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1.
Plast Reconstr Surg ; 145(2): 251e-262e, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985611

RESUMO

BACKGROUND: The authors refine their anatomical patient selection criteria with a novel midclavicular-to-inframammary fold measurement for nipple-sparing mastectomy performed through an inframammary approach. METHODS: Retrospective review was performed of all nipple-sparing mastectomies performed through an inframammary approach. Exclusion criteria included other mastectomy incisions, staged mastectomy, previous breast operation, and autologous reconstruction. Preoperative anatomical measurements for each breast, clinical course, and specimen weight were obtained. RESULTS: One hundred forty breasts in 79 patients were analyzed. Mastectomy weight, but not sternal notch-to-nipple distance, was strongly correlated with midclavicular-to-inframammary fold measurement on linear regression (R = 0.651; p < 0.001). Mastectomy weight was not correlated with ptosis. Twenty-five breasts (17.8 percent) had ischemic complications: 16 (11.4 percent) were nonoperative and nine (6.4 percent) were operative. Those with mastectomy weights of 500 g or greater were nine times more likely to have operative ischemic complications than those with mastectomy weights less than 500 g (p = 0.0048). Those with a midclavicular-to-inframammary fold measurement of 30 cm or greater had a 3.8 times increased incidence of any ischemic complication (p = 0.00547) and a 9.2 times increased incidence of operative ischemic complications (p = 0.00376) compared with those whose midclavicular-to-inframammary fold measurement was less than 30 cm. CONCLUSIONS: Breasts undergoing nipple-sparing mastectomy by means of an inframammary approach with midclavicular-to-inframammary fold measurement greater than or equal to 30 cm are at higher risk for having ischemic complications, warranting consideration for a staged approach or other incision. The midclavicular-to-inframammary fold measurement is useful for assessing the entire breast and predicting the likelihood of ischemic complications in inframammary nipple-sparing mastectomies. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.


Assuntos
Neoplasias da Mama/cirurgia , Isquemia/etiologia , Mastectomia/métodos , Mamilos/cirurgia , Tratamentos com Preservação do Órgão/métodos , Adulto , Idoso , Feminino , Humanos , Incidência , Isquemia/epidemiologia , Modelos Logísticos , Mastectomia/efeitos adversos , Pessoa de Meia-Idade , Tratamentos com Preservação do Órgão/efeitos adversos , Complicações Pós-Operatórias/etiologia , Análise de Regressão , Fatores de Risco
2.
Plast Reconstr Surg ; 145(2): 273e-283e, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985614

RESUMO

BACKGROUND: Optimizing outcomes and assessing appropriate candidates for breast reconstruction after nipple-sparing mastectomy is an ongoing goal for plastic surgeons. METHODS: All patients undergoing nipple-sparing mastectomy from 2006 to June of 2018 were reviewed and randomly divided into test and validation groups. A logistic regression model calculating the odds ratio for any complication from 12 risk factors was derived from the test group, whereas the validation group was used to validate this model. RESULTS: The test group was composed of 537 nipple-sparing mastectomies (50.2 percent), with an overall complication rate of 27.2 percent (146 nipple-sparing mastectomies). The validation group was composed of 533 nipple-sparing mastectomies (49.8 percent), with an overall complication rate of 22.9 percent (122 nipple-sparing mastectomies). A logistic regression model predicting overall complications was derived from the test group. Nipple-sparing mastectomies in the test group were divided into deciles based on predicted risk in the model. Risk increased with probability decile; decile 1 was significantly protective, whereas deciles 9 and 10 were significantly predictive for complications (p < 0.0001). The relative risk in decile 1 was significantly decreased (0.39; p = 0.006); the relative risk in deciles 9 and 10 was significantly increased (2.71; p < 0.0001). In the validation group, the relative risk of any complication in decile 1 was decreased at 0.55 (p = 0.057); the relative risk in deciles 9 and 10 was significantly increased (1.89; p < 0.0001). In a receiver operating characteristic curve analysis, the area under the curve was 0.668 (p < 0.0001), demonstrating diagnostic meaningfulness of the model. CONCLUSION: The authors establish and validate a predictive risk model and calculator for nipple-sparing mastectomy with far-reaching impact for surgeons and patients alike.


