3% a cinco años. Conclusión: La técnica de Spira constituye una opción segura y ofrece buenos resultados cosméticos y oncológicos como tratamiento y profilaxis de cáncer de mama en mamas ptósicas de moderado a gran tamaño. (AU)

Introduction: Spira technique is a type of nipple-sparing mastectomy that allows immediate reconstruction (IBR), ideal for ptosic breasts. Although, controversy persists regarding oncological results in breast cancer. The aim is to analyze complications, cosmetic outcomes, causes of reoperation and oncological results. Methods: Retrospective observational analysis of patients undergone surgery during 2003-2018 in our center. Study population is based on patients with breast carcinoma or undergoing prophylactic mastectomy due to high-risk, in which a skin-sparing mastectomy with a de-epithelialized derma-fat flap (modified Spira technique) and direct to implant reconstruction was performed. Short and long-term complications, sequelae, tumor recurrence and survival rates are analyzed. Results: A total of 247 mastectomies with immediate reconstruction in 139 patients, 216 bilateral (87.4%) and 31 unilateral (12.5%) were performed. 121 therapeutic (49%) and 126 prophylactic (51%). Median follow-up 81 months. Complications were observed in 16.2%; skin necrosis 5.3% and 5 cases of NAC necrosis (2%). Reoperation rate due to cosmetic sequelae was 17.4% (capsular contracture was the most frequent,11.3%) and a 39.3% of these patients have received RT. Recurrence of 14% (0.8% skin, 3.3% locoregional and 9.9% metastatic), 8 patients died (6.6%). Rates of FSD and OS were 92.6% and 93.3% respectively. Conclusion: Spira mastectomy is a safe option and provides good cosmetic and oncologic results as breast cancer treatment and prophylaxis in moderate-large ptosic breasts. (AU)

Mastectomía ahorradora de piel y pezón en carcinoma ductal in situ. Seguridad oncológica a 10 años / Nipple-sparing mastectomy in ductal carcinoma in situ. Oncological results over a 10-year period

OBJETIVO: El objetivo es evaluar la seguridad oncológica a 10 años de la mastectomía ahorradora de piel y pezón (MAP) en pacientes con carcinoma ductal in situ (CDIS). MÉTODO: Análisis observacional retrospectivo. Se realizaron 35 MAP en pacientes con CDIS durante 2005-2018. Evaluamos resultados histológicos, oncológicos y de morbilidad. RESULTADOS: Las indicaciones más frecuentes fueron márgenes afectos tras tumorectomía (31,5%), multifocalidad/multicéntricidad (22,8%), tumor >3 cm (8,6%) correlación desfavorable tamaño tumoral/mama (8,6%) y decisión de la paciente (8,6%). La técnica más usada fue incisión lateral externa en 11 pacientes, seguida de técnica de Spira en nueve casos. La presencia de CDIS se confirmó en 22 pacientes y en 11 no se encontró tumor en la pieza de mastectomía. La tasa de complicaciones fue 22,8%. Tras una mediana de seguimiento de 104 meses (DE 69,9) no se observó necrosis del pezón. Un 20% de pacientes precisó reintervención a largo plazo. Once pacientes (31,4%) recibieron tratamiento adyuvante (QT y/o RT). Solamente una paciente presentó recurrencia local (2,8%) 28 meses tras la intervención. Una paciente presentó metástasis tras 78 meses de SLE. Las tasas de SLE y SG fueron 94,3% y 97,22%. El análisis univariante mostró dos factores de riesgo de recurrencia: edad <40 [OR (IC95) 2,529 (1,230 - 5,199)] y márgenes afectos [OR (IC95) 5,242 (2,041 - 13,464)]. CONCLUSIÓN: La MAP es factible y segura en pacientes con CDIS no candidatas a cirugía conservadora

OBJECTIVE: The aim of this study was to assess the oncological safety of nipple-sparing mastectomy (NSM) in patients with ductal in situ carcinoma (DCIS) over a 10-year period. METHOD: Retrospective observational analysis. A total of 35 NSM were performed in patients with DCIS from 2005 - 2018. We assessed the histological, oncological and morbidity results. RESULTS: The most frequent indications were margin involvement after lumpectomy (31.5%), multifocality / multicentricity (22.8%), tumour size >3 cm (8.6%) unfavourable tumour / breast size correlation (8.6%) and patient choice (8.6%). The most commonly used technique was external lateral incision in 11 patients, followed by the Spira technique in 9 patients. DCIS was confirmed in 22 patients and no tumour was found in mastectomy specimen in 11 patients. The complication rate was 22.8%. After a median follow-up of 104 months (SD 69.9) there was no nipple necrosis. In all, 20% of the patients required long-term reintervention. Eleven patients (31.4%) underwent adjuvant treatment (chemotherapy and / or radiotherapy). Only one patient showed local recurrence (2.8%) 28 months after the intervention. One patient developed metastases after 78 months of disease-free survival (DFS). DFS and overall survival rates were 94.3% and 97.22%. Univariate analysis showed two risk factors for recurrence: age <40 years [OR (95% CI) 2.529 (1.230-5.199)] and margin involvement [OR (95% CI) 5.242 (2.041 - 13.464)]. CONCLUSION: NSM is safe and feasible in patients with DCIS who are not candidates for conservative surgery

