Is Latin America Ready to Identify Anaplastic Large Cell Lymphoma in Breast Implants Patients? Regional Encounter During the National Plastic Surgery Meeting in Cancun, Mexico.

INTRODUCTION: Anaplastic large cell lymphoma associated with breast implants is receiving increased attention. Most cases have been reported in Europe, North America (USA and Canada), Australia and New Zealand. Fewer cases have been reported in Latin America (including Mexico), Africa and Asia. METHODS: This report was delivered during our national plastic surgery meeting in Cancun in May 2017. Before the meeting, two participants reviewed the literature. The review was performed using the following information sources: PubMed, Embase, Cochrane, Fisterra, Google Scholar and LILACS, with entries from 1980 to August 2015 in several languages (English, Spanish, French and Portuguese). The results were revealed during the meeting to the other participants. The consensus was divided into two parts. The first part included an open-ended question regarding the incidence and prevalence of the problem. The second part included clinical scenarios with different items that were rated by the participants. After this activity, accordance among the responses was evaluated. RESULTS: Seven cases were reported during the meeting (3 from Mexico, 3 from Chile and 1 from Argentina). Fifty percent of the participants reported consulting with guidelines and clinical centers to help with potential cases. Most agreed that further studies must be done in cases of chronic seroma where the capsule plays an important role. DISCUSSION: A current debate exists about the incidence of this problem in Latin America because we did not report the same number of cases as Europe, Australia or North America. More studies are required to determine the differences among reports in Latin America. CONCLUSION: Most representatives agreed that further studies must be done. Concern is increasing, and the problem is known. Other factors involved may be considered, and the problem must not be ignored. NO LEVEL ASSIGNED: 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 .

Colitis pseudomembranosa tras abdominoplastia circunferencial postbariátrica. Caso clínico / Pseudomembranous colitis after post-bariatric circumferential abdominoplasty. Case report

Los pacientes que se someten a cirugía reconstructiva del contorno corporal tras pérdida masiva de peso secundaria a cirugía bariátrica, presentan cambios importantes en la microbiota intestinal, sus propiedades antimicrobianas y en la absorción de nutrientes. Estas alteraciones, sumadas al uso de antibióticos profilácticos para cirugía y agentes reductores de la motilidad intestinal, los vuelven susceptibles a infecciones nosocomiales por oportunistas como el Clostridium difficile, que tiene una presentación clínica que varía desde las formas leves hasta la colitis fulminante. Presentamos el caso de una paciente con pérdida masiva de peso posterior a un bypass gástrico, a quien se le realizó abdominoplastia circunferencial en flor de lis y que en el postoperatorio mediato presentó colitis pseudomembranosa tras autorrecetarse loperamida y que a pesar de los tratamientos agresivos utilizados, requirió abordaje quirúrgico con colectomía subtotal por el desarrollo de megacolon tóxico. Finalmente se logró resolver el cuadro séptico pero con secuelas gastrointestinales inherentes a una resección intestinal y disminución de la calidad de vida. Es de suma importancia la educación de los pacientes con pérdida masiva de peso respecto a las posibles complicaciones de la cirugía reconstructiva y los medicamentos utilizados, así como de su apego al tratamiento indicado por su médico (AU)

Patients undergoing reconstructive surgery of body contour after massive weight loss due to bariatric surgery, suffer important changes in the intestinal microbiota, its antimicrobial properties and the nutrient absorption capacity. These abnormalities, plus the utilization of prophylactic antibiotics for surgery and intestinal motility reducing agents, make patients vulnerable to nosocomial infections by opportunists such as Clostridium difficile, which has a clinical presentation that oscillates from mild to fulminant colitis. We present a case of a patient with massive weight loss after a bypass surgery who underwent circumferential abdominoplasty in fleur de lis and presented pseudomembranous colitis in the postoperative period after self-administration of loperamide. Despite aggressive treatments, the patient required surgery with subtotal colectomy due to the development of toxic megacolon. Finally, she managed to overcome sepsis, however with gastrointestinal sequels that diminish quality of life. It is extremely important to educate patients with massive weight loss about possible complications of reconstructive surgery and medications used, as well as their adherence to prescriptions made by the treating physician (AU)

Breast Implant and Anaplastic Large Cell Lymphoma Meta-Analysis.

