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1.
Am Surg ; 86(2): 134-139, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32167044

RESUMO

Postmastectomy reconstruction has been shown to be oncologically safe, but few studies have investigated factors influencing the type of reconstruction chosen, if at all. Records of female patients with stages 0 to 3 breast cancer undergoing mastectomy at a large academic institution between January 2010 and March 2018 were reviewed. Nine hundred sixty patients were included in this cohort; 784 patients had reconstruction. Younger age, earlier disease stage, private insurance, no history of diabetes, and bilateral mastectomy (BM) were associated with reconstruction. On multivariate analysis, younger age, BM, private insurance, and earlier disease stage predicted reconstruction. Of reconstruction patients, 453 had implants. Race, BMI, and later disease stage influenced the type of reconstruction; on multivariate analysis, higher BMI and later disease stage predicted flap reconstruction. Younger age, BM, private insurance, and earlier disease stage were associated with reconstruction, but the type of reconstruction was affected primarily by BMI and disease stage.


Assuntos
Neoplasias da Mama/cirurgia , Mamoplastia/métodos , Mastectomia/métodos , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Implantes de Mama/estatística & dados numéricos , Neoplasias da Mama/patologia , Feminino , Humanos , Cobertura do Seguro , Mamoplastia/estatística & dados numéricos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Adulto Jovem
2.
J Surg Oncol ; 121(6): 967-974, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32020633

RESUMO

BACKGROUND AND OBJECTIVES: To report on the outcomes and evolution of an oncoplastic mammaplasty referred to as geometric compensation mammaplasty. METHODS: Seventy-three patients with malignant tumours were operated on and followed up in five centres in two countries. Preoperative markings were performed using a Wise pattern. The resection of affected skin was geometrically compensated using another area of preserved skin. RESULTS: Mean pathological tumour size was 30.42 ± 21.98 mm. Twenty tumours (30.77%) were locally advanced and 15 (20.55%) were multicentric. Twenty-two patients (34.38%) were submitted to neoadjuvant chemotherapy. Cosmetic results were considered good or excellent in 59 cases (80.82%). Margins were positive in two cases (2.74%). Complications were partial wound dehiscence (n = 11; 15.07%), fat necrosis (n = 9; 12.33%), skin necrosis (n = 5; 6.85%), seromas (n = 5; 6.85%), enlarged scars (n = 7; 9.59%) and infection (n = 2; 2.74%). There were three cases of local recurrence (4.29%), two of bone metastasis (2.86%) and three of metachronous contralateral breast cancer (4.35%). No deaths were recorded within a mean follow-up of 35.33 ± 28.21 months. CONCLUSIONS: The technique allowed breast conservation in situations requiring a large resection of skin in difficult positions, with a high rate of free margins, correction of ptosis, satisfactory symmetry and few complications.


Assuntos
Neoplasias da Mama/cirurgia , Mamoplastia/métodos , Estudos de Coortes , Feminino , Seguimentos , Humanos , Mastectomia Segmentar/métodos , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
3.
Plast Reconstr Surg ; 145(2): 317-327, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985612

RESUMO

BACKGROUND: This study investigated the risk of reconstruction failure after mastectomy, immediate breast reconstruction, and radiotherapy to either a temporary tissue expander or permanent implant. METHODS: Records of women treated at a single institution between June of 1997 and December of 2011 were reviewed. Two patient groups were identified based on type of immediate breast reconstruction: tissue expander followed by exchange with a permanent implant and permanent implant. The study endpoint was rate of reconstruction failure, defined as a replacement, loss of the implant, or conversion to flap. RESULTS: The tissue expander/permanent implant and the permanent implant groups consisted of 63 and 75 patients, respectively. The groups were well balanced for clinical and treatment characteristics. With a median follow-up of 116 months, eight implant losses, 50 implant replacements, and four flap conversions were recorded. Reconstruction failure occurred in 22 of 63 patients in the expander/implant group and in 40 of 75 patients in the permanent implant group. A traditional proportional hazards model showed a higher risk of reconstruction failure for the expander/implant group (hazard ratio, 2.01) and a significantly shorter time to reconstruction failure compared with the permanent implant group (109.2 months versus 157.7 months; p = 0.03); however, according to a competing risk model, the between-groups cumulative incidences were not significantly different (hazard ratio, 1.09). CONCLUSIONS: Radiotherapy to either a tissue expander or a permanent implant presented a fairly large risk of reconstruction failure over time. The expander/implant group was not more likely to develop reconstruction failure compared to permanent implant group, but the timing of onset was shorter. More complex techniques should be investigated to lower the risk of reconstruction failure. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Neoplasias da Mama/cirurgia , Mastectomia/métodos , Expansão de Tecido/métodos , Adolescente , Adulto , Idoso , Antibacterianos/administração & dosagem , Implante Mamário/instrumentação , Implante Mamário/métodos , Neoplasias da Mama/radioterapia , Implantes de Medicamento , Feminino , Humanos , Mamoplastia/métodos , Pessoa de Meia-Idade , Polimetil Metacrilato/uso terapêutico , Cuidados Pós-Operatórios/métodos , Infecções Relacionadas à Prótese/prevenção & controle , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Terapia de Salvação/instrumentação , Terapia de Salvação/métodos , Expansão de Tecido/instrumentação , Dispositivos para Expansão de Tecidos , Resultado do Tratamento , Adulto Jovem
4.
Plast Reconstr Surg ; 145(2): 330-332, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985615

