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 .

Achados histopatológicos em mamoplastia redutora / Pathological findings in reduction mammaplasty

Introdução: a mamoplastia redutora é um dos procedimentos mais realizados em cirurgia plástica. O exame histopatológico dos espécimes de tais procedimentos é de grande importância para o diagnóstico de algumas patologias sem manifestação clínica prévia. Objetivo: analisar os resultados dos exames de patologia das pacientes submetidas à mamoplastia redutora no Serviço de Cirurgia Plástica do Hospital Universitário Cajuru. Métodos: estudo retrospectivo dos prontuários e exames anátomo- patólogicos das pacientes submetidas à mamoplastia redutora, no período de janeiro 2005 a janeiro 2007. Todas realizaram mamografia pré-operatória. As pacientes que apresentavam achados sugestivos de malignidade na mamografia foram excluídas do estudo. Resultados: foram revisados 64 prontuários de pacientes submetidas à mamoplastia redutora.A idade média das pacientes foi de 36 anos, apresentando uma variação de 18 a 53 anos. A ressecção média foi de 363 g e variou de 75 a 880 g. Dos resultados da patologia: 26 pacientes apresentaram alterações fibrocísticas, 11 fibrose estromal, 21 lipomastia e fibrose estromal e demais pacientes com alterações semelhantes. Uma paciente apresentou carcinoma intraductal in situ. Conclusão: o estudo patológico é de extrema importância para o diagnóstico de doenças sem manifestação clínica por isso deve ser considerado como exame de rotina.

Background: Reduction mamaplastyisoneofthe most common procedures performed in plastic surgery. Histopathological study of breast specimens is very important to determine the diagnosis of some diseases without clinical findings. Objective: verif the results of histopathologicalreportsofpatientssubmittedtoreduction mammaplasty at Plastic Surgery Service of Cajuru UniversityHospital. methods: retrospective study of patient files and pathological reports. All pacients had undergone reduction mammaplasty between January 2005 and January 2007. Preoperative mammagraphy was realized in all patients. Malignant findings excluded patient from study. Results: data of 64 patients who underwent breast reduction. The mean age of patients was 36 years old (range, 18 to 53 years). The mean resected breast tissue was 363 g (range, 75 to 880 g). From pathological results: 26 fibrocystic changes, 11 stromal fibrosis and others benign lesions. One patient had breast cancer. Conclusion: histopathological analysis of breast tissue is extremely important to diagnose mammary lesions without clinical findings, however must be performed routinely.

Retalho livre anterolateral da coxa para reconstrução de extremidades / Free anterolateral thigh flap for extremity reconstruction

Introdução: o retalho livre anterolateral da coxa tem se tornado uma das principais opções para reconstrução de defeitos de partes moles de cabeça e pescoço, tronco e extremidades pelas suas específicas vantagens sobre outros retalhos. Pacientes e métodos: entre abril de 2005 e janeiro de 2007, 18 retalhos anterolateral da coxa foram realizados no Hospital Universitário Cajuru - PUC/PR para reconstrução de extremidades (15 membros inferiores e 3 superiores). Quinze retalhos eram perfundidos por perfurantes miocutâneas e 3 por septocutâneas do ramo descendente da artéria circunflexa femoral lateral; dezessete pacientes do sexo masculino e um do feminino; a idade variou de 7 a 51 anos. Dezessete pacientes apresentavam feridas resultantes de trauma e um após ressecção de tumor ósseo de perna. Resultados: dos 18 retalhos, um evoluiu com necrose por congestão.A área doadora foi fechada primariamente em 11 casos e em 7 com enxerto de pele parcial. Não houve comprometimento funcional da área doadora e o resultado estético foi aceitável. Conclusões: o retalho anterolateral da coxa representa excelente opção para cobertura de defeitos de extremidades. Além do pedículo vascular longo, apresenta tecido fino e vascularizado para cobertura de tendões e ossos, com ampla disponibilidade cutânea e mínimo comprometimento da área doadora.

