Alternativas de reconstrucción mamaria inmediata

La mastectomía total por cáncer de mama produce una deformidad importante en las pacientes, con alteraciones severas de su autoestima, imagen corporal, sexualidad, y calidad de vida en general. El gold estándar en los países desarrollados es la reconstrucción mamaria inmediata y, actualmente existen pocas contraindicaciones absolutas para realizar alguna técnica de reconstrucción. Este artículo se describen las opciones reconstructivas (colgajos e implantes), tiempos de reconstrucción, ventajas y desventajas de ambas técnicas, potenciales complicaciones, y se propone un algoritmo de tratamiento. La elección de la técnica de reconstrucción debería ser decidida entre la paciente y su cirujano/a, considerando características físicas, factores relacionados con la enfermedad y tratamiento oncológico, y preferencias de las pacientes.

Total mastectomy for breast cancer treatment can be a cause of deformity and distress for patients, with severe impairment of self-esteem, body image, sexuality, and quality of life. In developing countries, immediate breast reconstruction is the gold standard, and there are only a few absolut contraindications for some technique of breast reconstruction. This article describes reconstructive options (flaps and allo-plastic material), reconstructive timing, pros and cons of both techniques, potential complications, and an algorithm of treatment is proposed. Choice of the reconstructive technique should be decided by the patient and her surgeon, considering physical characteristics, factors related with the disease and oncologic treatments, and patients' preferences.

Intensive hands-on microsurgery course provides a solid foundation for performing clinical microvascular surgery.

PURPOSE: Microvascular surgery requires highly specialized and individualized training; most surgical residency training programs are not equipped with microsurgery teaching expertise and/or facilities. The aim of this manuscript was to describe the methodology and clinical effectiveness of an international microsurgery course, currently taught year-round in eight countries. METHODS: In the 5-day microsurgery course trainees perform arterial and venous end-to-end, end-to-side, one-way-up, and continuous suture anastomoses and vein graft techniques in live animals, supported by video demonstrations and hands-on guidance by a full-time instructor. To assess and monitor each trainee's progress, the course's effectiveness is evaluated using "in-course" evaluations, and participant satisfaction and clinical relevance are assessed using a "post-course" survey. RESULTS: Between 2007 and 2017, more than 600 trainees participated in the microsurgery course. "In-course" evaluations of patency rates revealed 80.3% (arterial) and 39% (venous) performed in end-to-end, 82.7% in end-to-side, 72.6% in continuous suture, and 89.5% (arterial) and 62.5% (venous) one-way-up anastomoses, and 58.1% in vein graft technique. "Post-course" survey results indicated that participants considered the most important components of the microcourse to be "practicing on live animals", followed by "the presence of a full-time instructor". In addition, almost all respondents indicated that they were more confident performing clinical microsurgery cases after completing the course. CONCLUSIONS: Microvascular surgery requires highly specialized and individualized training to achieve the competences required to perform and master the delicate fine motor skills necessary to successfully handle and anastomose very small and delicate microvascular structures. The ever-expanding clinical applications of microvascular procedures has led to an increased demand for training opportunities. By teaching time-tested basic motor skills that form the foundation of microsurgical technique this international microsurgery-teaching course is helping to meet this demand.

What Makes a Beautiful Buttock Beautiful? A Case-Control Study Comparing Buttocks Models versus Normal Women by Magnetic Resonance Imaging, Photography and Anthropometry.