RESUMO

Dual-plane breast augmentation offers the advantages of a subpectoral implant location with the ability to expand its use to glandular ptotic and constricted lower pole breasts. Alas, high implant position or very loose breast tissue can lead to a notorious breast shape known as the "waterfall deformity." To prevent many of these undesired deformities, the authors introduce a novel pectoralis major median myotomy they call the "median cut." From all of the dual-plane breast augmentations that were performed by the two authors between the years 2011 and 2017, a total of 605 included a median cut to resolve an apparent waterfall deformity. Without this procedure, a shift to subglandular augmentation would have been performed. The authors strongly believe that the median cut is a powerful and effective way to avoid intraoperative waterfall deformities and to have more women benefit from a submuscular approach. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.


Assuntos
Mamoplastia/métodos , Músculos Peitorais/transplante , Adulto , Implante Mamário/métodos , Implantes de Mama , Feminino , Humanos , Miotomia/métodos , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Resultado do Tratamento
5.
Plast Reconstr Surg ; 145(2): 340-343, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985617

RESUMO

The history of autologous breast reconstruction has been characterized by the desire for progressively increasing reliability with decreasing donor-site morbidity. The robotic deep inferior epigastric artery perforator flap permits the longest possible pedicle harvest through the smallest possible fascial incision and, for this reason, may be the next stage in the evolution of minimally invasive, autologous breast reconstruction.


Assuntos
Mamoplastia/métodos , Retalho Perfurante , Procedimentos Cirúrgicos Robóticos/métodos , Feminino , Humanos , Pneumoperitônio Artificial/métodos , Reto do Abdome/transplante , Coleta de Tecidos e Órgãos/métodos , Sítio Doador de Transplante , Transplante Autólogo
6.
J Surg Oncol ; 121(3): 441-446, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31907948

RESUMO

BACKGROUND AND OBJECTIVES: Giant juvenile fibroadenoma (GJF) is a rare benign tumor that disfiguring affects the breast shape and quality of life of patients. This study aimed to report the experience of GJF management. METHODS: A Wise-pattern skin reducing tumor resection followed by immediate breast reconstruction with a dermal flap pocket was used. The long-term outcomes were assessed retrospectively by BREAST-Q questionnaire from 2008 to 2018. RESULTS: The study included eight patients with GJF. All patients achieved satisfactory results without severe complications. The BREAST-Q revealed that postoperative scores for satisfaction with breasts (69.3 ± 17.6) and sexual wellbeing (62.3 ± 27.6) were higher than the normative scores. The psychosocial wellbeing (69.7 ± 14.6) and physical wellbeing-chest (86.8 ± 13.0) scores were slightly lower than the normative scores. CONCLUSION: Although GJF is a benign tumor, it should be surgically removed. And the Wise-pattern skin reducing tumor resection with immediate breast reconstruction is a proper way to improve patients' satisfaction with breast size and shape and quality of life.


