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1.
Aesthet Surg J ; 41(6): NP322-NP326, 2021 05 18.
Artigo em Inglês | MEDLINE | ID: mdl-33511978

RESUMO

BACKGROUND: Several studies have reported that neck, back, and shoulder pain can be reduced after macromastia. However, only 1 study has specifically investigated the relation between macromastia and headaches. OBJECTIVES: This study aimed to determine the frequency of headaches in patients with macromastia by examining a sample from our clinic and to determine whether the patients experienced headache relief following breast reduction surgery. METHODS: One hundred patients, out of 456 patients who met the criteria, were contacted by telephone and administered a questionnaire. Statistical analysis was performed with SPSS version 17.0. Normal distribution of the variables was examined by histograms and Kolmogorov-Smirnov tests. Pearson's chi-square and Fisher's exact tests were used to compare groups. The Mann-Whitney U test was used to evaluate nonparametric variables between the patients who has 1500 grams or less breast tissue removed and the patients more than 1500 grams breast tissue removed. RESULTS: The incidence of headaches in patients with macromastia was found to be 29%. Among the patients with headaches, 65.52% reported relief after surgery. The relief rate for headaches was found to be associated with the amount of tissue removed. CONCLUSIONS: The incidence of headaches increased in patients with macromastia compared with the general population, and patients reported headache relief after surgery. In addition, as the amount of tissue removal increased, the relief rate for headaches after surgery also increased. Although additional studies are essential, preoperative headaches should be evaluated in breast reduction patients, and the removal of larger amounts of breast tissue should be considered among patients who report headaches.


Assuntos
Mama , Mamoplastia , Mama/anormalidades , Mama/cirurgia , Cefaleia/epidemiologia , Cefaleia/etiologia , Humanos , Hipertrofia/cirurgia , Mamoplastia/efeitos adversos
3.
Arch Gynecol Obstet ; 303(4): 1025-1037, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33389096

RESUMO

Pectus excavatum (PE) is one of the most common congenital deformities of the thorax and is characterized by a depressed sternum with reduction of the antero-posterior thoracic diameter. Although the majority of patients with PE have no physiologic limitations, it is often associated with psychological problems influencing the patients' quality of life. Surgical treatment options show particular variation with regard to invasiveness and morbidity of the respective procedures. Surgical treatment using a custom-made silicone implant represents a less invasive alternative for patients without further accompanying physical symptoms. This article describes the simultaneous correction of a PE combined with tubular breast deformity using this minimally invasive technique.


Assuntos
Mama/anormalidades , Tórax em Funil/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Adolescente , Mama/cirurgia , Feminino , Tórax em Funil/complicações , Humanos , Mamoplastia , Procedimentos Cirúrgicos Minimamente Invasivos , Próteses e Implantes
4.
J Plast Reconstr Aesthet Surg ; 74(3): 495-503, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33127349

RESUMO

BACKGROUND: Free nipple grafting indications in breast reduction surgery are outdated. Safety of inferior pedicle technique for large resections and long pedicles has not been clearly defined. We evaluated patients who underwent inferior pedicle reduction mammoplasty to define the safety constraints of the inferior pedicle. METHODS: A retrospective review of patients who underwent inferior pedicle reduction mammoplasty due to symptomatic macromastia at Mayo Clinic over a six-year period was conducted. Patients with prior breast surgeries were excluded. Demographics, breast measurements, and surgical outcomes were collected. Univariate and multivariate analyses were performed to assess for predictors of necrosis. RESULTS: Overall, 288 patients (576 breasts) underwent inferior pedicle breast reduction from 2014 to 2019. The mean sternal notch-to-nipple (SNN) distance was 31.5 cm (standard deviation[SD]:4.2; range[r]:16-48), and the mean nipple-to-inframammary fold (N-IMF) distance was 14.8 cm (SD:4.0; r:7.5-27). The mean resection weight was 699.6 g (SD:310.4; r:125-2,385). The median follow-up was 3.9 months (interquartile range[IQR]:2.8-9.0). The overall skin or nipple areolar complex necrosis rate was 2.1%; the overall complication rate was 14.8%. On multivariate analysis, overall necrosis was not found to be associated with the N-IMF distance (adjusted odds ratio[aOR]:1.05, 95%-CI 0.88-1.16). Resection weight was statistically associated with an increased risk of overall necrosis (aOR:1.003, 95%-CI 1.001-1.005), adjusting for N-IMF and SNN distances. CONCLUSION: Inferior pedicle breast reduction offers low risk of necrosis and can be safely performed in patients regardless of the N-IMF distance. No association was found between N-IMF distance and overall necrosis in our cohort, including lengths >15 cm. However, large resections could increase the risk of necrosis.


