Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 17.771
Filtrar
1.
Exp Oncol ; 46(1): 73-76, 2024 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-38852049

RESUMO

Virginal gigantomastia (VGM) is a benign disease of the breasts without a clearly established etiology. The treatment of VGM remains a problem. The conservative treatment is not effective while surgery is too traumatic. Most specialists recommend subcutaneous mastectomy with immediate implant reconstruction or reduction mammoplasty. The reduction mammoplasty with adjuvant hormone therapy is a variant of treatment of young patients with a risk of recurrence. We present a case of a patient with VGM who was operated in 2014. Reduction mammoplasty was performed. After 9 years, the patient had a relapse and second surgery, resection of the breasts with reduction mammoplasty. Tissues with cysts, fibrosis, hamartomas, and fibroadenomas were dissected. Histopathology revealed extensive fibrosis with hamartomas and fibroadenomas. The immunohistochemical examination of the breast tissue showed a high level (70%) of estrogen and progesterone receptors expression. We prescribed hormone therapy with tamoxifen 10 mg per day. Dynamic monitoring of the treatment result and control of the disease remission was carried out. Breast-conserving surgery performed in such patients can help alleviate the psychological, social, and physical disorders caused by VGM.


Assuntos
Mama , Hipertrofia , Humanos , Feminino , Mama/patologia , Mama/cirurgia , Mama/anormalidades , Mamoplastia/métodos , Adulto , Recidiva
2.
BJS Open ; 8(3)2024 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-38829692

RESUMO

BACKGROUND: Health-related quality of life and patient-related outcome measures for patients with cancer have gained increased interest over the last decade. However, few prospective studies with longitudinal data evaluated health-related quality of life in patients with breast cancer. This study aimed to investigate how health-related quality of life changed from the time of diagnosis to 1 year after breast cancer surgery for the main surgical techniques. METHODS: This prospective longitudinal single-centre study included patients with primary breast cancer diagnosed in 2019-2020 who underwent surgery. Patients completed a health-related quality of life questionnaire (Breast-Q) at baseline. One year after surgery, they completed the Breast-Q a second time, the EORTC (European Organization for Research and Treatment of Cancer) quality of life questionnaire-C30 and the quality of life questionnaire-BR23. Analysis of variance and Kruskal-Wallis tests were used to evaluate the differences in health-related quality of life between surgical groups. Analysis of covariance with robust standard errors was used to adjust for confounders. RESULTS: In total, 340 patients were included in the study; 160 patients received oncoplastic partial mastectomy, 112 received partial mastectomy, 42 received mastectomy and 26 had mastectomy with immediate reconstruction. Patients that had partial mastectomy or oncoplastic partial mastectomy were more satisfied with their breasts (P < 0.001), had a better body image (P = 0.006) and higher sexual functioning scores (P = 0.027) than patients who had a mastectomy with/without reconstruction. The oncoplastic and mastectomy with reconstruction groups had more breast symptoms than other groups (P < 0.001), and the mastectomy group had the least symptoms from the chest area. CONCLUSION: Partial mastectomy and oncoplastic partial mastectomy have the best outcomes in terms of breast satisfaction, body image and sexual functioning. This highlights the importance of preserving the breast when feasible and underscores that breast reconstruction is not equal to breast conservation. Registration number: NCT04227613 (http://www.clinicaltrials.gov).


Assuntos
Neoplasias da Mama , Mamoplastia , Mastectomia , Qualidade de Vida , Humanos , Feminino , Neoplasias da Mama/cirurgia , Neoplasias da Mama/psicologia , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Longitudinais , Mamoplastia/psicologia , Mamoplastia/métodos , Idoso , Inquéritos e Questionários , Adulto , Mastectomia Segmentar
3.
Syst Rev ; 13(1): 153, 2024 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-38849880

