Traducción y adaptación transcultural al español (castellano) del instrumento Breast-Q® módulo reconstrucción mamaria / Evaluation of results in breast reconstruction from the patient's perspective: transcultural validation of Breast Q reconstruction module

Resumen Introducción El Breast-Q® módulo reconstrucción mamaria es un instrumento específico para evaluar la calidad de vida asociada a la cirugía mamaria desde el punto de vista del paciente. Objetivo Realizar la traducción y adaptación transcultural del Breast-Q® módulo reconstrucción mamaria Versión 2.0 al español chileno. Materiales y Método Se utilizaron las guías de validación lingüística del MAPI/TRUST Research Institute . El proceso consistió en traducción inglés-español, contra-traducción español-inglés, conciliación y aplicación piloto a 6 pacientes. Resultados Todas las pacientes comprendieron la encuesta y no existieron dudas sobre redacción y parámetros lingüísticos. No se requirieron más modificaciones. Conclusiones El proceso de traducción y adaptación cultural del instrumento fue completado exitosamente. El instrumento se encuentra listo para la validación lingüística.

Introduction The Breast Q Reconstruction Module is a specific instrument for assessing breast surgery related quality of life from the patient's perspective. Aim To carry out a transcultural translation and adaptation of version 2.0 to Chilean Spanish. Materials and Method Linguistic validation guides of the MAPI/TRUST Research Institute were used. The process consisted of English-Spanish translation, Spanish-English back translation, conciliation and pilot application of the scale in 6 patients. Results Patients had good understanding and no doubt about redaction and linguistic parameters. No further modifications were needed. Conclusions Traduction and cultural adaptation of the instrument was completed successfully in Chilean population. The instrument is ready for linguistic validation.

Sexuality, depression and body image after breast reconstruction

OBJECTIVES: To evaluate the impact of breast reconstruction after mastectomy on sexual function, body image, and depression. METHODS: This cross-sectional, comparative, controlled study was conducted with 90 women between 18 and 65 years of age who had undergone either mastectomy alone (mastectomy group, n=30) or mastectomy combined with breast reconstruction (mastectomy-reconstruction group, n=30) at least one year prior to the study or who had no breast cancer (control group, n=30). Patients were assessed for sexual function, depression, and body image using the validated Brazilian-Portuguese versions of the Female Sexual Function Index, the Beck Depression Inventory, and the Body Dysmorphic Disorder Examination, respectively. RESULTS: The three groups were homogeneous for age, marital status, body mass index, and education level. The women in the mastectomy group reported significantly worse sexual function, greater depressive symptoms, and lower body image than those in the mastectomy-reconstruction and control groups. In the mastectomy group, the frequency of sexual dysfunction was significantly greater among patients without a marital partner and those with a higher level of education than among patients in the other two groups with the same characteristics. CONCLUSION: Patients who had undergone breast reconstruction after mastectomy reported better sexual function and body image and fewer depressive symptoms than patients who had undergone mastectomy alone. Sexual dysfunction was associated with the absence of a marital partner and a higher level of education and was more frequent in the mastectomy group.

Patient satisfaction with breast reconstructionusing musculocutaneous flap from latissimus dorsiversus from rectus abdominis: a cross-sectional study

ABSTRACT BACKGROUND: Breast cancer is the second most frequent type of cancer worldwide and the most common type among women. The treatment for this condition has evolved over recent decades with therapeutic and technological advances. Breast reconstruction techniques using musculocutaneous flaps from the latissimus dorsi and rectus abdominis have aroused interest regarding patients' quality of life. Our goal here was to compare patients' satisfaction scores after they underwent breast reconstruction using musculocutaneous flaps from either the latissimus dorsi or the rectus abdominis. DESIGN AND SETTING: Primary, clinical, analytical, observational and cross-sectional study conducted in a federal university and a public hospital. METHODS: Demographic and clinical data were collected. The Mini-Mental State Examination was then applied, with testing for specificity and sensitivity. Lastly, a breast evaluation questionnaire was applied to evaluate breast satisfaction among 90 women, who were divided into three groups: mastectomy (control; n = 30); breast reconstruction using flap from the latissimus dorsi (n = 30); and reconstruction using flap from the rectus abdominis (n = 30). RESULTS: The groups were homogeneous regarding the main demographic data and the questionnaire responses (P < 0.05). Compared with the control group, the reconstruction groups showed significant improvement in satisfaction (P < 0.0002) after one year. CONCLUSION: Within our sample, women who underwent breast reconstruction with flaps from either the latissimus dorsi or the rectus abdominis had similar satisfaction scores.