Assuntos
Mama/anormalidades , Hipertrofia , Mamoplastia , Necrose , Mamilos , Complicações Pós-Operatórias , Risco Ajustado/métodos , Adulto , Mama/patologia , Mama/fisiopatologia , Mama/cirurgia , Feminino , Humanos , Hipertrofia/diagnóstico , Hipertrofia/fisiopatologia , Hipertrofia/cirurgia , Mamoplastia/efeitos adversos , Mamoplastia/métodos , Pessoa de Meia-Idade , Necrose/diagnóstico , Necrose/etiologia , Necrose/prevenção & controle , Mamilos/patologia , Mamilos/transplante , Tamanho do Órgão , Avaliação de Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/prevenção & controle , Transplante de Tecidos/métodos , Transplante de Tecidos/normas , Estados Unidos
5.
Arch Gynecol Obstet ; 303(2): 521-531, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33123809

RESUMO

PURPOSE: Symptomatic macromastia causes physical and psychological problems that can lead to restrictions in the patients' social and working lives and a reduced quality of life. Associated medical treatments also have a considerable impact on health-care costs. Several studies have assessed these costs, but the total disease costs of macromastia have never been evaluated on the basis of real-world data. METHODS: The data for 76 patients who underwent reduction mammoplasty between 2008 and 2016 were collected using a two-part questionnaire (preoperative and postoperative), as well as the patient files. Topics surveyed, besides demographic data, included physician visits, medical imaging, medical procedures, medical treatments, rehabilitation and convalescent measures, drug intake, medical aids, exercise activity, and sick leave days before surgery, to calculate the costs per year of conservative treatment of symptomatic macromastia. RESULTS: The mean time from start of symptoms to surgery was 11.82 years. The data for this group of patients with symptomatic macromastia show that costs per patient amount to €1677.55 per year. These costs include medical consultation, radiological imaging, medical treatments and procedures, physical therapy and rehabilitation, medication, special brassieres, exercise classes costs for sick leave due to problems with macromastia, and travel expenses. CONCLUSIONS: These results show that considerable health-care costs arise due to macromastia with conservative treatment. Overall, macromastia costs €1677.55 per patient/year. In particular, lost productivity due to sick days and the costs of physiotherapy are factors driving the high costs.


Assuntos
Mama/anormalidades , Custos de Cuidados de Saúde , Hipertrofia/cirurgia , Mamoplastia/economia , Adulto , Mama/cirurgia , Efeitos Psicossociais da Doença , Feminino , Alemanha , Humanos , Hipertrofia/economia , Masculino , Mamoplastia/métodos , Pessoa de Meia-Idade , Qualidade de Vida , Inquéritos e Questionários
6.
Clin Plast Surg ; 48(1): 109-121, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33220898

RESUMO

This study investigated inconsistencies in the use of descriptors in breast surgery and recommends a novel nomenclature that will be adopted and standardized among plastic surgeons. The study used a modified Delphi methodology to first identify redundant descriptors or those with multiple interpretations, and then achieve consensus on ideal recommended nomenclature in breast surgery. The Delphi panel agreed that there was misuse of and lack of a clear definition for several terms, and recommended removal of these subjective terms. Replacement with more anatomic nomenclature was suggested. Stretch deformity, pectoral banding, and implant-gland mismatch were introduced as new terms.


