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1.
Anticancer Res ; 41(4): 2017-2024, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33813408

RESUMO

BACKGROUND/AIM: Synthetic meshes (SMs) and acellular dermal matrices (ADMs) are used in reconstructive breast surgery. In the absence of prospective comparative studies, the identification of differences relies on retrospective analyses. PATIENTS AND METHODS: Our analysis focused on the impact of pre- and postoperative radiotherapy (RTX) and material-related differences. The analysis included 281 breast cancer patients (362 breasts) after nipple- and skin-sparing mastectomy with subpectoral implant insertion. RESULTS: Overall, the implant loss rate was 23.1% using porcine ADM, 7% using partially resorbable SM (prSM), and 5.6% using non-resorbable SM (nrSM). After RTX, the implant loss rate was 56.3% with ADM, 13% with prSM and 13.2% with nrSM. The ADM group showed a significant effect of RTX on the postoperative seroma rate, wound infections, and implant loss rate. When prSM was used, RTX showed no significant effect. When using the nrSM, RTX significantly influenced complication rates regarding wound infections and implant loss. CONCLUSION: In material-assisted breast reconstructions with pre- or post-operative RTX, there is a significantly higher implant loss rate when using porcine ADM compared to SM.


Assuntos
Derme Acelular , Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Mamoplastia , Radioterapia Adjuvante/efeitos adversos , Telas Cirúrgicas , Adulto , Idoso , Implante Mamário/instrumentação , Implante Mamário/métodos , Implantes de Mama , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/patologia , Feminino , Humanos , Mamoplastia/instrumentação , Mamoplastia/métodos , Mastectomia Segmentar/instrumentação , Mastectomia Segmentar/métodos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
2.
Ann R Coll Surg Engl ; 103(5): e169-e172, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33930283

RESUMO

We present two immediate breast reconstruction cases utilising deep inferior epigastric perforator (DIEP) flaps in the presence of upper transverse abdominal scars and their outcomes. The available evidence in relation to its impact on abdominal skin perfusion and published clinical experience is reviewed.


Assuntos
Cicatriz/fisiopatologia , Mamoplastia/métodos , Retalho Perfurante/irrigação sanguínea , Pele/irrigação sanguínea , Abdome/cirurgia , Artérias Epigástricas/transplante , Feminino , Humanos , Pessoa de Meia-Idade
3.
Anticancer Res ; 41(4): 2123-2132, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33813423

RESUMO

BACKGROUND/AIM: Surgical stress has been correlated with higher rate of postoperative complications. Breast implants' surfaces (textured or smooth) represent an immunological stimulus. Our prospective study (BIAL2.20) evaluated post-operative leukocytes response at baseline and postoperative day (POD) 1 and 2 after implant-based breast reconstruction. PATIENTS AND METHODS: Between January and July 2020, 41 patients underwent reconstruction with textured (n=23) or smooth (n=18) implants. A full blood count and lymphocyte subsets were collected before surgery, on POD1 and POD2. Data were evaluated as difference and relative difference from baseline by two-way analysis of variance test (2-way-ANOVA). Mann-Whitney U-test was performed at each POD, whenever between-group 2-way-ANOVA reached statistical significance. RESULTS: Within-group-analysis showed statistically significant total leukocytosis in both groups. Within-group-analysis of lymphocytes subsets demonstrated statistically significant lymphopenia in the textured group for T-lymphocytes, and T-helper cells. Between-group-analysis showed statistically significant lymphopenia in T-helper subsets in the textured group at POD1 and POD2, when compared with the smooth group. CONCLUSION: Textured implants demonstrated a statistically significant impairment of T-helper trend during POD1 and POD2 when compared to smooth implants by between-group 2-way-ANOVA.


Assuntos
Implante Mamário , Implantes de Mama/efeitos adversos , Linfopenia/etiologia , Mamoplastia , Complicações Pós-Operatórias/imunologia , Linfócitos T Auxiliares-Indutores/patologia , Adulto , Idoso , Implante Mamário/efeitos adversos , Implante Mamário/instrumentação , Implante Mamário/métodos , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Desenho de Equipamento/efeitos adversos , Feminino , Humanos , Linfopenia/diagnóstico , Linfopenia/imunologia , Mamoplastia/efeitos adversos , Mamoplastia/instrumentação , Mamoplastia/métodos , Mastectomia/métodos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/patologia , Período Pós-Operatório , Estudos Prospectivos , Fatores de Tempo
4.
BMC Cancer ; 21(1): 214, 2021 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-33653297