Assuntos
Neoplasias da Mama/cirurgia , Mastectomia/efeitos adversos , Mamilos/cirurgia , Tratamentos com Preservação do Órgão/efeitos adversos , Complicações Pós-Operatórias/etiologia , Adulto , Idoso , Feminino , Humanos , Modelos Logísticos , Mastectomia/métodos , Pessoa de Meia-Idade , Tratamentos com Preservação do Órgão/métodos , Fatores de Risco
3.
Plast Reconstr Surg ; 145(2): 421e-432e, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985660

RESUMO

LEARNING OBJECTIVES: After reading this article, the participant should be able to: 1. Understand the indications for implant-based breast reconstruction and the indications for nipple preservation compared to skin-sparing or skin-reducing patterns. 2. Understand the indications for direct-to-implant breast reconstruction versus tissue expander/implant breast reconstruction and the advantages and disadvantages of total, partial, or no muscle coverage. 3. Understand the role of acellular dermal matrix or mesh in reconstruction. 4. Learn the advantages and disadvantages of different types and styles of implants and develop a postoperative plan for care and pain management. SUMMARY: Breast reconstruction with implants has seen a decade of advances leading to more natural breast reconstructions and lower rates of complications.


Assuntos
Implante Mamário/métodos , Implantes de Mama , Mamoplastia/métodos , Feminino , Humanos , Mamilos/cirurgia
5.
J Dairy Sci ; 103(2): 1776-1784, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31864745

RESUMO

The aim of this study was to demonstrate the noninferiority of a novel teat disinfectant based on copper and zinc (ZkinCu; Copper Andino, Santiago de Chile, Chile) compared with a previously proven glycolic acid active disinfectant (OceanBlu; DeLaval, Kansas City, MO) as a positive control, with respect to the incidence of new intramammary infections under natural challenge conditions on a commercial robotic dairy farm. This study was conducted in 6 robotic pens of approximately 60 milking cows each. The pens were randomly assigned to 1 of the 2 studied disinfectants. Throughout the 8 wk study, the same pre- and post-milking teat disinfectant was used in each pen. The same milking procedures were used in each robot throughout the study. Pre-milking hygiene consisted of applying the disinfectant (OceanBlu or ZkinCu) with the robotic arm. The same product was applied on the teats after milking. At the beginning of the study, all quarters of all study cows were sampled. In successive samplings (wk 2, 4, 6, and 8), composite milk samples were collected on farm to determine SCC. Once composite SCC results were available (2 d) and based on an SCC of ≥100,000 cells/mL, quarter milk samples underwent bacteriological culture. Clinical mastitis was identified by study personnel. Intramammary infection in biweekly quarter milk samples was determined based on composite SCC levels (≥100,000 cells/mL) and the presence of bacteria. A new IMI was defined as a quarter in which the organism isolated was not present in the previous bacteriological sample, or the previous composite SCC sample was <100,000 cells/mL. Clinical mastitis samples were also considered to be new IMI. The trial was designed as a positive control field trial, in which the objective was to show noninferiority of ZkinCu versus the control (OceanBlu). The overall crude incidences of new IMI for 2 wk at risk were 4.9 and 7.3% for the ZkinCu and OceanBlu groups, respectively. The predominant organisms recovered from quarters with new IMI were Streptococcus uberis, Corynebacterium spp., and coagulase-negative staphylococci in both the ZkinCu and OceanBlu groups. The risk of infection in the OceanBlu group was higher (ß = 0.644; 95% confidence interval = 0.05-1.22). The interaction of treatment by week was not significant. The new IMI rate estimates (95% confidence interval) for ZkinCu and OceanBlu were 1.7% (0.8-2.5) and 3.2% (1.7-4.7), respectively. One novel aspect of this study is that it was one of the first commercial noninferiority trials to evaluate a new pre- and post-milking teat disinfectant in a dairy herd with an automatic milking system. The experimental teat disinfectant ZkinCu, evaluated in this field trial with naturally occurring IMI, showed noninferiority relative to the positive control for the prevention of new IMI. This study was conducted in a herd with an automatic milking system, and the results are applicable to herds with similar characteristics. Additional studies are needed to ensure reproducibility under different management conditions.