OBJECTIVES: To describe characteristics of women with aesthetically ideal buttocks and differentiate them from women with normal buttocks. METHODS: Case-control study comparing anatomy of women with ideal buttocks (buttocks models) to women with normal buttocks using magnetic resonance images, anthropometric measurements and photography. RESULTS: Comparing to normal women, buttocks models have a narrower waist, narrower iliac crest, wider C point, wider hips and bigger and thicker gluteus maximus muscle (GMM). A bigger GMM adds more projection to the C point, point of maximum projection in the lateral view is 2.7 cm higher than the pubic bone. The amount of subcutaneous fat was equal in models and controls. CONCLUSIONS: Our study provides new knowledge regarding the tridimensional aspects of the beauty of the buttocks area. A beautiful buttock is a conjunction of adequate bony shape, muscle development, subcutaneous fat layer, and tight skin. Comparing to normal women, buttocks models have a narrower waist, narrower iliac crest, wider C point, wider hips and bigger and thicker Gluteus Maximus Muscle. Accurate understanding of the aesthetic goals in a given patient can guide surgical technique. 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 .

Liquiñe-Ofqui's fast slipping intra-volcanic arc crustal faulting above the subducted Chile Ridge.

The southernmost portion of the Liquiñe-Ofqui fault zone (LOFZ) lies within the proposed slab window which formed due to oblique subduction of the Chile Ridge in Patagonia. Mapping of paleo-surface ruptures, offsets, and lithological separations along the master fault allowed us to constrain geologic slip rates for the first time with dextral rates of 11.6-24.6 mm/year (Quaternary) and 3.6-18.9 mm/year (Late-Cenozoic) respectively. We had trouble mapping the LOFZ in one local because of a partially collapsed and previously undiscovered volcanic complex, Volcan Mate Grande (VMG: 1,280 m high and thus Vesuvius-sized) that grew in a caldera also offset along the LOFZ and has distinct geochemistry from adjacent stratovolcanoes. Besides the clear seismic and volcanic hazard implications, the structural connection along the main trace of the fast slipping LOFZ and geochemistry of VMG provides evidence for the slab window and insight into interplay between fast-slipping crustal intra-arc crustal faults and volcanoes.

Intraoperative Ketamine and Magnesium Therapy to Control Postoperative Pain After Abdominoplasty and/or Liposuction: A Clinical Randomized Trial.

PURPOSE: This study aimed to compare the effects of ketamine and ketamine associated with magnesium on opioid consumption and pain scores in patients undergoing abdominoplasty and/or liposuction compared to standard treatment. PATIENTS AND METHODS: A total of 63 patients were included and randomized as follows: 21 patients in the Control group, 20 patients in the Ketamine group (Ket), and 22 patients in the Ketamine-magnesium group (KetMag). The KetMag group received an IV bolus of 0.3 mg/kg of ketamine and 50 mg/kg magnesium, followed by continuous infusion of ketamine (0.15 mg/kg/h) and magnesium (10 mg/kg/h) until extubation. The Ket group received the same bolus and infusion of ketamine, together with a bolus and continuous infusion of placebo instead of magnesium. The Control group received saline instead of ketamine and magnesium. The groups were compared in morphine consumption during the first 12h, body-postoperative pain and disability scale until the 90th day, the time until the first morphine request on the PCA pump, pain scores, and the adverse effects related to the use of study drugs. RESULTS: The KetMag group had a lower morphine consumption by almost 50% during the first 12h than the Control and the Ket groups. In addition, the KetMag group required the first dose of morphine later than the other two groups. There were no differences in the adverse effects of the proposed treatments. Finally, multiple linear regression and a nonlinear approach analysis indicated that the Control group experienced a higher degree of pain and increased morphine consumption per hour than Ket and KetMag groups. CONCLUSION: Co-administration of intraoperative ketamine plus magnesium and ketamine alone are an effective and easy regime for reducing pain and opioid consumption in the postoperative period.

[Acute compartment syndrome as a complication of cutaneous loxoscelism mainly edematous]. / Síndrome compartimental agudo como complicación de un loxoscelismo cutáneo edematoso.

Acute compartment syndrome (ACS) is the increase of pressure in a closed osteofascial space. This reduces capillary perfusion below the level necessary for tissue viability. Injury could be irreversible if proper treatment is not performed. Hand ACS secondary to cutaneous loxoscelism with edematous predominance is extremely infrequent. We present a clinical case of a 22-year-old patient who started a hand compartment syndrome secondary to cutaneous loxoscelism (CL), requiring emergency surgical treatment with dorsal and palmar fasciotomy.