Análisis de costo-utilidad en Colombia del tratamiento integral del carcinoma de seno con reconstrucción inmediata frente a la reconstrucción diferida / Immediate versus delayed breast reconstruction in breast cancer patients in Colombia: A costutility analysis

Resumen Introducción. La reconstrucción mamaria inmediata o diferida hace parte del tratamiento del cáncer de mama. Cada país y sistema de salud costea y evalúa estos procedimientos de forma diferente. Es importante determinar cuál estrategia resulta de mayor costo-utilidad en Colombia. Objetivo. Evaluar la costo-utilidad del tratamiento del cáncer de mama con reconstrucción inmediata, comparada con la reconstrucción diferida. Materiales y métodos. Se utilizó un modelo de árbol de decisiones con un plazo previsto de un año desde la perspectiva del tercer pagador. Los datos de costos se tomaron del manual tarifario del Instituto de Seguros Sociales de 2001 más un ajuste del 30 % según la metodología del Instituto de Evaluación Tecnológica en Salud y el modelo de facturación del Centro Javeriano de Oncología del Hospital Universitario San Ignacio. Las probabilidades de transición y las utilidades se obtuvieron de médicos especialistas, de las pacientes y de la literatura médica. Se hicieron los análisis univariado y probabilístico de sensibilidad. Resultados. Los costos esperados per cápita fueron de COP$ 26'710.605 (USD$ 11.165) para la reconstrucción inmediata y de COP$ 6'459.557 (USD$ 11.060) para la diferida. La reconstrucción inmediata generó un costo incremental de COP$ 251.049 (USD$ 105), así como 0,75 años de vida ajustados por calidad (AVAC), en tanto que la diferida generó 0,63 AVAC, con una relación de costoutilidad incremental de COP $2'154.675 por AVAC (USD$ 901). Conclusiones. El costo por AVAC no superó el umbral de aceptabilidad del producto interno bruto (PIB) per cápita. Los costos durante el primer año resultaron similares y ambas técnicas son favorables para el sistema de salud colombiano, pero la utilidad de la reconstrucción inmediata reportada por los pacientes y en la literatura médica, es mayor.

Abstract Introduction. Breast reconstruction, either immediate or delayed, is part of the treatment of breast cancer. Each country and health system pays for and evaluates these procedures in different ways. Thus, it is important to determine which strategy is most cost-effective in Colombia. Objective: To evaluate the cost-utility of breast cancer treatment with immediate reconstruction compared with delayed reconstruction. Materials and methods: We used a decision tree model and a one-year time horizon from the perspective of the third-party payer; the cost data were taken from the Colombian Instituto de Seguros Sociales 2001 rate manual plus a 30% adjustment according to the methodology of the Instituto de Evaluación Tecnológica en Salud, IETS, and the billing model of the Centro Javeriano de Oncología at the Hospital Universitario San Ignacio. The transition probabilities and profits were obtained from medical specialists, patients, and the medical literature. We also conducted univariate and probabilistic sensitivity analyses. Results: The expected costs per capita were COP$ 26,710,605 (USD$ 11,165) for the immediate reconstruction and COP$ 26,459,557 (USD$ 11,060) for the deferred reconstruction. Immediate reconstruction generated an incremental cost of COP$ 251,049 (USD$ 105) and 0.75 quality-adjusted life years (QALY), while deferred reconstruction generated 0.63 QALYs, with an incremental cost-utility ratio of COP$ 2,154,675 per QALY (USD$ 901). Conclusions: The cost per QALY did not exceed the acceptability threshold of the Gross Domestic Product (GDP) per capita. The costs for the first year were similar. Both techniques are favorable for the Colombian health system, but the utility reported by patients and the literature is greater with the immediate reconstruction.