Assuntos
Cobre/farmacologia , Desinfetantes/farmacologia , Mastite Bovina/prevenção & controle , Zinco/farmacologia , Animais , Bovinos , Chile , Feminino , Glândulas Mamárias Animais/microbiologia , Mastite Bovina/microbiologia , Leite/microbiologia , Mamilos/microbiologia , Reprodutibilidade dos Testes , Staphylococcus/isolamento & purificação , Streptococcus/isolamento & purificação
6.
Rev. bras. cir. plást ; 34(4): 477-484, oct.-dec. 2019. ilus, tab
Artigo em Inglês, Português | LILACS | ID: biblio-1047906

RESUMO

Introdução: Sabe-se que o câncer de mama é hoje a segunda neoplasia mais frequente entre as mulheres, as quais são submetidas desde a tratamentos clínicos até cirúrgicos mutilantes da mama. Ter mamas bonitas e harmoniosas é um direito legítimo, sendo assim o conceito de reconstrução mamária e do complexo areolo papilar se torna importante na reinserção social feminina. Este estudo visa apresentar uma técnica eficaz de reconstrução areolar, utilizando enxerto cutâneo livre palpebral bilateral, demonstrando sua eficácia através de resultados fotográficos, comparação com outras técnicas já descritas e questionários de satisfação dos pacientes. Resultados: Foram avaliados, retrospectivamente, 50 pacientes operados de reconstrução areolar com enxerto de pele palpebral e outras técnicas já descritas, operados por um único cirurgião sênior. O grupo de pacientes operados com pele palpebral não obtiveram diferenças significativas dentro da análise de resultados, comparados com outras técnicas de reconstrução. Houve boa satisfação por parte dos pacientes, quanto ao resultado das cirurgias das aréolas. Conclusão: O estudo obteve baixos índices de complicações, apresentando-se como boa opção terapêutica, dentro do arsenal cirúrgico de reconstrução areolar.


Introduction: Breast cancer is currently the second most common neoplasm among women who undergo clinical treatments and breast-mutilating surgeries. Having beautiful and harmonious breasts is a legitimate right, so the concept of reconstructing the breast and nipple-areolar complex becomes important in female social reinsertion. This study aimed to present an effective technique of areolar reconstruction using free bilateral eyelid skin grafts and demonstrate its effectiveness through photographic results, comparison with previously described techniques, and patient satisfaction questionnaires. Results: The authors retrospectively evaluated 50 patients who underwent areolar reconstruction with eyelid skin grafts and other techniques performed by a single senior surgeon. Patients who underwent eyelid skin graft surgery did not achieve significantly different results from those who underwent other reconstruction techniques. Patients who underwent areola surgeries reported good satisfaction. Conclusion: The study revealed low complication rates and demonstrated that the use of eyelid skin is a good therapeutic option for areolar reconstruction.


Assuntos
Humanos , Feminino , História do Século XXI , Pacientes , Pele , Transplante , Mama , Satisfação do Paciente , Procedimentos Cirúrgicos Reconstrutivos , Estética , Pálpebras , Mamilos , Transplante/métodos , Transplante/estatística & dados numéricos , Mama/cirurgia , Satisfação do Paciente/estatística & dados numéricos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Pálpebras/cirurgia , Mamilos/cirurgia
8.
An Bras Dermatol ; 94(5): 549-552, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31777355

RESUMO

BACKGROUND: Nipple eczema is a less common presentation of atopic dermatitis. No studies in the literature have correlated nipple eczema in pregnancy as a manifestation of atopic dermatitis. OBJECTIVE: To evaluate whether nipple eczema presenting in pregnancy is a manifestation of atopic dermatitis. METHODS: This was a prospective observational study including 100 women who presented with nipple eczema for the first time during pregnancy. The exclusion criteria were any patient with previous history of nipple eczema, those already on oral or topical treatment for atopic dermatitis or nipple eczema, and other disorders mimicking eczema. Patients were divided into two groups ‒ nipple eczema with atopic dermatitis and without atopic dermatitis. Demographic data, clinical features, total leukocyte count, differential leukocyte count, absolute eosinophil counts, and serum IgE levels were compared between the two groups to detect association between nipple eczema in pregnancy and atopic dermatitis. RESULTS: Out of 100 patients, 39 were diagnosed with atopic dermatitis, whereas 61 were ruled out to have any features suggestive of atopic dermatitis. There were no statistically significant differences in mean age, mean duration of symptoms, and serum IgE levels. In patients with atopic dermatitis, bilateral symptoms were noted more commonly than in patients without the disease, but this was statistically insignificant. STUDY LIMITATIONS: Lack of long term follow-up and no large studies in literature to compare results. CONCLUSION: Nipple eczema in pregnancy follows a similar pattern as in other age groups. The clinical profile of patients is similar in cases with and without atopic dermatitis.