Assuntos
Implantes de Mama , Mama , Mamoplastia , Terminologia como Assunto , Mama/anormalidades , Mama/patologia , Mama/cirurgia , Implante Mamário , Feminino , Humanos
7.
Clin Plast Surg ; 48(1): 45-57, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33220904

RESUMO

Augmentation mastopexy is generally considered to be one of the most difficult operations in breast surgery. It has an undeserved reputation for high complication rates and unhappy patients. Through careful planning, surgical techniques involving manipulation of the breast while maintaining blood supply and implant cover, and good augmentation technique, the operation can achieve predictable results in most cases with a low complication rate. Techniques to assess and manage the 2 main complications of waterfall deformity and bottoming out are discussed.


Assuntos
Implante Mamário/efeitos adversos , Mama/cirurgia , Mamoplastia/métodos , Complicações Pós-Operatórias/cirurgia , Mama/anormalidades , Implante Mamário/métodos , Implantes de Mama/efeitos adversos , Feminino , Humanos , Mamoplastia/efeitos adversos , Reoperação
8.
Plast Reconstr Surg ; 146(6): 1213-1220, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33234945

RESUMO

BACKGROUND: Reduction mammaplasty effectively alleviates symptoms and restores quality of life. However, operating on adolescents remains controversial, partly because of fear of potential postoperative breast growth. This cross-sectional study provides surgeons with a method to predict the optimal timing, or biological "sweet spot," for reduction mammaplasty to minimize the risk of breast regrowth in adolescents. METHODS: The authors reviewed the medical records of women aged 12 to 21 years who underwent reduction mammaplasty from 2007 to 2019. Collected data included symptomology, perioperative details, and postoperative outcomes. RESULTS: Four hundred eighty-one subjects were included in analyses and were, on average, 11.9 years old at first menses (menarche) and 17.9 years old at surgery. Six percent of subjects experienced postoperative breast growth. Breast size appears to stabilize considerably later in obese adolescents compared to healthy-weight and overweight patients, and breast growth in obese macromastia patients may not end until 9 years after menarche. Operating on obese women before this time point increased the likelihood of glandular breast regrowth by almost 120 percent (OR, 1.18; 95 percent CI, 1.11 to 1.26). Surgery performed less than 3 years after menarche, the commonly regarded end of puberty, increased the likelihood of glandular regrowth by over 700 percent in healthy-weight and overweight subjects (OR, 7.43; 95 percent CI, 1.37 to 40.41). CONCLUSIONS: Findings suggest that reduction mammaplasty age restrictions imposed by care providers and third-party payors may be arbitrary. Surgical readiness should be determined on an individual basis incorporating the patient's biological and psychological maturity, obesity status, potential for postoperative benefit, and risk tolerance for postoperative breast growth. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.


Assuntos
Mama/anormalidades , Mama/crescimento & desenvolvimento , Hipertrofia/cirurgia , Mamoplastia/métodos , Obesidade/cirurgia , Tempo para o Tratamento , Adolescente , Mama/cirurgia , Criança , Estudos Transversais , Feminino , Humanos , Hipertrofia/etiologia , Hipertrofia/psicologia , Obesidade/complicações , Obesidade/psicologia , Seleção de Pacientes , Período Pós-Operatório , Qualidade de Vida , Recidiva , Resultado do Tratamento , Adulto Jovem
9.
Plast Reconstr Surg ; 146(5): 539e-547e, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33141528

