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3.
Rev. cir. (Impr.) ; 72(5): 418-426, oct. 2020. tab, graf, ilus
Artigo em Espanhol | LILACS | ID: biblio-1138733

RESUMO

Resumen Objetivo: Se presenta experiencia realizada en Servicio de Salud Talcahuano, de masculinización mamaria en el proceso de reasignación sexual, de transexuales masculinos. En Chile se estima que habrían 754 mujeres transexuales. Materiales y Método: Estudio de 47 individuos, intervenidos en Hospital Las Higueras de Talcahuano, entre 2006 y 2019, sometidos a masculinización mamaria mediante mastectomía subcutánea y reconstrucción del complejo areolomamilar. Resultados: Se intervinieron pacientes de todo el país; 59% corresponde a octava región; 42,5% operados entre los años 2017 y 2018. Un 36% rango de edad de 18 a 22 años. Un 68% IMC entre 24 y 30. Según el tamaño de las mamas, 57% copa B, 31% C, 12% D y 12% de gigantomastía. Un 29%, peso promedio de la mastectomía fue de 600 g; un 29% de 300 gramos y en 9% más de 800 g por lado. En 68% se utilizó abordaje submamario e injerto de piel total del complejo aréola pezón (CAP); otras tecnicas fueron periareolar, incisión en T y liposucción. La complicación más frecuente fue la colección. Biopsia normal en un 100%. Discusión: Experiencia pionera en Chile, realizada en un Hospital Público, en el difícil proceso de reasignación de género, en la población transexual de Chile. Individuos muy estigmatizados de parte de la comunidad, que encontraron en el Servicio de Salud de Talcahuano, una mano amiga, que les extendió su apoyo desinteresado y calificado, logrando excelentes resultados finales.


Aim: Describe the experience in Talcahuano Helath Service, of mammary masculinization in the sexual reassignment process, of male transsexuals. In Chile it is estimated that there will be 754 transsexual women. Materials and Method: Study of 47 individuals, operated at Las Higueras Hospital in Talcahuano, between 2006 and 2019, subjected to breast masculinization by subcutaneous mastectomy and reconstruction of the areolomamilar complex. Results: Patients from all over the country were operated; 59% corresponds to the Bio-Bio province; 42.5% operated between 2017 and 2018. A 36% range of ages from 18 to 22 years. 68% BMI between 24 and 30. According to the size of the breasts, 57% B cup, 31% C, 12% D and 12% gigantomasty. At 29%, the average weight of the mastectomy was 600 grams; 29% of 300 grams and 9% more than 800 grams per side. In 68%, the submammary approach and total skin graft of the CAP were used; Other techniques were periareolar, incision in T and liposuction. The most frequent complication was the collection. 100% normal biopsy. Discussion: Pioneering experience in Chile, carried out in a public hospital, in the difficult process of gender reassignment, in the transsexual population of Chile. Individuals very stigmatized by the community, who found in the Health Service of Talcahuano, a helping hand, which extended their selfless and qualified support, achieving excellent final results.


Assuntos
Humanos , Masculino , Feminino , Mastectomia Subcutânea/métodos , Pessoas Transgênero , Mamilos/cirurgia , Distribuição por Idade , Procedimentos Cirúrgicos Reconstrutivos
4.
Niger J Clin Pract ; 23(9): 1324-1327, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32913175

RESUMO

Infiltrating syringomatous adenoma of the nipple (SAN) is a rare benign neoplasm of the breast that is often misdiagnosed. SAN may present with a subareolar lesion and clinical, mammographic, and ultrasonographic findings associated with malignancy. We present the case of a 60-year-old woman with a painful, firm, solid tumor in her left breast and deformation of the left nipple-areolar complex (NAC). Histopathological test results were conflicting. The tumor, including the NAC were locally excised. Postsurgical immuno-histochemical tests revealed squamous histology, whereas myoepithelial cells were present in the resected specimen, a feature consistent with SAN. The pathologist noted microscopically positive surgical margins. Three months after surgery, tumor recurrence occurred. The patient underwent revision surgery with wide excision of the skin and gland around the lesion, followed by immediate breast reconstruction, using a pedicled myocutaneous latissimus dorsi (pLD) flap. Extreme care should be taken when diagnosing SAN to ensure proper treatment and prevent recurrence.