Assuntos
Doenças Mamárias/patologia , Dermatite Atópica/patologia , Eczema/patologia , Mamilos/patologia , Complicações na Gravidez/patologia , Adulto , Doenças Mamárias/sangue , Doenças Mamárias/diagnóstico , Dermatite Atópica/sangue , Dermatite Atópica/diagnóstico , Eczema/sangue , Eczema/diagnóstico , Feminino , Humanos , Imunoglobulina E/sangue , Índia , Contagem de Leucócitos , Neutrófilos , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/diagnóstico , Trimestres da Gravidez , Estudos Prospectivos
9.
Anticancer Res ; 39(10): 5709-5714, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31570471

RESUMO

BACKGROUND/AIM: Recently, "conservative" mastectomy with immediate breast reconstruction (M-R) has become the gold standard when the breast must be removed. We analyzed the evolution in the choice of mastectomy type in our Unit, focusing on factors associated with renounce to reconstruction and risk factors for its failure. PATIENTS AND METHODS: Clinical-pathological and surgical features of 132 patients who underwent mastectomy in our Unit from 2004 to 2016 were analyzed. M-R rate and different mastectomy techniques' rates between 2004-2009 and 2010-2016 were compared. RESULTS: M-R was associated with younger age at diagnosis (p<0.001) and early tumor stage (p=0.03). M-R rate increased from 49.1% to 72.2% (p=0.002) in the last years, with prominent use of nipple-sparing-mastectomy (p<0.001). M-R failure rate was associated with previous or subsequent irradiation/chemotherapy in 92.3% of cases. CONCLUSION: M-R and particularly nipple-sparing-mastectomy represented the standard in more recent years; reconstruction failure was associated with irradiation/chemotherapy, especially in implant-based reconstructions.


Assuntos
Neoplasias da Mama/cirurgia , Mamoplastia/tendências , Mastectomia/tendências , Implantes de Mama/tendências , Feminino , Humanos , Mamilos/cirurgia , Estudos Retrospectivos , Dispositivos para Expansão de Tecidos/tendências
10.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 44(9): 1009-1015, 2019 Sep 28.
Artigo em Chinês | MEDLINE | ID: mdl-31645490

RESUMO

OBJECTIVE: To investigate the experience and efficacy of endoscopic thyroidectomy for papillary thyroid microcarcinoma (PTMC) through total areola approach.
 Methods: A total of 117 PTMC patients, who were diagnosed pathologically in Minimally Invasive Surgical Center, Second Xiangya Hospital, Central South University from June 2016 to December 2017, were divided into a endoscopic surgery group (n=72) and an open surgery group (n=45). The number of dissected central lymph nodes, blood loss, amount of drainage, occurrence of postoperative complication and recurrence were collected and compared.
 Results: Compared with the open surgery group, the blood loss was less and the operative time was longer in the endoscopic surgery group (P<0.05). There were no significant differences between the 2 groups in the number of dissected central lymph nodes, amount of drainage and occurrence of postoperative complication (all P>0.05). The mean follow-up time was more than 20 months, and there was no recurrence in the 2 groups. 
 Conclusion: Endoscopic thyroidectomy with central compartment neck dissection through total areola approach is safe and feasible in patients with PTMC. It has many advantages, such as no scar on neck, less blood loss, shorter hospital stay and more acceptable to young patients.


Assuntos
Carcinoma Papilar/cirurgia , Endoscopia , Neoplasias da Glândula Tireoide/cirurgia , Humanos , Mamilos , Tireoidectomia
11.
BMJ Case Rep ; 12(9)2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31537599

RESUMO

Florid papillomatosis (FP) of the nipple, or nipple adenoma, is a rare breast tumour, affecting middle-aged group population. A 46-year-old woman presented to us with a cauliflower-like FP of the right nipple with no blood stained discharge or breast lump. FP can be mistaken clinically for Paget's disease and occasionally misinterpreted as invasive ductal or intraductal carcinoma. Extensive intervention, correct diagnosis and prompt treatment are essential. Any breast pathology requires triple assessment including FP of the nipple. Once the diagnosis of ductal carcinoma is excluded, simple complete excision can be undertaken. This is to ensure complete obliteration of disease recurrence and preservation of cosmetic result. We discuss the pathology and psychosocial aspects of FP.