Síndrome compartimental agudo como complicación de un loxoscelismo cutáneo edematoso / Acute compartment syndrome as a complication of cutaneous loxoscelism mainly edematous

Resumen El síndrome compartimental agudo (SCA) es el aumento de la presión en un espacio osteofascial cerrado. Esto reduce la presión capilar bajo el nivel necesario para la viabilidad de los tejidos del compartimento. El SCA de mano como complicación de un loxoscelismo cutáneo (LC) de predominio edematoso es muy poco frecuente. Presentamos el caso de una mujer de 22 años que presentó un SCA de la mano secundario a un LC y que requirió tratamiento quirúrgico de urgencia mediante una fasciotomía dorsal y palmar.

Abstract Acute compartment syndrome (ACS) is the increase of pressure in a closed osteofascial space. This reduces capillary perfusion below the level necessary for tissue viability. Injury could be irreversible if proper treatment is not performed. Hand ACS secondary to cutaneous loxoscelism with edematous predominance is extremely infrequent. We present a clinical case of a 22-year-old patient who started a hand compartment syndrome secondary to cutaneous loxoscelism (CL), requiring emergency surgical treatment with dorsal and palmar fasciotomy.

High-Definition Liposculpture: What are the Complications and How to Manage Them?

BACKGROUND: High-definition liposculpture is a novel surgical technique widely accepted among plastic surgeons. The aim of this article is to describe surgical outcomes with a special emphasis on complications in high-definition liposculpture patients. METHODS: An historical cohort of patients who underwent high-definition liposculpture from two senior surgeons was reviewed. Technique, patient selection criteria, preoperative marks and surgical outcomes are described. Postoperative complications are discussed. RESULTS: A total of 417 patients underwent high-definition liposculpture between 2015 and 2018. Primary liposuction and secondary liposuction were performed in 308 (74%) and 109 (26%), respectively. Combined surgeries were performed in 121 cases (29%). There were no systemic complications. Local complications included hyperpigmentation (n = 276), seroma (n = 125), nodular fibrosis (n = 83), unsatisfactory definition in superficial liposuction areas (n = 16), unnatural appearance of body contour (n = 17), VASER-related burns (n = 3) and Mondor's syndrome (n = 2). Most patients (94%) were satisfied with the results. CONCLUSION: High-definition liposculpture is a body contouring technique that has shown excellent results. Despite non-serious complications were frequent, most complications were local and safely treated without affecting surgical outcome. To know these complications will help to recognize them earlier and to adjust patient expectation about the postoperative period. 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.

Is Banning Texturized Implants to Prevent Breast Implant-Associated Anaplastic Large Cell Lymphoma a Rational Decision? A Meta-Analysis and Cost-Effectiveness Study.

BACKGROUND: Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an emergent disease that threatens patients with texturized breast implants. Major concerns about the safety of these implants are leading to global changes to restrict the utilization of this product. The principal alternative is to perform breast augmentation utilizing smooth implants, given the lack of association with BIA-ALCL. The implications and costs of this intervention are unknown. OBJECTIVES: The authors of this study determined the cost-effectiveness of smooth implants compared with texturized implants for breast augmentation surgery. METHODS: A tree decision model was utilized to analyze the cost-effectiveness. Model input parameters were derived from published sources. The capsular contracture (CC) rate was calculated from a meta-analysis. Effectiveness measures were life years, avoided BIA-ALCL, avoided deaths, and avoided reoperations. A sensitivity analysis was performed to test the robustness of the model. RESULTS: For avoided BIA-ALCL, the incremental cost was $18,562,003 for smooth implants over texturized implants. The incremental cost-effectiveness ratio was negative for life years, and avoided death and avoided reoperations were negative. The sensitivity analysis revealed that to avoid 1 case of BIA-ALCL, the utilization of smooth implants would be cost-effective for a risk of developing BIA-ALCL equal to or greater than 1:196, and there is a probability of CC with smooth implants equal to or less than 0.096. CONCLUSIONS: The utilization of smooth implants to prevent BIA-ALCL is not cost-effective. Banning texturized implants to prevent BIA-ALCL may involve additional consequences, which should be considered in light of higher CC rates and more reoperations associated with smooth implants than with texturized implants.