Assuntos
Fibroadenoma/cirurgia , Mamoplastia/métodos , Qualidade de Vida , Transplante de Pele , Retalhos Cirúrgicos/transplante , Adolescente , Criança , Gerenciamento Clínico , Feminino , Fibroadenoma/patologia , Seguimentos , Humanos , Prognóstico , Estudos Retrospectivos
7.
Plast Reconstr Surg ; 145(2): 303-311, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985608

RESUMO

BACKGROUND: The authors compared long-term health care use and cost in women undergoing immediate autologous breast reconstruction and implant-based breast reconstruction. METHODS: This study was conducted using the OptumLabs Data Warehouse, which contains deidentified retrospective administrative claims data, including medical claims and eligibility information from a large U.S. health insurance plan. Women who underwent autologous or implant-based breast reconstruction between January of 2004 and December of 2014 were included. The authors compared 2-year use rates and predicted costs of care. Comparisons were tested using the t test. RESULTS: Overall, 12,296 women with immediate breast reconstruction were identified; 4257 with autologous (35 percent) and 8039 with implant-based (65 percent) breast reconstruction. The proportion of autologous breast reconstruction decreased from 47.2 percent in 2004 to 32.7 percent in 2014. The mean predicted reconstruction cost of autologous reconstruction was higher than that of implant-based reconstruction in both unilateral and bilateral surgery. Similar results for mean predicted 2-year cost of care were seen in bilateral procedures. However, in unilateral procedures, the 2-year total costs were higher for implant-based than for autologous reconstruction. Two-year health care use rates were higher for implant-based reconstruction than for autologous reconstruction for both unilateral and bilateral procedures. Women undergoing unilateral implant-based reconstruction had higher rates of hospital admissions (30.3 versus 23.1 per 100; p < 0.01) and office visits (2445.1 versus 2283.6 per 100; p < 0.01) than those who underwent autologous reconstruction. Emergency room visit rates were similar between the two methods. Bilateral procedures yielded similar results. CONCLUSION: Although implant-based breast reconstruction is a less expensive index operation than autologous breast reconstruction, it was associated with higher health care use, resulting in similar total cost of care over 2 years.


Assuntos
Implante Mamário/métodos , Neoplasias da Mama/cirurgia , Mamoplastia/métodos , Adolescente , Adulto , Assistência Ambulatorial/economia , Assistência Ambulatorial/estatística & dados numéricos , Implante Mamário/economia , Implantes de Mama/economia , Implantes de Mama/estatística & dados numéricos , Neoplasias da Mama/economia , Custos e Análise de Custo , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Utilização de Instalações e Serviços , Feminino , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Mamoplastia/economia , Pessoa de Meia-Idade , Estudos Retrospectivos , Transplante Autólogo/economia , Transplante Autólogo/estatística & dados numéricos , Estados Unidos , Adulto Jovem
8.
Plast Reconstr Surg ; 145(2): 284e-294e, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985618

RESUMO

The American Society of Plastic Surgeons commissioned the Autologous Breast Reconstruction Performance Measure Development Work Group to identify and draft quality measures for the care of patients undergoing autologous breast reconstruction and other breast reconstruction surgery. Four outcome measures and one process measure were identified. Outcomes include patient satisfaction with information for all breast reconstruction, a subscale of the BREAST-Q, and the length of stay, operative time, and rate of blood transfusion for autologous blood transfusion. The process measure looks at coordination of care around managing the breast reconstruction patient's care, with the physician coordinating the ongoing care, be it an oncologist, radiologist, other specialist, or primary care physician. All measures in this report were approved by the American Society of Plastic Surgeons Quality and Performance Measures Work Group and the American Society of Plastic Surgeons Executive Committee. The Work Group recommends the use of these measures for quality initiatives, continuing medical education, maintenance of certification, American Society of Plastic Surgeons' Qualified Clinical Data Registry reporting, and national quality-reporting programs.


Assuntos
Mamoplastia/métodos , Mastectomia/métodos , Garantia da Qualidade dos Cuidados de Saúde/métodos , Medicina Baseada em Evidências , Feminino , Humanos , Mamoplastia/normas , Satisfação do Paciente
9.
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
12.
Int J Radiat Oncol Biol Phys ; 106(3): 514-524, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31756414