RESUMO

BACKGROUND: Reduction mammaplasty provides symptomatic relief to patients with macromastia. Insurance companies act as gatekeepers of health care by determining the medical necessity of surgical procedures, including reduction mammaplasty. The authors sought to evaluate insurance coverage and policy criteria for reduction mammaplasty. METHODS: The authors conducted a cross-sectional analysis of U.S. insurance policies on reduction mammaplasty. Insurance providers were selected based on their enrolment data and market share. The authors conducted telephone interviews and Web-based searches to identify the policies. Medical necessity criteria were abstracted from the publicly available policies that offered coverage. RESULTS: The authors reviewed 63 insurers. One in 10 insurers had no established policy for reduction mammaplasty. Of the 48 publicly available policies, shoulder pain and backache were the most common symptoms required for preapproval (98 percent and 98 percent). A minimum resection volume was requested by 88 percent of policies. One-third of policies (31 percent) offered a choice between removal of a minimum weight per breast or a volume based on body surface area. Over half of companies (54 percent) used body surface area calculations to predict minimum resection volume. Medical necessity that extended beyond national recommendations included trial of weight loss (23 percent) and nipple position (10 percent). CONCLUSIONS: Insurance policy criteria for reduction mammaplasty are discordant with current national recommendations and current clinical evidence. Many policies use outdated criteria that do not correlate with symptom relief and consequently limit access to reduction mammaplasty. Here, the authors propose a comprehensive guideline to maximize coverage of reduction mammaplasty.


Assuntos
Mama/anormalidades , Hipertrofia/cirurgia , Cobertura do Seguro/normas , Seguro Saúde/normas , Mamoplastia/economia , Políticas , Mama/cirurgia , Estudos Transversais , Feminino , Guias como Assunto , Humanos , Hipertrofia/economia , Cobertura do Seguro/economia , Seguro Saúde/economia , Mamoplastia/métodos , Mamoplastia/normas , Estados Unidos
10.
Sultan Qaboos Univ Med J ; 20(3): e357-e361, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33110653

RESUMO

Clear cell hidradenoma (CCH) is a tumour originating from the eccrine sweat glands. It usually presents in the limbs, axilla or trunk. CCH of the breast is rare and can present as a cystic lesion in the breast that can be easily misdiagnosed as malignancy. We report a 36-year-old female patient who presented at the Sultan Qaboos University Hospital Breast Clinic, Muscat, Oman, in 2018 with a lump in her left breast. Ultrasound examination reported a complex cystic lesion with a solid, vascular component. An ultrasound-guided core needle biopsy was suggestive of clear cell hidradenoma. Surgical excision was performed and histopathology confirmed the diagnosis of CCH of the breast. This is the first ever case of a diagnosis of CCH made using core needle biopsy. CCH can be challenging to diagnose; therefore, awareness of its histopathological and ultrasonographic features are essential to avoid misdiagnosis and over treatment.


Assuntos
Acrospiroma/diagnóstico , Biópsia com Agulha de Grande Calibre/normas , Mama/patologia , Acrospiroma/patologia , Adulto , Biópsia com Agulha de Grande Calibre/métodos , Biópsia com Agulha de Grande Calibre/estatística & dados numéricos , Mama/anormalidades , Mama/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Humanos , Omã , Ultrassonografia/métodos
11.
Pan Afr Med J ; 36: 282, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33117476

RESUMO

Accessory breast tissue is an uncommon condition which occurs in 0.4-6% of women. It is mostly located in the axilla and has a high incidence of being misdiagnosed. Usually it is bilateral and presents as an asymptomatic mass during pregnancy or lactation. The diagnosis of ectopic breast tissue is important as it can undergo the same pathological changes that occur in a normal breast, such as mastitis, fibrocystic disease and carcinoma. We present a case of a bilateral axillary localization of accessory breast in a 45-year-old woman. The principal symptom was pain and the clinical diagnosis was bilateral lipoma. However, subsequent imaging and histopathological examination proved it to be an accessory breast tissue.


Assuntos
Axila/patologia , Doenças Mamárias/diagnóstico , Mama/anormalidades , Mama/patologia , Doenças Mamárias/patologia , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade
12.
Medicine (Baltimore) ; 99(44): e22816, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126320