RESUMO

BACKGROUND: The outcomes of immediate autologous breast reconstruction (IABR) after partial mastectomy followed by postoperative radiotherapy (RT) in terms of aesthetics, treatment-related complications, and local control are unclear. In this study, we evaluated the efficacy of IABR after partial mastectomy with or without breast RT, and thus the impact of radiation on autologous flap transfer. METHOD: A retrospective cohort study involving consecutive breast cancer patients who underwent IABR after partial mastectomy between July 2011 and December 2017 at Shengjing Hospital was performed. Patients were divided into two groups based on whether or not they received RT after IABR. We compared aesthetic outcomes and changes in the flap size over the three-dimensional coordinates at various timepoints (pre-RT, 1, 6, and 12 months post-RT), as well as postoperative complications, survival, and recurrence rates between the two groups. RESULTS: In total, 84 breast cancer patients were enrolled, with 32 patients in the RT group and 52 in the non-RT group. At a median follow-up time of 33.3 months, no significant difference was found in the rate of regional recurrence between the two groups (3.13% vs. 3.85%, P = 1.00), and no local recurrences occurred in either group. At the timepoints pre-RT, 1, and 6 months post-RT (approximately 4, 7, and 12 months after IABR, respectively), 77 (91.7%), 70 (83.3%), and 83 (98.8%) patients, respectively, had achieved very good or good cosmetic outcomes, and only changes in breast skin color at 1 month after RT significantly differed between the RT and non-RT groups, with very good or good cosmetic result rates of 62.5% vs. 96.2%, respectively (P < 0.001). No significant difference in the reduction of flap size was observed at any timepoint between the two groups. There were no significant differences between the two groups in the rates of postoperative complications including necrosis of the flap, infection, hematoma, or seroma (all P > 0.05). Additionally, no grade 3 or greater RT-associated adverse events occurred during or after RT. CONCLUSION: RT following IABR provides aesthetically satisfactory results without intolerable adverse complications and may safely be performed in patients who underwent IABR after partial mastectomy.


Assuntos
Neoplasias da Mama/radioterapia , Mamoplastia/métodos , Mastectomia Segmentar , Retalhos Cirúrgicos , Adulto , Idoso , Neoplasias da Mama/mortalidade , Neoplasias da Mama/cirurgia , Terapia Combinada , Feminino , Humanos , Mamoplastia/efeitos adversos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Avaliação de Resultados em Cuidados de Saúde , Radioterapia/efeitos adversos , Estudos Retrospectivos
5.
Ann R Coll Surg Engl ; 103(3): 186-190, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33645273

RESUMO

BACKGROUND: Prophylactic antibiotics are used in acellular dermal matrix-assisted implant-based breast reconstructions. However, there are no universally accepted guidelines regarding the best regimen. This retrospective, multicentre study was designed to compare the different prophylactic antibiotic regimens in these patients in three hospitals across two NHS trusts over a five-year period. METHODS: Case notes and electronic records were reviewed for all patients undergoing acellular dermal matrix-assisted implant-based breast reconstructions between January 2010 and December 2014. Prophylactic antibiotic regimens, duration of use, wound infection, implant loss, seroma and therapeutic antibiotic use was recorded. Patients were divided into groups based on prophylactic antibiotic regimen and actual duration of use. Intergroup analysis was performed using Stata 13.0. Implant loss due to infection was the primary outcome measure. RESULTS: A total of 105 patients had 122 breast reconstructions performed over the study period. Four prophylactic antibiotic regimens were identified: single dose (n = 20), three doses (n = 17), antibiotics for five-seven days (n = 51) and antibiotics until drains removed (n = 32). There was no statistically significant difference (p > 0.05) between the various regimens in implant loss, wound infection, therapeutic antibiotic prescription or seroma rates. Based on the actual duration of prophylactic antibiotics usage, three groups were identified: prophylactic antibiotics given for one day (n = 26), antibiotics for up to one week (n = 76) and for more than one week (n = 13). Again, no statistically significant difference was observed in the groups for any outcome measure. CONCLUSION: The study demonstrated no difference in outcomes between different prophylactic antibiotic regimens in acellular dermal matrix-assisted implant-based breast reconstructions.


Assuntos
Derme Acelular , Antibacterianos/administração & dosagem , Antibioticoprofilaxia/métodos , Implante Mamário/métodos , Mastectomia , Infecções Relacionadas à Prótese/epidemiologia , Transplante de Pele/métodos , Infecção da Ferida Cirúrgica/epidemiologia , Neoplasias da Mama/prevenção & controle , Neoplasias da Mama/cirurgia , Remoção de Dispositivo , Duração da Terapia , Feminino , Humanos , Mamoplastia/métodos , Pessoa de Meia-Idade , Mastectomia Profilática , Estudos Retrospectivos , Seroma/epidemiologia
6.
J Surg Oncol ; 123(5): 1232-1237, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33567142

RESUMO

BACKGROUND: The internal mammary artery/vein (IMA/V) are commonly used recipients for free flap breast reconstruction, but requires costal cartilage resection and limits future use of the IMA. This study aimed to evaluate the feasibility of the thoracoacromial artery/vein (TAA/V) as recipients for deep inferior epigastric artery perforator (DIEP) flap breast reconstruction compared with using the IMA/V. METHODS: Medical charts of patients who underwent free DIEP flap breast reconstruction using the TAA/V or the IMA/V as recipient vessels were reviewed. Patient and vessel characteristics, time for vessel preparation and anastomosis, and postoperative pain were compared between TAA/V and IMA/V groups. RESULTS: Thirty-four patients were included; 12 in TAA/V group, and 22 in IMA/V group. There was no flap failure in both groups. There were statistically significant differences between TAA/V and IMA/V groups in vessel preparation time (10.9 ± 3.7 min vs. 24.1 ± 6.0 min, p < .001), anastomosis time (31.2 ± 12.1 min vs. 42.1 ± 11.2 min, p = .017), and total dose of acetaminophen (4566.7 ± 1015.6 mg vs. 5436.4 ± 1323.3 mg, p = .041). CONCLUSIONS: The TAA/V could be safely used as recipient vessels for DIEP flap breast reconstruction with shorter time and less postoperative pain.