Winged Ribs: An Underestimated Problem That May Compromise Breast Augmentation Outcomes.

Chest wall shape is an important aspect to consider when planning a breast augmentation. Minor chest wall deformities are usually underestimated by the patient and surgeon and may compromise postoperative outcomes. Lower costal cartilage dysmorphia or winged rib is one of these minor underestimated chest wall deformities characterized by a visible and palpable cartilaginous prominence under the inframammary fold and causes discomfort in patients decreasing the satisfaction with the breast augmentation surgery. For these patients, the author utilized an innovative surgical technique that allows resection of the protruding cartilages and placement of breast implants through the same surgical incision. Six patients with winged ribs underwent breast augmentation and costal cartilage resection via this method and there were no intraoperative or early postoperative complications, and all patients were satisfied with the aesthetical result after 6 months of follow-up. The presented surgical technique has a short learning curve with excellent postoperative results. Cases are presented to demonstrate the improved postoperative chest wall contour combined with breast augmentation outcome.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 .

PHARYNGO-ILEO-COLO-ANASTOMOSIS WITH MICRO-VASCULAR BLOOD SUPPLY AUGMENTATION FOR ESOPHAGO-GASTRIC REPLACEMENT DUE TO ESOPHAGO-GASTRIC NECROSIS AFTER CAUSTIC INGESTION.

BACKGROUND: Complete esophago-gastric necrosis after caustic ingestion is a challenging surgical scenario for reconstruction of the upper digestive transit. AIM: To present a surgical technique for reconstruction of the upper digestive tract after total esophagectomy and gastrectomy due to esophageal and gastric necrosis. METHOD: The transit was re-established by means of a pharyngo-ileo-colic interposition with microsurgical arterial and venous anastomosis for augmentation of blood supply. Colo-duodeno-anastomosis and ileo-transverse colic anastomosis were performed for complete digestive transit reconstruction. RESULT: This procedure was applied in a case of 41 years male attempted suicide by ingesting alkali caustic liquid (concentrated sodium hydroxide). Total necrosis of the esophagus and stomach occurred, which required initially total esophago-gastrectomy, closure at the level of the crico-pharyngeal sphincter and jejunostomy for enteral feeding with a highly deteriorated quality of life . The procedure was performed later and there were no major early and late postoperative complications and normal nutritional conditions were re-stablished. CONCLUSION: The procedure is feasible and must be managed by multidisciplinary team in order to re-establish a normal quality of life.

Long-Term Quality-of-Life Outcomes After Body Contouring Surgery: Phase IV Results for the Body-QoL® Cohort.

