Genital Self-Image and Body Dysmorphic Disorder Symptoms in Patients Undergoing Central Wedge vs. Linear Resection Labiaplasty: A Randomized Clinical Trial.

BACKGROUND: Labiaplasty, a surgical procedure designed to address labia minora hypertrophy, has been closely linked to the improvement of genital self-image and the alleviation of symptoms related to body dysmorphic disorder. Brazil stands as the global leader in the prevalence of labiaplasty procedures. OBJECTIVE: This study aimed to assess alterations in genital self-image and symptoms of body dysmorphic disorder in individuals with labia minora hypertrophy who underwent either wedge or trim labiaplasty. METHODS: A total of 48 adult women undergoing labiaplasty were enrolled in this randomized clinical trial with two parallel groups. Allocation ratio was 1:1. The Study Group (SG) underwent wedge labiaplasty, while the Control Group (CG) underwent trim labiaplasty. Genital self-image and symptoms of body dysmorphic disorder were assessed both preoperatively and six months postoperatively, using validated tools. RESULTS: After a six-month intervention period, a statistically significant improvement in genital self-image was observed (p<0.001), alongside a marked decrease in the score of symptoms related to body dysmorphic disorder (p<0.001). There were no significant differences in outcomes between the groups. Furthermore, no statistically significant associations were noted between complications and the specific technique employed. CONCLUSION: The study findings underscore the noteworthy improvement in genital self-image and a concurrent reduction in symptoms of body dysmorphic disorder, evident in both the wedge and linear labiaplasty groups at the six-month postoperative assessments. These results suggest that the choice of surgical technique does not significantly impact these outcomes.

Congenital and acquired symmastia: a novel correction technique.

BACKGROUND: Symmastia, first defined by Spence in 1984, is a medical condition characterized by the convergence of breast tissues in the midline, resulting in the absence of adhesion between the skin and subcutaneous tissue over the presternal area. It can be either congenital or acquired. Currently, there is no universally accepted treatment for symmastia. This study presents a surgical approach, preoperative, and postoperative care for the correction of symmastia. METHODS: Between January 2014 and December 2020, a surgical technique was performed on 100 patients, including 59 with congenital symmastia and 41 with acquired symmastia. The technique involved creating a thin skin flap and attaching it to the sternum to reconstruct the intermammary V-shaped region. RESULTS: All patients in both groups underwent subglandular implant placement, with textured/polyurethane prostheses used in 97% of cases. Three cases did not use any implants. In the corrective surgery, patients received smaller, round implants, following the steps of the surgical approach devised by the author. The median satisfaction scores were high in both groups. CONCLUSION: The surgical approach described in this study is a safe, one-time procedure with a low risk of complications and high patient satisfaction. The technique is reproducible and provides consistent outcomes.

Quality Regarding the Systematic Reviews in Breast Plastic Surgery.

There are few data in the literature evaluating the quality of systematic reviews in breast plastic surgery. This study aimed to evaluate the quality of SR in breast plastic surgery. This is a secondary, observational and analytical study. SR studies on breast plastic surgery, published until 2020, were included. The search for articles was performed in the CCTR, LILACS, MEDLINE and SCIELO databases. After selection and full reading of the studies, they were evaluated according to the AMSTAR-2 instrument. The search identified 810 references, among which 583 did not meet the eligibility criteria, and 227 studies were evaluated. The median publication time of the articles was 57.0 ± 59.0 months, the average impact factor was 0.65 citations per month, and the AMSTAR-2 score was 66.2 ± 32.3. Among the articles evaluated, 39.65% performed a meta-analysis, 52.42% used PRISMA, and most articles pointed out the need for further studies to answer their proposed question (92.95%). Articles that used PRISMA had shorter publication times (39.0 ± 34.0 months) and higher AMSTAR-2 scores (77.6 ± 17.7). An increase in the number of publications and a tendency to increase the AMSTAR-2 score and decrease the impact factor of the article were observed (p < 0.001). In conclusion, the quality of SR in breast plastic surgery has been improving over the years; however, improved methodology and the development of randomized clinical trials are still needed to serve as a basis for SR.Level of Evidence III 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 .

Oncologic Safety of Fat Grafting for Autologous Breast Reconstruction in an Animal Model of Residual Breast Cancer.