Assuntos
Neoplasias da Mama/cirurgia , Artérias Epigástricas/cirurgia , Mamoplastia/métodos , Artéria Torácica Interna/cirurgia , Retalho Perfurante/irrigação sanguínea , Artérias Torácicas/cirurgia , Veias/cirurgia , Adulto , Idoso , Neoplasias da Mama/patologia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Retalho Perfurante/transplante , Prognóstico , Estudos Retrospectivos
7.
J Surg Oncol ; 123(5): 1215-1231, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33621375

RESUMO

As the sophistication of microsurgical breast reconstruction continues to evolve, plastic surgeons are focusing on techniques to improve functional and psychosocial outcomes for patients, including breast sensation. Interest in neurotization of breast flaps, among both patients and surgeons, has grown significantly in recent years. This study aimed to review the outcomes of neurotization across autologous flap reconstructions, to provide a comprehensive analysis of the efficacy of this technique in improving postoperative sensory recovery.


Assuntos
Neoplasias da Mama/cirurgia , Mama/inervação , Mamoplastia/métodos , Regeneração Nervosa , Transferência de Nervo/métodos , Sensação/fisiologia , Feminino , Humanos , Transplante Autólogo
8.
J Plast Reconstr Aesthet Surg ; 74(3): 463-474, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33309318

RESUMO

INTRODUCTION: Post-mastectomy breast reconstruction (PMBR) is an important component of the multidisciplinary care of breast cancer patients. Despite the improved quality of life, significant racial disparities exist in the receipt of PMBR. Given the increasing population of Black, Asian and minority ethnic (BAME) women in UK, it is important to address this disparity. Our review aims to identify the barriers and facilitators influencing the uptake of PMBR in BAME women and raise awareness for physicians on interventions that could improve uptake of PMBR in BAME women. METHODS: The methodology outlined by the Cochrane guidelines was used to structure this systematic review. Systematic searches for qualitative studies on barriers and/or facilitators to PMBR in ethnic women published in English were conducted. The following databases were searched from their inception up to June 2019: MEDLINE, EMBASE, PubMed, Cochrane Library, Google Scholar and Scopus. Reference lists of all included articles and relevant systematic reviews were also hand-searched for possible additional publications. Publication year or status restrictions were not applied. Only full text articles published in English and by peer reviewed journals are included. Exclusion criteria were as follows: quantitative studies on barriers and/or facilitators to PMBR, abstracts, conference proceedings, non-English language and non-specific to BAME women. A thematic synthesis approach was used through the development of sub-themes and themes from the findings of the included qualitative studies. RESULTS: Five studies satisfied the inclusion and exclusion criteria. Three overarching themes emerged from our review: physician-associated factors (physician recommendations), patient-associated factors (knowledge, language, community and cultural, emotions, logistics, patient characteristics) and system-associated factors (insurance coverage, income status). CONCLUSION: Our systematic review suggests that there is a paucity of data in the literature on the barriers and facilitators to PMBR in BAME women. Considering the expanding population of BAME women and increasing breast cancer incidence, it is imperative that future research in this field is carried out. Physician and patient-associated factors were identified as the most important yet modifiable factors. Adopting a combination of culturally tailored interventions targeting these factors may help improve the access of PMBR in BAME women. REGISTRATION: Prospero ID: CRD42019133233.


Assuntos
Neoplasias da Mama , Assistência à Saúde Culturalmente Competente/etnologia , Mamoplastia , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Qualidade de Vida , Neoplasias da Mama/etnologia , Neoplasias da Mama/psicologia , Neoplasias da Mama/cirurgia , Grupos Étnicos , Feminino , Humanos , Mamoplastia/métodos , Mamoplastia/psicologia , Mastectomia/métodos
9.
Clin Plast Surg ; 48(1): 17-32, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33220902

RESUMO

Patients have been requesting implant removal in revisional breast surgery and options for breast improvement without the use of breast implants in primary breast surgery. This article focuses on perioperative decision making and surgical technique in performing a mastopexy with autoaugmentation and fat grafting. The use of a lower island of breast parenchyma relocated to the upper pole through a central pedicle in primary surgery and a superior pedicle in postexplantation cases, along with fat grafting can provide improvement in global volume or simply additional volume in areas of deficiency, such as the upper poles and medial cleavage region.


