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1.
Int Breastfeed J ; 16(1): 84, 2021 10 18.
Artigo em Inglês | MEDLINE | ID: mdl-34663383

RESUMO

BACKGROUND: Despite numerous benefits, many mothers stop breastfeeding soon after birth. A common reason for this is the experience of pain or discomfort. One resource which women use to share their breastfeeding challenges and seek support are online forums. This study aimed to collect data from online forums to explore 1) usage of forums as social support for breastfeeding-related pain; 2) experiences of breastfeeding-related pain; 3) perceptions and strategies to deal with breastfeeding-related pain; and 4) the impact of pain on breastfeeding duration. METHODS: Data was gathered through searches of online forums based in the UK and USA: Netmums, What to Expect and Mumsnet using key terms: 'painful breastfeeding' and 'sore breastfeeding'. Data extraction took place in July 2018 and included posts made between 2012 and 2018. Data included 123 posts and 193 replies, analysed using thematic analysis. RESULTS: The first theme identified was 'variation in types of pain', highlighting the variety of painful experiences and their descriptions. In particular, this theme reveals the large variety of different types of pain women experience at different stages throughout their breastfeeding journey, as well as the different pain characteristic they focus on in the description of their experience (i.e., location, sensory or physical aspects). Secondly, the theme 'perceived causes and explanations for pain' revealed how women interpret pain experiences either due to a recognised condition or behavioural cause. The third theme 'cessation of breastfeeding related to pain' identified. How women experience both physical and psychological struggles (e.g., guilt) related to breastfeeding cessation, with pain being a main factor in considering cessation of breastfeeding. Finally, the theme 'shared experiences and support' identified women's strong need for both practical and emotional support to deal with pain. Many women look for this support through the knowledge exchange offered on the online forums. CONCLUSIONS: Pain was a key reason for breastfeeding cessation, commonly associated with strong feelings of guilt. The online forums provide a unique form of social support for breastfeeding women to find ways to cope with the pain, while highlighting the urgent need for more appropriate antenatal education on realistic expectation surrounding breastfeeding.


Assuntos
Aleitamento Materno , Mastodinia , Percepção da Dor , Aleitamento Materno/efeitos adversos , Feminino , Humanos , Mães , Gravidez , Pesquisa Qualitativa
2.
JBI Evid Implement ; 19(3): 236-244, 2021 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-34491923

RESUMO

INTRODUCTION AND AIMS: Breastfeeding is one of the best ways to ensure healthy growth and development of an infant. Nipple pain and trauma are common complications associated with breastfeeding, which render it difficult for the mother to continue breastfeeding. The aim of this project was to promote evidence-based practice in the management of nipple pain or trauma for breastfeeding mothers in a large tertiary hospital in China. METHODS: The project was conducted using the Joanna Briggs Institute framework and Practical Application of Clinical Evidence System. Six audit criteria were applied in baseline and follow-up audits to assess compliance in practice with best practice recommendations. The Getting Research into Practice tool was used to help analyze barriers to the fulfillment of each audit criterion based on the baseline audit results. Implementation strategies were discussed and then undertaken to overcome the barriers and bring changes to the current practice. RESULTS: The baseline audit results demonstrated poor compliance in nipple pain or trauma management practice with all of the six criteria. Significant improvements were achieved in the follow-up audit. Specifically, the compliance rate increased from 15 to 100% for criterion 1 and from 2 to 93% for criterion 2. For criteria 3, 4, 5 and 6, the compliance rate increased from 0 to 90, 85, 100 and 86%, respectively. CONCLUSION: The current evidence-based implementation project was successfully conducted and achieved great improvement in the management of nipple pain or trauma associated with breastfeeding. Continuous effort is required to maintain changes and further improve practice.


Assuntos
Mastodinia , Mães , Aleitamento Materno , Feminino , Humanos , Mamilos , Centros de Atenção Terciária
3.
Artigo em Inglês | MEDLINE | ID: mdl-34200727