BACKGROUND: Clinical outcomes suggest that postoncologic reconstruction with fat grafting yields cumulative incidence curves of recurrence comparable to those of other breast reconstruction procedures; however, results from experimental research studies suggest that adipose stem cells can stimulate cancer growth. In this study, a novel animal model of residual cancer was developed in mouse mammary pads to test whether lipofilling impacts the probability of locoregional recurrence of breast cancer after breast conserving surgery. METHODS: Mammary fat pads of female NOD-SCID gamma mice were each injected with MCF-7 cells in Matrigel. Tumors were allowed to engraft for 2 weeks, after which time either sterile saline (n = 20) or human fat graft (n = 20) was injected adjacent to tumor sites. After 8 weeks, tumors were assessed for volume measurement, histologic grade, Ki67 positivity, and metastatic spread. RESULTS: Animals receiving lipofilling after tumor cell engraftment had lower tumor volume and mass (p = 0.046 and p = 0.038, respectively). Macroscopic invasion was higher in the saline group. Histologic grade was not significantly different in the two groups (p = 0.17). Ki67 proliferation index was lower in tumors surrounded by fat graft (p = 0.01). No metastatic lesion was identified in any animal. CONCLUSIONS: Adipose transfer for breast reconstruction performed in the setting of residual breast tumor in a clinically relevant animal model did not increase tumor size, proliferation, histologic grade, or metastatic spread. This study supports the oncologic safety of lipofilling as part of the surgical platform for breast reconstruction after cancer therapy.

Support system for decision making in the identification of risk for body dysmorphic disorder: a fuzzy model.

PURPOSE: To develop a fuzzy linguistic model to quantify the level of distress of patients seeking cosmetic surgery. Body dysmorphic disorder (BDD) is a mental condition related to body image relatively common among cosmetic surgery patients; it is difficult to diagnose and is a significant cause of morbidity and mortality. Fuzzy cognitive maps are an efficient tool based on human knowledge and experience that can handle uncertainty in identifying or grading BDD symptoms and the degree of body image dissatisfaction. Individuals who seek cosmetic procedures suffer from some degree of dissatisfaction with appearance. METHODS: A fuzzy model was developed to measure distress levels in cosmetic surgery patients based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), diagnostic criterion B for BDD. We studied 288 patients of both sexes seeking abdominoplasty, rhinoplasty, or rhytidoplasty in a university hospital. RESULTS: Patient distress ranged from "none" to "severe" (range=7.5-31.6; cutoff point=18; area under the ROC curve=0.923). There was a significant agreement between the fuzzy model and DSM-IV criterion B (kappa=0.805; p<0.001). CONCLUSION: The fuzzy model measured distress levels with good accuracy, indicating that it can be used as a screening tool in cosmetic surgery and psychiatric practice.

Sexuality after breast reconstruction post mastectomy.

BACKGROUND: Sexual dysfunction is a medical condition that can lead to relationship issues as well as depression and has a somatoform basis. It is estimated to affect 49 % of Brazilian women. Studies have shown that both cancer diagnosis and its surgical treatment (mastectomy) affect women psychologically and can lead to psychiatric disorders. The aim of this study was to evaluate and compare sexuality in women who underwent mastectomy alone with those who underwent breast reconstruction after mastectomy. METHOD: This descriptive transversal study analyzed two groups of patients, one with 17 women after mastectomy alone and another with 19 women who underwent breast reconstruction post mastectomy. The patients ranged in age from 18 to 60 years old. The exclusion criteria were illiteracy; ongoing chemotherapy, radiotherapy, or psychiatric treatment; or if any surgery had been performed the previous year. All patients were from the Gynecology and Plastic Surgery Department of the Federal University of São Paulo. They voluntarily answered the FSFI (Female Sexual Function Index) questionnaire. Statistical analyses were performed using Student's t test and Pearson's coefficient, and the significance level used was p < 0.05. RESULTS: Data showed a lower FSFI score for the mastectomy-alone group compared to the breast reconstruction group (median = 10.15 ± 2.636 and 22.44 ± 3.055, respectively; p = 0.0057). There was no relationship established between the scores and postoperative time (post, p = 0.9382; pre, p = 0.2142) or between scores and remuneration income (post, p = 0.7699; pre, p = 0.5245), stable relationship (post, p = 0.2613; pre, p = 0.5245), and age (post, p = 0.3951; pre, p = 0.8427) for both groups. Mean age has shown no significant difference (p = 0.4740; median post = 47.71 ± 2.012; medina pre = 46.69 ± 1.809). CONCLUSION: An improvement in sexual function has been observed in patients who underwent breast reconstruction after mastectomy, probably as a result of better self-esteem as well as body image, both of which are affected by a mastectomy. The aesthetic results were evaluated using a questionnaire, and all the patients answered positively. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The impact of surgical treatment on the self-esteem of patients with breast hypertrophy, hypomastia, or breast asymmetry.