Introduction: The free anterolateral thigh flap is becoming one of the most preferred options for head and neck, trunk and extremity soft tissue reconstruction because of its specifics advantages over other flaps. Patients and methods: Between April 2005 and January 2007, 18 fasciocutaneous anterolateral thigh flaps were transfer red for extremity reconstruction a tCajuru University Hospital (15 lower limbs and 3 upper limbs). Fifteen flaps were supplied by myocutaneous perforators and 3 flaps were supplied by septo cutane ous per for ator sofdescending branch of the lateral circumflex femoral artery. Seventeen patients were male; the age ranged from 7 to 51 years. Seventeenpatientshadwoundsresultingfromtraumaand one patient after a bone tumor ressection of leg extremity. Results: between the 18 cases, one flap overcame with necrosisby congestion. The donor site was primarily closed in 11 cases and with skin graft in 7 patients. There was no functional impairment in donor site and the aesthetic result was acceptable. Conclusions: the free anterolateral thigh flap represents an excellent option for covering extremity defects. Besides a long vascular pedicle, this flap has a thinand vascularized tissue for covering tend onsandbone, with availability of large amount of skin, and minimum donor-site morbidity.

Influence of minoxidil on ischemic cutaneous flaps in rats

OBJETIVOS: Avaliar a influência do minoxidil, um vasodilatador, na prevenção de necrose, em retalhos isquêmicos, em ratos. MÉTODOS: Preparam-se retalhos cutâneos ventrais, medindo 8x4 cm, baseados na artéria epigástrica cranial direita, em 20 ratos - Wistar. Administrou-se 50 mg/kg/dia de sulfato de minoxidil aos ratos do grupo experimento e o mesmo volume de solução salina isotônica aos do grupo controle, por sonda oro-gástrica. Iniciou-se o tratamento 24 horas antes da operação e manteve-se, diariamente, por 7 dias, no pós-operatório. Realizou-se a avaliação da microcirculação dos retalhos fluxometria a laser 24 horas antes da operação, no pós-operatório imediato e após 7 dias. Desenhou-se a área de necrose do retalho em molde e avaliou-se em relação ao tamanho total por 2 métodos: planimetria e peso/papel. RESULTADOS: Constatou-se aumento de fluxo na extremidade distal e medial (M1) (p=0,0484), no grupo experimento. Houve diferença na prevenção da necrose nos retalhos do grupo experimento (p=0,0433), porém quando esta se instalou, não houve diferença quanto ao tamanho da área necrosada (p=0,1051 e p=0,2799). CONCLUSÃO: O uso de minoxidil é efetivo para evitar a instalação da necrose de retalhos potencialmente isquêmicos, porém, quando o processo se instala, não existe diferença na sobrevida destes, com a dose e a via empregadas neste estudo, em ratos.

Influence of minoxidil on ischemic cutaneous flaps in rats.

PURPOSE: To evaluate the influence of minoxidil, a well known vasodilator, on ischemic flap necrosis prevention in rats. METHODS: Ventral cutaneous flaps, measuring 8x4 cm, were designed in 20 Wistar rats based on the right cranial epigastric artery. In the experiment group, 50 mg/kg/day of minoxidil sulfate was administered by orogastric tube and the same amount of saline solution was administered to the control group. Such procedure was initiated 24 h before surgery and kept once a day through the 7th postoperative day. Microcirculation was evaluated with laser fluxometry 24 h before surgical procedure, at immediate postoperative and at the 7th postoperative day. Flap necrosis area was evaluated by 2 methods: planimetry and weight/paper ratio. RESULTS: A significant flow increase in distal and medial extremity at M1 (medial point 1) (p=0.0484) was observed in the experiment group. There was significant difference in flap necrosis prevention in the experiment group (p=0.0433), although after necrosis took place there was no significant difference in necrosis size. (p=0.1051 and p=0.2799). CONCLUSION: Minoxidil sulfate is effective in avoiding necrosis in ischemic flaps, but after necrosis is present there is no difference in survival area between experimental and control groups.