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2.
Aesthetic Plast Surg ; 45(6): 2593-2601, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-33837459

RESUMO

Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL) is a distinctive type of T-cell lymphoma arising around breast implants. We performed a review of the existing literature with the aim of providing an evidence-based overview of the available data on BIA-ALCL with a standardized evaluation of the quality of the studies and investigating the potential association between textured breast implants and BIA-ALCL.We analyzed the literature reporting estimates of relative or absolute risks of BIA-ALCL in case-control, cohort studies and case series studies. The total number of BIA-ALCL cases reported in literature is very low. Furthermore, most of the reported cases have been reported in case-control studies or case series. This means that our knowledge is based on a low level of evidence. Moreover, low-medium quality scores were observed in the included case series studies. In relation to the rarity of the event, better information could only derived by international cooperation to pool together data deriving from all over the world, with the clear need of better reporting patients and implant characteristics in case series and when adding data to public registries. 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 .


Assuntos
Implante Mamário , Implantes de Mama , Neoplasias da Mama , Linfoma Anaplásico de Células Grandes , Implante Mamário/efeitos adversos , Implantes de Mama/efeitos adversos , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/etiologia , Estudos de Casos e Controles , Feminino , Humanos , Linfoma Anaplásico de Células Grandes/epidemiologia , Linfoma Anaplásico de Células Grandes/etiologia , Linfoma Anaplásico de Células Grandes/cirurgia
3.
Plast Reconstr Surg ; 147(5S): 31S-38S, 2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-33890878

RESUMO

SUMMARY: The authors reviewed the available evidence on revision surgery following implant-based breast surgery with the aim of investigating whether any difference in the surgical approach should be proposed if the patient has a textured device. They included in their review 31 studies presenting different approaches for revision surgery following implant-based breast surgery (both aesthetic and reconstructive), with a level of evidence ranging from 4 to 5. None of the included studies proposed different surgical approaches for revision surgery in patients carrying textured devices. The authors conclude that no different surgical attitudes in revision surgery following implant-based breast surgery should be adopted if the patient has a textured device according to the available evidence, when a correct approach is performed to face the complication or adverse event, following a thorough preoperative study of the patient with the proper diagnostic tools.


Assuntos
Implante Mamário/métodos , Implantes de Mama/efeitos adversos , Remoção de Dispositivo/métodos , Procedimentos Cirúrgicos Eletivos/métodos , Reoperação/métodos , Feminino , Migração de Corpo Estranho/cirurgia , Humanos , Mamoplastia/métodos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/cirurgia , Desenho de Prótese , Propriedades de Superfície , Cirurgia Plástica/métodos
4.
Breast ; 57: 25-35, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33711697

RESUMO

INTRODUCTION: The potential advantages of oncoplastic breast conserving surgery (BCS) have not been validated in robust studies that constitute high levels of evidence, despite oncoplastic techniques being widely adopted around the globe. There is hence the need to define the precise role of oncoplastic BCS in the treatment of early breast cancer, with consensual recommendations for clinical practice. METHODS: A panel of world-renowned breast specialists was convened to evaluate evidence, express personal viewpoints and establish recommendations for the use of oncoplastic BCS as primary treatment of unifocal early stage breast cancers using the GRADE approach. RESULTS: According to the results of the systematic review of literature, the panelists were asked to comment on the recommendation for use of oncoplastic BCS for treatment of operable breast cancer that is suitable for breast conserving surgery, with the GRADE approach. Based on the voting outcome, the following recommendation emerged as a consensus statement: Oncoplastic breast conserving surgery should be recommended versus standard breast conserving surgery for the treatment of operable breast cancer in adult women who are suitable candidates for breast conserving surgery (with very low certainty of evidence). DISCUSSION: This review has revealed a low level of evidence for most of the important outcomes in oncoplastic surgery with lack of any randomized data and absence of standard tools for evaluation of clinical outcomes and especially patients' values. Despite areas of controversy, about one-third (36%) of panel members expressed a strong recommendation in support of oncoplastic BCS. Presumably, this reflects a synthesis of views on the relative complexity of these techniques, associated complications, impact on quality of life and costs.


Assuntos
Neoplasias da Mama/cirurgia , Mastectomia Segmentar , Neoplasias da Mama/patologia , Estudos Transversais , Feminino , Abordagem GRADE , Humanos , Estudos Prospectivos , Qualidade de Vida
5.
Genes (Basel) ; 12(2)2021 02 10.
Artigo em Inglês | MEDLINE | ID: mdl-33578759

RESUMO

Growing numbers of asymptomatic women who become aware of carrying a breast cancer gene mutation (BRCA) mutation are choosing to undergo risk-reducing bilateral mastectomies with immediate breast reconstruction. We reviewed the literature with the aim of assessing the oncological safety of nipple-sparing mastectomy (NSM) as a risk-reduction procedure in BRCA-mutated patients. Nine studies reporting on the incidence of primary breast cancer post NSM in asymptomatic BRCA mutated patients undergoing risk-reducing bilateral procedures met the inclusion criteria. NSM appears to be a safe option for BRCA mutation carriers from an oncological point of view, with low reported rates of new breast cancers, low rates of postoperative complications, and high levels of satisfaction and postoperative quality of life. However, larger multi-institutional studies with longer follow-up are needed to establish this procedure as the best surgical option in this setting.