RESUMO

BACKGROUND: Breast cancer is the most common malignancy among women in the UK. Following mastectomy, reconstruction is now integral to the surgical management of breast cancer, of which implant-based reconstruction (IBBR) is the most common type. IBBR initially evolved from pre-pectoral to post-pectoral due to complications, but with developments in oncoplastic techniques and new implant technology, interest in pre-pectoral IBBR has increased. Many surgeons use acellular dermal matrices (ADM); however, there is little evidence in literature as to whether this improves surgical outcomes in terms of complications, failure and patient satisfaction. This review aims to assess the available evidence as to whether there is a difference in surgical outcomes for breast reconstructions using ADM versus non-use of ADM. METHODS: A database search will be performed using Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Clinicaltrials.org. The search timeframe will be 10 years. Studies will be screened using inclusion and exclusion criteria and data extracted into a standardised spreadsheet. Risk of bias will be assessed. Screening, extraction and risk-of-bias assessments will be performed independently by two reviewers and discrepancies discussed and rectified. Data analysis and meta-analysis will be performed using Microsoft Excel and R software. Forest plots will be used for two-arm studies to calculate heterogeneity and p-value for overall effect. DISCUSSION: With the renaissance of pre-pectoral IBBR, it is important that surgeons have adequate evidence available to assist operative decision-making. Assessing evidence in literature is important to help surgeons determine whether using ADM for IBBR is beneficial compared to non-use of ADM. This has potential impacts for patient complications, satisfaction and cost to healthcare trusts. SYSTEMATIC REVIEW REGISTRATION: PROSPERO 2023 CRD42023389072.


Assuntos
Derme Acelular , Neoplasias da Mama , Mamoplastia , Revisões Sistemáticas como Assunto , Humanos , Feminino , Neoplasias da Mama/cirurgia , Mamoplastia/métodos , Mastectomia/métodos , Implante Mamário/métodos , Implantes de Mama , Satisfação do Paciente
4.
J Vis Exp ; (207)2024 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-38829141

RESUMO

Oncoplastic breast surgery, with its focus on improving cosmetic outcomes while maintaining oncological safety, has fundamentally transformed the landscape of breast cancer surgical treatment, giving rise to an array of techniques for breast reconstruction. Nipple-sparing mastectomy (NSM) with immediate implant-based breast reconstruction (IBBR) has emerged as a cornerstone in managing early breast cancer. Aligned with the principles of minimally invasive surgery, recent years have witnessed the widespread integration of endoscopic approaches in breast surgery, encompassing procedures like endoscopic breast-conserving surgery (E-BCS) and endoscopic nipple-sparing mastectomy (E-NSM), among others. Capitalizing on the advantages of inconspicuous and shorter incisions, improved visibility, and the avoidance of radiation therapy, the popularity of E-NSM with IBBR is on the rise. However, conventional E-NSM with IBBR often requires two or more incisions, which can result in suboptimal cosmetic outcomes and even prosthesis loss.This paper presents a comprehensive account of the intricate surgical procedures involved in endoscopic bilateral nipple-sparing mastectomy with immediate pre-pectoral implant-based breast reconstruction. The insights shared are drawn from the collective experience of our institution. Notable benefits associated with the described surgical approach encompass enhanced cosmetic outcomes, improved postoperative quality of life, and enhanced physiological functions attributable to the application of pre-pectoral implant-based breast reconstruction through a single incision.


Assuntos
Neoplasias da Mama , Endoscopia , Mamilos , Humanos , Feminino , Endoscopia/métodos , Neoplasias da Mama/cirurgia , Mamilos/cirurgia , Mamoplastia/métodos , Mamoplastia/instrumentação , Mastectomia/métodos , Axila/cirurgia , Implantes de Mama
5.
Ann Plast Surg ; 92(6S Suppl 4): S372-S375, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38856997