Assuntos
Adenoma/patologia , Adenoma/cirurgia , Doenças Mamárias/patologia , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Mamilos/patologia , Papiloma/patologia , Papiloma/cirurgia , Adenoma/diagnóstico por imagem , Doenças Mamárias/diagnóstico por imagem , Neoplasias da Mama/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Mamografia/métodos , Pessoa de Meia-Idade , Doença de Paget Mamária/diagnóstico , Papiloma/diagnóstico por imagem , Resultado do Tratamento , Ultrassonografia Mamária/métodos
12.
Klin Lab Diagn ; 64(8): 481-483, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31479603

RESUMO

A case of benign proliferative formation of the mammary gland of a rare histological form - subareolar sclerosing ductal hyperplasia in combination with papillomatosis of the nipple is presented. Pathology belongs to the group of complex sclerosing lesions. When setting the morphological (cytological, histological) diagnosis, it is necessary to take into account the clinical picture - the state of the nipple-areola complex, in particular, the presence / absence of nipple discharge and its involvement in the pathological process.


Assuntos
Glândulas Mamárias Humanas/patologia , Mamilos/patologia , Papiloma/patologia , Humanos , Hiperplasia
13.
Zhonghua Wai Ke Za Zhi ; 57(10): 51-56, 2019 Oct 01.
Artigo em Chinês | MEDLINE | ID: mdl-31510733

RESUMO

Objective: To compare the clinical efficacy between endoscopic nipple-sparing mastectomy with immediat reconstruction using prosthesis implantation and open surgery. Methods: Totally 189 early-stage breast cancer patients admitted at Department of Breast and Thyroid Surgery, Southwest Hospital, Third Military Medical University from January 2013 to December 2017 were enrolled. Among them, 104 patients underwent endoscopic nipple sparing mastectomy with immediat reconstruction using prosthesis implantation (endoscopic group), with an age of (41.7±6.1) years (range: 25 to 51 years), and 85 patients underwent traditional open surgery (open group), with an age of (41.6±7.7) years (range: 27 to 67 years). The operative duration, the volume of intraoperative blood loss, the volume of drainage in 3 days after surgery, postoperative complications and patients' satisfaction of breast reconstruction were compared between the two groups using t test, Mann-Whitney U test, χ(2) test or non-parametric test. Results: There were no statistically significant differences in postoperative complications, the rates of recurrence and overall survival between the two groups (P>0.05). The operative duration (sentinel lymph node biopsy: (178± 80) minutes vs. (198±42) minutes, t=-2.082, P=0.039; axillary lymph node dissection: (204±79) minutes vs. (233±49) minutes, t=-2.952, P=0.004), the volume of drainage in three days postoperative ((183±141)ml vs. (237±104) ml, t=- 2.938, P=0.004) in the open group were lower than endoscopic group. The volume of intraoperative blood loss in the endoscopic group was lower than that in the open group ((87±64) ml vs. (62± 36) ml, t=3.210, P=0.002). Patients' satisfaction of breast reconstruction in the endoscopic group was higher than that in the open group. Conclusions: Both endoscopic nipple sparing mastectomy with immediat reconstruction using prosthesis implantation and open surgery are safe in oncology. Endoscopic surgery maybe more suitable alternative in breast reconstruction for early-stage breast cancer patients.


Assuntos
Implante Mamário , Neoplasias da Mama/cirurgia , Mastectomia/métodos , Mamilos/cirurgia , Adulto , Idoso , Implantes de Mama , Endoscopia , Feminino , Humanos , Mastectomia/instrumentação , Pessoa de Meia-Idade , Estudos Retrospectivos
14.
Cir. plást. ibero-latinoam ; 45(3): 253-260, jul.-sept. 2019. ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-184398