RESUMO

Mastalgia, or breast pain, is common among women which can lead to significant impairment in daily living. Hence, finding an effective treatment that can alleviate the symptom is very important. Thus, we carry out this study to determine the efficacy of evening primrose oil (EPO) for mastalgia treatment in women. The review included published randomised clinical trials that evaluated EPO used for treating mastalgia against a placebo or other treatments, irrespective of the blinding procedure, publication status, or sample size. Two independent authors screened the titles and abstracts of the identified trials; full texts of relevant trials were evaluated for eligibility. Two reviewers independently extracted data on the methods, interventions, outcomes, and risk of bias. The random-effects model was used for estimating the risk ratios and mean differences with 95% confidence intervals. Thirteen trials with 1752 randomised patients were included. The results showed that EPO has no difference to reduce breast pain compared to topical NSAIDS, danazol, or vitamin E. The number of patients who achieved pain relief was no different compared to the placebo or other treatments. The EPO does not increase adverse events, such as nausea, abdominal bloating, headache or giddiness, increase weight gain, and altered taste compared to a placebo or other treatments. EPO is a safe medication with similar efficacy for pain control in women with mastalgia compared to a placebo, topical NSAIDS, danazol, or vitamin E.


Assuntos
Mastodinia , Feminino , Humanos , Ácidos Linoleicos/uso terapêutico , Mastodinia/tratamento farmacológico , Óleos Vegetais/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Ácido gama-Linolênico/uso terapêutico
4.
Asian Nurs Res (Korean Soc Nurs Sci) ; 15(3): 197-202, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34048977

RESUMO

PURPOSE: This study aimed to describe the clinical response to five-step systematic therapy (FSST) in the management of plugged ducts and mastitis. FSST was a comprehensive milk stasis dredging treatment, which contained five steps to make the milk out of the plugged duct. METHODS: This retrospective study included 922 breastfeeding women, 714 with plugged ducts, and 208 with mastitis who received FSST from June to September 2017. The breast pain score, swelling degree, and range of breast induration were recorded pre-FSST and post-FSST. RESULTS: After a single FSST, pain score and swelling degree were significantly improved (both p < .001) in all cases. After FSST, the mean breast pain relief score was 1.69 ± 0.70, whereas the mean swelling fade away degree was 1.61 ± 0.62. In the subgroup analysis, pain score and swelling degree were significantly improved (both p < .001) in the plugged ducts group and the mastitis group. The score of pain relief in the plugged ducts group was less than that in the mastitis group (1.63 ± 0.68 vs. 1.91 ± 0.70, t = 5.30; p < .001), whereas improvement of swelling fade away was greater in the plugged ducts group than the mastitis group (1.65 ± 0.64 vs. 1.48 ± 0.56, t = 3.49; p = .001). The composition ratio of changes in induration range between the two groups was statistically different (Pearson χ2 = 137.87, p < .001), of which more obvious improvement in the plugged ducts group than the mastitis group (χ2 = 25.65, p < .001). CONCLUSION: FSST can relieve pain, reduce breast swelling and range of induration, and for plugged ducts or mastitis varied degree differently.


Assuntos
Doenças Mamárias/terapia , Mastite/terapia , Adolescente , Adulto , Aleitamento Materno , Extração de Leite/métodos , Crioterapia/métodos , Feminino , Humanos , Terapia a Laser/métodos , Massagem/métodos , Mastodinia/etiologia , Mastodinia/terapia , Mortalidade , Educação de Pacientes como Assunto , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
5.
Online braz. j. nurs. (Online) ; 20: e20216508, 05 maio 2021. ilus
Artigo em Inglês, Espanhol, Português | LILACS, BDENF - Enfermagem | ID: biblio-1284571

RESUMO

OBJETIVO: Identificar na literatura científica a aplicação da laserterapia de baixa intensidade no tratamento de traumas mamilares em puérperas. MÉTODO: Trata-se de uma revisão integrativa da literatura. O levantamento das publicações ocorreu no período de setembro a novembro de 2020, utilizando os descritores "low-level light therapy" e "laser therapy", além da palavra-chave: "nipple trauma", nas bases de dados da PubMed, EMBASE, CINAHL, Scopuse Web of Science.Após a leitura e análise dos artigos, 3 artigos foram selecionados para a amostra final. RESULTADOS: Os dados analisados compuseram dois eixos temáticos denominados: "Uso da laserterapia no alívio da dor mamilar" e "Uso da laserterapia na cicatrização de fissuras mamilares". CONCLUSÃO: A aplicação da laserterapia resultou na diminuição da dor e boa regeneração tecidual mamilar, contribuindo para manutenção do aleitamento materno.