RESUMO

PURPOSE: To compare single-stage direct-to-implant (DTI) immediate reconstruction to the commonly used 2-stages expander and implant (TE/I) or autologous reconstruction with focus on postmastectomy radiation therapy (PMRT) setting. METHODS AND MATERIALS: We reviewed the charts of 1,286 patients who underwent 1,814 breast reconstructions at our institution with and without PMRT from 1997 to 2017. Patients were divided into 6 groups according to type of reconstruction and PMRT status. Primary objective was reconstruction complications defined solely on surgical reintervention operative notes such as infection, skin necrosis, and fat necrosis across all groups. Implant-related complications such as capsular contracture, implant rupture or exposure, or implant failure were compared between TE/I and DTI. Kaplan-Meier estimates were used to calculate 5-year cumulative incidence of complications. The secondary objective was to compare the 3 reconstruction types in settings of immediate reconstruction followed by PMRT on multivariable analysis. RESULTS: Median follow-up was 5.8 years. Among 1286 patients, 41.1% (N = 529/1286) received PMRT. Among 1814 reconstructed breasts, autologous, single-stage, and TE/I represented 18.7%, 34.8%, and 46.2%, respectively. With no PMRT, the 5-year cumulative incidence of any reconstruction complication was 11.1%, 12.6%, and 19.5% for autologous, DTI, and TE/I reconstructions, respectively. The addition of PMRT resulted in 5-year cumulative incidence of 15.1%, 18.2%, and 36.8%, respectively. The multivariable analysis showed that DTI was associated with lesser complications compared with TE/I, whereas no significant difference was noted between DTI and autologous. CONCLUSIONS: Single-stage DTI reconstruction had significantly lower complication rates than TE/I with and without PMRT. Single-stage complication rates were not significantly different from autologous complication rates in PMRT settings. Single-stage reconstruction may offer a valuable option for patients receiving PMRT.


Assuntos
Implante Mamário/efeitos adversos , Implantes de Mama/efeitos adversos , Neoplasias da Mama/radioterapia , Mamoplastia/efeitos adversos , Complicações Pós-Operatórias , Dispositivos para Expansão de Tecidos/efeitos adversos , Neoplasias da Mama/cirurgia , Feminino , Humanos , Incidência , Mamoplastia/métodos , Mamoplastia/estatística & dados numéricos , Pessoa de Meia-Idade , Necrose , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/epidemiologia , Radioterapia Adjuvante/efeitos adversos , Radioterapia Adjuvante/estatística & dados numéricos , Estudos Retrospectivos , Pele/patologia , Pele/efeitos da radiação , Fatores de Tempo
13.
Ann R Coll Surg Engl ; 102(2): 115-119, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31538808

RESUMO

BACKGROUND: Surgical management of breast cancer with gigantomastia can be challenging when planning breast conservation, as major breast reduction is required. Complex oncoplastic procedures can carry an additional surgical risk in this situation. We suggest batwing mammoplasty as a simple and safe oncoplastic procedure for those patients. MATERIALS AND METHODS: Fourteen patients with gigantomastia diagnosed with breast cancer were included in this prospective cohort study. All underwent batwing mammoplasty and contralateral symmetrisation procedure between May 2016 and June 2018. Patient satisfaction assessed by the Breast-Q questionnaire. RESULTS: All patients had a body mass index above 30kg/m2 with a mean of 36.7kg/m2 (range 31.6-44.9kg/m2). The mean distance from midclavicular point to nipple was 42cm (range 38-50cm). The mean operative time was 83 minutes for procedures done by a single surgeon. Mean specimen weight was 1.2kg (ranging from 1.035-1.63kg). Postoperative complications occurred in 14.2% of patients. Nipple-areola complex viability was not compromised nor sensation impaired. The mean Breast-Q score for patient satisfaction with breasts was 68.6 (range 61-74). The mean score for physiological wellbeing was 77.3 (range 64-84) and the mean score for physical wellbeing was 35 (range 31-40). CONCLUSION: Batwing mammoplasty is a safe and simple oncoplastic procedure in patients who have breast cancer with gigantomastia. It has short operative time and low complications rate. In our cohort of patients, there was no delay in the delivery of adjuvant treatment. The cosmetic outcome was favourable with a high patient satisfaction.


Assuntos
Neoplasias da Mama/cirurgia , Mama/anormalidades , Hipertrofia/cirurgia , Mamoplastia/métodos , Mastectomia/métodos , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Mama/cirurgia , Neoplasias da Mama/complicações , Feminino , Humanos , Hipertrofia/complicações , Mamoplastia/efeitos adversos , Mastectomia/efeitos adversos , Pessoa de Meia-Idade , Duração da Cirurgia , Satisfação do Paciente , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Resultado do Tratamento
14.
Plast Reconstr Surg ; 145(1): 1e-8e, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31881596