Outcomes analysis of breast reduction in Brazilian women using the BREAST-Q® questionnaire: a cross-sectional controlled study

OBJECTIVE: The aim of this study was to analyse patient-reported outcomes of reduction mammoplasty among Brazilian women. METHODS: A total of 100 women were enrolled in this cross-sectional controlled study, 50 with breast hypertrophy (Hypertrophy Group) and 50 who had undergone breast reduction at least six and up to 12 months before (Mammoplasty Group). The Brazilian version of the BREAST-Q® was applied to assess patient-reported outcomes. The module reduction/mastopexy was used, and the preoperative and postoperative versions were applied to the hypertrophy and mammoplasty groups, respectively. RESULTS: The mammoplasty group presented higher scores for the subscales satisfaction with breasts, psychosocial well-being, sexual well-being and physical well-being (p=0.0001 for all of these subscales). CONCLUSION: These results suggest that patients submitted to reduction mammoplasty are satisfied with the outcomes and present better quality of life scores compared with women with breast hypertrophy.

Factores que afectan la calidad de vida en pacientes con cirugía de aumento mamario: estudio de cohorte / Factors that affect the quality of life of patients with breast augmentation surgery: a cohort study

Introducción: El instrumento Breast-Q® se ha ocupado para medir la calidad de vida de las pacientes sometidas a cirugía de aumento mamario. Se desconocen los factores que determinan la mejoría en la calidad de vida de estas pacientes. El objetivo de este trabajo es identificar los factores determinantes de la mejoría de la calidad de vida en pacientes sometidas a aumento mamario. Materiales y métodos: Se estudió una cohorte prospectiva de 52 pacientes sometidas a aumento mamario. Se estudiaron características sociodemográficas, mediciones antropométricas, variables relativas a la cirugía y se aplicó el instrumento Breast-Q®. Para el análisis estadístico se utilizó estadística descriptiva, el test de Wilcoxon para muestras pareadas y modelos de regresión lineal y logística. Resultados: Se encontró mejoría en la calidad de vida de forma global (p < 0,00001) y en todos los dominios salvo en el de «síntomas físicos¼. Dentro de los factores determinantes, existió una relación positiva entre el volumen de la prótesis y la mejoría en la calidad de vida de forma global (p = 0,032) y en los dominios «autoimagen y autoestima¼ (p = 0,01) y «vida sexual¼ (p = 0,001). Conclusión: La cirugía de aumento mamario incrementa significativamente la calidad de vida medido mediante el instrumento Breast-Q®. Los determinantes de la mejoría en la calidad de vida estarían directamente relacionados con el volumen de la prótesis.

Introduction: Breast-Q® instrument has been used for measuring the quality of life of patients undergoing breast augmentation surgery. The factors that determine the improvement in the quality of life of these patients are unknown. The aim of this work is to identify the determinant factors of improvement in the quality of life in patients undergoing breast augmentation. Materials and methods: A prospective cohort of 52 patients undergoing breast augmentation was studied. Sociodemographic features, anthropometric measurements, variables related to surgery were studied and the Breast-Q® instrument was applied. For statistical analysis it was used descriptive statistics and linear and logistic regression models. Results: We found improvement in the quality of life, globally (P < .00001) and in all domains except "physical symptoms’ domain. Among the determining factors, there was a positive correlation between the prosthesis volume and improvement in quality of life globally (P = .032) and in the domains "self-image and self-esteem" (P = .01) and "sexual life" (P = .001). Conclusion: Breast augmentation surgery significantly increases the quality of life measured by the Breast-Q® instrument. The determinant factors of improvement in quality of life, would be directly related to the implants volume.