BACKGROUND: Body contouring surgery (BCS) is becoming increasing popular for aesthetic and reconstructive purposes, particularly among patients with massive weight loss (MWL). However, data on quality of life (QoL) following the surgery are limited, especially long-term QoL. OBJECTIVES: The authors evaluated the effect of BCS on QoL and the durability of this effect over time. METHODS: QoL was measured with the Body-QoL® instrument at 3 time points among consecutively treated patients: the day before BCS, 1 to 9 months postoperatively (short term), and 1 to 2.7 years postoperatively (long term). Total Body-QoL scores were compiled, as were scores for the instrument's main domains: body satisfaction, sex life, self-esteem and social performance, and physical symptoms. Scores were examined for the entire study population and separately for the cosmetic and MWL cohorts. RESULTS: Fifty-seven of the 112 patients participated in the short-term assessment and 84 in the long-term assessment. Total Body-QoL scores increased significantly (P < 0.0001), from 44.0 ± 14.1 preoperatively to 85.5 ± 17.5 short-term postoperatively and to 84.4 ± 12.7 long-term postoperatively. Scores for the 2 postoperative assessments did not differ significantly. Similar results were observed for scores on each separate domain. Although preoperative scores were lower for the MWL cohort than the cosmetic cohort (33.9 ± 15.6 vs 46.1 ± 12.8; P = 0.0002), they improved substantially after BCS, approaching scores for the cosmetic cohort. CONCLUSIONS: QoL increases significantly after BCS. This favorable outcome remained stable throughout long-term follow-up and was true for the cosmetic and MWL cohorts.

Pharyngo-ileo-colo-anastomosis with micro-vascular blood supply augmentation for esophago-gastric replacement due to esophago-gastric necrosis after caustic ingestion / Faringo-íleo-colo-anastomose com suprimento sanguíneo microvascular para substituição esofagogástrica por necrose esofagogástrica após ingestão cáustica

ABSTRACT Background : Complete esophago-gastric necrosis after caustic ingestion is a challenging surgical scenario for reconstruction of the upper digestive transit. Aim : To present a surgical technique for reconstruction of the upper digestive tract after total esophagectomy and gastrectomy due to esophageal and gastric necrosis Method: The transit was re-established by means of a pharyngo-ileo-colic interposition with microsurgical arterial and venous anastomosis for augmentation of blood supply. Colo-duodeno-anastomosis and ileo-transverse colic anastomosis were performed for complete digestive transit reconstruction. Result: This procedure was applied in a case of 41 years male attempted suicide by ingesting alkali caustic liquid (concentrated sodium hydroxide). Total necrosis of the esophagus and stomach occurred, which required initially total esophago-gastrectomy, closure at the level of the crico-pharyngeal sphincter and jejunostomy for enteral feeding with a highly deteriorated quality of life . The procedure was performed later and there were no major early and late postoperative complications and normal nutritional conditions were re-stablished. Conclusion: The procedure is feasible and must be managed by multidisciplinary team in order to re-establish a normal quality of life.

RESUMO Racional: A necrose esofagogástrica completa após ingestão cáustica é um cenário cirúrgico desafiador para a reconstrução do trânsito digestivo alto. Objetivo: Apresentar uma técnica cirúrgica para reconstrução do trato digestivo superior após esofagectomia total e gastrectomia por necrose esofágica e gástrica. Método: O trânsito foi restabelecido por interposição faringo-íleo-cólica com anastomose arterial e venosa microcirúrgica com aumento do suprimento sanguíneo. Adicionalmente, anastomose colo-duodeno-anastomótica e íleo-transversa foram realizadas para reconstrução completa do trânsito digestivo. Resultado: Este procedimento foi aplicado em um homem de 41 anos com tentativa de suicídio pela ingestão de líquido cáustico alcalino (hidróxido de sódio concentrado). Ocorreu necrose total do esôfago e do estômago, o que exigiu inicialmente esofagogastrectomia total, fechamento ao nível do esfíncter cricofaríngeo e jejunostomia para alimentação enteral produzindo qualidade de vida altamente deteriorada. O procedimento foi realizado mais tardiamente e não houve maiores complicações pós-operatórias precoces e tardias e condições nutricionais normais foram restabelecidas. Conclusão: O procedimento é viável e deve ser manejado por equipe multidisciplinar a fim de restabelecer a qualidade de vida normal.