OBJECTIVE: To identify in the scientific literature the application of low-level laser therapy in the treatment of nipple traumas in puerperal women. METHOD: This is an integrative literature review.The survey of publications took place from September to November2020, using the descriptors "low-level light therapy" and "laser therapy", in addition to the keyword"nipple trauma", in the PubMed, EMBASE, CINAHL, Scopus and Web of Science databases.After reading and analyzing the articles, 3 were selected for the finalsample. RESULTS: The analyzed data composed two thematic axes, namely: "The use of laser therapy for nipple pain relief" and "The use of laser therapy in the healing of nipple fissures". CONCLUSION: The application of laser therapy resulted in pain reduction and in good nipple tissue regeneration, contributing to the maintenance of breastfeeding.


OBJETIVO: Identificar en la literatura científica la aplicación de laserterapia de baja intensidad en el tratamiento del traumatismo del pezón en mujeres posparto. MÉTODO: Se trata de una revisión integradora de la literatura. El levantamiento de publicaciones se realizó de septiembre a noviembre de 2020, utilizando los descriptores "low-level light therapy" y "laser therapy", además de la palabra clave: "nipple trauma", en las bases de datos de PubMed, EMBASE, CINAHL, Scopus y Web of Science. Después de leer y analizar los artículos, se seleccionaron 3 artículos para la muestra final. RESULTADOS: Los datos analizados comprendieron dos ejes temáticos denominados: "Uso de laserterapia para aliviar el dolor del pezón" y "Uso de laserterapia para la cicatrización de las grietas del pezón". CONCLUSIÓN: La aplicación de laserterapia dio como resultado una disminución del dolor y una buena regeneración del tejido del pezón, contribuyendo al mantenimiento de la lactancia.


Assuntos
Humanos , Feminino , Doenças Mamárias/radioterapia , Aleitamento Materno , Terapia com Luz de Baixa Intensidade , Período Pós-Parto , Cicatrização , Mastodinia
6.
Gynecol Obstet Fertil Senol ; 49(5): 493-499, 2021 05.
Artigo em Francês | MEDLINE | ID: mdl-33757920

RESUMO

Breast pain is a concern in perimenopausal and postmenopausal women, quantifiable using validated tools, and may pre-exist or appear after initiation of a HRT. OBJECTIVES: A review of the literature was conducted to evaluate the frequency of breast pain, its evolution with age, its changes under HRT, its link with a possible risk of subsequent breast cancer, and the diagnostic (breast imaging) or therapeutic management modalities (pharmacological or other) in women taking HRT. METHOD: A review of the literature was carried out by consulting Medline, Cochrane Library data and international recommendations in French and English up to the end of 2019. RESULTS: Published data confirm the importance of breast pain in relation to breast cancer risk. Women with breast pain prior to or related to the use of HRT have a significantly increased risk of breast cancer compared to women without breast pain. The risk is increased in cases of moderate to severe breast pain. In the presence of diffuse breast pain without abnormalities on clinical examination, it is not recommended to change the usual indications for screening, whether organized or individual. For focal breast pain, breast imaging (mammography and possibly ultrasound) is recommended. In the absence of abnormalities on breast imaging, a reassuring dialogue has to take place. With regard to HRT, doses of estrogens should be reduced until the breast pain decreases, or even stop the HRT if this symptom persists despite the use of low doses. Wearing a bra brassiere-type can also reduce breast pain.


Assuntos
Neoplasias da Mama , Mastodinia , Neoplasias da Mama/terapia , Feminino , Seguimentos , Humanos , Mastodinia/diagnóstico , Mastodinia/terapia , Menopausa , Pós-Menopausa , Encaminhamento e Consulta
7.
Complement Ther Clin Pract ; 43: 101346, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33691268

RESUMO

BACKGROUND: and Purpose: Breast pain is a common condition presented at breast care clinics and bras are often recommended to reduce symptoms, although criteria and pathways for obtaining appropriate bras are limited. This multi-study, randomised controlled trial (RCT) aimed to establish criteria and performance variables to prescribe bras for breast pain patients, to implement this bra prescription, and evaluate whether, compared to standard care alone, the bra prescription improves breast pain and quality of life (QoL). MATERIALS AND METHODS: Eighteen breast pain patients from a UK hospital were assigned to standard care or bra prescription groups and completed the study. Bra prescription patients were prescribed a bra to wear every day for eight weeks. Patient Global Impression of Change (PGIC), breast pain intensity, QoL, and adherence were assessed. RESULTS: Between-groups there were no differences in baseline breast pain or QoL and no differences in PGIC or breast pain following the intervention. Within-groups, improvements in QoL within bra prescription patients were identified. CONCLUSION: This study developed a framework for bra prescription for breast pain patients and the intervention demonstrated improvements in QoL.