¿Qué factores influyen en la satisfacción de los pacientes sometidos a reducción mamaria?: análisis de un estudio de cohorte utilizando el instrumento Breast-Q® / The factors that influence the satisfaction of patients subjected to breast reduction: analysis of a cohort study using Breast-Q® scores

Introducción: El instrumento Breast-Q® se ha ocupado de medir la calidad de vida de las pacientes sometidas a cirugía de reducción mamaria o mastopexia. Se desconocen los factores que determinan la mejoría en la calidad de vida de estas pacientes. El objetivo de este trabajo es identificar los factores determinantes de la mejoría de la calidad de vida en pacientes sometidas a reducción mamaria. Materiales y métodos: Se estudió una cohorte prospectiva de 41 pacientes sometidas a reducción mamaria o mastopexia sin implantes. Se estudiaron características sociodemográficas, mediciones antropométricas, variables relativas a la cirugía y se aplicó el instrumento Breast-Q®. Para el análisis estadístico se utilizó estadística descriptiva, modelos de ecuaciones de estimación generalizada y modelos de regresión lineal y logística. Resultados: Se encontró mejoría en la calidad de vida de forma global (p < 0,0001) y por dominios. Dentro de los factores determinantes, existió una relación positiva entre la magnitud de la resección y la mejoría en la calidad de vida de forma global (p = 0,032) y en el dominio de síntomas físicos (p = 0,012). Destaca además una mejoría del 50% con resecciones de tejido mamario sobre los 300 g. Conclusión: La cirugía de reducción mamaría y mastopexia incrementan significativamente la calidad de vida medida mediante el instrumento Breast-Q® en pacientes con hipertrofia o ptosis mamaria. Los determinantes de esta mejora estarían directamente relacionados con la cantidad de tejido resecado, con una mejoría del 50% con resecciones sobre los 300 g.

Introduction: Breast-Q® instrument has been used for measuring the quality of life of patients undergoing breast reduction or breast lift surgery. The factors that determine the improvement in the quality of life of these patients are unknown. The aim of this work is to identify the determinant factors of improvement in the quality of life in patients undergoing breast reduction. Materials and methods: A prospective cohort of 41 patients undergoing breast reduction or breast lift without implants was studied. Sociodemographic features, anthropometric measurements, variables related to surgery were studied and the Breast-Q® instrument was applied. For statistical analysis it was used descriptive statistics, generalized estimating equations models and linear and logistic regression models. Results: We found improvement in the quality of life, globally (P < .0001) and per domains. Among the determining factors, there was a positive correlation between the extent of resection and improved quality of life globally (P = .032) and in the domain of physical symptoms (P = .012). Also highlights an improvement of 50% with resection of breast tissue above 300 g. Conclusion: Breast reduction and breast lift surgery significantly increases the quality of life measured by the Breast-Q® instrument in patients with breast hypertrophy or ptosis. The determinant factors of this improvement would be directly related to the amount of tissue resected, with a 50% improvement with resections above 300 g.

Las mujeres sometidas a reducción mamaria mejoran su apariencia estética, autoestima, síntomas físicos y vida sexual / Effects of breast reduction surgery on the quality life

Abstract Background: The results of breast reduction surgery are usually reported in terms of anthropometric assessments. However the impact of surgery in quality of life is seldom informed. Aim: To assess the effects of breast reduction surgery on the quality of life of patients. Material and Methods: The "Breast-QReduction and Mastopexy Module" was prospectively applied to all women subjected to breast reductionsurgery in a University Hospital during one year. Results: Twenty women answered the survey in thepreoperative period and 20 in the postoperative period. The most commonly cutaneous pattern employedthat the inverted T in 10 women, followed by the Wise pattern in six patients. The most commonly usedpedicles were superior in 10 patients, followed by superomedial in seven patients. Mean excision weightwas 923 g (range 150-2850). Mean Breast Q score improved from 45 to 65%. Satisfaction with breastappearance improved from 31 to 83%, self-esteem from 39 to 80%, sexuality from 50 to 81% and physicalsymptoms decreased from 48 to 16%. There was a significant association between the magnitude of excision and improvement in physical symptoms. Conclusions: Quality of life improves notably in womenafter breast reduction surgery.