RESUMO

BACKGROUND: An important component of preoperative counseling and patient selection involves surgical risk stratification. There are many tools developed to predict surgical complications. The Modified Frailty Index (mFI) calculates risk based on the following five elements: hypertension, chronic obstructive pulmonary disease, congestive heart failure, diabetes, and functional status. Recent literature demonstrates the efficacy of the mFI across multiple surgical disciplines. We elected to investigate its utility in oncoplastic reductions (OCR). METHODS: A retrospective review of all patients with breast cancer who underwent OCR from 1998 to 2020 was queried from a prospectively maintained database. Patient demographics, comorbidities, and surgical details were reviewed. The mFI was computed for each patient. The primary clinical outcome was the development of complications. RESULTS: 547 patients were included in the study cohort. The average age was 55 and the average body mass index was 33.5. The overall complication rate was 19% (n = 105) and the major complication rate was 9% (n = 49). Higher frailty scores were significantly associated with the development of major complications (P < 0.05). mFI scores of 0 had a major complication rate of 5.7%; scores of 1, 13%; and scores of 2, 15.1%. The relative risk of a major complication in patients with elevated mFI (>0) was 2.2. Age, body mass index, and resection weights were not associated with complications (P = 0.15, P = 0.87, and P = 0.30 respectively) on continuous analysis. CONCLUSIONS: Elevated mFI scores are associated with an increased major complication profile in patients who are undergoing OCR. Hypertension and diabetes are the most common comorbidities in our population, and this tool may assist with preoperative counseling and risk stratification. Benefits of this risk assessment tool include its ease of calculation and brevity. Our study is the first to demonstrate its utility in OCR; however, further study in high-risk patients would strengthen the applicability of this frailty index.


Assuntos
Neoplasias da Mama , Fragilidade , Mamoplastia , Complicações Pós-Operatórias , Humanos , Feminino , Fragilidade/diagnóstico , Mamoplastia/métodos , Mamoplastia/efeitos adversos , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias da Mama/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Medição de Risco , Idoso , Adulto
6.
Ann Plast Surg ; 92(6S Suppl 4): S397-S400, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38857002

RESUMO

BACKGROUND: Ultrasound-guided regional field blocks are not widely used in outpatient plastic surgeries. The efficacy of truncal blocks (PEC1 + SAP) has not been established in plastic surgery. The purpose of this study was to analyze the outcomes of these newer anesthetic techniques compared with traditional blind local anesthetic infiltration in patients undergoing breast augmentation. METHODS: This retrospective institutional review board-approved cohort study compared the outcomes of the different practices of 2 plastic surgeons at the same accredited outpatient surgery center between 2018 and 2022. Group 1 received an intraoperative blind local infiltration anesthetic. Group 2 underwent surgeon-led, intraoperative, ultrasound-guided PEC1 (Pectoralis 1) + SAP (serratus anterior plane) blocks. Patients who underwent any procedure other than primary submuscular augmentation mammoplasty were excluded from the study. The outcomes measured included operative time, opioid utilization in morphine milligram equivalents (MME), pain level at discharge, and time spent in the post anesthetic care unit (PACU). RESULTS: Sixty patients met the inclusion criteria for each group for a total of 120 patients. The study groups were similar to each other. Patients receiving PEC1 + SAP blocks (group 2) had significantly lower average MME requirements in the PACU (3.04 MME vs 4.52 MME, P = 0.041) and required a shorter average PACU stay (70.13 minutes vs 80.38 minutes, P = 0.008). There were no significant differences in the pain level at discharge, operative time, or implant size between the 2 groups. CONCLUSIONS: Surgeon-led, intraoperative, ultrasound-guided PEC1 + SAP blocks significantly decreased opioid utilization in the PACU by 33% and patient time in the PACU by 13%, while achieving similar patient pain scores and operating times.


Assuntos
Anestesia Local , Mamoplastia , Bloqueio Nervoso , Dor Pós-Operatória , Ultrassonografia de Intervenção , Humanos , Feminino , Estudos Retrospectivos , Adulto , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Anestesia Local/métodos , Mamoplastia/métodos , Manejo da Dor/métodos , Músculos Peitorais/cirurgia , Pessoa de Meia-Idade , Medição da Dor , Período de Recuperação da Anestesia , Anestésicos Locais/administração & dosagem , Estudos de Coortes
7.
Ann Plast Surg ; 92(6S Suppl 4): S432-S436, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38857009