Assuntos
Tecido Adiposo/transplante , Mama/cirurgia , Mamoplastia/métodos , Retalhos Cirúrgicos , Autoenxertos , Remoção de Dispositivo , Feminino , Humanos
10.
Clin Plast Surg ; 48(1): 45-57, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33220904

RESUMO

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


Assuntos
Implante Mamário/efeitos adversos , Mama/cirurgia , Mamoplastia/métodos , Complicações Pós-Operatórias/cirurgia , Mama/anormalidades , Implante Mamário/métodos , Implantes de Mama/efeitos adversos , Feminino , Humanos , Mamoplastia/efeitos adversos , Reoperação
11.
Plast Reconstr Surg ; 147(1): 1-10, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33370043

RESUMO

BACKGROUND: The purpose of this study was to evaluate the safety and effectiveness of autologous fat grafting after radiotherapy. METHODS: All studies published before December of 2019 were collected by searching on PubMed, Embase, Cochrane, Web of Science, China National Knowledge Infrastructure, and Wanfang Data. After independently screening the studies and extracting the data, Stata was applied to perform meta-analysis. RESULTS: Seventeen qualified articles were eventually included, involving a total of 1658 patients, of which 1555 underwent autologous fat grafting. Overall, empirically from the data, the use of autologous fat grafting after radiotherapy does not increase the incidence of complications or the risk of tumor recurrence. Through statistical analysis, the authors found that 152 patients suffered complications after undergoing autologous fat grafting [152 of 1555 (9.8 percent)]; 72 patients suffered complications after undergoing postradiotherapy autologous fat grafting [72 of 1040 (6.9 percent)], including seven cases of tumor recurrence [seven of 1040 (0.7 percent)]; and 80 patients suffered complications after undergoing autologous fat grafting without radiotherapy [80 of 515 (15.5 percent)], including seven cases of tumor recurrence [seven of 515 (1.4 percent)]. The authors also found that 970 of 1040 patients (93.3 percent) were satisfied with the results of postradiotherapy autologous fat grafting for breast reconstruction. CONCLUSIONS: This study has provided an evidence-based conclusion supporting the use of autologous fat grafting for breast reconstruction after radiotherapy. Autologous fat grafting can effectively correct breast deformity and contracture caused by breast-conserving therapy and radiotherapy and increase patient satisfaction without increasing the rate of tumor recurrence.


Assuntos
Tecido Adiposo/transplante , Neoplasias da Mama/terapia , Mamoplastia/efeitos adversos , Recidiva Local de Neoplasia/epidemiologia , Mama/patologia , Mama/efeitos da radiação , Mama/cirurgia , Neoplasias da Mama/epidemiologia , Feminino , Humanos , Mamoplastia/métodos , Mastectomia/efeitos adversos , Recidiva Local de Neoplasia/etiologia , Radioterapia Adjuvante/efeitos adversos , Tempo para o Tratamento , Transplante Autólogo/efeitos adversos , Transplante Autólogo/métodos , Resultado do Tratamento
12.
Plast Reconstr Surg ; 147(1): 38-45, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33370047

RESUMO

BACKGROUND: Despite advances in skin envelope reduction techniques and experienced nipple-sparing mastectomy flap procedures, the rate of nipple malposition and secondary revision in these patients remains high and eligible candidates are limited. In this article, the authors present a novel technique combining skin reduction nipple-sparing mastectomy surgery with single-stage skin-only mastopexy and direct-to-implant reconstruction. METHODS: A retrospective review was performed at a single institution from 2015 to 2018. All patients were operated on using this technique consecutively, by a breast and plastic surgeon team (A.F. and A.M.). Surgical technique and outcomes were compared with the currently accepted literature. RESULTS: Twenty-six patients (40 breasts) underwent this technique; all were single-stage direct-to-implant reconstructions. The average body mass index was 31 kg/m2. A Wise pattern was used in 35 breasts (87.5 percent) and prepectoral placement was used in 25 breasts (62.5 percent). Overall complications included seroma [n = 6 (15 percent)], vertical/T-junction dehiscence [n = 4 (10 percent)], skin necrosis [n = 4 (10 percent)], superficial or partial nipple necrosis [n = 4 (10 percent)], with no total nipple-areola complex lost and no reconstructive failures at 18.7 months' average follow-up. CONCLUSIONS: In this article, the authors share a novel reconstructive technique in which the skin envelope is reduced, the nipple-areola complex is repositioned, and a direct-to-implant reconstruction is performed in a single stage at the time of mastectomy. Consideration of pearls and pitfalls accompanies a review of the authors' experienced complication profile, and is discussed in the context of current literature. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Mamoplastia/efeitos adversos , Mastectomia Subcutânea/efeitos adversos , Mamilos/cirurgia , Complicações Pós-Operatórias/epidemiologia , Retalhos Cirúrgicos/efeitos adversos , Tecido Adiposo/transplante , Adulto , Idoso , Implantes de Mama , Neoplasias da Mama/cirurgia , Feminino , Seguimentos , Humanos , Mamoplastia/instrumentação , Mamoplastia/métodos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Reoperação/métodos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Retalhos Cirúrgicos/transplante , Resultado do Tratamento
13.
Plast Reconstr Surg ; 147(1): 25e-29e, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33370048