Resumen Objetivo: Tradicionalmente la evaluación de resultados en reducción mamaria se ha limitado a evaluaciones antropométricas, que si bien nos entregan una evaluación objetiva de un aspecto de los resultados, resultan insuficientes para evaluar el impacto global en calidad de vida (CdV) de la cirugía en nuestros pacientes. Es por esto que el objetivo de este trabajo es determinar el cambio en calidad de vida en mujer es sometidas a reducción mamaria y explorar sus factores determinantes. Materiales y Métodos: Se realizó un estudio de cohorte prospectiva con todas las pacientes que ingresaron al Hospital Clínico de la Universidad de Chile (HCUCH) y se sometieron a reducción mamaria por cualquier técnica desde julio de 2013 a abril de 2014. La calidad de vida (CdV) se midió con el instrumento validado Breast-Q Reduction and Mastopex y Module. Se utilizó estadística descriptiva para caracterizar la muestra y analítica para determinar el cambio en CdV y sus factores pronósticos. Resultados: Entre julio de 2013 y abril de 2014 se operaron 25 pacientes, el seguimiento promedio fue de 7 meses. Veinte pacientes contestaron el Breast-Q preoperatorio y 20 el post operatorio. El patrón cutáneo más empleado fue la T acortada (10; 55,6%) seguido por el patrón de Wise (6; 33,3%); el pedículo más usado fue el superior (10; 55,6%) seguido del supero medial (7; 38,9%). La resección promedio total fue de 923 g, variando entre 150 g y 2.850 g. El puntaje promedio del Breast-Q subió de45% a 65% (p = 0,005). Las pacientes mejoraron su satisfacción con la apariencia mamaria desde un 30,8%a un 82,9% (p < 0,001), su autoestima de 38,7% a 80,1% (p < 0,001), síntomas físicos de 47,8% a 15,5% (p= 0,003) y sexualidad de 50,0% a 81,4% (p < 0,001). La magnitud de la resección se asoció a la mejoría de síntomas físicos (Coeff 0,07; p = 0,023). No se encontraron otras asociaciones significativas entre el cambio en parámetros de calidad de vida y variables independientes. Conclusiones: En este reporte preliminar hemos podido objetivar que existe una mejoría significativa en la calidad de vida de las pacientes sometidas a una reducción mamaria tanto en forma global como también en cada uno de los aspectos evaluados, mejorando significativamente su autoimagen, autoestima, vida sexual y síntomas físicos.

Influencia de la apariencia de las mamas en la calidad de vida: diferencias entre población preoperatoria de mamoplastía de reducción y población control / Criterion validity of a questionnaire to assess quality of life associated to the appearance of breasts in women

Objetivo: El Breast Q Reduction and Mastopexy Module es un instrumento específico para la evaluación de calidad de vida asociado a mamas desde la perspectiva del paciente, recientemente validado para uso en español en Chile. Cuenta con evaluación pre y postoperatoria. El objetivo del presente estudio es conocer la validez de criterio al comparar las distribuciones en distintas poblaciones de individuos así como la diferencia del puntaje entre el pre y postoperatorio. Materiales y Métodos: El instrumento validado en español Breast Q Reduction-Mastopexy Module fue sometido a prueba para evaluar su validez de criterio comparando los resultados de la escala en pacientes que deseaban someterse a cirugía versus 2 grupos control, uno de pacientes hospitalizados por otra causa y otro de estudiantes de medicina. Resultados: Se aplicó la encuesta a 46 mujeres, 6 pacientes preoperatorios de mamoplastía de reducción, 20 alumnas de medicina y 20 pacientes hospitalizadas por otra causa. Hubo diferencias estadísticamente significativas entre las pacientes y los grupos control en los dominios autoimagen corporal (p = 0,0001), desempeño social (p = 0,0035) y síntomas físicos (p = 0,0058), no se observaron diferencias en el dominio de sexualidad (p = 0,1432), sin embargo, sólo 4/6 pacientes contestaron la encuesta ya que las otras 2 declararon no tener vida sexual. Conclusiones: Estos resultados preliminares sugieren que la versión en español del Breast Q Reduction-Mastopexy Module es un instrumento útil para evaluar calidad de vida asociada a las mamas en mujeres chilenas.

