Caracterización morfométrica nuclear de glándulas mamarias sanas en mujeres adultas mayores

Introducción: Las glándulas mamarias son órganos que durante las diferentes etapas de la vida en la mujer sufren modificaciones, donde se involucran los procesos de proliferación, diferenciación y apoptosis, bajo el control hormonal. Sin embargo, una vez que cesan dichas influencias hormonales ocurren cambios que llevan a la involución de dicho órgano. Objetivo: Caracterizar el factor de forma, perímetro, área y volumen de los núcleos de las células epiteliales glandulares mamarias. Métodos: Para caracterizar las glándulas mamarias sanas en mujeres de 60 años y más, se realizó un estudio de serie de casos en 14 mujeres fallecidas que no tenían lesiones benignas o malignas del órgano. Todas examinadas por el departamento de Anatomía Patológica del Hospital Provincial Vladimir Ilich Lenin en Holguín, en el período comprendido de septiembre 2018 a septiembre 2019. Para mejor valoración, la muestra de estudio se dividió en dos grupos de edades: de 60-75 años de edad y mayores de 75 años. Resultados: Tanto el factor de forma como el perímetro, área y volumen de los núcleos de las células epiteliales de los conductos mamarios son menores en las mujeres mayores de 75 años. Conclusiones: Existen diferencias notables en los indicadores morfométricos estudiados en ambos grupos de edades. Específicamente el tamaño y la forma de los núcleos de células epiteliales se ven afectados con la edad, lo cual se corresponde con la baja actividad metabólica de las células epiteliales mamarias en esta etapa de la vida.

Introduction: The mammary glands are organs that during the different stages of life in women undergo modifications, where the processes of proliferation, differentiation and apoptosis are involved, under hormonal control. However, once these hormonal influences cease, changes occur that lead to the involution of said organ. Objective: To determine the shape factor, perimeter, area and volume of the nuclei of glandular epithelial cells. Methods: To characterize healthy mammary glands in women aged 60 years and older, a case series study was conducted on 14 deceased women who had no benign or malignant lesions of the organ. All examined by the Department of Pathological Anatomy of the Provincial Hospital V.I. Lenin in Holguín, in the period between September, 2018 - September, 2019. For a better assessment, the study sample was divided into two age groups: from 60 to 75 years of age; age and older than 75 years. Results: Both the shape factor and the perimeter, area and volume of the nuclei of the epithelial cells of the mammary ducts are lower in women older than 75 years. Conclusions: There are notable differences in the morphometric indicators studied. Epithelial cell nuclei are affected with age, which corresponds to the low metabolic activity of mammary epithelial cells at this stage of life.

Representações sociais de puérperas sobre as mamas no aleitamento / Representaciones sociales de puérperas sobre la pechos en lactancia / Social representations of puerperals about the breast in breastfeeding

Objetivo: Apreender representações sociais de puérperas sobre as mamas no período do aleitamento. Método: Pesquisa qualitativa, fundamentada na teoria das representações sociais. Utilizou-se o teste de associação livre de palavras, aplicado a 95 puérperas num Centro de Parto Normal de Salvador-Ba, no período de novembro de 2017 a fevereiro de 2018. Realizou-se a análise da estrutura das representações sociais a partir da árvore de similitude das evocações livres. Resultados: As representações sociais das puérperas sobre as mamas são marcantemente a dor e o tamanho, influenciadas por elementos periféricos que envolvem o ato de amamentar e a saúde, estando associadas as suas crenças, conhecimentos e valores afetivos. As participantes reconhecem que as mamas são partes importantes do corpo que requerem cuidado cotidianamente. Conclusão: Os achados corroboram para novos olhares para subjetividades que envolvem o aleitamento, podendo nortear práticas de cuidado em saúde que colaborem para satisfação enquanto nutriz.(AU)

Objective: To apprehend social representations of postpartum women about their breasts during the breastfeeding period. Method: Qualitative research, based on the theory of social representations. The free word association test was used, applied to 95 postpartum women in a Normal Delivery Center in Salvador-Ba, from November 2017 to February 2018. The analysis of the structure of social representations was carried out from the tree of similarity of free evocations. Results: The postpartum women's social representations about the breasts are markedly pain and size, influenced by peripheral elements that involve the act of breastfeeding and health, being associated with their beliefs, knowledge and affective values. Participants recognize that the breasts are important parts of the body that require daily care. Conclusion: The findings corroborate new perspectives on subjectivities that involve breastfeeding, which may guide health care practices that contribute to satisfaction as a nursing mother.(AU)