RESUMO

BACKGROUND: During a deep inferior epigastric perforator (DIEP) flap harvest, the identification and localization of the epigastric arteries and its perforators are crucial. Holographic augmented reality is an innovative technique that can be used to visualize this patient-specific anatomy extracted from a computed tomographic scan directly on the patient. This study describes an innovative workflow to achieve this. METHODS: A software application for the Microsoft HoloLens was developed to visualize the anatomy as a hologram. By using abdominal nevi as natural landmarks, the anatomy hologram is registered to the patient. To ensure that the anatomy hologram remains correctly positioned when the patient or the user moves, real-time patient tracking is obtained with a quick response marker attached to the patient. RESULTS: Holographic augmented reality can be used to visualize the epigastric arteries and its perforators in preparation for a deep inferior epigastric perforator flap harvest. CONCLUSIONS: Potentially, this workflow can be used visualize the vessels intraoperatively. Furthermore, this workflow is intuitive to use and could be applied for other flaps or other types of surgery.


Assuntos
Realidade Aumentada , Mamoplastia/métodos , Retalho Perfurante/transplante , Cirurgia Assistida por Computador/métodos , Coleta de Tecidos e Órgãos/métodos , Artérias Epigástricas/diagnóstico por imagem , Artérias Epigástricas/cirurgia , Estudos de Viabilidade , Feminino , Holografia , Humanos , Imageamento Tridimensional/métodos , Cuidados Intraoperatórios/métodos , Retalho Perfurante/irrigação sanguínea , Tomografia Computadorizada por Raios X
14.
Plast Reconstr Surg ; 147(1): 111e-122e, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33370068

RESUMO

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Understand the available donor sites for autologous breast reconstruction. 2. Describe the advantages and limitations of each donor site. 3. Provide a rational, algorithmic preoperative evaluation and approach for patients seeking autologous breast reconstruction. 4. Develop an effective postoperative monitoring system to minimize complications and maximize salvage of microvascular thromboses. SUMMARY: Breast reconstruction remains at the heart of the field of plastic and reconstructive surgery, and it is continuously evolving. Tremendous advances in breast implant technology and supplemental products, particularly acellular dermal matrices, have revolutionized breast reconstruction in the modern era. However, microvascular free flap breast reconstruction has also witnessed profound advancements with exceptionally high success rates, with the ability to provide the most durable and natural breast reconstruction. Although the pendulum oscillates between prosthesis-based reconstruction and autologous tissue, the present synopsis will focus on autologous free flap breast reconstruction from an historical perspective, recent advancements in microsurgery, and the future of autologous breast reconstruction.


Assuntos
Mamoplastia/métodos , Complicações Pós-Operatórias/prevenção & controle , Guias de Prática Clínica como Assunto , Retalhos Cirúrgicos/transplante , Coleta de Tecidos e Órgãos/normas , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/genética , Neoplasias da Mama/cirurgia , Feminino , Aconselhamento Genético , Humanos , Mamoplastia/efeitos adversos , Mamoplastia/normas , Mastectomia/efeitos adversos , Anamnese , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/genética , Obesidade/epidemiologia , Seleção de Pacientes , Exame Físico/normas , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Cuidados Pré-Operatórios/métodos , Cuidados Pré-Operatórios/normas , Medição de Risco/métodos , Medição de Risco/normas , Fatores de Risco , Retalhos Cirúrgicos/efeitos adversos , Tempo para o Tratamento/normas , Coleta de Tecidos e Órgãos/efeitos adversos , Coleta de Tecidos e Órgãos/métodos , Resultado do Tratamento
15.
Plast Reconstr Surg ; 147(1): 123e-134e, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33370069

RESUMO

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Describe the risks, benefits, and safety profile of oncoplastic procedures for partial breast reconstruction, and how they compare to breast conservation-therapy alone. 2. Have a working knowledge of oncoplastic techniques and how they are addressed from the multidisciplinary perspective. 3. Understand the limitations of oncoplastic techniques and how to avoid unfavorable results. SUMMARY: Oncoplastic surgical techniques have expanded indications for breast conservation and have improved both oncologic and reconstructive outcomes. This article will focus on some of the barriers to adoption and discuss ways to improve safety through streamlining the process, understanding the oncologic concerns, and evaluating unfavorable outcomes that might interfere with the appropriate delivery of breast cancer care.