RESUMO

BACKGROUND: The impact of insurance and socioeconomic status on breast reconstruction modalities when access to care is controlled is unknown. METHODS: Records for patients who underwent breast reconstruction at an academic medical center between 2013 and 2017 were reviewed and analyzed using chi-square analysis and logistic regression. RESULTS: One thousand six hundred eighty-three breast reconstructions were analyzed. The commercially insured were more likely to undergo microvascular autologous breast reconstruction (44.4 percent versus 31.3 percent; p < 0.001), with an odds ratio of 2.22, whereas patients with Medicare and Medicaid were significantly more likely to receive tissue expander/implant breast reconstruction, with an odds ratio of 1.42 (41.7 percent versus 47.7 percent; p = 0.013). Comparing all patients with microvascular reconstruction, the commercially insured were more likely to receive a perforator flap (79.7 percent versus 55.3 percent versus 43.9 percent), with an odds ratio of 4.23 (p < 0.001). When stratifying patients by median household income, those in the highest income quartile were most likely to receive a perforator flap (82.1 percent) (p < 0.001), whereas those in the lowest income quartile were most likely to receive a muscle-sparing transverse rectus abdominis myocutaneous flap (36.4 percent) (p < 0.001). CONCLUSIONS: Patients at the same academic medical center had significantly different breast reconstruction modalities when stratified by insurance and household income. Despite similar access to care, differences in insurance types may favor higher rates of perforator flap breast reconstruction among the commercially insured. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.


Assuntos
Renda/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Mamoplastia/métodos , Mamoplastia/estatística & dados numéricos , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Fatores Socioeconômicos , Estados Unidos
15.
Plast Reconstr Surg ; 145(1): 32-37, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31881600

RESUMO

Skin adhesives have become standard in wound closure as alternatives to traditional sutures or as sterile occlusive dressings after surgery of all types. The literature is replete with case reports of contact dermatitis following exposure to cyanoacrylate-based adhesives, such as 2-octyl cyanoacrylate. Nonetheless, it has been the impression of the senior author and others that the incidence of allergic and/or contact dermatitis is much higher than commonly considered. The authors prospectively studied 102 consecutive patients who underwent breast surgery performed by the senior author with 2-octyl cyanoacrylate placed over incisions as an occlusive dressing. Two patients with a known glue allergy did not receive cyanoacrylate at surgery but were scratch tested to confirm the diagnosis. All patients were followed postoperatively. Twelve patients went on to develop significant dermatitis postoperatively after glue placement. Cyanoacrylate was confirmed as the cause of all rashes by allergy scratch testing for a total incidence of 14 percent (14 patients). Given the popularity of cyanoacrylate products across emergency rooms, clinics, and operating rooms, awareness of the true incidence of these reactions may caution against their use in the future. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.


Assuntos
Cianoacrilatos/efeitos adversos , Dermatite de Contato/epidemiologia , Mamoplastia/métodos , Adesivos Teciduais/efeitos adversos , Técnicas de Fechamento de Ferimentos/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Dermatite de Contato/etiologia , Feminino , Humanos , Incidência , Pessoa de Meia-Idade , Estudos Prospectivos , Virginia/epidemiologia , Adulto Jovem
16.
Plast Reconstr Surg ; 145(1): 38-42, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31881601

RESUMO

Medical tattooing is a critical reconstructive component in women following mastectomy. Recently, novel three-dimensional tattooing techniques mimicking depth by using light and shadow principles have allowed for aesthetically superior results. However, results are variable between providers, and professionals skilled in tattooing are often inaccessible to patients. To assess the need and obtain more background information regarding current practices, the authors recorded survey results from 753 plastic and reconstructive surgery offices. Results showed that 23 percent of facilities that offer reconstruction do not perform or refer for nipple-areola complex tattooing, leaving the patients to seek the service on their own. In this article, the authors present the nipple-by-number device, a three-dimensionally-printed stencil to ensure an accurate, consistent, and personalized aesthetic result during three-dimensional nipple-areola complex tattooing. The nipple-by-number device permits the plastic surgeon or supervised treating specialist to inexpensively, efficiently, and expeditiously perform the three-dimensional nipple-areola complex tattooing in their office. Furthermore, the device gives the patients the option of having their premorbid nipple-areola complex anatomy restored through preoperative photographs or choosing a different nipple-areola complex from a catalogue of designs. The device can be applied on any reconstructed breast mound whether or not a nipple projection procedure has been performed.