Assuntos
Proteína BRCA1/genética , Proteína BRCA2/genética , Mamoplastia/métodos , Mastectomia/métodos , Mutação , Qualidade de Vida/psicologia , Adulto , Doenças Assintomáticas , Neoplasias da Mama/genética , Neoplasias da Mama/patologia , Neoplasias da Mama/psicologia , Neoplasias da Mama/cirurgia , Tomada de Decisão Clínica/ética , Feminino , Seguimentos , Expressão Gênica , Humanos , Mamoplastia/psicologia , Mamoplastia/reabilitação , Mastectomia/psicologia , Mastectomia/reabilitação , Pessoa de Meia-Idade , Mamilos/irrigação sanguínea , Mamilos/inervação , Medição de Risco/estatística & dados numéricos
7.
Oncologist ; 26(1): e66-e77, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33044007

RESUMO

INTRODUCTION: The rapid spread of COVID-19 across the globe is forcing surgical oncologists to change their daily practice. We sought to evaluate how breast surgeons are adapting their surgical activity to limit viral spread and spare hospital resources. METHODS: A panel of 12 breast surgeons from the most affected regions of the world convened a virtual meeting on April 7, 2020, to discuss the changes in their local surgical practice during the COVID-19 pandemic. Similarly, a Web-based poll based was created to evaluate changes in surgical practice among breast surgeons from several countries. RESULTS: The virtual meeting showed that distinct countries and regions were experiencing different phases of the pandemic. Surgical priority was given to patients with aggressive disease not candidate for primary systemic therapy, those with progressive disease under neoadjuvant systemic therapy, and patients who have finished neoadjuvant therapy. One hundred breast surgeons filled out the poll. The trend showed reductions in operating room schedules, indications for surgery, and consultations, with an increasingly restrictive approach to elective surgery with worsening of the pandemic. CONCLUSION: The COVID-19 emergency should not compromise treatment of a potentially lethal disease such as breast cancer. Our results reveal that physicians are instinctively reluctant to abandon conventional standards of care when possible. However, as the situation deteriorates, alternative strategies of de-escalation are being adopted. IMPLICATIONS FOR PRACTICE: This study aimed to characterize how the COVID-19 pandemic is affecting breast cancer surgery and which strategies are being adopted to cope with the situation.


Assuntos
Neoplasias da Mama/terapia , COVID-19/prevenção & controle , Mastectomia/tendências , Pandemias/prevenção & controle , Padrões de Prática Médica/tendências , Agendamento de Consultas , Neoplasias da Mama/patologia , COVID-19/epidemiologia , COVID-19/transmissão , COVID-19/virologia , Controle de Doenças Transmissíveis/organização & administração , Controle de Doenças Transmissíveis/normas , Progressão da Doença , Procedimentos Cirúrgicos Eletivos/normas , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/tendências , Feminino , Carga Global da Doença , Alocação de Recursos para a Atenção à Saúde/normas , Alocação de Recursos para a Atenção à Saúde/estatística & dados numéricos , Alocação de Recursos para a Atenção à Saúde/tendências , Humanos , Mastectomia/economia , Mastectomia/normas , Mastectomia/estatística & dados numéricos , Terapia Neoadjuvante/estatística & dados numéricos , Salas Cirúrgicas/economia , Salas Cirúrgicas/estatística & dados numéricos , Salas Cirúrgicas/tendências , Seleção de Pacientes , Admissão e Escalonamento de Pessoal/economia , Admissão e Escalonamento de Pessoal/estatística & dados numéricos , Admissão e Escalonamento de Pessoal/tendências , Padrões de Prática Médica/economia , Padrões de Prática Médica/organização & administração , Padrões de Prática Médica/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Encaminhamento e Consulta/tendências , SARS-CoV-2/patogenicidade , Cirurgiões/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos , Tempo para o Tratamento
9.
Gland Surg ; 8(Suppl 4): S281-S286, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31709168

RESUMO

Surgical treatment of breast cancer has changed during the last few decades. Long-term evaluation of several studies performed worldwide have confirmed that conservative surgery (CS) and radical mastectomy have similar survival rates. Due to CS being the gold standard for treatment for most women with breast cancer, advances in materials, mastectomy and reconstructive surgery techniques, now give us the possibility to perform on our patients a great outcome with oncological security. Both advances, in plastic and oncologic surgery, created a new discipline, called oncoplastic breast surgery, that allow surgeons to resect large breast specimens preventing subsequent deformities with the correct previous planning. This is particularly important when more than 30% of the breast volume will be resected because it allows for planning CS depending on the site of the lesion and for establishing the limits between CS and mastectomy.