Assuntos
Neoplasias da Mama/terapia , Mamoplastia/efeitos adversos , Mastectomia Segmentar/efeitos adversos , Recidiva Local de Neoplasia/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Mama/diagnóstico por imagem , Mama/patologia , Mama/cirurgia , Neoplasias da Mama/mortalidade , Neoplasias da Mama/patologia , Quimioterapia Adjuvante , Feminino , Humanos , Mamoplastia/métodos , Mastectomia Segmentar/métodos , Oncologia/métodos , Oncologia/organização & administração , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/etiologia , Planejamento de Assistência ao Paciente/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Seleção de Pacientes , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Melhoria de Qualidade , Radioterapia Adjuvante , Reoperação/estatística & dados numéricos , Medição de Risco/métodos , Cirurgia Plástica/métodos , Cirurgia Plástica/organização & administração , Retalhos Cirúrgicos/transplante , Fatores de Tempo , Tempo para o Tratamento
16.
Cir. plást. ibero-latinoam ; 46(4): 381-400, oct.-dic. 2020. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-198720

RESUMO

INTRODUCCIÓN Y OBJETIVO: La mastopexia combinada con implantes que presentamos bajo la denominación Técnica reglada, tiene como finalidad el tratamiento en forma simultánea del volumen y posición de la mama usando implantes de gel de silicona, logrando así el aumento y levantamiento de la mama en un solo tiempo quirúrgico, mediante una sistematización en pasos. MATERIAL Y MÉTODO: Describimos esta sistematización basada en 5 reglas fundamentales y presentamos un estudio sobre pacientes que consultaron por hipotrofia, tejido mamario inconsistente y ptosis mamaria con o sin pérdida masiva de peso, en la Unidad de Cirugía Plástica y Posbariátrica de Caracas, Venezuela, entre 2009 y 2019. RESULTADOS: Practicamos mastopexia por Técnica reglada en 481 pacientes entre 19 y 61 años de edad, en las que el 37.63% (n=181) presentaban condición postbariátrica, 23.91% (n=115) fueron cirugías primarias y 56.13% (n=270) cirugías secundarias. En el 84.62% (n=407) realizamos mastopexia con técnica de pedículo superior, que fue la más frecuentemente utilizada en pacientes sin condición postbariátrica (54%); la mastopexia con técnica de pedículo inferior fue la menos utilizada, en el 2.49% (n=12), y mayormente en pacientes con condición postbariátrica (83.33%). En cuanto al patrón de piel, realizamos cicatrices mínimas en el 84% (n=404) y T invertida en el 16% (n=77). Empleamos implantes de silicona redondos con un rango de volumen de 400 a 500 cc en el 62.37% (n=300). Las complicaciones se dieron en el 14.34% (n=69), siendo las más frecuentes: licuefacción grasa (3.95 %), celulitis (3.53%) y seroma (3.11%), con cirugía de revisión en 3 casos. CONCLUSIONES: El paso a paso de la Técnica reglada ofrece al cirujano una guía práctica para realizar en forma efectiva la combinación de mastopexia con el uso de implantes mamarios, con bajo índice de complicaciones demostrado a través de nuestra casuística


BACKGROUND AND OBJECTIVE: Mastopexy combined with implants that we present with the denomination Regulated technique, aims to simultaneously treat the volume and position of the breast, using silicone gel implants, thus achieving the increase and lifting of the breast in a single surgical time, through a systematization of steps. METHODS: We describe this systematization based on 5 main rules, and present an study in patients who consulted for hypotrophy, inconsistent breast tissue and breast ptosis with or without massive weight loss, carried out in patients who attended the Plastic and Postbariatric Surgery Unit (Caracas, Venezuela) during the period 2009-2019. RESULTS: Mastopexy was performed by Regulated technique in 481 patients between 19 and 61 years old; 37.63% (n=181) had postbariatric condition, 23.91% (n=115) were primary surgeries, 56.13% (n=270) secondary surgeries; 84.62% (n=407) underwent mastopexy with the superior pedicle technique, being the most frequently used in patients without post-bariatric condition (54%), and mastopexy with the inferior pedicle technique was the least used, only in (2.49%) (n=12), and mostly in patients with post-bariatric condition (83.33%). Regarding the skin pattern, minimal scars were made in 84% (n=404) and inverted T in 16% (n=77). Round silicone implants with a volume range of 400 to 500 cc were used in 62.37% (n=300). Complications occurred with an incidence of 14.34% (n=69), the most frequent being: fat liquefaction (3.95%), cellulite (3.53%) and seroma (3.11%), only requiring revision surgery in 3 cases. CONCLUSIONS: The step by step of the Regulated technique offers the surgeon a practical guide to effectively perform the combination of mastopexy with the use of breast implants, with a low rate of complications demonstrated by our clinical series


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Implantes de Mama/normas , Implante Mamário/métodos , Mamoplastia/métodos , Técnicas de Sutura , Pesos e Medidas Corporais/normas , Pesos e Medidas Corporais/instrumentação , Estudos Prospectivos , Índice de Massa Corporal , Complicações Pós-Operatórias , Mamografia/instrumentação , Mamografia/normas
17.
Cir. plást. ibero-latinoam ; 46(4): 401-410, oct.-dic. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-198723