Assuntos
Neoplasias da Mama/cirurgia , Mamoplastia/métodos , Mamilos/cirurgia , Tatuagem/métodos , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Satisfação do Paciente
17.
Plast Reconstr Surg ; 145(1): 21e-29e, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31881599

RESUMO

BACKGROUND: XPAND II was a prospective, multicenter, single-arm, open-label, continued-access study designed to confirm the results from the XPAND study, a multicenter, prospective, randomized study for breast reconstruction. The AeroForm device received clearance from the U.S. Food and Drug Administration in December 2016 based on the results of the pivotal XPAND trial, which compared the AeroForm to saline expanders. METHODS: Fifty women were treated in the XPAND II study and implanted with the AeroForm device (86 devices). The study endpoint was successful completion of the second-stage surgery, and secondary endpoints were days to complete expansion and reconstruction, and patient/physician satisfaction. Following implantation, women were administered 10-cc doses of carbon dioxide at home up to three times daily. When adequate expansion was achieved, the expanders were exchanged for standard breast implants. RESULTS: The primary endpoint (successful exchange to standard breast implant, precluding non-device-related failures) is 100 percent. All-cause interim success is 95 percent, with three subjects (four breasts) failing primary exchange because of non-device-related reasons. Median time to complete expansion was 21 days (range, 5 to 117 days). Median time to complete the reconstruction was 112 days (range, 55 to 329 days). Ninety-six percent of the subjects were very or moderately satisfied with the AeroForm expansion process. CONCLUSIONS: Results of the XPAND II continued access study confirm and improve on previous results from the randomized trial (XPAND). These results validate that the AeroForm patient-controlled, needle-free carbon dioxide tissue expander is safe and effective for two-stage breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Implantes de Mama , Neoplasias da Mama/cirurgia , Mamoplastia/instrumentação , Dispositivos para Expansão de Tecidos , Adulto , Idoso , Mama/cirurgia , Feminino , Humanos , Mamoplastia/métodos , Mastectomia/efeitos adversos , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
18.
Cir. Esp. (Ed. impr.) ; 97(10): 575-581, dic. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-187933

RESUMO

Introducción: La reconstrucción inmediata (RMI) tras mastectomía en pacientes que han recibido quimioterapia neoadyuvante (QTNA) sigue siendo controvertida. El objetivo de este estudio es analizar y comparar resultados oncológicos y las tasas de complicaciones y reintervención en pacientes sometidas a QTNA y un grupo control. Métodos: Análisis observacional retrospectivo de casos-controles. Pacientes con cáncer de mama intervenidas de mastectomía bilateral con RMI (MBRMI) mediante prótesis directa durante el periodo 2000-2016. Grupo que recibió QTNA emparejadas máximo 1:5 respecto a las pacientes sin QTNA (grupo control). Evaluamos diferencias entre grupos mediante test χ2 o Fisher (variables cualitativas), U de Mann-Whitney o t de Student (variables cuantitativas). Análisis de supervivencia mediante curvas de Kaplan-Meier y test de log-rank (SPSS 22.0). Resultados: Un total de 171 pacientes con MBRMI, 62 pacientes (36,3%) tras QTNA y 109 pacientes (63,7%) en grupo control sin QTNA. Mediana de seguimiento de 52,0 (RIQ: 23,0-94,0) meses. La indicación para practicar una MBRMI más frecuente en ambos grupos es la elección de la paciente (32,7%). No hay diferencias estadísticamente significativas entre los grupos en cuanto a tasa de complicaciones (24,2% en el grupo QTNA y 19,3% en el grupo control [p = 0,44]). Sí existen diferencias en resultados oncológicos. Las pacientes del grupo QTNA tienen 3 veces más riesgo que las pacientes del grupo control de presentar recidiva en un momento determinado del tiempo (3,009 [1,349-6,713]) según el análisis univariante. Conclusiones: La RMI mediante prótesis directa tras mastectomías ahorradoras de piel es una opción viable de tratamiento para pacientes con cáncer de mama que reciben QTNA