Background: The Breast QoL Reduction and Mastopexy Module assesses quality of life associated to breast appearance from the point of view of the patient. Its Spanish version was recently validated in Chile. Aim: To assess the criterion validity of the instrument applying it in different populations of women and in the pre and post-operative periods. Material and Methods: The questionnaire was applied to six women subjected to reduction mammoplasty in the pre and post-operative period. It was also applied to 20 women hospitalized for other causes and 20 female medical students. Results: There were significant differences between operated women and their non-operated counterparts in the domains body self-image, social performance and physical symptoms. No differences in sexuality were found. However this last question was answered only by four operated patients, since two declared not to have sex life. Conclusions: The questionnaire is useful to assess quality of life associated to the appearance of breasts.

Validación de un instrumento para evaluar calidad de vida asociada a hipertrofia mamaria en mujeres chilenas / Validation of a Spanish version of the breast related symptoms questionnaire for breast hypertrophy

Breast hypertrophy has been associated with a significant impact on quality of life. Aim: To validate a specific scale to evaluate quality of life of Chilean women with symptomatic breast hypertrophy. Material and Methods: We included 80 women, 40 patients (20 undergoing reduction mammoplasty) and 40 controls. The Breast Related Symptoms (BRS) questionnaire in Spanish was used. The results are expressed as a score ranging from 0 to 100, with higher values representing better specific quality of life. Internal consistency, reliability and validity of the test were evaluated. The results of patients and controls and the scores of patients undergoing reduction mammoplasty, before and after surgery, were compared. A receiver operating characteristic (ROC) curve was constructed to define the score cutoff point defining symptomatic breast hypertrophy. Results: The Cronbach´s alpha was 0.96, linear weighed kappa test-retest was 0.87 [95% confidence intervals (CI) 0.31-1] and inter-observer variability was 0.79 [95% CI 0.71-0.87]. Participants with breast hypertrophy had a lower specific quality of life than the control group (25 (2-71) and 91 (25-100) respectively, p < 0.01). In patients undergoing surgery, the preoperative score was lower than the postoperative figures (37 (12-71) and 96 [94-100] respectively, p < 0.01). The area under the ROC curve was 0.97 (p < 0,001) and the cutoff point for symptomatic breast hypertrophy was a score below 72.1. Conclusions: The Spanish version of the BRS questionnaire is a valid and reliable instrument to measure specific quality of life in Chilean women with mammary hypertrophy.

Mamoplastía de reducción: resultados desde la perspectiva del paciente: validación lingüística y psicométrica del Breast Q Reduction and Mastopexy Module Instrument / Validation of the Spanish version of the breast Q reduction and mastopexy module

Background: The Breast Q Reduction and Mastopexy Module evaluate breast related quality of life from the perspective of the patients. Body self-image, social performance, sexuality and physical symptoms are assessed. Aim: To translate the Breast Q Reduction and Mastopexy Module to Spanish and validate the translated version to be used in Chile. Material and Methods: The linguistic validation guidelines of the MAPI/TRUST Research institute were used and the survey was applied to six patients aged 29 +/- 6 years with 14 +/- 2 years of studies. The internal stability of the test was assessed using Cronbach alpha. Results: The mean body mass index of the patients was 25 +/- 1 kg/m². The internal stability of the scale was 97 percent. The scores of the test in the preoperative period ranged from 74 to 125 points. Conclusions: The Breast Q Reduction and Mastopexy Module is a valid instrument to assess the results of reductive mammoplasty among Spanish speaking patients.