RESUMO

INTRODUCCIÓN Y OBJETIVO: Los colgajos toracoabdominales permiten el cierre de defectos torácicos con una menor morbilidad y dificultad técnica respecto a los colgajos a distancia. En cirugía recontructiva oncológica mamaria se utilizaron primariamente como colgajos fasciocutáneos para pacientes con cáncer de mama localmente avanzado (T3 y T4) que requieren grandes resecciones de piel y necesitan una cubierta rápida y eficaz del defecto torácico. En los últimos años han resurgido como opción terapéutica para solucionar complicaciones postquirúrgicas por isquemia y necrosis cutánea con exposición de expansores o implantes mamarios. El aumento de la mastectomía reductora de riesgo ha llevado a zonas de necrosis cutáneas pequeñas que requieren colgajos de vecindad para solucionar la complicación. Es en esta última indicación donde estos colgajos tienen una aplicación óptima. MATERIAL Y MÉTODO: Describimos el colgajo toracoabdominal como una técnica reconstructiva de gran utilidad para cubrir defectos cutáneos en cirugía mamaria y presentamos una clasificación útil para clarificar sus indicaciones, extraída de nuestra experiencia con dichos colgajos. RESULTADOS: Elaboramos una clasificación didáctica de los colgajos toracoabdominales, presentamos un caso clínico de cada modelo de colgajo, y recopilamos nuestra casuística. CONCLUSIONES: Destacamos el uso específico en complicaciones de cirugías de reconstrucción mamaria de los colgajos toracoabdominales como alternativa que aporta tejidos de igual coloración, fácil de realizar, con cierre directo de la zona donante por lo general y con un pedículo vascular fiable. Además, aportamos una clasificación propia


BACKGROUND AND OBJECTIVE: The thoracoabdominal flap allows the closure of thoracic defects with a lower morbidity and technical difficulty compared to remote flaps. In mammary oncological reconstructive surgery, they were primarily used as fasciocutaneous flaps for patients with locally advanced breast cancer (T3 and T4) that require large skin resections and a fast and effective coverage of the thoracic defect. In recent years they have resurged as a therapeutic option to solve postoperative complications due to ischemia and skin necrosis with exposure of expanders or breast implants.The increase in the practice of risk-reducing mastectomy has led to areas of small skin necrosis that require local flaps to solve the complication. It is in this last indication where these flaps have an optimal application. METHODS: In this study, the thoracoabdominal flap is presented as a very useful reconstructive technique to cover skin defects in breast surgery. A classification is presented in order to clarify these fasciocutaneous flaps as well as our experience with theme. RESULTS: We elaborate a didactic classification of thoracoabdominal flaps, presenting a clinical case of each flap model, and compiling our casuistry. CONCLUSIONS: We highlight the specific use in complications of breast reconstruction surgeries of thoracoabdominal flaps as an alternative that provides tissues of the same color, easy to perform, with direct closure of the donor area and with a reliable vascular pedicle. In addition, we provide our own classification


Assuntos
Humanos , Feminino , Adulto , Retalhos Cirúrgicos/classificação , Retalhos Cirúrgicos/cirurgia , Neoplasias da Mama/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Mamoplastia/métodos , Mastectomia/métodos , Neoplasias da Mama/patologia , Falha de Prótese , Mastectomia/reabilitação
18.
Rev. cuba. cir ; 59(4): e1030, oct.-dic. 2020. tab
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1149847

RESUMO

RESUMEN Introducción: La reconstrucción mamaria inmediata disminuye el impacto psicológico del cáncer de mama y mejora la calidad de vida de las pacientes. Objetivo: Evaluar la simetría en la reconstrucción mamaria inmediata en el Instituto Nacional de Oncología y Radiobiología de Cuba. Método: Se realizó un estudio analítico y prospectivo, de cohorte incidente, en el Servicio de Cirugía Reconstructiva del Instituto Nacional de Oncología y Radiobiología de 2014 al 2017. Se incluyeron 41 pacientes que consintieron participar en el estudio. Se recogieron variables demográficas y onco-reconstructivas. Se utilizó un software creado en la institución para evaluar la simetría mamaria. Los datos se recogieron de la historia clínica. Se aplicaron el test de Chi-cuadrado corregido y la razón de momios para el análisis estadístico. Resultados: El 30,2 por ciento de mujeres reconstruidas pertenecieron al grupo de 30 a 39 años; el 46,3 por ciento tenían sobrepeso. La mejor simetría se encontró con las técnicas oncoplásticas (31,7 por ciento), seguida de la mastectomía ahorradora de piel. La técnica de expansión tisular con la mastectomía presentó mayores complicaciones (63,6 por ciento) y menor simetría. La necrosis parcial de piel fue la mayor complicación en 7,3 por ciento y estuvo relacionadas con las técnicas ahorradoras de piel. Conclusiones: Evaluar de forma objetiva la simetría mamaria permitió conocer la efectividad de las técnicas quirúrgicas reconstructivas. Con las técnicas de cirugía oncoplástica y mastectomía ahorradora de piel se obtuvieron los mejores resultados estéticos y pocas complicaciones. La expansión mamaria inmediata con una mastectomía radical modificada no ofrece ninguna ventaja(AU)