RESUMO

Antecedentes y Objetivo. El éxito de una intervención de Cirugía Plástica está en su planificación. Las medidas antropométricas son importantes en la evaluación preoperatoria para mejorar los resultados quirúrgicos; sin embargo, las variantes anatómicas en cada paciente pueden alterar esta planificación. Nuestro objetivo es ubicar, mediante comprobación radiológica, las referencias anatómicas antropométricas del esqueleto torácico que permiten proyectar de manera más precisa en el tórax los puntos y líneas antropomórficos necesarios para planificar la cirugía mamaria, a saber: posición del complejo areola-pezón, surco submamario y meridiano de la mama. Material y método. Realizamos un estudio retrospectivo, descriptivo y transversal evaluando radiografías de tórax póstero-anteriores y laterales en una población general de mujeres para determinar los puntos precisos de referencia anatómica en el tórax de la ubicación del surco submamario (SS), del punto P (punto más alto de proyección mamaria, pezón) y del meridiano mamario (punto M). Resultados. Sobre un total de 61 radiografías en mujeres de entre 11 y 40 años de edad, el punto de máxima proyección del pezón estuvo ubicado en la cuarta costilla y el cuarto espacio intercostal en el 87% de los casos. En el 98% el surco submamario coincidió con la sexta costilla. Determinamos una diferencia de 1 a 2 cm entre el meridiano mamario escogido por la media entre la línea axilar anterior y la medioesternal y el que se ubica en la línea medioclavicular en el 88% de los casos. Conclusiones. Determinar estructuras fijas del esqueleto torácico que se relacionan de manera constante con estructuras y referencias de la mama (pezón, surco submamario y meridiano mamario), da al cirujano plástico criterios objetivos para la selección y proyección de puntos clave en la planificación de la cirugía mamaria, con proporción y armonía individualizadas en cada paciente, de cara a obtener resultados más estéticos y simétricos


Background and Objective. The success of a Plastic Surgery intervention is in its planning. Anthropometric measures are important in preoperative evaluation to improve surgical outcomes; however, anatomical variants in each patient can alter this planning. Our objective is to locate, through radiological verification, the anthropometric anatomical references of the thoracic skeleton that allow the anthropomorphic points and lines necessary to plan breast surgery to be projected more precisely in the chest, namely: position of the areola-nipple complex, submammary groove and meridian of the breast. Methods. We conduct a retrospective, descriptive and cross-sectional study evaluating postero-anterior and lateral chest radiographs in a general population of women, to determine the precise anatomical reference points in the thorax of the location of the submammary groove (SS), of point P (highest breast projection, nipple) and breast meridian (point M). Results. On a total of 61 radiographs in women between 11 and 40 years of age, the point of maximum projection of the nipple was located in the fourth rib and the fourth intercostal space in 87% of cases. In 98% the submammary groove coincided with the sixth rib. We determined a difference of 1 to 2 cm between the mammary meridian chosen by the mean between anterior and mid-sternal axillary line and that located in the midclavicular line in 88% of cases. Conclusions. Determining fixed structures of the thoracic skeleton that are constantly related to structures and references of the breast (nipple, submammary groove and breast meridian), gives the plastic surgeon objective criteria for the selection and projection of key points in the planning of breast surgery, with proportion and harmony individualized in each patient, in order to obtain more aesthetic and symmetrical results


Assuntos
Humanos , Feminino , Criança , Adolescente , Adulto Jovem , Adulto , Mama/anatomia & histologia , Antropometria/métodos , Tórax/anatomia & histologia , Radiografia Torácica , Mama/cirurgia , Estudos Retrospectivos , Estudos Transversais , Mamilos/anatomia & histologia , Mamilos/diagnóstico por imagem , Mamilos/cirurgia
15.
Nursing (Säo Paulo) ; 22(256): 3160-3164, set.2019.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1026022

RESUMO

O objetivo desse artigo foi identificar os tratamentos sugeridos na literatura para tratamento de lesão e dor mamilar durante o aleitamento materno. Trata-se de uma Revisão Integrativa de Literatura, realizada na base de dados Pubmed e LILACS, onde foi encontrado oito artigos. A maioria dos estudos adotou a correção da pega associados ao uso de pomadas a base de lanolina para o tratamento da dor e trauma mamilar. Outros tratamentos indicados incluíram o uso leite materno além de medicamentos tópicos e orais, porém observou-se que somente houve evidência estatisticamente significante o uso de lanolina. Conclusão: A correção da pega e o uso da lanolina mostraram serem eficazes para o tratamento da dor e fissura mamária.(AU)


The objective of this article was to identify the treatments suggested in the literature for the treatment of nipple injury and pain during breastfeeding. It is an Integrative Review of Literature, carried out in the Pubmed database and LILACS, where eight articles were found. Most studies have adopted the correction of the handle associated with the use of lanolin-based ointments for the treatment of pain and nipple trauma. Other indicated treatments included the use of breast milk in addition to topical and oral medications, but it was observed that there was only statistically significant use of lanolin. Conclusion: Handle correction and lanolin use have been shown to be effective for the treatment of breast pain and fissure.(AU)