RESUMO

RATIONALE: Ectrodactyly ectodermal dysplasia-cleft lip/palate (EEC) syndrome, limb-mammary syndrome (LMS), and acro-dermato-ungual-lacrimal-tooth (ADULT) syndrome are caused by a TP63 gene disorder and have similar features. In the present article, a R319H mutation in TP63 is reported, and the correlation between genotype and phenotype is discussed based on the current case and previous literature. PATIENT CONCERNS: A 13-year-old Japanese boy had ectrodactyly in the right hand and left foot and syndactyly in the left and right foot, and tooth shape abnormalities. DIAGNOSES: Peripheral blood samples were obtained, and mutation analysis was performed. A heterozygous G>A transition at cDNA position 956 of the TP63 gene was found. The patient was diagnosed with ELA (EEC/LM/ADULT) syndrome based on his clinical features and mutation analysis results. INTERVENTIONS: The patient underwent surgery to correct the left foot malformation at 1 year of age and the right foot syndactyly at 11 years of age. OUTCOMES: No complications were observed after the first and second operations. He can walk comfortably after them, and no additional interventions will be planned in him. We continued to follow up with him up to the present. LESSONS: The concept of ELA syndrome, which is the original concept of combining 3 syndromes (EEC syndrome/LMS/ADULT syndrome) into a unique clinical entity, can help clinicians to better understand TP63-related syndromes and improve the differential diagnosis of these syndromes.


Assuntos
Anodontia/sangue , Mama/anormalidades , Fissura Palatina/sangue , Displasia Ectodérmica/sangue , Dedos/anormalidades , Deformidades Congênitas da Mão/sangue , Obstrução dos Ductos Lacrimais/sangue , Deformidades Congênitas dos Membros/sangue , Unhas Malformadas/sangue , Transtornos da Pigmentação/sangue , Fatores de Transcrição/análise , Proteínas Supressoras de Tumor/análise , Adolescente , Anodontia/genética , Fissura Palatina/genética , Displasia Ectodérmica/genética , Deformidades Congênitas da Mão/genética , Humanos , Japão , Obstrução dos Ductos Lacrimais/genética , Deformidades Congênitas dos Membros/genética , Masculino , Mutação/genética , Unhas Malformadas/genética , Transtornos da Pigmentação/genética , Fatores de Transcrição/sangue , Proteínas Supressoras de Tumor/sangue
13.
Plast Reconstr Surg ; 146(4): 400e-408e, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32969994

RESUMO

BACKGROUND: Young women with congenital breast asymmetry have impaired psychological well-being and self-esteem. However, little is known regarding the effects of surgical intervention in this population. This cohort study aims to assess postoperative changes in health-related quality of life following surgical treatment of breast asymmetry in young women using a prospective, longitudinal study design. METHODS: From 2008 to 2018, 45 young women undergoing surgical correction of breast asymmetry of benign cause and 101 unaffected, female controls completed the following surveys: Short-Form 36v2, Rosenberg Self-Esteem Scale, and Eating-Attitudes Test-26. Surveys were administered at baseline and at up to 9-year follow-up. RESULTS: Participants with breast asymmetry scored significantly worse than controls at baseline on the Rosenberg Self-Esteem Scale and in two Short-Form 36v2 domains: Social-Functioning and Role-Emotional. Asymmetry participants experienced significant postoperative improvements on the Rosenberg Self-Esteem Scale, and in three Short-Form 36v2 domains: Role-Physical, Social Functioning, and Mental Health. These improvements were sustained for a minimum of 5 years. Postoperatively, asymmetry participants' quality of life was comparable to controls and did not vary by age at the time of surgery, asymmetry severity, or diagnosis. CONCLUSIONS: Surgical treatment of breast asymmetry in young women yields significant and sustained improvements in psychosocial quality of life. Postoperatively, patients returned to a level of functioning commensurate with their peers. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Mama/anormalidades , Mama/cirurgia , Mamoplastia , Qualidade de Vida , Adolescente , Estudos de Coortes , Anormalidades Congênitas/psicologia , Anormalidades Congênitas/cirurgia , Feminino , Humanos , Estudos Longitudinais , Estudos Prospectivos , Autorrelato , Resultado do Tratamento , Adulto Jovem
15.
Cir. plást. ibero-latinoam ; 46(3): 259-269, jul.-sept. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-196912