Assuntos
Adenoma/cirurgia , Erros de Diagnóstico/efeitos adversos , Recidiva Local de Neoplasia/cirurgia , Mamilos/cirurgia , Siringoma/cirurgia , Adenoma/patologia , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Feminino , Humanos , Mamoplastia , Mamografia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Mamilos/patologia , Papiloma/patologia , Papiloma/cirurgia , Siringoma/diagnóstico , Siringoma/patologia , Resultado do Tratamento
5.
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
6.
Plast Reconstr Surg ; 146(2): 250-254, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740571

RESUMO

The concept of sensate autologous breast reconstruction is not novel, and prior literature has focused mainly on sensate abdominally based breast reconstruction. The goal of this article is to present the authors' results with a novel technique performing sensate implant-based reconstruction. A database was prospectively maintained for patients who underwent implant-based sensate breast reconstruction. The anterior branch of the lateral fourth intercostal is identified and preserved during the mastectomy by the breast surgeon. A processed nerve allograft is used as an interpositional graft connecting the donor nerve to the targeted nipple-areola complex. The sensory recovery process was objectively monitored using a pressure-specified sensory device. Thirteen patients underwent the proposed technique. Eight patients with 15 breasts were monitored for sensory recovery. For sensory measurement, the nipple had a mean threshold of 67.33 ± 34.48 g/nm. The upper inner (29 ± 26.75 g/nm) and upper outer (46.82 ± 32.72 g/nm) nipple-areola complex quadrants demonstrated better scores during the moving test compared with the static test. Mean time between the test and surgery was 4.18 ± 2.3 months, and mean time between the second test and surgery was 10.59 ± 3.57 months. Threshold improvements were documented after the second test for all nipple-areola complex areas evaluated. This is the first study to report on early results obtained after performing sensate implant-based breast reconstruction. More studies are required to determine the long-term outcomes and impact on quality of life and to assess whether patient or breast characteristics impact the success of this procedure.


Assuntos
Implantes de Mama , Mamoplastia/métodos , Regeneração Nervosa/fisiologia , Transferência de Nervo/métodos , Mamilos/cirurgia , Recuperação de Função Fisiológica , Sensação/fisiologia , Adulto , Neoplasias da Mama/cirurgia , Feminino , Seguimentos , Humanos , Mastectomia Subcutânea/métodos , Mamilos/inervação , Estudos Prospectivos , Qualidade de Vida , Fatores de Tempo
12.
Anticancer Res ; 40(6): 3543-3550, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32487656

RESUMO

BACKGROUND/AIM: A retrospective study was performed in 246 breast cancer patients to define whether tumor-to-nipple distance (TND) assessment by breast MRI may select patients eligible to nipple-sparing mastectomy (NSM) as compared to permanent section assessment of retroareolar margin. PATIENTS AND METHODS: Pre- and post-operative parameters including imaging data, histology of the primary tumor, biologic prognostic factors, and adjuvant regimens were retrieved; patients with close/positive retroareolar margins underwent nipple or NAC excision. The primary endpoint was loco-regional recurrence (LRR). RESULTS: Patients with TND ≤2 cm had a significantly higher rate of invasive ductal carcinoma (p<0.003) and excision margins less than 2 mm (p<0.000). Eleven retroareolar specimens were positive at definitive pathology; final re-excision specimen examination showed residual disease in seven patients (63.6%). At a median follow-up of 31 to 33 months, no NAC recurrence did occur; disease-free survival was more than 96%, and LRR was homogeneously distributed among TND subgroups. CONCLUSION: Therapeutic NSM is a safe procedure independently of TND assessed at preoperative breast MRI. Permanent section assessment of retroareolar tissue is more accurate and cost-effective than frozen section. Furthermore, delayed nipple and/or NAC excision did not impair local disease control.


Assuntos
Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Margens de Excisão , Adulto , Idoso , Neoplasias da Mama/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Mamoplastia/métodos , Mastectomia/métodos , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Mamilos/cirurgia , Recidiva , Carga Tumoral
13.
Plast Reconstr Surg ; 146(1): 38-40, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32590639

RESUMO

Chest masculinization is the most common gender-affirming operation performed. With increased access to care and improved insurance coverage, there has been a marked increase in the number of procedures performed. A video is presented with narration focused on the surgical technique of a "double-incision" mastectomy for gender-affirming chest masculinization. The Fisher grading scale used in technique selection of double-incision versus periareolar mastectomy, based on patient-specific anatomical parameters, is reviewed. Technical pearls for refinement of the double-incision top surgery technique for gender affirmation are then demonstrated.