El objetivo de este artículo fue identificar los tratamientos sugeridos en la literatura para el tratamiento de la lesión del pezón y el dolor durante la lactancia. Es una Revisión Integrativa de Literatura, realizada en la base de datos Pubmed y LILACS, donde se encontraron ocho artículos. La mayoría de los estudios han adoptado la corrección del mango asociada con el uso de ungüentos a base de lanolina para el tratamiento del dolor y el traumatismo del pezón. Otros tratamientos indicados incluyeron el uso de leche materna además de medicamentos tópicos y orales, pero se observó que solo había un uso estadísticamente significativo de lanolina. Conclusión: la corrección del mango y el uso de lanolina han demostrado ser efectivos para el tratamiento del dolor y la fisura en los senos.(AU)


Assuntos
Humanos , Feminino , Dor , Ferimentos e Lesões , Aleitamento Materno , Mamilos , Serviços de Saúde Materno-Infantil , Saúde Materna
16.
Plast Reconstr Surg ; 144(5): 1023-1032, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31373992

RESUMO

BACKGROUND: Nipple-sparing mastectomy in patients with large, ptotic breasts is a reconstructive challenge. Staged breast reduction before prophylactic nipple-sparing mastectomy has been shown to decrease complications; however, a direct comparison of outcomes between staged and nonstaged techniques is lacking. METHODS: A retrospective review of all patients that underwent staged breast reduction before nipple-sparing mastectomy was conducted. Staged cases were matched to nonstaged nipple-sparing mastectomy cases according to known risk factors for complications. Individual staged cases with appropriate matches in all these categories were then each paired to two nonstaged cases according to the nearest higher and lower mastectomy weight. Staged and nonstaged cohorts were compared with regard to demographics, operative characteristics, and reconstructive outcomes. RESULTS: Eighteen staged breast reductions were identified, performed at an average of 5.0 months before nipple-sparing mastectomy. Staged reductions were matched to 36 prophylactic nonstaged reductions. Average combined mastectomy weight (breast reduction and mastectomy weight) in the staged group was significantly higher than in the nonstaged group (992.6 g versus 640 g; p = 0.0004), although isolated mastectomy weights were comparable (607.1 g versus 640.0 g, respectively; p = 0.6311). Major mastectomy flap necrosis rates were significantly lower in the staged cohort than in the nonstaged cohort (0 percent versus 22.2 percent, respectively; p = 0.0415). Rates of minor mastectomy flap necrosis, partial nipple necrosis, and explantation trended lower in the staged cohort. CONCLUSION: In patients with large breast size, staged breast reduction before nipple-sparing mastectomy had significantly lower rates of major flap necrosis compared with nonstaged cases after controlling for other known risk factors for complications. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Índice de Massa Corporal , Mama/anormalidades , Hipertrofia/cirurgia , Mamoplastia/métodos , Mastectomia Subcutânea/métodos , Satisfação do Paciente/estatística & dados numéricos , Adulto , Mama/cirurgia , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Mamoplastia/efeitos adversos , Mastectomia Subcutânea/efeitos adversos , Pessoa de Meia-Idade , Mamilos , Seleção de Pacientes , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia , Reoperação/métodos , Estudos Retrospectivos , Medição de Risco , Resultado do Tratamento
17.
Am Surg ; 85(7): 768-771, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31405426

RESUMO

Both skin-sparing mastectomy (SSM) and nipple-sparing mastectomy (NSM) are well accepted in the management of breast cancer. Factors that influence the decision of choosing one of these techniques over the other, however, remain to be well elucidated. From January 2010 to December 2017, 734 patients at our institution underwent one of these two procedures. Factors differentiating these patient cohorts were compared. In this study, 196 (26.7%) underwent NSM and 538 (73.3%) underwent SSM. The median age of patients at the time of surgery was 50 years (range, 22-78 years). On multivariate analysis, younger patient age, insurance type, BRCA+ mutation status, smaller breast size (by weight), and those who did not undergo neoadjuvant chemotherapy were more likely to undergo NSM. Surgeon also was an independent predictor of whether patients had NSM or SSM. There may be many factors that play into the decision to pursue NSM versus SSM, but younger patient age, BRCA mutation status, breast size, and whether the patient had neoadjuvant chemotherapy may be key among them. Insurance status may also be a factor for some patients. Aside from these factors, some surgeons may be more or less inclined to perform NSM.