Manejo quirúrgico de pacientes adultos con anomalías vasculares: serie de casos / Surgical management of adult patients with vascular anomalies: series of cases

Introducción: Las anomalías vasculares son un grupo heterogéneo de patologías, que considera tanto tumores como malformaciones vasculares. Son, habitualmente, de diagnostico y manejo durante la infancia, algunas lesiones persisten hasta la edad adulta. El tratamiento habitual considera terapias poco invasivas, siendo la alternativa resecctiva un opcion infrecuente. Objetivos: El objetivo de este estudio es presentar el manejo quirúrgico de pacientes portadores de anomalías vasculares realizado por el equipo de Cirugía Plástica y Reconstructiva del Hospital Clínico de la Universidad de Chile. Material y Métodos: Serie de casos retrospectiva de pacientes con diagnóstico de anomalias vasculares, sometidos a manejo quirúrgico por el equipo de Cirugía Plástica y Reconstructiva del Hospital Clínico de la Universidad de Chile. Se incluyó todos los pacientes con diagnóstico de anomalías vasculares intervenidos entre los años 2010 ­ 2016. Se realizó una revisión del historial clínico de cada paciente elaborando un análisis descriptivo. Resultados: Serie de 9 pacientes, 6 (66,6%) de sexo femenino, con edad promedio de 34,88 ±15,70 años. De los cuales 6 (66,67%) presentaron malformaciones vasculares y 2 (22,22%) tumores vasculares. Se observo compromiso de cabeza en 6 (66,67%) casos y 2 (22,22,%) genital. Se utilizo colgajos locales de avance en 6 (66,67%) y colgajos de transposición en 2 (22,22%) casos. Conclusiones: El manejo quirúrgico es una alternativa terapéutica segura que ofrece resultados buenos a las lesiones complejas. Y por tanto, creemos que es necesario un trabajo multidisciplinario entre pediatras, dermatólogos, radiólogos fisiatras, psicólogos y cirujanos plásticos para poder ofrecer mejores resultados a nuestros pacientes.

Introduction: Vascular anomalies are a heterogeneous group of pathologies, which considers tumors and vascular malformations. Usually diagnosed and treated during childhood, some lesions persist into adulthood. The usual treatment considers non-invasive therapies, being the respective alternative an uncommon option. Objectives: Present the surgical management of adults patients with vascular anomalies performed by the Plastic and Reconstructive Surgery team of the Clinical Hospital of the University of Chile. Material and methods: Retrospective case series of patients with diagnosis of vascular anomalies submitted to surgical management by the Plastic and Reconstructive Surgery team of the Clinical Hospital of the University of Chile. All patients with diagnosis of vascular anomalies operated between the years 2010 - 2016 were included. A review of the clinical history of each patient was carried out and a descriptive analysis was done. Results: Series of 9 patients, 6 (66.6%) female, with a mean age of 34.88 ± 15.70 years. Of these, 6 (66.67%) had vascular malformations and 2 (22.22%) had vascular tumors. Head involvement was observed in 6 (66.67%) cases and 2 (22.22%) genital. Local flaps were used in 6 (66.67%) and transposition flaps in 2 (22.22%) cases. Conclusions: Surgical management is a safe therapeutic alternative that offers beneficial results to complex lesions. Therefore, we believe a multidisciplinary work between pediatricians, dermatologists, radiologists.

Manejo quirúrgico de pacientes con hidrosadenitis supurativa: experiencia del Hospital Clínico de la Universidad de Chile / Surgical management of patients with hidradenitis suppurativa: experience of the Clinical Hospital of the University of Chile