RESUMO

BACKGROUND: The Goldilocks breast reconstruction utilizes redundant mastectomy skin flaps to fashion a breast mound; however, there is concern that imbrication of these skin flaps may predispose to fat necrosis and make detection of local breast cancer recurrence more difficult. Goldilocks patients follow a traditional postmastectomy screening pathway that includes clinical examination for locoregional recurrence, but it is unclear if this is sufficient. We evaluate our Goldilocks reconstruction case series to determine rates of diagnostic imaging, biopsy, and locoregional and distant recurrence. METHODS: Sixty-six patients (94 breasts) undergoing Goldilocks breast reconstruction were retrospectively reviewed. Any diagnostic postoperative imaging/biopsies performed and that confirmed local or distant breast cancer recurrence were noted. RESULTS: Average time of follow-up was 45 months. Most patients in this cohort had stage 0 (27.3%) or stage I (40.9%) breast cancer. There were a total of 11 (11.7%) concerning breast masses identified. Seven (7.4%) masses were biopsied, of which 5 were benign and 2 were invasive cancer recurrence. Four masses (4.3%) underwent diagnostic imaging only, all with benign findings. Five patients in this series were found to have either distant disease or a second primary cancer in the nonoperative contralateral breast. CONCLUSIONS: Rates of local recurrence following Goldilocks are not higher than expected after other types of postmastectomy reconstruction. Clinical monitoring successfully detected local recurrence in all affected patients in this series. More definite guidelines around the routine screening of Goldilocks mastectomy patients may aid in early detection of local breast cancer recurrence.


Assuntos
Neoplasias da Mama , Recidiva Local de Neoplasia , Humanos , Feminino , Neoplasias da Mama/cirurgia , Neoplasias da Mama/patologia , Recidiva Local de Neoplasia/patologia , Estudos Retrospectivos , Pessoa de Meia-Idade , Adulto , Mamoplastia/métodos , Idoso , Mastectomia , Seguimentos , Retalhos Cirúrgicos
8.
Ann Plast Surg ; 92(6S Suppl 4): S413-S418, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38857006

RESUMO

BACKGROUND: Hourly flap checks are the most common means of flap monitoring during the first 24 hours following autologous breast reconstruction (ABR). This practice often requires intensive care unit (ICU) admission, which is a key driver of health care costs and decreased patient satisfaction. This study addresses these issues by demonstrating decreased cost and length of admission associated with a 4-hour interval between flap checks during the first 24 hours following ABR. METHODS: This is a retrospective review of ABR surgeries performed by multiple surgeons from 2017 to 2020. Two cohorts were identified, one that underwent flap checks every hour in the ICU (Q1 cohort) and the other that underwent flap checks every 4 hours on the hospital floor (Q4 cohort). Our primary outcome measures were length of stay (LOS), flap takebacks, flap loss, and encounter cost. RESULTS: Rates of flap takeback and loss did not differ between cohorts (P = 0.18, P = 0.21). The Q4 cohort's average LOS was shorter than the Q1 cohort (P = 0.002). The Q4 cohort's average cost was also $25,554.80 less than the Q1 cohort (P < 0.001). This association persisted after controlling for LOS, operating room takeback, timing and laterality of reconstruction, and flap configuration (hazard ratio = 0.65, P = 0.0007). CONCLUSION: This study demonstrates the benefits of lengthened flap check intervals during the first 24 hours following ABR. These intervals decrease the cost of ABR while also maintaining safety, making ABR a more accessible option for breast reconstruction patients.


Assuntos
Tempo de Internação , Mamoplastia , Retalhos Cirúrgicos , Humanos , Mamoplastia/métodos , Mamoplastia/economia , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Fatores de Tempo , Tempo de Internação/estatística & dados numéricos , Adulto , Cuidados Pós-Operatórios/métodos , Monitorização Fisiológica/métodos , Transplante Autólogo
9.
Ann Plast Surg ; 92(6S Suppl 4): S419-S422, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38857007

RESUMO

BACKGROUND: Tissue expander-based breast reconstruction is associated with high rates of infectious complications, often leading to tissue expander explants and delays in receipt of definitive breast reconstruction and adjuvant therapy. In this study, we describe a single-stage technique where deep inferior epigastric artery perforator (DIEP) flaps are used to salvage actively infected tissue expanders among patients originally planning for free flap reconstruction. METHODS: In this technique, patients with tissue expander infections without systemic illness are maintained on oral antibiotics until the day of their DIEP flap surgery, at which time tissue expander explant is performed in conjunction with aggressive attempt at total capsulectomy and immediate DIEP flap reconstruction. Patients are maintained on 1-2 weeks of oral antibiotics tailored to culture data. Patients undergoing this immediate salvage protocol were retrospectively reviewed, and complications and length of stay were assessed. RESULTS: In a retrospective series, a total of six consecutive patients with culture-proven tissue expander infections underwent tissue expander removal and DIEP flap reconstruction in a single stage and were maintained on 7-14 days of oral antibiotics postoperatively. Within this cohort, no surgical site infections, microvascular complications, partial flap losses, reoperations, or returns to the operating room were noted within a 90-day period. CONCLUSIONS: Among a select cohort of patients, actively infected tissue expanders may be salvaged with free flap breast reconstruction in a single surgery with a low incidence of postoperative complications. Prospective studies are needed to evaluate the influence of this treatment strategy on costs, number of surgeries, and dissatisfaction after staged breast reconstruction complicated by tissue expander infections.