Reconstrucción inmediata mediante implante directo tras quimioterapia neoadyuvante. ¿Es una práctica segura? / Direct-to-implant breast reconstruction after neoadjuvant chemotherapy: A safe option?

Introducción: La reconstrucción inmediata (RMI) tras mastectomía en pacientes que han recibido quimioterapia neoadyuvante (QTNA) sigue siendo controvertida. El objetivo de este estudio es analizar y comparar resultados oncológicos y las tasas de complicaciones y reintervención en pacientes sometidas a QTNA y un grupo control. Métodos: Análisis observacional retrospectivo de casos-controles. Pacientes con cáncer de mama intervenidas de mastectomía bilateral con RMI (MBRMI) mediante prótesis directa durante el periodo 2000-2016. Grupo que recibió QTNA emparejadas máximo 1:5 respecto a las pacientes sin QTNA (grupo control). Evaluamos diferencias entre grupos mediante test χ2 o Fisher (variables cualitativas), U de Mann-Whitney o t de Student (variables cuantitativas). Análisis de supervivencia mediante curvas de Kaplan-Meier y test de log-rank (SPSS 22.0). Resultados: Un total de 171 pacientes con MBRMI, 62 pacientes (36,3%) tras QTNA y 109 pacientes (63,7%) en grupo control sin QTNA. Mediana de seguimiento de 52,0 (RIQ: 23,0-94,0) meses. La indicación para practicar una MBRMI más frecuente en ambos grupos es la elección de la paciente (32,7%). No hay diferencias estadísticamente significativas entre los grupos en cuanto a tasa de complicaciones (24,2% en el grupo QTNA y 19,3% en el grupo control [p = 0,44]). Sí existen diferencias en resultados oncológicos. Las pacientes del grupo QTNA tienen 3 veces más riesgo que las pacientes del grupo control de presentar recidiva en un momento determinado del tiempo (3,009 [1,349-6,713]) según el análisis univariante. Conclusiones: La RMI mediante prótesis directa tras mastectomías ahorradoras de piel es una opción viable de tratamiento para pacientes con cáncer de mama que reciben QTNA

Introduction: Immediate reconstruction (IBR) after mastectomy in patients who have received neoadjuvant chemotherapy (NACT) remains controversial. The aim of this study is to analyze and compare oncological results as well as complication and reoperation rates in patients undergoing NACT and a control group. Methods: Retrospective observational case-control study of patients with breast cancer who underwent bilateral mastectomy and direct-to-implant IBR (BMIBR) from 2000-2016. The group that received NACT was matched 1:5 to patients without NACT (Control group). We evaluated differences between groups using the χ2 or Fisher test (qualitative variables), Mann-Whitney U or Student's t-test (quantitative variables). The survival analysis was performed using Kaplan-Meier curves and log-rank test (SPSS 22.0). Results: The study included a total of 171 patients with BMIBR: 62 patients (36.3%) after NACT and 109 patients (63.7%) in the control group without NACT. Median follow-up was 52.0 (IQR: 23.0-94.0) months. In both groups, the indication for BMIBR was patient choice (32.7%). There were no statistically significant differences between groups in terms of complication rate (24.2% in the NACT group and 19.3% in the control group [P = .44]), but differences in oncological results were found. Patients in the NACT Group had three times more risk of recurrence at a given time than patients in the control group (3.009 [1.349-6.713]) according to the univariate analysis. Conclusions: Direct-to-implant IBR after skin-sparing mastectomy is a viable option for breast cancer patients undergoing NACT

Direct-to-implant breast reconstruction after neoadjuvant chemotherapy: A safe option? / Reconstrucción inmediata mediante implante directo tras quimioterapia neoadyuvante. ¿Es una práctica segura?