Objetivo: Aprender las representaciones sociales de las mujeres posparto sobre sus senos durante el período de lactancia. Método: Investigación cualitativa, basada en la teoría de las representaciones sociales. Se utilizó la prueba de asociación libre de palabras, aplicada a 95 puérperas en un Centro de Parto Normal en Salvador-Ba, de noviembre de 2017 a febrero de 2018. El análisis de la estructura de las representaciones sociales se realizó a partir del árbol de similitud de evocaciones libres. Resultados: Las representaciones sociales de las mujeres posparto sobre las mamas son marcadamente dolorosas y de tamaño, influenciadas por elementos periféricos que involucran el acto de la lactancia materna y la salud, estando asociadas a sus creencias, conocimientos y valores afectivos. Los participantes reconocen que los senos son partes importantes del cuerpo que requieren cuidados diarios. Conclusión: Los hallazgos corroboran nuevas perspectivas sobre subjetividades que involucran la lactancia materna, las cuales pueden orientar prácticas de cuidado de la salud que contribuyan a la satisfacción como madre lactante.(AU)

Cáncer de mama en hombre: Presentación de caso / Male Breast Cancer: Case Report

El cáncer de mama en hombres es poco frecuente, representa menos del 1 % de todos los cánceres masculinos, se presenta entre los 60-70 años con un pico de edad de 67 años; el carcinoma ductal invasivo es el que prevalece en varones, clínicamente se detecta como un nódulo unilateral indoloro retroareolar, o paraareolar. A diferencia de la mujer donde se realizan estudios de tamizaje, en los hombres suele diagnosticarse más tarde, porque buscan atención médica tardíamente por la poca incidencia de cáncer en pacientes masculinos, por la ausencia de signos y síntomas tempranos. Actualmente se puede utilizar para el diagnóstico la mamografía que ayuda a diferenciar entre enfermedades mamarias benignas y malignas. En este artículo se presenta el caso clínico de un paciente que acude al Instituto Hondureño de Seguridad Social, a quien se le diagnosticó carcinoma ductal.

Breast cancer in men is rare, it represents less then 1% of all male cancers, it's present between the ages of 60 through 70 years with an age peak at 67 years; the invasive ductal carcinoma is the most prevalent in men. Clinically, it is detected as an odorless, unilateral retro- or paraareolar nodule. Unlike with women, where screening studies are performed, in men it's usually diagnosed later on, because the low incidence of this cancer in male patients and the absence of early signs and symptoms leads to a delayed search for medical attention delayed. For diagnosis, a mammography can be used that helps differentiate between benign and malign mammary diseases. In this article we presented the clinical case of a patient that visits the Honduran Social Security Institute, diagnosed with ductal carcinoma.

Mamoplastia pós-cirurgia bariátrica usando suporte protético complementar de contenção glandular / Breast augmentation after bariatric surgery by using complementary prosthetic support for glandular containment

INTRODUÇÃO: A pele de pacientes emagrecidas pós-cirurgia bariátrica apresenta alterações estruturais e proteômicas e não resiste ao peso das mamas, levando-as à flacidez residual precoce, exigindo suporte auxiliar. O objetivo é aplicar suporte auxiliar de lâmina de polipropileno não absorvível mais poliglecaprone absorvível ou lâmina de silicone de bustos, em forma de "soutien interno" como auxiliar de sustentação da pele, para manutenção da forma das mamas, e flacidez no mínimo comparável a outras pacientes sem emagrecimento pela cirurgia bariátrica. MÉTODOS: Nove pacientes foram submetidas à mamoplastia em T invertido com modelagem dos tecidos mamários, com redução do volume e envolvidos com lâmina de sustentação auxiliar. RESULTADOS: Não houve flacidez precoce e em observação de até 4 anos ela era aceitável. Uma delas apresentou seroma, drenado com boa resolução. Serão operadas outras 24 pacientes dentro do protocolo, acompanhadas e observadas por 2 anos com controle mamográfico, ultrassônico e ressonância magnética. CONCLUSÃO: A mamoplastia redutora pós-cirurgia bariátrica requer suporte extra à glândula mamária. A pele estruturalmente alterada não suporta o seu peso e haverá flacidez precoce.