ABSTRACT Introduction: Immediate breast reconstruction reduces the psychological impact of breast cancer and improves the quality of life of patients. Objective: To assess symmetry in immediate breast reconstruction at the of Cuba. Method: An analytical and prospective study of incident cohort was carried out in the reconstructive surgery service at the National Institute of Oncology and Radiobiology (INOR), from 2014 to 2017. Forty-one patients who consented to participate in the study were included. Demographic and oncoreconstructive variables were collected. A software created in the institution was used to assess breast symmetry. The data were collected from the medical histories. The corrected chi-square test and odds ratio were applied for statistical analysis. Results: 30.2 percent of women who received reconstruction belonged to the age group 30-39 years; 46.3 percent were overweight. The best symmetry was found with oncoplastic techniques (31.7 percent), followed by skin-sparing mastectomy. The tissue expansion technique with mastectomy presented greater complications (63.6 percent) and less symmetry. Partial skin necrosis was the major complication, accounting for 7.3 percent of the cases, and was related to skin-sparing techniques. Conclusions: Objectively evaluating breast symmetry allowed us to know the effectiveness of reconstructive surgical techniques. With oncoplastic surgery and skin-sparing mastectomy techniques, the best aesthetic outcomes and few complications were obtained. Immediate breast expansion with a modified radical mastectomy offers no benefit(AU)


Assuntos
Humanos , Feminino , Adulto , Neoplasias da Mama/cirurgia , Mastectomia Radical Modificada/efeitos adversos , Mamoplastia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Qualidade de Vida , Análise Estatística , Estudos Prospectivos , Estudos de Coortes
19.
Anticancer Res ; 40(10): 5739-5742, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32988900

RESUMO

BACKGROUND/AIM: Locoregional recurrence (LRR) of breast cancer is reported to occur at a rate of 5%-15%. Wide excision of LRR is the recommended treatment, which can increase the probability of subsequent local control. Herein, we describe a surgical technique wherein a pedicled skin and subcutaneous flap close the skin defect after resection of a breast cancer LRR without use of a skin graft. PATIENTS AND METHODS: We reviewed four patients who underwent surgical resection using a pedicled rotation flap for chest wall recurrence after mastectomy. RESULTS: The surgical margin was set 2 cm apart from the tumor margin. After resection of tumor from the chest wall, we formed an adjacent pedicled flap and rotated the flap to the skin defect. There were no post-operative complications, including wound necrosis. CONCLUSION: Surgical resection with a pedicled rotation flap for post-mastectomy breast cancer LRR is a highly feasible way to achieve complete resection.


Assuntos
Neoplasias da Mama/cirurgia , Mastectomia/efeitos adversos , Recidiva Local de Neoplasia/patologia , Retalhos Cirúrgicos , Idoso , Neoplasias da Mama/patologia , Feminino , Humanos , Mamoplastia/métodos , Margens de Excisão , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/etiologia
20.
Plast Reconstr Surg ; 146(4): 409e-413e, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32969997

RESUMO

Breast reconstruction remains an important field in plastic surgery, with most procedures using implants and/or autologous tissue. Few series report on experience with fat grafting as the primary form of breast reconstruction. The present article describes a new method of breast reconstruction using a three-dimensional absorbable mesh construct-or Lotus scaffold-and autologous fat grafting. A retrospective review was performed for all patients who underwent breast reconstruction using the Lotus scaffold and autologous fat grafting. Postoperative mammograms and magnetic resonance imaging scans were analyzed. Tissue specimens collected at subsequent procedures were harvested and stained with hematoxylin and eosin for histologic evaluation. Lastly, compression testing of the scaffold was performed using a tensiometer and digital tracking technology. Twenty-two patients underwent reconstruction of 28 breasts using the Lotus scaffold and autologous fat grafting between February of 2015 and February of 2018. Average follow-up was 19 months. All patients were satisfied with final breast shape and size. Mean patient age was 60.5 years and the average body mass index was 28 kg/m. Patients required on average two fat grafting sessions to achieve a successful result (range, zero to four). Postoperative mammography and magnetic resonance imaging showed robust adipose tissue in the breast with a slowly resorbing mesh and no oil cysts or calcifications. Histologic evaluation showed the presence of fat tissue around the scaffold and no evidence of capsule formation. Compression testing revealed the Lotus scaffold to be compliant with a high-resilience profile. The Lotus scaffold with autologous fat grafting is a viable method for breast reconstruction, giving the patient an autologous reconstruction with less morbidity compared to free tissue transfer. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.


Assuntos
Implantes Absorvíveis , Tecido Adiposo/transplante , Mamoplastia/métodos , Telas Cirúrgicas , Engenharia Tecidual/métodos , Tecidos Suporte , Idoso , Feminino , Humanos , Mamoplastia/instrumentação , Pessoa de Meia-Idade , Estudos Retrospectivos , Transplante Autólogo
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