Assuntos
Artérias Epigástricas , Mamoplastia , Retalho Perfurante , Terapia de Salvação , Dispositivos para Expansão de Tecidos , Humanos , Retalho Perfurante/irrigação sanguínea , Feminino , Estudos Retrospectivos , Mamoplastia/métodos , Pessoa de Meia-Idade , Artérias Epigástricas/transplante , Artérias Epigástricas/cirurgia , Terapia de Salvação/métodos , Adulto , Infecções Relacionadas à Prótese/cirurgia , Antibacterianos/uso terapêutico , Antibacterianos/administração & dosagem , Expansão de Tecido/métodos , Neoplasias da Mama/cirurgia , Resultado do Tratamento , Remoção de Dispositivo/métodos
10.
Ann Plast Surg ; 92(6S Suppl 4): S453-S460, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38857013

RESUMO

BACKGROUND: Individual outcomes may not accurately reflect the quality of perioperative care. Textbook outcomes (TOs) are composite metrics that provide a comprehensive evaluation of hospital performance and surgical quality. This study aimed to investigate the prevalence and predictors of TOs in a multi-institutional cohort of patients who underwent breast reconstruction with deep inferior epigastric artery perforator flaps. METHODS: For autologous reconstruction, a TO was previously defined as a procedure without intraoperative complications, reoperation, infection requiring intravenous antibiotics, readmission, mortality, systemic complications, operative duration ≤12 hours for bilateral and ≤10 hours for unilateral/stacked reconstruction, and length of stay (LOS) ≤5 days. We investigated associations between patient-level factors and achieving a TO using multivariable regression analysis. RESULTS: Of 1000 patients, most (73.2%) met a TO. The most common reasons for deviation from a TO were reoperation (9.6%), prolonged operative time (9.5%), and prolonged LOS (9.2%). On univariate analysis, tobacco use, obesity, widowed/divorced marital status, and contralateral prophylactic mastectomy or bilateral reconstruction were associated with a lower likelihood of TOs (P < 0.05). After adjustment, bilateral prophylactic mastectomy (odds ratio [OR], 5.71; P = 0.029) and hormonal therapy (OR, 1.53; P = 0.050) were associated with a higher likelihood of TOs; higher body mass index (OR, 0.91; P = <0.001) was associated with a lower likelihood. CONCLUSION: Approximately 30% of patients did not achieve a TO, and the likelihood of achieving a TO was influenced by patient and procedural factors. Future studies should investigate how this metric may be used to evaluate patient and hospital-level performance to improve the quality of care in reconstructive surgery.


Assuntos
Mamoplastia , Retalho Perfurante , Humanos , Feminino , Mamoplastia/métodos , Pessoa de Meia-Idade , Retalho Perfurante/irrigação sanguínea , Retalho Perfurante/transplante , Adulto , Estudos Retrospectivos , Neoplasias da Mama/cirurgia , Artérias Epigástricas/transplante , Microcirurgia/métodos , Resultado do Tratamento , Complicações Pós-Operatórias/epidemiologia , Mastectomia/métodos , Tempo de Internação/estatística & dados numéricos
11.
Ann Plast Surg ; 92(6S Suppl 4): S441-S444, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38857011