Assuntos
Mastectomia/métodos , Cirurgia de Readequação Sexual/métodos , Transexualidade/cirurgia , Feminino , Humanos , Mamilos/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Pessoas Transgênero
15.
Oncol Res Treat ; 43(7-8): 354-361, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32570247

RESUMO

BACKGROUND: We aimed to assess patient satisfaction and aesthetic outcome in breast cancer patients undergoing nipple-sparing mastectomy (NSM) and immediate breast reconstruction. MATERIALS AND METHODS: The study population comprised 215 patients with histopathologically diagnosed breast cancer. The inclusion criteria were as follows: a diagnosis of breast cancer, a tumor of any size, any stage of nodal metastasis, and a tumor margin >2.0 cm from the margin of the nipple-areola complex. To measure the aesthetic outcome, the Lowery scale was used. After mastectomy, immediate breast reconstruction was performed using the transverse rectus abdominis myocutaneous (TRAM) flap, and by pacing the silicone implant. RESULTS: Most of the patients were aged between 40 and 51 years. Lymphadenopathy was positive in 87 out of 215 subjects; among these 87 subjects, 61 showed macrometastasis and 26 micrometastasis. A lateral incision was performed for mastectomy in all cases, and immediate breast reconstruction was performed using autologous grafts: the latissimus dorsi myocutaneous (TRAM) flap in 83% of cases, and silicone implants in 17% of cases were used for reconstruction. An excellent aesthetic outcome was seen in 70% of the cases, and 22% showed a good outcome. CONCLUSIONS: NSM is a very safe and technically feasible procedure that provides a high level of patient satisfaction and an excellent aesthetic outcome.


Assuntos
Neoplasias da Mama/cirurgia , Mamoplastia/métodos , Mastectomia/métodos , Retalho Miocutâneo/transplante , Mamilos/cirurgia , Tratamentos com Preservação do Órgão/métodos , Reto do Abdome/transplante , Pele/patologia , Adulto , Implantes de Mama/estatística & dados numéricos , Neoplasias da Mama/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Satisfação do Paciente , Silicones/química
17.
Rev. senol. patol. mamar. (Ed. impr.) ; 33(2): 39-44, abr.-jun. 2020. ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-197282

RESUMO

OBJETIVO: El objetivo es evaluar la seguridad oncológica a 10 años de la mastectomía ahorradora de piel y pezón (MAP) en pacientes con carcinoma ductal in situ (CDIS). MÉTODO: Análisis observacional retrospectivo. Se realizaron 35 MAP en pacientes con CDIS durante 2005-2018. Evaluamos resultados histológicos, oncológicos y de morbilidad. RESULTADOS: Las indicaciones más frecuentes fueron márgenes afectos tras tumorectomía (31,5%), multifocalidad/multicéntricidad (22,8%), tumor >3 cm (8,6%) correlación desfavorable tamaño tumoral/mama (8,6%) y decisión de la paciente (8,6%). La técnica más usada fue incisión lateral externa en 11 pacientes, seguida de técnica de Spira en nueve casos. La presencia de CDIS se confirmó en 22 pacientes y en 11 no se encontró tumor en la pieza de mastectomía. La tasa de complicaciones fue 22,8%. Tras una mediana de seguimiento de 104 meses (DE 69,9) no se observó necrosis del pezón. Un 20% de pacientes precisó reintervención a largo plazo. Once pacientes (31,4%) recibieron tratamiento adyuvante (QT y/o RT). Solamente una paciente presentó recurrencia local (2,8%) 28 meses tras la intervención. Una paciente presentó metástasis tras 78 meses de SLE. Las tasas de SLE y SG fueron 94,3% y 97,22%. El análisis univariante mostró dos factores de riesgo de recurrencia: edad <40 [OR (IC95) 2,529 (1,230 - 5,199)] y márgenes afectos [OR (IC95) 5,242 (2,041 - 13,464)]. CONCLUSIÓN: La MAP es factible y segura en pacientes con CDIS no candidatas a cirugía conservadora


OBJECTIVE: The aim of this study was to assess the oncological safety of nipple-sparing mastectomy (NSM) in patients with ductal in situ carcinoma (DCIS) over a 10-year period. METHOD: Retrospective observational analysis. A total of 35 NSM were performed in patients with DCIS from 2005 - 2018. We assessed the histological, oncological and morbidity results. RESULTS: The most frequent indications were margin involvement after lumpectomy (31.5%), multifocality / multicentricity (22.8%), tumour size >3 cm (8.6%) unfavourable tumour / breast size correlation (8.6%) and patient choice (8.6%). The most commonly used technique was external lateral incision in 11 patients, followed by the Spira technique in 9 patients. DCIS was confirmed in 22 patients and no tumour was found in mastectomy specimen in 11 patients. The complication rate was 22.8%. After a median follow-up of 104 months (SD 69.9) there was no nipple necrosis. In all, 20% of the patients required long-term reintervention. Eleven patients (31.4%) underwent adjuvant treatment (chemotherapy and / or radiotherapy). Only one patient showed local recurrence (2.8%) 28 months after the intervention. One patient developed metastases after 78 months of disease-free survival (DFS). DFS and overall survival rates were 94.3% and 97.22%. Univariate analysis showed two risk factors for recurrence: age <40 years [OR (95% CI) 2.529 (1.230-5.199)] and margin involvement [OR (95% CI) 5.242 (2.041 - 13.464)]. CONCLUSION: NSM is safe and feasible in patients with DCIS who are not candidates for conservative surgery