BACKGROUND: Currently, the concept of health includes not only the absence of disease but also a complete state of physical, psychological, and social well-being with increased emphasis on the importance of self-esteem. This study aimed to evaluate the impact of surgical treatment on the self-esteem of patients with breast asymmetry, breast hypertrophy, or hypomastia. METHODS: The Rosenberg Self-Esteem UNIFESP-EPM Scale was administered preoperatively and in the early and late postoperative periods to assess self-esteem. The sample comprised three groups of patients: the breast asymmetry group (n=35), the breast hypertrophy group (n=50), and the hypomastia group (n=40). RESULTS: Surgical treatment had a positive and similar impact on the self-esteem of the patients in the three study groups. CONCLUSIONS: Correction of breast asymmetry, breast hypertrophy, and hypomastia improved the patient's self-esteem. All three groups reported a similar increase in self-esteem (decrease in total scores) after breast reconstruction.

Sexualidade de mulheres mastectomizadas e submetidas à reconstrução mamária / Sexuality of women that suffered mastectomy and those who had been submitted to the mammary reconstruction

Objetivo: O objetivo deste estudo é avaliar, por meio do questionário FSFI (Female Function Sexual Index), e comparar a sexualidade de mulheres mastectomizadas e de mulheres que se submeteram à reconstrução mamária pós-tratamento do câncer de mama. Métodos: Foi realizado um estudo descritivo transversal. A casuística foi composta por dois grupos, um com 17 mulheres mastectomizadas e outro com 19 mulheres submetidas à reconstrução mamária pós-mastectomia, com idades entre 18 e 60 anos. Os critérios de exclusão foram: analfabetismo, vigência de tratamento de quimioterapia, radioterapia ou psiquiátrico e o tratamento cirúrgico a menos de um ano. Todas elas são pacientes dos ambulatórios de cirurgia plástica ou de mastologia da Universidade Federal de São Paulo. As voluntárias responderam ao questionário FSFI. A analise estatística foi realizada aplicando-se o teste t de Student e o coeficiente de correlação de Pearson, tendo sido adotado o nível de significância de p ≤ 0,05. Resultados: Os escores obtidos das respostas das mulheres mastectomizadas foram significativamente menores que os das submetidas à reconstrução (médias: 10,15 ± 2,636 e 22,44 ±3,055, respectivamente; p = 0,0057). Não foram observadas correlações entre os escores e o tempo de pós-operatório (pós - p = 0,9382; pré - p = 0,2142), assim como para o desenvolvimento de atividade remunerada (pós - p = 0,7699; pré – p = 0,5245), relação estável (pós - p = 0,2613; pré - p = 0,5245) e idade (pós - p = 0,3951; pré – p = 0,8427) entre os dois grupos. A idade média das pacientes não teve diferença significativa (p = 0,4740; media pós = 47,71 ± 2,012; media pré = 46,69 ± 1,809). Conclusão: Existe melhora da função sexual das pacientes mastectomizadas após a reconstrução mamária.

Objectives: The purpose of this study is to evaluate, through the FSFI (Female Function Sexual Index) questionnaire, and to compare the sexuality of women that suffered mastectomy and those who had been submitted to the mammary reconstruction post-treatment of breast cancer. Methods: A transversal descriptive study was carried out. The casuistic was composed by two groups, one with 17 women that suffered mastectomy and another with 19 submitted women to the mammary reconstruction after-mastectomy, with ages between 18 and 60 years old. The exclusion criteria were: illiteracy, use of chemotherapy, radiotherapy, psychiatric treatment, and surgical treatment in less than one year. All the patients are from the ambulatory of plastic surgery or mastology of São Paulo Federal University. The volunteers answered the FSFI questionnaire. The statistical analysis was carried out by applying the Student's t-test and Pearson's correlation coefficient, p ≤ 0.05 was taken as the significance level. Results: The scores obtained from the answers of women that suffered mastectomy were significantly lower than those from women submitted to reconstruction (means: 10.15 ± 2.636 and 22.44 ± 3.055, respectively; p = 0.0057). Correlations were not found between scores and postoperative time (post - p = 0.9382; pre - p = 0.2142) ,as well as for the development of paid activity (post - p = 0.7699; pre - p = 0.5245), stable relation (post - p = 0.2613; pre - p = 0.5245), and age (post - p = 0.3951; pre - p = 0.8427) between both groups. The mean age of the patients did not have a significant difference (p = 0.4740; post mean = 4771 ± 2.012; pre mean = 46.69 ± 1.809). Conclusion: There is an improvement of the sexual function in patients that suffered mastectomy after breast reconstruction.

Factors associated with hernia and bulge formation at the donor site of the pedicled TRAM flap.