Assuntos
Neoplasias da Mama/cirurgia , Mastectomia/métodos , Mamilos , Tratamentos com Preservação do Órgão/métodos , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Análise Multivariada , Satisfação do Paciente , Adulto Jovem
18.
J Dairy Sci ; 102(10): 9488-9494, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31421876

RESUMO

Ample research has described the assessment of dimensional changes for different teat traits, whereas diagnostic techniques to reliably assess blood circulation in teats of dairy cows are limited. Here, we describe the development and evaluation of a scanning technique to quantify blood flow in teats of dairy cows using power Doppler ultrasonography. In 2 consecutive trials, 384 teat scans [trial 1, n = 256 (sagittal plane, n = 128; transverse plane, n = 128); trial 2, n = 128 (transverse plane)] from 16 cows were obtained by the same 2 operators. Perfusion intensity from single images (trial 1) and video images (trial 2) were assessed using a commercially available software program. Intraclass correlation coefficients (ICC) and concordance correlation coefficients (CCC) were used to assess interoperator reproducibility (agreement between measurements performed by different operators) and intraoperator repeatability (agreement between measurements performed by the same operator). In trial 1, interoperator ICC and CCC indicated poor agreement (ICC ≤0.26, CCC ≤0.26). Intraoperator ICC and CCC demonstrated poor agreement between duplicate measurements within operators (ICC ≤0.19, CCC ≤0.19). Modifications after trial 1 included (1) a different ultrasound device, (2) analysis of video clips rather than single images, (3) restriction to 1 sectional plane (i.e., transverse), and (4) a scanning sequence such that repeated scans within operators were measured one after another. Through these modifications, intraoperator repeatability in trial 2 yielded fair to good agreement, with intraoperator ICC and CCC over both operators ranging from 0.44 to 0.70 and from 0.57 to 0.69, respectively, whereas interoperator ICC and CCC showed poor agreement (ICC = 0.35, CCC = 0.34). We conclude that repeatable measurements of blood perfusion intensity of teats in dairy cows can be attained with power Doppler ultrasonography. Power Doppler ultrasonography is a suitable tool to quantify slow flow in small vessels and may be an acceptable diagnostic technique to assess changes in blood circulation that result from machine milking in teats of dairy cows, although further research is necessary to validate this hypothesis.


Assuntos
Bovinos/sangue , Leite/metabolismo , Software , Ultrassonografia Doppler/veterinária , Animais , Feminino , Glândulas Mamárias Animais/irrigação sanguínea , Glândulas Mamárias Animais/diagnóstico por imagem , Mamilos/irrigação sanguínea , Mamilos/diagnóstico por imagem , Fenótipo , Reprodutibilidade dos Testes
20.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(7): 907-911, 2019 Jul 15.
Artigo em Chinês | MEDLINE | ID: mdl-31298012

RESUMO

Objective: To review the research on distribution of the nerve and blood supply of breast, and the development of breast reduction in recent years. Methods: The related literatures about the distribution of the nerve and blood supply of breast, the development of breast reduction, and postoperative lactation function in recent years were reviewed extensively. The above aspects were analyzed and summarized in combination with the author's experiences. Results: With the anatomical study of mammary gland, nipple areola complex nerve distribution and blood supply, breast reduction has been developed rapidly, and a variety of surgical methods have been formed. But each has its own advantages and disadvantages, and its indications are different. Through the application and improvement of the auxiliary examination technique, severe complications such as nipple areola complex necrosis reduce obviously after operation. Through the selection of position of the incision and pedicle, the degree of retaining the pedicle glands, the application of auxiliary liposuction technique, and the improvement of suture technique, the scar of incision reduces, the sensation of nipple areola is preserved more, and a more satisfactory breast shape is obtained. Some of the patients who gave birth after breast reduction have lactation function. Conclusion: There are some shortcomings in various surgical methods at present, individualized surgical methods should be adopted according to the characteristics of the patients. Further research is needed on how to preserve more sensation of nipple areola, obtain a good and lasting breast shape, and preserve lactation function of women after operation.


Assuntos
Mama , Mamoplastia , Sensação , Técnicas de Sutura , Mama/irrigação sanguínea , Feminino , Humanos , Mamilos/irrigação sanguínea , Período Pós-Operatório
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