RESUMO

INTRODUCCIÓN Y OBJETIVO: Después de recorrer las diferentes técnicas para la reparación de la mama tuberosa desde los años 70 hasta ahora, concluimos que no existe un procedimiento fácil y sin complicaciones tanto por la técnica en sí como por el uso de implantes aloplásticos. Comparamos las desventajas y ventajas, indicaciones y complicaciones, del trasplante de grasa frente al implante aloplástico, con el fin de que el cirujano plástico tenga en consideración la técnica de transferencia grasa a la hora de llevar a cabo el procedimiento de reconstrucción de una mama tuberosa, puesto que se trata de una técnica que puede reportar mejores resultados que la mera utilización de implantes. MATERIAL Y MÉTODO: Estudio retrospectivo sobre 40 pacientes con mamas tuberosas corregidas mediante autoinjerto graso y con seguimiento postoperatorio medio de 23.4 meses. RESULTADOS: El total de pacientes operadas fue de 40, cada una en 2 tiempos. La técnica habitual fue la de Coleman para la infiltración del injerto graso. Presentamos 8 casos, 2 por cada grado de tuberosidad según la clasificación de Von-Heigburg, y su resolución. CONCLUSIONES: En nuestra experiencia en el tratamiento de la mama tuberosa con este método, el implante graso es la técnica de elección porque produce cicatrices mínimas, proporciona una forma más natural al seno y excluye las complicaciones del material aloplástico. Es un procedimiento sencillo, con una curva de aprendizaje rápida. Además, la lipoescultura asociada es un valor importante, la atención postoperatoria es simple y las complicaciones son poco frecuentes


BACKGROUND AND OBJECTIVE: After touring the different techniques for the repair of the tuberous breast from the 70`s until now, we conclude that there is no easy procedure and free of complications both by the technique itself and by the use of alloplastic implants. We compare the disadvantages and advantages, indications and complications of fat transplantation versus alloplastic implants in order for the plastic surgeon to take into consideration the fat transfer technique when carrying out the reconstruction procedure of a tuberous breast, since this technique can yield better results than the sole use of implants. METHODS: A retrospective study was carried out on 40 patients with tuberous breasts corrected by using a fat autograft and with a postoperative follow-up of 23.4 months. RESULTS: Total number of operated patients was 40, each one operated on in 2 stages. The usual technique was that of Coleman for infiltration of the fat graft. We present 8 cases, 2 for each degree in relation to the Von-Heigburg classification, and its resolution. CONCLUSIONS: In our experience, fat implant is the technique of choice in this process because the scars are minimal, the breast shape is more natural, excludes complications of alloplastic material and it's a simple procedure with a quick learning curve. Besides, associated liposculpture is an important value, postoperative care is simple, and complications are uncommon


Assuntos
Humanos , Feminino , Adolescente , Adulto Jovem , Adulto , Mama/anormalidades , Mama/cirurgia , Autoenxertos/cirurgia , Mamoplastia/métodos , Doenças Mamárias/diagnóstico , Implantes de Mama , Tecido Adiposo/transplante , Estudos Retrospectivos , Cuidados Pós-Operatórios , Mamoplastia/instrumentação , Doenças Mamárias/cirurgia , Transplante Autólogo/métodos , Mamilos/patologia , Mamilos/cirurgia , Antibacterianos/administração & dosagem
18.
Plast Reconstr Surg ; 146(2): 127e-136e, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740569