Introducción: La hidrosadenitis supurativa es una enfermedad crónica de la piel en zonas que contienen glándulas apocrinas. Clásicamente se describe un manejo multimodal. La cirugía es una estrategia reconstructiva eficaz, frecuentemente postergada. No existen reportes sobre la experiencia a nivel nacional en el manejo de este grupo de pacientes. Objetivos: Exponer los resultados de manejo quirúrgico reconstructivo de pacientes con diagnóstico de hidrosadenitis supurativa por parte de un equipo de cirugía plástica de un hospital clínico. Material y Métodos: Serie de casos retrospectiva de pacientes con diagnóstico de hidrosadenitis supurativa con manejo quirúrgico. Se realizó una revisión del historial clínico de cada paciente y se elaborando un análisis descriptivo. Resultados: Trece pacientes, 7 (53,8%) de sexo femenino, edad promedio de 30,5±5,9 años. Se realizó manejo quirúrgico de 17 lesiones, siendo las más frecuentes 9 (52,9%)Axilar y 5 (29,4%) Inguino-perianal. Se realizó drenaje­curaciones en 2 (11,8%) y resección-cobertura en 15 (88,2%), 14 (82,3%) con colgajos y 2 (11,8%) injertos. Discusión: El manejo quirúrgico es una alternativa terapéutica eficaz para el control de la hidrosadenitis supurativa, presentando buenos resultados estéticos y funcionales con bajas complicaciones.

Introduction: Hidradenitis suppurativa is a chronic skin diseases of areas that contain apocrine glands. Classically a multimodal management is described. Surgery is an effective treatment, often postponed. Objectives: Present results of reconstructive surgical management of patients with hidradenitis suppurativa by a plastic surgery team of a clinical hospital. Material and methods: Retrospective case series of patients with hidradenitis suppurativa with surgical management. A review of the clinical history of each patient was carried out and a descriptive analysis was carried out. Results: 13 patients, 7 (53.8%) female, mean age of 30.5 ± 5.9 years. Surgical management of 17 lesions was performed, the most frequent lesions were 9 (52.9%) Axillary and 5 (29.4%) Inguino-perianal. Drainage were performed in 2 (11.8%) and resection-coverage in 15 (88.2%), 14 (82.3%) with flaps and 2 (11.8%) grafts. Discussion: Surgical management is an effective therapeutic alternative for the management of hidradenitis suppurativa, presenting good esthetic and functional results with low complications.

Resultados a largo plazo en calidad de vida en cirugía de contorno corporal: Fase IV en la cohorte Body-Qol® / Long-term outcomes in quality of life after body contouring surgery: Phase IV results in the Body-Qol® cohort

Introducción: La calidad de vida es uno de los resultados en cirugía de contorno corporal más importantes. La evidencia sobre la calidad de vida de estos pacientes a largo plazo es escasa. El objetivo de este estudio fue determinar si la calidad de vida obtenida en el postoperatorio temprano posterior a la cirugía de contorno corporal se mantiene a largo plazo. Métodos: Se diseñó un estudio de cohorte prospectiva compuesta por pacientes postoperados de cirugía de contorno corporal con más de un año de seguimiento. La calidad de vida fue medida con el instrumento Body-Qol®. Se compararon los puntajes preoperatorios, postoperatorios tempranos y postoperatorios tardíos. Se realizó el análisis estadístico con las pruebas de Kruskal-Wallis y Kolmogorov-Smirnov. Resultados: La cohorte se compuso de 112 pacientes con un seguimiento a largo plazo del 75%. En toda la cohorte la calidad de vida mejoró entre el preoperatorio (43,9 ± 14,1 puntos) y ambas mediciones postoperatorias (85,2 ± 16,8 postoperatorio temprano y 83,6 ± 13,5 postoperatorio tardío), siendo estadísticamente significativo (p < 0,0001). Entre el postoperatorio temprano y tardío no existió diferencia (p = 0,112). El análisis por dominios demostró la misma tendencia. Los pacientes con pérdida masiva de peso tuvieron puntajes preoperatorios menores, pero igualaron a la población estética en ambas mediciones postoperatorias. Conclusiones: La calidad de vida mejora significativamente posterior a la cirugía de contorno corporal de forma temprana, y esta mejoría es estable en el tiempo. Esto se observa tanto en los pacientes estéticos como en los posteriores a la pérdida masiva de peso.