RESUMO

INTRODUCTION: Skin-sparing mastectomy (SSM) is often used when tumor location prohibits performing a nipple-sparing mastectomy (NSM). We examined a square excision of the nipple-areolar complex (NAC) and an X-shaped purse string closure after implant-based reconstruction. METHODS: A retrospective review was performed on patients undergoing periareolar SSM and immediate implant-based reconstruction from January 2015 through December 2022, specifically identifying those patients who had square NAC excision and skin closure. RESULTS: Twenty-nine patients met the inclusion criteria. They underwent 54 periareolar SSM and immediate implant-based reconstruction (bilateral 25, unilateral 4). Indications for surgery were cancer (30) and prophylactic (24; 2 patients had bilateral cancer). Reconstructive methods included tissue expander (TE) (36 [66.7%]) and direct-to-implant (DTI) (18 [33.3%]). The mean mastectomy weights and final implant sizes were similar between the 2 groups. Overall wound complications occurred in 13 (24.1%) of the breasts: mastectomy skin flap necrosis (MSFN; 10 [18.5%]) and infection (3 [5.6%]). Reconstructive failure occurred in 3 cases: TE, 1 (infection); DTI, 2 (MSFN/exposure). MSFN by reconstructive method: TE, 4 (11.1%); DTI, 6 (33.3%) (P = 0.05, comparing MSFN rates between TE and DTI methods). The mean initial TE fill volume was 247.1 cc; mean implant size in the DTI group was 417.8 cc (P < 0.0001). CONCLUSIONS: The square NAC excision and closure can minimize the surgical incision in implant reconstruction. Two-stage TE reconstruction permits lower initial fill volumes, which reduces the risk of MSFN after box to X closure of SSM and implant-based reconstruction. It is useful in small- to moderate-sized breasts with mild ptosis in patients who are not candidates for NSM.


Assuntos
Neoplasias da Mama , Mastectomia Subcutânea , Humanos , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Neoplasias da Mama/cirurgia , Adulto , Mastectomia Subcutânea/métodos , Mamoplastia/métodos , Implantes de Mama , Implante Mamário/métodos , Mamilos/cirurgia , Tratamentos com Preservação do Órgão/métodos , Idoso , Mastectomia/métodos , Resultado do Tratamento
12.
Rev Assoc Med Bras (1992) ; 70(suppl 1): e2024S119, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38865539

RESUMO

OBJECTIVE: The radical change in the treatment of breast cancer has promoted the necessity for more comprehensive training of the professionals involved, ensuring the preservation of oncological safety while also allowing for cosmetic interventions to benefit breast cancer survivors. The aim of this study was to present the methods employed in the training of breast surgeons, highlighting the importance of oncoplasty and breast reconstruction. METHODS: A literature review was conducted in two databases, identifying articles related to medical education in the context of oncoplastic surgery and breast reconstruction. We also assessed the Brazilian experience in oncoplastic centers. RESULTS: The basis for educational discussions was derived from 16 articles. We observed approaches that included hands-on courses utilizing simulator models, porcine models, cadaver labs, and fellowship programs. Positive outcomes were observed in Brazil, a fact based on seven oncoplasty training centers for senior mastologists and five training centers for junior mastologists. From 2009 to 2023, an estimated 452 seniors and 42 juniors received training, representing approximately 30% of mastologists in Brazil who have acquired training and experience in oncoplasty. CONCLUSION: Despite the limited number of publications on training methods, oncoplastic centers have made significant progress in Brazil, establishing a successful model that can be replicated in other countries.


Assuntos
Neoplasias da Mama , Mamoplastia , Humanos , Mamoplastia/educação , Mamoplastia/métodos , Feminino , Neoplasias da Mama/cirurgia , Brasil , Mastectomia/educação , Mastectomia/métodos , Competência Clínica
13.
Br J Surg ; 111(6)2024 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-38877844