Recent studies have shown a relationship between lymphoma and breast implants. We performed a meta-analysis about this problem. We found 80 cases, 50 of which were reported in the United States (62.5%). The average age was 52 years. The average time between breast implant surgery and lymphoma was 11 years. Forty-one percent of the breast implants were silicone, 42.19% were saline and 15.8% were unknown. The coverage of the breast implants was texturized in 21.3% and unknown in 78%. The most common brands were McGhan and Mentor. In 72.6% of the cases, the brand was unknown. The clinical findings were seroma (67.33%), nodes (13.8%), mass (22.1%), other (11.7%) and unknown (32%). The most common surgical treatment was capsulectomy and breast implant removal. In 97% of the cases, ALK was negative and 3% were positive. The most common marker was CD30. The most common chemotherapy regimen was CHOP. Three patients died. Two of the patients had extracapsular extension of the disease and breast cancer history. Lymphoma related with the breast implant was a different type of lymphoma, and in most cases, it was less aggressive. The disease was confined to the capsule. Few patients developed aggressive disease, were extracapsular and showed bad prognosis.

Guía clínica para el manejo interdisciplinario del paciente con secuelas de pérdida masiva de peso durante la cirugía plástica reconstructive / Interdisciplinary clinical guidelines for massive weight loss patients during plastic reconstructive surgery

Antecedentes y Objetivos. La obesidad está considerada como una pandemia y México ocupa uno de los primeros lugares mundiales en número de casos en población adulta y el primero en el grupo infantil. Desde 2008 se pusieron en marcha Unidades de Cirugía Bariátrica para el manejo del paciente obeso, con lo cual se inició también la Reconstrucción postpérdida masiva de peso por los Servicios de Cirugía Plástica. Sin embargo, no existen protocolos descritos de manejo perioperatorio de este tipo de pacientes en nuestro país. El objetivo del presente trabajo es crear una guía clínica para el manejo interdisciplinario del paciente con secuelas de pérdida masiva de peso basada en los resultados obtenidos en un centro de reconstrucción postbariátrica. Material y Método. Creamos para ello un equipo de expertos de cada área involucrada y se estandarizó el manejo pre, trans y postoperatorio de todos los pacientes con secuelas de pérdida masiva de peso a fin de evaluar los resultados obtenidos. Resultados. Se realizaron 314 procedimientos reconstructivos en 144 pacientes postbariátricos. El 93% fueron de sexo femenino. La edad promedio fue de 37.2 años. Los procedimientos realizados fueron: abdominoplastia en un 39.17%; mastopexia en un 10.5%; torsoplastia en un 7.69%; braquioplastia en un 7.01%; cruroplastia en un 5.09%; y ritidoplastia en un 2.54%. El tiempo quirúrgico promedio fue de 221.2 minutos, con un sangrado transoperatorio medio de 275 ml. Las complicaciones presentadas alcanzaron el 4.77% y la mortalidad fue de 0%. Las recomendaciones emitidas por cada experto involucrado en el proceso de reconstrucción permitieron obtener resultados favorables en relación a la morbi-mortalidad, que fue equiparable e incluso inferior a la reportada en otras series. Conclusiones. Creemos que el seguimiento de una guía clínica basada en la estandarización del manejo de 314 procedimientos en una población con características similares, nos permite realizar la reconstrucción postpérdida masiva de peso de forma eficaz y segura (AU)

Background and Objectives. Obesity is now considered a pandemic problem. México occupies one of the highest places in the world with adults and children with obesity or overweight. In 2008 multiple Bariatric Surgery Centers were created in the country. Therefore, the massive weight loss reconstruction started to be performed by Plastic Surgery Services. They lack of clinical practice guidelines. Our objective is to create an interdisciplinary clinical practice guidelines for the massive weight loss patient reconstruction, based on the results and experience of a Postbariatric Reconstruction Center. Methods. A highly specialized interdisciplinary team was created in order to perform a complete clinical evaluation before the patients was operated by Plastic Surgery. All the perioperative management was standarized by every clinical area and we described the guidelines based on the final results. Results. AA total of 314 reconstruction procedures were performed in 144 postbariatric patients. The 93% of the population were female. Average age was 37.2 years old. The procedures performed were: abdominoplasty in 39.17%; mastope; and rhytidectomy in 2.54%. Average surgical time were 221.2 minutes. Intraoperative haemorrage was 275 ml as an average. Complications were developed in the 4.77% of the procedures with a mortality rate of 0%. The recomendations emitted by every clinical expert, awolled to obtain a good outcome concerning about the low rate of morbility and mortality, even better than other international series described. Conclusions. The application of clinical guidelines in the management of massive weight patient sustained in a 314 postbariatric Plastic Surgery procedure in a standarized population allows to perform an effective and safe surgery (AU)