INTRODUCTION: The skin presents structural and proteomic changes after bariatric surgery and cannot withstand the weight of the breasts, which leads to early residual flaccidity, requiring auxiliary support. The goal is to apply a nonabsorbable polypropylene-poliglecaprone absorbable auxiliary mesh support or Bustos silicone sheet, in the form of an "internal brassiere," to support the skin in order to maintain the shape and flaccidity of the breasts comparable with those of normal breasts. METHODS: Nine patients underwent mammoplasty in inverted T with modeling of tissue implants, reduction of breast volume, and wrapping with an auxiliary support mesh. RESULTS: Flaccidity was not observed at an early stage and the condition was acceptable for up to 4 years of follow-up. One of the patients had a seroma, which was drained with good resolution. Another 24 patients will be operated according to the protocol and observed for 2 years by using mammography, ultrasonography, and magnetic resonance imaging. CONCLUSION: Reduction mammoplasty after bariatric surgery requires additional support for the mammary gland. The structurally altered skin could not support the weight of the breasts, resulting in early flaccidity.

Avaliação do posicionamento do complexo aréolo-papilar na evolução pós-operatória da cirurgia de mamoplastia de aumento / Evaluation of nipple-areola complex position after breast augmentation surgery

Patients submitted to augmentation mammoplasty are often concerned about the possibility of sagging breasts. Although plastic surgeons usually respond that this is unlikely, this is not supported by the literature. This study aimed to precisely understand the changes in nipple aréola complex position after breast implantation, especially phenomena of "tendency to ptosis" and "bottoming out." Methods: Medicai and photographic records were selected from among patients operated on at the Ivo Pitanguy Institute - 38th Infirmary of the Santa Casa de Misericordia of Rio de Janeiro from January 2009 to December 2010 and analyzed, and a literature review was performed. Results: Among 20 breasts in 10 patients, bottoming out was observed in 9 breasts in 6 patients, including 5 moderate and 4 mild. There was tendency to ptosis in 9 breasts in 5 patients, including 3 mild and 6 moderate. Only one breast did not present changes in the nipple-areola complex. Conclusion: Bottoming out and tendency to ptosis occur frequently after breast augmentation and require further to ptosis occur frequently after breast augmentation and require further study...

A mastoplastia de aumento, muito comumente, gera na paciente indagações acerca da possibilidade de queda das mamas. A resposta do cirurgião plástico é geralmente afirmativa, porém, este não encontra respaldo na literatura. Neste trabalho, objetivamos justamente entender a variação de posição do complexo aréolo-papilar pós-inclusão de implantes mamários observando, principalmente, os fenômenos de "tendência à ptose" e "bottoming out". Métodos: Seleção de prontuários dentre as pacientes operadas no Instituto Ivo Pitanguy - Enfermaria 38 da Santa Casa de Misericórdia do Rio de Janeiro de jan/2009 a dez/201O, com base em critérios de inclusão e exclusão, utilizando-se para esta pesquisa de revisão dos prontuários, registro fotográfico e revisão da literatura. Resultados: Dentre as 20 mamas (10 pacientes) analisadas observamos "bottoming out" em nove mamas (seis pacientes), das quais cinco de graus moderados e quatro leves. Houve "tendência à ptose" em nove mamas (cinco pacientes) sendo três leves e seis moderadas. Conclusão: Os fenômenos bottomlng out" e tendência à ptose" são uma realidade que precisa ser amplamente estudada para melhor esclarecimento das pacientes...

Inyección de sustancias externas para el aumento del tamaño mamario: representación mamográfica. Serie de casos / Injection of Foreign Substances to Increase Breast Size: Mammographic Representation. Case Series