Assuntos
Mastodinia , Qualidade de Vida , Mama , Humanos , Mastodinia/tratamento farmacológico , Prescrições
9.
Sci Rep ; 11(1): 2620, 2021 01 29.
Artigo em Inglês | MEDLINE | ID: mdl-33514830

RESUMO

The aim of this study is to compare patients with and without mastalgia and to analyze the factors affecting mastalgia and its severity. The patient's age, height, weight, educational status, marital status, and occupation were recorded in all subjects. In addition, the women were asked about the presence of any risk factors for mastalgia, such as tea and coffee consumption, smoking, alcohol consumption, and weight gain. The sternal notch to nipple distance (SNND) was measured to determine whether there was breast sagging. Mastalgia was significantly more common in women with BMIs of > 30 kg/m2 (OR: 2.94, CI 1.65-5.24), those who were primary school graduates or illiterate (OR: 2.96, CI 1.6-5.46), and those with SNND values of 22-25 cm (OR: 2.94, CI 1.79-4.82). In these women, drinking more than 6 cups of tea a day (OR: 2.15, CI 1.32-3.5), smoking at least 10 cigarettes a day (OR: 2.94, CI 1.78-4.83), and drinking alcohol at least once a week (OR: 2.1, CI 1.12-3.91) were found to be important factors that increased the risk of mastalgia. As a result, it has been found that severe mastalgia complaints cause by obesity, sagging breasts, never giving birth, unemployment anxiety, regular smoking, alcohol use, and excessive tea consumption.


Assuntos
Mastodinia/epidemiologia , Adulto , Consumo de Bebidas Alcoólicas/efeitos adversos , Estudos de Casos e Controles , Feminino , Humanos , Estilo de Vida , Pessoa de Meia-Idade , Obesidade/patologia , Fatores de Risco , Fumar/efeitos adversos , Adulto Jovem
10.
Breastfeed Med ; 16(3): 222-229, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33305973

RESUMO

Background: Nipple pain is a common cause of early cessation of breastfeeding. A nipple shield (shield) is often used to improve breastfeeding comfort. There are concerns that shield use may limit milk transfer. The aims of this study were to determine whether shield use reduces milk transfer and maternal nipple pain. Methods: A within-subject study of two groups of breastfeeding dyads (infants <6 months) was conducted; Control Group (CG): no breastfeeding difficulties; Pain Group (PG) shield used for nipple pain. There were two monitored sessions where shield use was randomized. Test weights and pain questionnaires were completed, and percentage of available milk removed (PAMR) was calculated. Results: Twenty-five PG (6 ± 4 postnatal weeks) and 34 CG (9 ± 6 postnatal weeks) had similar 24-hour milk production (PG: 676 ± 239 mL, CG: 775 ± 162 mL, p = 0.083). PG mean milk transfer volume and PAMR did not differ with shield use (no shield: 46 mL, 59%; shield: 40 mL, 53%, volume p = 0.38, PAMR p = 0.64). CG mean volume and PAMR were reduced with shield use (no shield: 65 mL, 64%; shield: 31 mL, 33%, volume p < 0.001, PAMR p < 0.001). PG pain scores were similar with and without shield use (Visual Analog Scale p = 0.44, McGill p = 0.97). Conclusions: Shield use did not impact either milk production or milk transfer in breastfeeding women experiencing nipple pain.


Assuntos
Mastodinia , Mamilos , Animais , Aleitamento Materno , Feminino , Humanos , Lactente , Leite , Equipamentos de Proteção
11.
Breastfeed Med ; 16(4): 318-324, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33305975