Introduction: Immediate reconstruction (IBR) after mastectomy in patients who have received neoadjuvant chemotherapy (NACT) remains controversial. The aim of this study is to analyze and compare oncological results as well as complication and reoperation rates in patients undergoing NACT and a control group. Methods: Retrospective observational case-control study of patients with breast cancer who underwent bilateral mastectomy and direct-to-implant IBR (BMIBR) from 2000-2016. The group that received NACT was matched 1:5 to patients without NACT (Control group). We evaluated differences between groups using the χ2 or Fisher test (qualitative variables), Mann-Whitney U or Student's t-test (quantitative variables). The survival analysis was performed using Kaplan-Meier curves and log-rank test (SPSS 22.0). Results: The study included a total of 171 patients with BMIBR: 62 patients (36.3%) after NACT and 109 patients (63.7%) in the control group without NACT. Median follow-up was 52.0 (IQR: 23.0-94.0) months. In both groups, the indication for BMIBR was patient choice (32.7%). There were no statistically significant differences between groups in terms of complication rate (24.2% in the NACT group and 19.3% in the control group [P = .44]), but differences in oncological results were found. Patients in the NACT Group had three times more risk of recurrence at a given time than patients in the control group (3.009 [1.349-6.713]) according to the univariate analysis. Conclusions: Direct-to-implant IBR after skin-sparing mastectomy is a viable option for breast cancer patients undergoing NACT


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Implantes de Mama/efeitos adversos , Neoplasias da Mama/cirurgia , Mamoplastia/métodos , Resultado do Tratamento , Implantes de Mama/normas , Estudos de Casos e Controles , Quimioterapia Adjuvante/métodos , Mamoplastia/normas , Mastectomia/métodos , Terapia Neoadjuvante/métodos , Recidiva Local de Neoplasia/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Análise de Sobrevida
19.
Cir. plást. ibero-latinoam ; 45(4): 361-368, oct.-dic. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-186020

RESUMO

Introducción y objetivo: La reconstrucción mamaria tras mastectomía bilateral cumple un papel fundamental para garantizar la salud psicológica y la vida social y sexual de la mujer. Las técnicas empleadas pueden ser autólogas, aloplásticas y mixtas, siendo las autólogas de elección en la mayoría de casos. Realizamos este estudio con el fin de dilucidar si existen diferencias en cuanto a la satisfacción con el resultado final de la reconstrucción comparando las tres técnicas. Material y método: Comparamos una serie de 35 pacientes intervenidas de reconstrucción mamaria postmastectomía bilateral, tanto inmediata como diferida en el Servicio de Cirugía Plástica del Hospital Universitario La Paz, en Madrid, España: 21 mediante técnica aloplástica, 4 con técnica autóloga y 10 con técnica mixta. Usamos 2 encuestas: una tipo Likert para valoración del resultado morfológico y funcional y una Escala Visual Analógica para valoración del resultado global. Además, valoramos la proporción de complicaciones asociadas a cada técnica y el estudio de factores de confusión sobre el resultado de la reconstrucción. Resultados: La técnica más empleada fue la aloplástica. La técnica autóloga recibió una mejor puntuación en todas las escalas de satisfacción empleadas. Sin embargo, solo encontramos diferencias estadísticamente significativas (p=0.02) cuando la valoración la realizó el cirujano. En cuanto al estudio de las complicaciones, la técnica autóloga fue la que tuvo mayor proporción de complicaciones (20%). No obstante, al comparar la aparición de complicaciones en las 3 técnicas estudiadas, únicamente encontramos diferencias estadísticamente significativas en cuanto a la aparición de necrosis cutánea (p = 0.033) a expensas de la técnica mixta. Conclusiones: En general, observamos una mayor satisfacción con la técnica autóloga frente al resto de técnicas, en todas las encuestas, tanto en las valoraciones del cirujano como de las pacientes, sin presentar diferencias en la proporción de complicaciones


Background and objective: Breast reconstruction after bilateral mastectomy plays an essential role in guaranteeing psychological health and social and sexual life of women. The techniques used can be autologous, alloplastic or a combination of both, being autologous techniques of choice in most cases. We conducted this study in order to elucidate whether there are differences in satisfaction regarding the final result of the reconstruction by comparing the 3 techniques. Methods: This study compares a series of 35 patients operated on breast reconstruction after bilateral mastectomy at La Paz University Hospital in Madrid, Spain, both immediate and deferred: 21 operated on with alloplastic technique, 4 with autologous technique and 10 with mixed technique. Two surveys have been used: a Likert type survey to assess morphological and functional result and a Visual Analogue Scale for the assessment of the overall result. In addition, we reviewed the proportion of complications associated with each technique and the study of confounding factors on the outcome of the reconstruction. Results: The most commonly used technique in this series was the aloplastic one. The autologous technique was the one that received the best score in all the satisfaction scales used. However, statistically significant differences are only found when the evaluation is performed by the surgeon (p = 0.02). Regarding the study of complications, the autologous technique had the highest proportion of complications (20%). Nevertheless, when comparing the appearance of complications in the 3 techniques, only statistically significant differences were found in the appearance of skin necrosis (p = 0.033), at the expense of the mixed technique. Conclusions: In general, greater satisfaction was observed with the autologous technique compared to the rest of them, in all the surveys, both in the surgeon's assessments and those of the patients, with no differences in the proportion of complication