RESUMO

BACKGROUND: Oncoplastic breast-conserving surgery may allow women with early breast cancer to avoid a mastectomy, but many women undergo more extensive surgery, even when breast-conserving options are offered. The aim of the ANTHEM qualitative study was to explore factors influencing women's surgical decision-making for and against oncoplastic breast-conserving surgery. METHODS: Semi-structured interviews were conducted with a purposive sample of women who had received either oncoplastic breast-conserving surgery or a mastectomy with or without immediate breast reconstruction to explore their rationale for procedure choice. Interviews were transcribed verbatim and analysed thematically. Trial registration number: ISRCTN18238549. RESULTS: A total of 27 women from 12 centres were interviewed. Out of these, 12 had chosen oncoplastic breast-conserving surgery and 15 had chosen a mastectomy with or without immediate breast reconstruction. Overwhelmingly, women's decisions were guided by their surgical teams. Decision-making for and against oncoplastic breast-conserving surgery was influenced by three key inter-related factors: perceptions of oncological safety; the importance of maintaining/restoring femininity and body image; and practical issues. Oncological safety was paramount. Women who reported feeling reassured that oncoplastic breast-conserving surgery was oncologically safe were happy to choose this option. Those who were not reassured were more likely to opt for a mastectomy, as a perceived 'safer' option. Most women wished to maintain/restore femininity, with the offer of immediate breast reconstruction essential to make a mastectomy an acceptable option. Practical issues such as the perceived magnitude of the surgery were a lesser concern. CONCLUSION: Decision-making is complex and heavily influenced by the surgical team. High-quality, accurate information about surgical options, including appropriate reassurance about the short- and long-term oncological safety of oncoplastic breast-conserving surgery is vital if women are to make fully informed decisions.


Assuntos
Neoplasias da Mama , Tomada de Decisões , Mamoplastia , Mastectomia Segmentar , Mastectomia , Pesquisa Qualitativa , Humanos , Feminino , Neoplasias da Mama/cirurgia , Neoplasias da Mama/psicologia , Mastectomia Segmentar/métodos , Pessoa de Meia-Idade , Adulto , Mamoplastia/métodos , Mastectomia/métodos , Idoso , Reino Unido , Entrevistas como Assunto
15.
J Plast Reconstr Aesthet Surg ; 93: 173-182, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38703705

RESUMO

PURPOSE: The BREAST-Q Breast Cancer module is a patient-reported outcome measure for women with breast cancer diagnosis. Our research team developed and validated a novel BREAST-Q scale for this module that measures quality of life outcomes specific to cancer worry. The aim of this study was to investigate patient related breast reconstruction factors that are associated with worse scores on the new BREAST-Q Cancer Worry Scale. METHODS: Women with a history of breast cancer treated with mastectomy and reconstruction, aged ≥18 years, and English-speaking were recruited through the Love Research Army between October and November 2019. Participants completed demographic and clinical questions alongside the BREAST-Q Cancer Worry Scale. Univariable and multivariable regression analyses were used to identify participant characteristics associated with cancer worry scores. RESULTS: Among the 554 potential respondents, 538 (97.1%) completed the Cancer Worry Scale. The average patient age was 58.4 (+9.8) years. Cancer Worry scores were normally distributed with a mean of 46.4 (+17.2). Cancer Worry scores were significantly associated (p < 0.01) with younger age, history of radiation therapy, complications associated with breast surgery since diagnosis, use of textured breast implants, and shorter duration since surgery. CONCLUSIONS: This exploratory analysis provides evidence of patient characteristics that may be associated with cancer worry following postmastectomy breast reconstruction.


Assuntos
Ansiedade , Neoplasias da Mama , Mamoplastia , Mastectomia , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Humanos , Feminino , Pessoa de Meia-Idade , Neoplasias da Mama/cirurgia , Neoplasias da Mama/psicologia , Mamoplastia/psicologia , Estudos Transversais , Ansiedade/etiologia , Ansiedade/psicologia , Mastectomia/psicologia , Idoso , Adulto , Implantes de Mama/psicologia
16.
J Plast Reconstr Aesthet Surg ; 93: 187-189, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38703708

RESUMO

Here we describe a template of DIEP flap inset that prioritises projection, lateral flow and natural ptosis; key elements of an aesthetically successful delayed breast reconstruction. By not excising the full length of the mastectomy scar, and preserving the scar laterally, we increase the 3-dimensional aesthetic of the breast, moving the final reconstructed breast aesthetic further away from an unintentional 2-dimensional resurfacing. Through controlling the initial take-off around the whole circumference of the breast footprint, a favourable and durable breast conus is consistently achieved. This technique employs designated segments of comparatively more rigid irradiated mastectomy skin flaps, to positively influence reconstructed breast aesthetics at the time of flap inset. Conceptually, this reminds the authors of how the green sepals of a rose shape the bud of petals.