RESUMO

BACKGROUND: Reduction mammaplasty is the standard of care for symptomatic macromastia. The process of requesting insurance coverage for reduction mammaplasty is cumbersome and potentially controversial, and insurance policies vary significantly. The goal of our analysis is to identify trends in insurance coverage rates, assess for the presence of disparities, and propose ways to increase chances of successful preauthorization. METHODS: The authors performed a retrospective review of preauthorizations for reduction mammaplasty at a single institution from 2012 to 2017. Insurance company names were deidentified. Preauthorization denial rates were assessed by year, insurance carrier, and reason for denial. Multiple regression analysis was performed to identify predictors for predetermination denial by insurance companies. RESULTS: Among 295 preauthorizations, 212 were approved (72 percent) and 83 were denied (28 percent), among which 18 were appealed, 13 successfully. Rates of insurance denials have been increasing steadily, from 18 percent to 41 percent. Medicaid had the lowest denial rates (9.3 percent), whereas private carriers denials ranged from 21.4 to 62.1 percent. In terms of reason for denial, 30 percent were because of contract exclusion, 39 percent were because of inadequate documentation or not meeting medical criteria, and 12 percent were because of inadequate predicted resection weight. Certain private insurance carriers were the only independent predictors of predetermination denial. CONCLUSIONS: Rate of preauthorization denials is high and has been increasing steadily. Insurance criteria remain arbitrary. A proper documentation and appeal process by the plastic surgeon may improve rates of insurance approval. Although resection weight does not correlate with symptom relief, predicted breast tissue resection weight continues to be critical for insurance approval.


Assuntos
Mama/anormalidades , Hipertrofia/cirurgia , Reembolso de Seguro de Saúde/economia , Mamoplastia/economia , Garantia da Qualidade dos Cuidados de Saúde/normas , Adulto , Mama/cirurgia , Feminino , Seguimentos , Humanos , Cobertura do Seguro/economia , Mamoplastia/métodos , Estudos Retrospectivos , Estados Unidos
19.
J Int Med Res ; 48(6): 300060520920463, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32529879

RESUMO

Gestational gigantomastia (GGM) is a rare complication of pregnancy. The etiology of GGM is yet to be fully established. Treatment methods for GGM include medical therapy and surgery. If medical treatment is unsuccessful, surgery may be required. Currently available surgical interventions are either breast reduction or mastectomy with delayed reconstruction. We report a case of a 25-year-old woman (G1P1) who presented with massive enlargement of both breasts during puerperium. Because of the limited effect of medical therapy, surgical intervention was considered to be the first choice. Bilateral mastectomies with grafting of the nipple-areola complex and immediate bilateral tissue expander implantation were performed. Reconstruction was fully completed 8 months after the initial procedure by replacing tissue expanders with definitive implants. Despite being a benign condition, GGM can turn into a serious problem. GGM can be successfully reconstructed by mastectomy with delayed reconstruction and grafting of the nipple-areola complex.


Assuntos
Mama/anormalidades , Hipertrofia/cirurgia , Mamoplastia/métodos , Mastectomia/métodos , Mamilos/transplante , Complicações na Gravidez/cirurgia , Adulto , Mama/cirurgia , Implantes de Mama , Feminino , Humanos , Mamoplastia/instrumentação , Mastectomia/efeitos adversos , Satisfação do Paciente , Gravidez , Tempo para o Tratamento , Dispositivos para Expansão de Tecidos , Resultado do Tratamento
20.
Clin Imaging ; 68: 57-60, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32570010

RESUMO

Gigantomastia is an abnormal and rare breast condition characterized by excessive breast tissue growth that can result in physical and psychosocial debilitation. While the etiology is not fully understood, it is postulated that abnormal endogenous hormone stimulation plays a contributory role and often requires mastectomy for definitive treatment. Proliferation of all elements is commonly observed, including glands, ducts, stroma, fat, vessels and skin. Pseudoangiomatous stromal hyperplasia (PASH) is an additional benign breast disease defined microscopically by proliferation of mammary stroma. PASH often clinically presents as an incidental finding while evaluating other benign or malignant lesions, or less commonly as a palpable, well-circumscribed breast mass. Uncommon cases have been reported in which PASH presents as a bilateral, diffuse process. In this case presentation, we report a rare case of a 20-year-old woman presenting with acute onset gigantomastia most likely due to diffuse PASH.


Assuntos
Angiomatose , Neoplasias da Mama , Adulto , Angiomatose/patologia , Mama/anormalidades , Mama/diagnóstico por imagem , Mama/patologia , Mama/cirurgia , Neoplasias da Mama/patologia , Feminino , Humanos , Hiperplasia/patologia , Hipertrofia , Mastectomia , Adulto Jovem
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