10.
Plast Reconstr Surg Glob Open ; 7(10): e2426, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31772879

RESUMO

Background: Autologous fat grafting has broad applications in reconstructive and aesthetic breast surgery as a natural filler and for its regenerative purposes. Despite the widespread use of fat grafting, there remains no shared consensus on what constitutes the optimal fat grafting technique and its oncological safety. For this reason, the authors of this study have organized a Survey and an International Consensus Conference that was held at the Aesthetic Breast Meeting in Milan (December 15, 2018). Methods: All studies on fat grafting, both for breast aesthetic and reconstructive purposes, were electronically screened. The literature review led to 17 "key questions" that were used for the Survey. The authors prepared a set of 10 "key statements" that have been discussed in a dedicated face-to-face session during the meeting. Results: The 10 key statements addressed all the most debated topics on fat grafting of the breast. Levels of evidence for the key statements ranged from III to IV with 2 statements (20%) supported by a level of evidence III and 6 statements (60%) by level of evidence IV. Overall consensus was reached for 2 statements (20%) with >75% agreement reached for 7 statements. Conclusions: The survey demonstrated a diversity of opinion and attitude among the panelists with regard to technique. Clear recommendations for evidence-based clinical practice for fat grafting use both in aesthetic and reconstructive breast surgery could not be defined due to the scarcity of level 1 or 2 studies.

14.
Aesthet Surg J ; 39(2): 164-173, 2019 01 17.
Artigo em Inglês | MEDLINE | ID: mdl-29579138

RESUMO

Background: Breast shape is defined utilizing mainly qualitative assessment (full, flat, ptotic) or estimates, such as volume or distances between reference points, that cannot describe it reliably. Objectives: The authors quantitatively described breast shape with two parameters derived from a statistical methodology denominated by principal component analysis (PCA). Methods: The authors created a heterogeneous dataset of breast shapes acquired with a commercial infrared 3-dimensional scanner on which PCA was performed. The authors plotted on a Cartesian plane the two highest values of PCA for each breast (principal components 1 and 2). Testing of the methodology on a preoperative and posttreatment surgical case and test-retest was performed by two operators. Results: The first two principal components derived from PCA characterize the shape of the breast included in the dataset. The test-retest demonstrated that different operators obtain very similar values of PCA. The system is also able to identify major changes in the preoperative and posttreatment stages of a two-stage reconstruction. Even minor changes were correctly detected by the system. Conclusions: This methodology can reliably describe the shape of a breast. An expert operator and a newly trained operator can reach similar results in a test/re-testing validation. Once developed and after further validation, this methodology could be employed as a good tool for outcome evaluation, auditing, and benchmarking.


Assuntos
Neoplasias da Mama/cirurgia , Mama/diagnóstico por imagem , Imageamento Tridimensional/métodos , Mamoplastia/normas , Mastectomia/efeitos adversos , Adulto , Idoso , Pontos de Referência Anatômicos/anatomia & histologia , Pontos de Referência Anatômicos/diagnóstico por imagem , Benchmarking/métodos , Mama/anatomia & histologia , Mama/cirurgia , Feminino , Humanos , Imageamento Tridimensional/instrumentação , Raios Infravermelhos , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde/métodos , Análise de Componente Principal , Smartphone , Adulto Jovem
18.
Breast Cancer Res Treat ; 172(3): 523-537, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30182349

RESUMO

PURPOSE: Indications for nipple-sparing mastectomy (NSM) have broadened to include the risk reducing setting and locally advanced tumors, which resulted in a dramatic increase in the use of NSM. The Oncoplastic Breast Consortium consensus conference on NSM and immediate reconstruction was held to address a variety of questions in clinical practice and research based on published evidence and expert panel opinion. METHODS: The panel consisted of 44 breast surgeons from 14 countries across four continents with a background in gynecology, general or reconstructive surgery and a practice dedicated to breast cancer, as well as a patient advocate. Panelists presented evidence summaries relating to each topic for debate during the in-person consensus conference. The iterative process in question development, voting, and wording of the recommendations followed the modified Delphi methodology. RESULTS: Consensus recommendations were reached in 35, majority recommendations in 24, and no recommendations in the remaining 12 questions. The panel acknowledged the need for standardization of various aspects of NSM and immediate reconstruction. It endorsed several oncological contraindications to the preservation of the skin and nipple. Furthermore, it recommended inclusion of patients in prospective registries and routine assessment of patient-reported outcomes. Considerable heterogeneity in breast reconstruction practice became obvious during the conference. CONCLUSIONS: In case of conflicting or missing evidence to guide treatment, the consensus conference revealed substantial disagreement in expert panel opinion, which, among others, supports the need for a randomized trial to evaluate the safest and most efficacious reconstruction techniques.


Assuntos
Neoplasias da Mama/cirurgia , Mamoplastia/métodos , Mastectomia Subcutânea/métodos , Consenso , Feminino , Humanos , Mastectomia Subcutânea/efeitos adversos , Necrose , Mamilos/patologia , Retalhos Cirúrgicos/patologia
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