Assuntos
Estética , Mamoplastia , Mastectomia , Humanos , Mamoplastia/métodos , Feminino , Mastectomia/métodos , Retalho Perfurante/irrigação sanguínea , Neoplasias da Mama/cirurgia , Artérias Epigástricas/transplante , Retalhos Cirúrgicos/irrigação sanguínea , Cicatriz/prevenção & controle , Cicatriz/etiologia , Pessoa de Meia-Idade
18.
J Plast Reconstr Aesthet Surg ; 93: 246-253, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38723510

RESUMO

BACKGROUND: Augmentation mastopexy has a 20-fold higher complication rate than primary augmentation. Performing augmentation mastopexy in post-bariatric patients poses an additional challenge owing to the reduced quality of the soft skin tissue. Therefore, it is technically complex and also fraught with complications. Implant dislocation, recurrent ptosis, wound healing problems with exposed implants, and the threat of implant loss are complications that must be prevented. METHODS: We present a case series study on our technique for stabilizing breast implants using the double inner bra technique (DIB) in which a laterobasal myofascial flap and an inferiorly based dermoglandular flap form a double inner bra for implant stabilization and protection. RESULTS: Thirty-seven cases were operated on using this technique from December 2020 to June 2023. No hematomas (0%), seromas (0%), infections (0%), and implant losses (0%) were recorded. Moreover, none of the patients had implant malposition (0%). With regard to recurrent ptosis mammae or waterfall deformity, 7 cases (2.6%) showed early ptosis within the first 3 months, and the number of ptosis decreased over time. Furthermore, 5 (1.81%) patients showed ptosis mammae after 6-12 months. Implant defect or rupture has not yet occurred (0%). CONCLUSION: The DIB is an easy-to-learn and versatile technique. It has low complication rates and can be used to achieve esthetically satisfactory mid- to long-term results.


Assuntos
Cirurgia Bariátrica , Implante Mamário , Complicações Pós-Operatórias , Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Cirurgia Bariátrica/métodos , Cirurgia Bariátrica/efeitos adversos , Implante Mamário/métodos , Implante Mamário/efeitos adversos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Mamoplastia/métodos , Mamoplastia/efeitos adversos , Retalhos Cirúrgicos , Implantes de Mama
20.
J Plast Surg Hand Surg ; 59: 65-71, 2024 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-38769740

RESUMO

Radiotherapy is important in breast cancer treatment. A side effect of the treatment is fibrosis that decreases the possibility for a successful breast reconstruction with expanders and with high patient satisfaction with the result. The most common option for mastectomized, irradiated women wishing for a breast reconstruction is autologous tissue transplantation. However, some patients are not suitable for flap surgery. Fifty mastectomized and irradiated women were included in a randomized controlled trial. They underwent breast reconstruction with expanders and were allocated 1:1 to either receive pre-treatment with autologous fat transplantation (AFT) or not. Primary outcomes were frequency of reoperations and complications. Secondary outcomes were number of days in hospital, number of outpatient visits to surgeon or nurse and patient reported outcome as reported with Breast Q. Follow-up time was 2 years. Fifty-two per cent of the intervention group and 68% of the controls underwent reoperations (p = 0.611). Thirty-two per cent of the intervention group and 52% of the controls had complications (p = 0.347). The median number of consultations with the nurse was four in the intervention group and six in the control group (p = 0.002). The AFT patients were significantly more satisfied with their breasts and psychosocial well-being after 2 years. They also had higher increase in satisfaction with breasts, psychosocial well-being, and sexual well-being when comparing baseline with 2 years postoperatively. This randomized controlled trial indicates benefits of AFT prior to breast reconstruction with expanders, especially on patient reported outcome even if the study sample is small.


Assuntos
Tecido Adiposo , Neoplasias da Mama , Mamoplastia , Satisfação do Paciente , Transplante Autólogo , Humanos , Feminino , Pessoa de Meia-Idade , Neoplasias da Mama/cirurgia , Mamoplastia/métodos , Adulto , Tecido Adiposo/transplante , Reoperação , Mastectomia , Implantes de Mama , Complicações Pós-Operatórias , Dispositivos para Expansão de Tecidos , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...