The purpose of this study was to evaluate the correlation between risk factors and hernia or bulge formation at the donor site of the transverse rectus abdominis myocutaneous (TRAM) flap. A retrospective study was conducted between September 2005 and December 2008 in 206 patients who underwent breast reconstruction with pedicled TRAM flap. Eight (3.9%) of these patients had abdominal wall hernia and 26 (12.6%) had abdominal bulging. The incidence of hernia was significantly higher (P < 0.05) among patients with body mass index (BMI) >/= 30 kg/m(2) (hernia incidence, 15.0%) than that among patients with BMI <30 kg/m(2) (hernia incidence, 3.2%), while the incidence of abdominal bulge was significantly lower (P < 0.05) among patients with BMI >/= 30 kg/m(2) (abdominal bulge incidence, 5.0%) than that among patients with BMI >/= 30 kg/m(2) (abdominal bulge incidence, 19.1%). Therefore, obesity was identified as a risk factor for abdominal wall hernia. It was also found that the use of mesh to reinforce the abdominal wall significantly reduced (P < 0.025) the incidence of hernia (use of mesh (hernia incidence, 2.5%) versus non-mesh (hernia incidence, 5.9%)) and abdominal bulge (use of mesh (abdominal bulge incidence, 9.9%) versus non-mesh (abdominal bulge incidence, 17.3%)) among the patients.

Functional capacity and postural pain outcomes after reduction mammaplasty.

BACKGROUND: Neck, shoulder, and lower back pain and reduction of functional capacity can be caused by breast hypertrophy. Reduction mammaplasty appears to improve these aspects. After a systematic review of the literature, no scientific evidence was found to confirm this hypothesis. The authors' objective was to evaluate the impact of reduction mammaplasty on pain and functional capacity of patients with mammary hypertrophy. METHODS: One hundred patients with mammary hypertrophy, between 18 and 55 years old, with no previous mammary surgery, were consecutively selected from the Plastic Surgery Outpatient Clinic of the Universidade Federal de São Paulo-Escola Paulista de Medicina and randomly allocated into two groups. Group A (n = 50) underwent mammaplasty reduction immediately, whereas group B patients (n = 50) were placed on a waiting list (control group). All patients were interviewed for clinical and demographic data and evaluated to measure pain and functional capacity. To measure shoulder, neck, and lower back pain, a visual analogue scale (0 = no pain, 10 = unbearable pain) was used. The Stanford Health Assessment Questionnaire (HAQ-20), Brazilian validated version (0 = best, 3 = worst), was applied to assess functional capacity. Pain and functional capacity were measured at baseline and 6 months after surgery. RESULTS: Forty-six of 50 patients, from both groups, completed the study. The mean (+/-SD) patient age in groups A and B was 31.6 +/- 11 and 32.3 +/- 10 years, respectively. The mean breast tissue weight was 1052 +/- 188 g. Functional capacity in group A was improved 6 months after reduction mammaplasty, compared with group B (control), in the following aspects: getting dressed, getting up, walking, maintaining personal hygiene, reaching, and grasping objects. The mean pain intensity dropped in the lower back, from 5.7 to 1.3; in the shoulders, from 6.1 to 1.1; and in the neck, from 5.2 to 0.9. CONCLUSION: Reduction mammaplasty improved functional capacity and relieved pain in the lower back, shoulders, and neck of patients with mammary hypertrophy.

Quality of life after reduction mammaplasty.

Reduction mammaplasty is a common procedure in plastic surgery. Patients seek the operation for neck and lower back pain, and social and emotional problems. The evaluation of health results based on the patient's opinion has become an important and reliable method for the analysis of alterations resulting from treatment. To evaluate the impact of plastic surgery on the quality of life of patients with mammary hypertrophy we used the SF-36 standardised questionnaire in a prospective study of 44 patients preoperatively and three and six months postoperatively. There were significant improvements in seven of the eight aspects of the SF-36 (physical function, physical role, pain, energy, social function, emotional role, and mental health). Only general health was unchanged.

Evaluations of the aesthetic results and patient satisfaction with the late pedicled TRAM flap breast reconstruction.

With the goal of evaluating the aesthetic results, testing the reliability of the rating systems used, and determining the patients' level of satisfaction with their breast reconstruction, pedicled transverse rectus abdominis musculocutaneous flap reconstruction was performed in 20 patients who had undergone mastectomy. The results were evaluated and compared 3, 6, and 12 months after reconstruction using the patients' own assessments (a rating of 0-10 points) and scoring by two senior plastic surgeons (using 0-10-point global rating scales as well as the five subscales of the modified Garbay system). The interrater and intrarater agreement was poor to fair for the majority of the subscales. When evaluating by grades, there was significant difference (p < 0.001) between the patients and the raters at postoperative months 3 and 6. At month 12, one of the raters attributed significantly lower grades (p < 0.001) than the patients and the other rater. The authors observed a higher level of satisfaction by the patients than by the raters.