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Mamoplastia/métodos , Satisfação do Paciente , Hospitais Universitários , Mastectomia , Estudos Retrospectivos , Estudos Longitudinais , Escala Visual Analógica , Inquéritos e Questionários , Fatores de Risco , Índice de Massa Corporal
20.
Cir. plást. ibero-latinoam ; 45(4): 369-375, oct.-dic. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-186021

RESUMO

Introducción y objetivo: A diferencia de los resultados oncológicos, no existen métodos estándar para evaluar los resultados estéticos. Muchos estudios han evaluado resultados cosméticos y calidad de vida después de la cirugía de cáncer de mama; los resultados fueron muy inconsistentes, tal vez debido al uso de evaluaciones subjetivas no confirmadas, al pequeño tamaño poblacional del estudio, al diseño retrospectivo y las diferencias en las medidas de calidad de vida. El objetivo del presente estudio es determinar el estado de calidad de vida con el instrumento Breast-Q(R) (previamente autorizado por 2018 Mapi Research Trust(C) y validado también para su aplicación en español) en mujeres sometidas a reconstrucción mamaria postmastectomía entre 2013-2018. Material y método: Estudio de cohorte que incluye pacientes con diagnóstico de cáncer de mama sometidas a reconstrucción mamaria. Medimos su calidad de vida con el instrumento Breast-Q(R) en su versión en español. Mostramos las variables cuantitativas como promedios y desviación estándar. Los datos cualitativos como frecuencias y porcentajes. El análisis del antes y después de la reconstrucción mamaria con la prueba de Wilcoxon. Tomamos como significativo un valor p <0.05. Para el análisis de los datos utilizamos el paquete estadístico SPSS versión 22. Resultados: La satisfacción en cuanto a sus pezones, tórax, la información referida y en general, fue superior a 75 puntos sobre 100. De manera interesante, también el bienestar psicológico estuvo por encima del 75 de promedio. Al comparar el antes y después de la satisfacción con sus senos y del bienestar sexual encontramos un aumento significativamente estadístico. Conclusiones: La evaluación mediante el instrumento Breast-Q® entre nuestro grupo de estudio demostró que la reconstrucción mamaria mejora la calidad de vida de las pacientes sometidas a este procedimiento


Backgorund and objective: Unlike oncological results there are no standard methods to evaluate aesthetic results. Many studies have evaluated cosmetic results and quality of life after breast cancer surgery with very inconsistent results perhaps due to the use of unconfirmed subjective evaluations, the small size of the population study, the retrospective design of the studies and differences in measures of quality of life. Our objective is to determine the quality of life status with Breast-Q(R) instrument (previously authorized by 2018 Mapi Research Trust(C) and also validated for its application in Spanish), in women with post-mastectomy breast reconstruction in 2013-2018. Methods: Cohort study including patients diagnosed with breast cancer who underwent breast reconstruction. Quality of life was measured by the Breast-Q(R) instrument in its Spanish version. The quantitative variables are shown as averages and standard deviation. Qualitative data such as frequencies and percentages. The analysis of the before and after breast reconstruction with the Wilcoxon test. A value p < 0.05 was taken as significant. The statistical package SPSS version 22 was used to analyze the data. Results: Satisfaction regarding their nipples, their thorax, the referred information, and in general is above 75 points out of 100. Interestingly, psychological well-being is also above 75 on average. When comparing the before and after satisfaction with their breasts and sexual well-being, a statistically significant increase was found. Conclusions: The evaluation using the Breast-Q(C) instrument among our study group showed that breast reconstruction improves the quality of life of patients undergoing this procedure


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Qualidade de Vida , Mamoplastia/métodos , Estudos de Coortes , Satisfação do Paciente , Neoplasias da Mama/diagnóstico , Estudos Retrospectivos , Estatísticas não Paramétricas , Mastectomia/estatística & dados numéricos , Cuidados Pós-Operatórios/métodos
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