INTRODUCTION: Immediate reconstruction (IBR) after mastectomy in patients who have received neoadjuvant chemotherapy (NACT) remains controversial. The aim of this study is to analyze and compare oncological results as well as complication and reoperation rates in patients undergoing NACT and a control group. METHODS: Retrospective observational case-control study of patients with breast cancer who underwent bilateral mastectomy and direct-to-implant IBR (BMIBR) from 2000-2016. The group that received NACT was matched 1:5 to patients without NACT (Control group). We evaluated differences between groups using the χ2 or Fisher test (qualitative variables), Mann-Whitney U or Student's t-test (quantitative variables). The survival analysis was performed using Kaplan-Meier curves and log-rank test (SPSS 22.0). RESULTS: The study included a total of 171 patients with BMIBR: 62 patients (36.3%) after NACT and 109 patients (63.7%) in the control group without NACT. Median follow-up was 52.0 (IQR: 23.0-94.0) months. In both groups, the indication for BMIBR was patient choice (32.7%). There were no statistically significant differences between groups in terms of complication rate (24.2% in the NACT group and 19.3% in the control group [P=.44]), but differences in oncological results were found. Patients in the NACT Group had three times more risk of recurrence at a given time than patients in the control group (3.009 [1.349-6.713]) according to the univariate analysis. CONCLUSIONS: Direct-to-implant IBR after skin-sparing mastectomy is a viable option for breast cancer patients undergoing NACT.

Treatment of Implant Exposure due to Skin Necroses after Skin Sparing Mastectomy: Initial Experiences Using a Not Selective Random Epigastric Flap.

Breast prostheses exposure is probably the most devastating complication after a skin sparing mastectomy (SSM) and implant-based, one-stage, breast reconstruction. This complication may occur in the immediate post-operative period or in the weeks and even months after the procedure. In most cases, the cause is poor skin coverage of the implant due to skin necrosis. PATIENTS AND METHODS: Eight consecutive cases of implant exposure (or risk of exposure) due to skin necrosis in SSM patients over a period of 5 years, all patients were treated using a random epigastric rotation flap, executed by the same medical team. RESULTS: A random epigastric flap (island or conventional rotation flap) was used to cover the skin defect. All the patients completed the procedure and all prostheses were saved; there were no cases of flap necrosis or infection. CONCLUSIONS: Cases of skin necrosis after SSM and immediate implant reconstruction, in which the implant is at risk of exposure, can be successfully treated with a random epigastric rotation flap.

Reduction mammaplasty improves levels of anxiety, depression and body image satisfaction in patients with symptomatic macromastia in the short and long term.

OBJECTIVE: To evaluate the psychological consequences (anxiety, depression and body image dissatisfaction) of symptomatic macromastia and the effectiveness of breast reduction surgery in re-establishing the mental health of the patient in the short and long term. METHOD: 119 patients over 18 years old who had been diagnosed with symptomatic macromastia were assessed, before surgery, one month after the operation and one year later. Patients completed the Hospital Anxiety and Depression Scale (HADS) and the Body Image Dissatisfaction subscale of the Eating Disorders Inventory (EDI-2). Participants were also asked about their physical appearance, social relationships and their satisfaction with regards to clothing and dress. RESULTS: The average age of the patients was 40.7 (SD = 12.02), 80.2% had a body mass index ≥25 kg/m2. Before surgery, we found psychological distress with values indicating clinical anxiety and body image dissatisfaction. Younger women (< 36 years old) were more psychologically affected. At one month after surgery, there were significant improvements: there were lower scores for anxiety (p < 0.001), depression (p < 0.001) and body image dissatisfaction (p < 0.001). When compared with the pre-surgery scores, all these results showed improvement one year after the intervention (p < 0.001). There were also improvements in social relationships (p < 0.001) and satisfaction with clothing and dress. CONCLUSION: Reduction mammaplasty can alleviate the psychological impact of symptomatic macromastia.

Hidatidosis muscular primaria / Primary muscular hydatid disease

Introducción y objetivos. La localización primaria de los quistes hidatídicos en músculo es del 1 al 4 por ciento según las escasas series publicadas. Pretendemos contribuir al conocimiento del tratamiento de la infestación en esta infrecuente localización. Métodos. Presentamos un estudio retrospectivo de 13 casos de hidatidosis muscular primaria (edad media, 53 años; rango, 30-82; 8 varones), el 4,2 por ciento del total de casos de hidatidosis tratados en nuestro servicio entre 1983 y 1999.Resultados y conclusiones. La presentación clínica más frecuente fue la presencia de una masa silente de lento crecimiento. En el proceso diagnóstico los tests inmunológicos son ineficaces, y son fundamentales la sospecha clínica y las pruebas de imagen, sobre todo la resonancia nuclear magnética. La punción del quiste, realizada con fines diagnósticos o terapéuticos, no está exenta de complicaciones y en ningún caso consigue la total eliminación de la enfermedad, lo que se consigue únicamente con la realización de cirugía radical, complementada con tratamiento antihelmíntico (albendazol o mebendazol) cuando se sospecha enfermedad residual para evitar su diseminación, aunque tampoco consigue por sí solo eliminar la enfermedad (AU)