RESUMO

Introduction: Health care providers treating lactating women for nipple and breast pain often attribute symptoms to Candida albicans infection. However, multiple other conditions may present with pain, erythema, and pruritis. We explored the experience of a breastfeeding medicine practice that received referrals for patients failing antifungal therapy and who desired further evaluation for alternative diagnoses. Materials and Methods: We conducted a retrospective chart review of breastfeeding women referred for evaluation of "yeast" to a breast surgery/breastfeeding medicine practice from July 2016 to August 2019. Results: Twenty-five women met inclusion criteria. Median age was 33 (range 24-43) and median months postpartum was 4 (range 0.5-18). All 25 women reported minimal to no improvement on oral and/or topical antifungal therapy. In addition to history and examination, milk culture was obtained in four women, punch biopsy in one, and core needle biopsy in one. No woman was confirmed to have a diagnosis of Candida. Diagnoses were changed to the following: subacute mastitis/mammary dysbiosis (n = 8), nipple bleb (n = 6), dermatitis (n = 6), vasospasm (n = 2), milk crust (n = 1), hyperlactation (n = 1), and postpartum depression (n = 1). Treatment included discontinuation of antifungal medication, as well as the following per individual diagnoses: antibiotics and probiotics; 0.1% triamcinolone cream; heat therapy; discontinuation of exclusive pumping; and antidepressant medication and counseling referral. All women experienced resolution of symptoms following revision of diagnosis and change in management (range 2-42 days). Conclusion: While persistent nipple and breast pain in breastfeeding is often attributed to Candida, this cohort demonstrates that providers should consider multiple other conditions in their differential diagnosis. Accurate, timely diagnosis is crucial, as pain is a risk factor for premature cessation of breastfeeding. Symptomatic resolution occurs on appropriate therapy.


Assuntos
Doenças Mamárias , Mastodinia , Doenças Mamárias/tratamento farmacológico , Aleitamento Materno , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactação , Mastodinia/tratamento farmacológico , Mamilos , Estudos Retrospectivos
12.
Breastfeed Med ; 16(1): 82-92, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33030349

RESUMO

Objectives: To investigate the effect of kinesio taping (KT) and manual lymphatic drainage (MLD) on pain severity, breast engorgement, and milk volume in postpartum women. Materials and Methods: In this prospective randomized-controlled trial, we recruited 67 postpartum women who had breast engorgement and randomly assigned them to the KT, MLD, and control group. In the KT group, taping plus breast care was performed, MLD plus breast care was performed in the MLD group, and in the control group, only routine breast care was given for 10 days. Pain, breast engorgement, body temperature, and milk volume were measured. Examinations were repeated on days 1, 4, and 10. Results: The MLD group had significant reductions in pain and breast engorgement at all postintervention days compared with the control and KT group (p < 0.05). Milk volume increased among three groups, but the change in the MLD group was higher than in the KT and control groups (p < 0.05). There was no significant difference in the milk volume among the KT and control groups at all postintervention days (p > 0.05). Conclusions: MLD relieved breast pain and firmness more and increased milk volume in postpartum women compared with the KT and control groups. MLD can be recommended to postnatal mothers to better manage breast engorgement.


Assuntos
Drenagem Linfática Manual , Mastodinia , Aleitamento Materno , Feminino , Humanos , Período Pós-Parto , Estudos Prospectivos
13.
Radiat Oncol ; 15(1): 235, 2020 Oct 13.
Artigo em Inglês | MEDLINE | ID: mdl-33050920

RESUMO

BACKGROUND: Intensity-modulated radiotherapy (IMRT) improves dose homogeneity and late toxicity compared to simple tangential techniques in adjuvant whole-breast radiotherapy for patients with breast cancer. Simultaneous-integrated boost (SIB) radiotherapy shortens the overall treatment time and improves dose homogeneity. However, prospective randomized trials regarding IMRT with SIB for adjuvant radiotherapy in breast cancer are lacking. METHODS: The IMRT-MC2 (MINT) trial is a phase III prospective randomized controlled trial comparing IMRT with SIB (Arm A: whole breast 28 × 1.8 Gy, Boost 28 × 2.3 Gy) to 3D-conformal radiotherapy with a sequential boost (Arm B: whole breast 28 × 1.8 Gy, boost 8 × 2 Gy) in patients with breast cancer after BCS. Indication for boost radiotherapy was defined as age < 70 years or age > 70 years with presence of additional risk factors. This is a retrospective analysis of acute toxicity at one of two trial sites. RESULTS: Five hundred two patients were randomized, of which 446 patients were eligible for this analysis. There was no statistically significant difference in terms of any grade radiation dermatitis between the two treatment arms at the end of treatment (p = 0.26). However, radiation dermatitis grade 2/3 (29.1% vs. 20.1 and 3.5% vs. 2.3%) occurred significantly more often in Arm A (p = 0.02). Breast/chest wall pain at the first follow-up visit was significantly more common in patients treated on Arm B (p = 0.02). CONCLUSIONS: Treatment on both arms was well tolerated, however there were some differences regarding radiodermatitis and breast pain. Further analyses are ongoing. TRIAL REGISTRATION: clinicaltrials.gov , NCT01322854 , registered 24th March 2011.