Desde hace muchos años se ha introducido el uso de ciertas sustancias inyectables externas autólogas y/o halopáticas, con el objetivo de aumentar, reformar o restablecer el volumen de ciertas áreas corporales, especialmente los senos. Dentro de los métodos más observados se encuentra desde el uso del propio tejido adiposo extraído de otras zonas corporales del paciente hasta la aplicación de sustancias externas, que van desde la parafina hasta el hidrogel de poliacrilamida no protésico y el ácido hialurónico. Sin embargo, existen otros métodos de origen empírico, como sustancias oleosas, sintéticas o la mezcla de varias de estas, con las cuales se obtiene aumento del volumen del área deseada, pero con detrimento del estroma objeto de la inyección, el cual altera internamente su estructura; de esta forma, el parénquima, especialmente el mamario, sufre alteraciones irreversibles que se representan por medio de los estudios de imágenes diagnósticas. Estas alteraciones, por lo general, desencadenan hechos indeseables y llevan a una pérdida definitiva del tejido mamario, o derivan en algunas comorbilidades que pueden comprometer la salud del paciente en otros órganos, como se ha demostrado en varios casos descritos en la literatura. El artículo presenta cuatro casos.

For many years, the use of certain external injectable autologous and / or halopatic substances has been introduced, aiming to increase, amend or re-establish the volume of certain body areas, especially the breasts. One of the most observed methods includes the use of adipose tissue itself which is extracted from other body parts of the patient, as well as the application of external substances, ranging from the paraffin to the non-prosthetic polyacrylamide hydrogel and hyaluronic acid. However, there are other methods of empirical origin, such as oily, synthetic or a mixture of several of these substances. These methods achieve an increase of the volume of the desired area but at the expense of stromal which is the object of the injection, which internally alters its structure. In this manner, the parenchyma, especially the breast, suffers from irreversible changes which are represented through diagnostic imaging studies. Generally speaking, these alterations trigger events and lead to undesirable results and lead to a permanent loss of breast tissue, or are derived from some comorbidities that can compromise the health of the patient in other organs. This has been proven in several cases described in the literature. This article presents four cases.

La Lactancia y la madre / Breast feeding and the mother

Los beneficios de la lactancia en el recién nacido son conocidos y aceptados universalmente pero en cuanto a la madre, no se tiene este mismo nivel de información a pesar de ser un tema ampliamente investigado en la comunidad científica. En esta revisión se evalúan publicaciones que tratan precisamente sobre los efectos que la lactancia tiene en la madre, su asociación farmacológica, contraindicaciones y patología. Metodología: se realizó una búsqueda en la base de datos de Medline a través de Pubmed con los términos MeSH “mothers and breast feeding”, limitando la búsqueda a artículos de metanálisis. También se accedió a la base de datos de Cochrane y se realizó una búsqueda manual. La selección de los artículos se hizo de acuerdo con su pertinencia con el tema de esta revisión. En la búsqueda manual se incluyeron artículos relacionados con fisiología, interacciones medicamentosas y patología de la lactancia. Resultados: se revisan los efectos de la lactancia en la madre en cuanto a su desarrollo, contraindicaciones, beneficios, uso de fármacos y patologías de este período como la ingurgitación mamaria, grietas del pezón, galactocele y mastitis. Conclusiones: la lactancia conlleva beneficios que han sido evaluados en la madre, el niño, en los sistemas de salud y la sociedad. Para su desarrollo se requiere de una integración hormonal específica que tiene su mayor actividad durante el embarazo. Con la lactancia se han descrito beneficios maternos como menor ganancia de peso en el posparto y disminución en los riesgos de diabetes tipo 2, cáncer de ovario y de mama. En este período, se presentan relaciones especiales con algunos fármacos y patologías que son revisadas en el artículo.

The benefits of breastfeeding in the newborn are known and universally accepted but as the mother does not have this same level of information despite being a widely researched topic in the scientific community. This review assesses publications that deal specifically on the effects that breastfeeding has on the mother, her pharmacologic association, contraindications, and pathology. Methods: the Medline database was searched by Pubmed with the MeSH key words “mothers and breast feeding” with limits of meta-analysis publications. I also hand-searched relevant journals and Cochrane database. The publications were chosen because of their relationship with the issue Results: The search included articles related to physiology, drug interactions on breast feeding, hormonal regulations, contraindications, mother’s benefits and diseases of this period. Conclusion: breastfeeding produce benefits in the mother, babies, health systems and at large on society. To get a successful lactation a hormonal regulation should be developed specially during pregnancy. Breastfeeding has mother’s benefits such as a return to prepregnancy weight and lower risk on maternal type 2 diabetes, ovary and breast cancers. Breastfeeding special relationships with medications and diseases proper of this period are reviewed.