Introduction: One of the most important outcomes in patients undergoing body-contouring surgery is quality of life. Data on long-term quality of life is deficient. The main purpose of this study is to determine if short-term QoL after body contouring surgery maintains in the long-term follow up. Methods: A cohort study was designed; patients with at least one-year follow-up from the surgery were included. Quality of life was measured with the Body-Qol© instrument. All patients answered the preoperative Body-Qol© and at least one measurement after one year of follow-up from body contouring surgery. The preoperative scores, short-term scores and long-term follow-up scores were compared. The statistical analysis was made with Kruskal-Wallis y Kolmogorov-Smirnov tests. Results: The cohort was integrated by 112 patients; the long-term follow-up was of 75%. Quality of life improved between the preoperative measure (43.9 ± 14.1 points) and both short-term and long-term measures (85.2 ± 16.8 early postoperative y 83.6 ± 13.5 late postoperative), which was statistically significant (P< .0001). There was no difference between the short-term and long-term measures (P = .112). The domain analysis demonstrated the same tendency. Massive weight loss patients had lower preoperative scores but improved more after BCS, reaching almost cosmetic values. Conclusions: Quality of life improves soon after surgery and is stable over time. This was observed for both massive weight loss and cosmetic patients.

Cambios en la calidad de vida en mujeres sometidas a aumento mamario: resultados preliminares de un estudio de cohortes / Changes in quality of life in women subjected to augmentation mammoplasty: preliminary results of a cohort study

Objetivo Determinar los cambios en calidad de vida en mujeres sometidas a mamoplastia de aumento o mastopexia con prótesis, usando el instrumento validado Breast-Q®. Materiales y métodos Estudio de cohortes prospectivo. Se incluyeron todas las pacientes operadas de mamoplastia de aumento o mastopexia de aumento en el Hospital Clínico de la Universidad de Chile entre octubre de 2013 y mayo de 2014. La calidad de vida (CdV) se midió con el instrumento validado Breast-Q®. Se realizó estadística descriptiva y analítica para evaluar el cambio global en CdV y por dominios considerando estadísticamente significativo un valor p < 0,05. Resultados En el periodo estudiado se operaron 58 pacientes, 33 (56,9%) completaron el instrumento Breast-Q® en el preoperatorio y 25 (75,7%) de ellas en el postoperatorio. La CdV subió de un 49,7% a un 82,5% (p < 0,001); analizando por dominio hubo mejoría en autoestima (52% a 88%, p < 0,001), autoimagen (22% a 80%, p < 0,001) y vida sexual (31% a 86%, p < 0,001). Los síntomas físicos empeoraron desde un 94% a 75% (p < 0,001). Conclusiones El aumento mamario mejora la CdV, específicamente la autoestima, la autoimagen y la vida sexual, pero las molestias físicas aumentan. La satisfacción global fue alta.

Objective To determine the changes in the quality of life of women subjected to augmentation mammoplasty or a prosthesis mastopexy, using the validated tool Breast-Q®. Materials and methods A prospective cohorts study was conducted that included operated on for augmentation mammoplasty or augmentation mastopexy in the Hospital Clínico de la Universidad de Chile (HCUCH) between October 2013 and May 2014. The quality of life (QoL) was measured using the Breast-Q® validated tool. Descriptive and analytic statistics were performed to evaluate the overall change in QoL and by domains, considering a p<.05 as statistically significant. Results A total of 58 patients were operated on, of whom 33 (56.9%) completed the Breast-Q® questionnaire before surgery, and 25 (75.7%) of them in the post-operative period. The quality of life increased from 49.7% to 82.5% (p<.001). When analysed by domain, there was an improvement in Self-esteem (52% to 88%, p<.001), Self-image (22% to 80%, p<.001) and Sex Life (31% to 86%, p<.001). The physical symptoms increased from 75% to 94% (p<.001). Conclusions Breast augmentation improves the quality of life, in particular, self-esteem, self-image, and sex life, but physical discomforts increased. The overall satisfaction was high.