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Neoplasias da Mama/cirurgia , Mastectomia/métodos , Mastectomia Segmentar/métodos , Carcinoma Ductal de Mama/cirurgia , Mamoplastia/métodos , Tratamentos com Preservação do Órgão/métodos , Estudos Retrospectivos , Resultado do Tratamento , Recidiva Local de Neoplasia/patologia , Mamilos/cirurgia
19.
J Plast Reconstr Aesthet Surg ; 73(7): 1299-1305, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32430266

RESUMO

BACKGROUND: In most breast reduction techniques, the pedicle of the nipple-areola complex (NAC) is de-epithelialized to preserve the subdermal plexus, thereby decreasing the risk of NAC necrosis. However, deskinning the pedicle is faster and makes it more pliable, which potentially improves the aesthetic outcome. There is no scientific evidence regarding the beneficial effects of de-epithelialization. In this study, we present data from patients undergoing breast reduction with deskinning of a superomedial pedicle. METHODS: In the period June 2013 to March 2019, a single surgeon performed all breast reductions using a superomedial glandular pedicle. The patients were included retrospectively and data were collected by reviewing the medical records. The NAC necrosis rate was compared with data from the literature through a systematic review. RESULTS: The cohort consisted of 142 consecutive patients. The median resection weight was 287 g (interquartile range (IQR), 197-399) per breast. No complete NAC necroses occurred during the follow-up period, but two patients (1.4%) developed partial NAC necrosis. In the literature, the rate of NAC necrosis (complete or partial) was 1.5% of patients undergoing breast reduction with de-epithelialization. CONCLUSION: The rate of NAC necrosis after breast reduction with deskinning of the pedicle was comparable with breast reductions with de-epithelialization that has been reported in the literature. Our findings support that the pedicle in breast reduction surgery can be deskinned safely in patients with low resection weights.


Assuntos
Mamoplastia/métodos , Adulto , Estudos de Coortes , Procedimentos Cirúrgicos Dermatológicos , Feminino , Humanos , Pessoa de Meia-Idade , Necrose , Mamilos/patologia , Mamilos/cirurgia , Complicações Pós-Operatórias/patologia , Estudos Retrospectivos
20.
Updates Surg ; 72(3): 893-899, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32449032

RESUMO

Nipple Sparing Mastectomy (NSM) requires the entire breast tissue to be removed, maintaining the nipple-areola complex, and represents nowadays the gold standard of the demolitive breast surgery. Although it represents the evolution of conservative breast surgery, NSM presents some limitations in the selection of women candidates for treatment, and still there are no real guidelines regarding its indications, but simply objective data to address the choice. How the breast surgery approach to demolitive and conservative surgery has changed over time? We evaluated throughout the years (from 2009 up to 2018) the time trend of NSM at our institution and analysed the main differences between patients undergone NSM and other mastectomies and/or breast conserving surgery in terms of cancer size, multicentricity and biological profile. We found 781 NSMs, 1261 other mastectomies and 5621 breast conservative surgeries. Among NSMs, 39.6% were reconstructed with tissue expander and 58.1% with definitive prosthesis. From 2009 to 2018 we found a general increase of NSM rate (from 21.3% of all mastectomies in 2009 to 67.3% in 2018) and a decrease of total mastectomies (from 78.7% of all mastectomies in 2009 to 32.7% in 2018). In line with the literature data, our data confirm that in the recent years NSM represents the gold standard for radical breast surgery. Undisputed in prophylaxis, NSM is continuously acquiring more support in being used as first line treatment for locally advanced disease.


Assuntos
Neoplasias da Mama/cirurgia , Mama/cirurgia , Mastectomia/métodos , Mastectomia/tendências , Mamilos/cirurgia , Tratamentos com Preservação do Órgão/métodos , Tratamentos com Preservação do Órgão/tendências , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Reconstrutivos/tendências , Implantes de Mama , Neoplasias da Mama/patologia , Feminino , Humanos , Estadiamento de Neoplasias , Dispositivos para Expansão de Tecidos
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