Assuntos
Neoplasias da Mama/radioterapia , Radioterapia Conformacional/efeitos adversos , Reirradiação/efeitos adversos , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Feminino , Humanos , Mastodinia/etiologia , Pessoa de Meia-Idade , Estudos Prospectivos , Radiodermatite/etiologia , Radioterapia Adjuvante , Radioterapia de Intensidade Modulada/efeitos adversos , Estudos Retrospectivos
14.
Cochrane Database Syst Rev ; 9: CD006946, 2020 09 18.
Artigo em Inglês | MEDLINE | ID: mdl-32944940

RESUMO

BACKGROUND: Engorgement is the overfilling of breasts with milk, often occurring in the early days postpartum. It results in swollen, hard, painful breasts and may lead to premature cessation of breastfeeding, decreased milk production, cracked nipples and mastitis. Various treatments have been studied but little consistent evidence has been found on effective interventions. OBJECTIVES: To determine the effectiveness and safety of different treatments for engorgement in breastfeeding women. SEARCH METHODS: On 2 October 2019, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP), and reference lists of retrieved studies. SELECTION CRITERIA: All types of randomised controlled trials and all forms of treatment for breast engorgement were eligible. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for eligibility, extracted data, conducted 'Risk of bias' assessment and assessed the certainty of evidence using GRADE. MAIN RESULTS: For this udpate, we included 21 studies (2170 women randomised) conducted in a variety of settings. Six studies used individual breasts as the unit of analysis. Trials examined a range of interventions: cabbage leaves, various herbal compresses (ginger, cactus and aloe, hollyhock), massage (manual, electromechanical, Oketani), acupuncture, ultrasound, acupressure, scraping therapy, cold packs, and medical treatments (serrapeptase, protease, oxytocin). Due to heterogeneity, meta-analysis was not possible and data were reported from single trials. Certainty of evidence was downgraded for limitations in study design, imprecision and for inconsistency of effects. We report here findings from key comparisons. Cabbage leaf treatments compared to control For breast pain, cold cabbage leaves may be more effective than routine care (mean difference (MD) -1.03 points on 0-10 visual analogue scale (VAS), 95% confidence intervals (CI) -1.53 to -0.53; 152 women; very low-certainty evidence) or cold gel packs (-0.63 VAS points, 95% CI -1.09 to -0.17; 152 women; very low-certainty evidence), although the evidence is very uncertain. We are uncertain about cold cabbage leaves compared to room temperature cabbage leaves, room temperature cabbage leaves compared to hot water bag, and cabbage leaf extract cream compared to placebo cream because the CIs were wide and included no effect. For breast hardness, cold cabbage leaves may be more effective than routine care (MD -0.58 VAS points, 95% CI -0.82 to -0.34; 152 women; low-certainty evidence). We are uncertain about cold cabbage leaves compared to cold gel packs because the CIs were wide and included no effect. For breast engorgement, room temperature cabbage leaves may be more effective than a hot water bag (MD -1.16 points on 1-6 scale, 95% CI -1.36 to -0.96; 63 women; very low-certainty evidence). We are uncertain about cabbage leaf extract cream compared to placebo cream because the CIs were wide and included no effect. More women were satisfied with cold cabbage leaves than with routine care (risk ratio (RR) 1.42, 95% CI 1.22 to 1.64; 152 women; low certainty), or with cold gel packs (RR 1.23, 95% CI 1.10 to 1.38; 152 women; low-certainty evidence). We are uncertain if women breastfeed longer following treatment with cold cabbage leaves than routine care because CIs were wide and included no effect. Breast swelling and adverse events were not reported. Compress treatments compared to control For breast pain, herbal compress may be more effective than hot compress (MD -1.80 VAS points, 95% CI -2.07 to -1.53; 500 women; low-certainty evidence). Massage therapy plus cactus and aloe compress may be more effective than massage therapy alone (MD -1.27 VAS points, 95% CI -1.75 to -0.79; 100 women; low-certainty evidence). In a comparison of cactus and aloe compress to massage therapy, the CIs were wide and included no effect. For breast hardness, cactus and aloe cold compress may be more effective than massage (RR 0.66, 95% CI 0.51 to 0.87; 102 women; low-certainty evidence). Massage plus cactus and aloe cold compress may reduce the risk of breast hardness compared to massage alone (RR 0.38, 95% CI 0.25 to 0.58; 100 women; low-certainty evidence). We are uncertain about the effects of compress treatments on breast engorgement and cessation of breastfeeding because the certainty of evidence was very low. Among women receiving herbal compress treatment, 2/250 experienced skin irritation compared to 0/250 in the hot compress group (moderate-certainty evidence). Breast swelling and women's opinion of treatment were not reported. Medical treatments compared to placebo Protease may reduce breast pain (RR 0.17, 95% CI 0.04, 0.74; low-certainty evidence; 59 women) and breast swelling (RR 0.34, 95% CI 0.15 to 0.79; 59 women; low-certainty evidence), whereas serrapeptase may reduce the risk of engorgement compared to placebo (RR 0.36, 95% CI 0.14 to 0.88; 59 women; low-certainty evidence). We are uncertain if serrapeptase reduces breast pain or swelling, or if oxytocin reduces breast engorgement compared to placebo, because the CIs were wide and included no effect. No women experienced adverse events in any of the groups receiving serrapeptase, protease or placebo (low-certainty evidence). Breast induration/hardness, women's opinion of treatment and breastfeeding cessation were not reported. Cold gel packs compared to control For breast pain, we are uncertain about the effectiveness of cold gel packs compared to control treatments because the certainty of evidence was very low. For breast hardness, cold gel packs may be more effective than routine care (MD -0.34 points on 1-6 scale, 95% CI -0.60 to -0.08; 151 women; low-certainty evidence). It is uncertain if women breastfeed longer following cold gel pack treatment compared to routine care because the CIs were wide and included no effect. There may be little difference in women's satisfaction with cold gel packs compared to routine care (RR 1.17, 95% CI 0.97 to 1.40; 151 women; low-certainty evidence). Breast swelling, engorgement and adverse events were not reported. AUTHORS' CONCLUSIONS: Although some interventions may be promising for the treatment of breast engorgement, such as cabbage leaves, cold gel packs, herbal compresses, and massage, the certainty of evidence is low and we cannot draw robust conclusions about their true effects. Future trials should aim to include larger sample sizes, using women - not individual breasts - as units of analysis.


Assuntos
Doenças Mamárias/terapia , Transtornos da Lactação/terapia , Terapia por Acupuntura , Brassica , Doenças Mamárias/etiologia , Crioterapia/métodos , Feminino , Humanos , Massagem , Mastodinia/terapia , Ocitocina/uso terapêutico , Peptídeo Hidrolases/uso terapêutico , Fitoterapia/métodos , Folhas de Planta , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Terapia por Ultrassom/métodos
15.
Medicine (Baltimore) ; 99(33): e21516, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32871998

RESUMO

INTRODUCTION: Breast filler injections are less commonly used due to their associated complications, such as pain and foreign body reactions. Yet, these fillers are often administered illegally, resulting in aesthetic or life-threatening complications. These are treated by removing the foreign material, and the breasts are reconstructed using silicone implants or autologous tissue/fat injection. PATIENT CONCERNS: Case 1. A 45-year-old woman with polyacrylamide gel injections in both breasts visited our clinic for breast pain and tenderness. Grade I ptosis was observed in each breast, without skin necrosis and discoloration. Case 2. A 51-year-old woman, with unknown breast filler injections, visited our clinic for painful masses. Intraoperatively, massive amounts of foreign material had severely infiltrated the nearby tissues; thus, an immediate breast reconstruction could not be performed. Three months later, severe deformities including shrinkage and irregular breast skin surfaces were observed. DIAGNOSIS: Case 1. Multiple cystic lesions, fluid collection in the retromammary spaces, and diffuse infiltration were observed on mammography, computed tomography, and ultrasonography. Case 2. Multiple cystic lesions, calcified areas, and diffuse infiltrations in the axillae and retromammary spaces were observed on mammography, computed tomography, and ultrasonography. INTERVENTIONS: Case 1. The foreign material was removed and the breasts were reconstructed using silicone implants into subpectoral pocket with acellular dermal matrices (Alloderm, Lipocell Corporation). Case 2. A delayed reconstruction was undertaken using silicone implants covered by latissimus dorsi muscle flaps, 3 months after the foreign material removal. OUTCOMES: Case 1. The foreign material was removed and there were no complications such as foreign body reaction, capsular contracture. Ptosis was corrected and both breasts were symmetric with proper projection. Case 2. Residual foreign material was removed and there were no complications such capsular contracture, implant malposition. CONCLUSION: Massive injections of foreign materials into the breast can cause severe infiltration and associated foreign body reactions. By a near-complete removal of the foreign materials and breast reconstruction using silicone implants, we achieved satisfactory results, without complications such as wound disruption, capsular contracture, and implant malposition.


Assuntos
Resinas Acrílicas/efeitos adversos , Preenchedores Dérmicos/efeitos adversos , Reação a Corpo Estranho/cirurgia , Mamoplastia/métodos , Mastodinia/cirurgia , Feminino , Reação a Corpo Estranho/induzido quimicamente , Humanos , Mastodinia/induzido quimicamente , Pessoa de Meia-Idade
16.
Ann Surg Oncol ; 27(12): 4844-4852, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32748152

RESUMO

BACKGROUND: Saturated fatty acid esters may cause mastalgia via hypersensitivity of breast epithelium to circulating hormones. Evening primrose oil (EPO) may restore the saturated/unsaturated fatty acid balance and decrease sensitivity to steroidal hormones or prolactin. Conflicting results exist regarding EPO treatment for mastalgia. The aim of this study was to determine the effectiveness of EPO and factors affecting its efficacy in treatment of mastalgia. METHODS: The study included 1015 patients, ages 14-82 (mean age 42.21 ± 10.8), admitted to Acibadem Breast Clinic between January 2015 and March 2018. The patients were divided into group I (n = 581) treated with EPO (1300 mg, twice a day) and group II (n = 434) treated with paracetamol (500 mg, twice a day). The visual analog scale was used to assess EPO's therapeutic efficacy, compared with paracetamol, measured at admittance, 2 weeks, and 6 weeks. Clinical factors affecting the efficacy of EPO were analyzed. RESULTS: The therapeutic efficacy of EPO on mastalgia was significantly higher than with paracetamol (p < 0.001). Factors significantly affecting the efficacy of EPO treatment were hormone replacement therapy (HRT), IUD-with-levonorgestrel, iron deficiency, overt hypothyroidism, and Hashimoto thyroiditis (p < 0.01). Replacement of iron or thyroid hormone efficiently treated mastalgia in patients that did not respond to EPO treatment. Side effects (allergy, anxiety, blurred vision, constipation, and nausea) were rare and not statistically significant (p = 0.88). CONCLUSION: EPO can be used in the treatment of mastalgia without significant side effects. HRT, IUD-with-levonorgestrel, iron deficiency, overt hypothyroidism, and Hashimoto thyroiditis significantly affect the efficacy of EPO on mastalgia.


Assuntos
Mastodinia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Ácidos Linoleicos , Mastodinia/tratamento farmacológico , Mastodinia/etiologia , Pessoa de Meia-Idade , Óleos Vegetais , Adulto Jovem , Ácido gama-Linolênico/uso terapêutico
17.
Am J Case Rep ; 21: e921360, 2020 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-32756533

RESUMO

BACKGROUND Breast metastases from melanoma are rare. Amelanotic melanoma is difficult to diagnose, as primary lesions not only lack the pigment typical of melanoma, but also lack other features associated with these tumors, including asymmetry, irregular borders, and color variegation. CASE REPORT A 58-year-old woman presented with an enlarging mass on her left breast, a finding confirmed by physical examination. Mammography showed a 10-cm breast mass of category 4 according to the Breast Imaging Reporting and Data System (BI-RADS). Staging computed tomography (CT) showed widely scattered metastatic sites in the brain, lungs, mediastinum, and adrenal glands. A biopsy of the mass in her left breast was non-diagnostic due to extensive necrosis. Because of severe pain, simple left breast mastectomy was performed. Tissue from the mastectomy revealed a diagnosis of amelanotic malignant melanoma. CONCLUSIONS Diagnosing amelanotic melanoma is difficult without tissue biopsy as these tumors lack the typical features of melanoma and can mimic other dermatologic diseases. This frequently results in a significant delay in diagnosing amelanotic melanoma, with patients often presenting with advanced stage disease having poor prognosis.


Assuntos
Neoplasias da Mama , Mastodinia , Melanoma Amelanótico , Neoplasias Cutâneas , Neoplasias da Mama/diagnóstico , Diagnóstico Tardio , Feminino , Humanos , Mastectomia , Melanoma Amelanótico/diagnóstico , Pessoa de Meia-Idade , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/cirurgia
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