Objetivo: El Breast Q Reduction and Mastopexy Module es un instrumento específico para la evaluación de calidad de vida asociado a mamas desde la perspectiva del paciente, publicado originalmente en inglés, el cual cuenta con una evaluación pre y otra postoperatoria. El objetivo del presente estudio es traducir y validar este instrumento al español para su uso en Chile. Material y Método: Se utilizaron las guías de validación lingüística del MAPI/TRUST Research institute. El proceso de validación requirió la traducción ingles-español, contra traducción español-inglés, conciliación inglés-inglés y aplicación piloto de la escala en al menos 5 sujetos. La estabilidad interna se evaluó con el alfa de Cronbach, se utilizó estadística descriptiva y analítica para analizar los resultados. Resultados: Las 6 pacientes evaluadas tuvieron una edad promedio de 29 +/- 16 (SD) años, IMC 25 +/- 1 kg/m² y 14 +/- 2 años de estudio. La estabilidad interna de la escala fue de 97 por ciento. Los resultados obtenidos entre el preoperatorio de las pacientes, variaron de 74 a 125 puntos, con una mediana de 98 puntos. Conclusiones: El instrumento Breast Q Reduction and Mastopexy Module es un instrumento válido, confiable y reproducible para la evaluación de los resultados de la mamoplastía de reducción, desde la perspectiva de los pacientes chilenos hispanoparlantes.

A prática da reconstrução mamária no universo psicoafetivo da mulher mastectomizada / The practice of breast reconstruction in the psychic and emotional universe of woman submited to mastectomies

Objetivo: conhecer e analisar o significado da reconstrução mamária em mulheres portadoras de câncer submetidas à mastectomia radical ou sua perspectiva, por meio de informações por elas aportadas, sentimentos, adesão e sentidos relacionados a sua prática, com vistas a subsidiar a abordagem desse tratamento no campo da saúde pública brasileira. Métodos: para isso, foi realizado um estudo exploratório de natureza qualitativa, utilizando-se entrevistas com um grupo de 20 mulheres a respeito da reconstrução mamária. Resultados e discussão: verificou-se a influência positiva do procedimento sobre a qualidade de vida e bem-estar, quando incluído na terapêutica médica. Como fator negativo, registrou-se a falta de informação por parte das mulheres a respeito da possibilidade cirúrgica da reconstrução mamária como parte importante do tratamento.

Sexualidade de mulheres mastectomizadas e submetidas à reconstrução mamária / Sexuality of women that suffered mastectomy and those who had been submitted to the mammary reconstruction

Objetivo: O objetivo deste estudo é avaliar, por meio do questionário FSFI (Female Function Sexual Index), e comparar a sexualidade de mulheres mastectomizadas e de mulheres que se submeteram à reconstrução mamária pós-tratamento do câncer de mama. Métodos: Foi realizado um estudo descritivo transversal. A casuística foi composta por dois grupos, um com 17 mulheres mastectomizadas e outro com 19 mulheres submetidas à reconstrução mamária pós-mastectomia, com idades entre 18 e 60 anos. Os critérios de exclusão foram: analfabetismo, vigência de tratamento de quimioterapia, radioterapia ou psiquiátrico e o tratamento cirúrgico a menos de um ano. Todas elas são pacientes dos ambulatórios de cirurgia plástica ou de mastologia da Universidade Federal de São Paulo. As voluntárias responderam ao questionário FSFI. A analise estatística foi realizada aplicando-se o teste t de Student e o coeficiente de correlação de Pearson, tendo sido adotado o nível de significância de p ≤ 0,05. Resultados: Os escores obtidos das respostas das mulheres mastectomizadas foram significativamente menores que os das submetidas à reconstrução (médias: 10,15 ± 2,636 e 22,44 ±3,055, respectivamente; p = 0,0057). Não foram observadas correlações entre os escores e o tempo de pós-operatório (pós - p = 0,9382; pré - p = 0,2142), assim como para o desenvolvimento de atividade remunerada (pós - p = 0,7699; pré – p = 0,5245), relação estável (pós - p = 0,2613; pré - p = 0,5245) e idade (pós - p = 0,3951; pré – p = 0,8427) entre os dois grupos. A idade média das pacientes não teve diferença significativa (p = 0,4740; media pós = 47,71 ± 2,012; media pré = 46,69 ± 1,809). Conclusão: Existe melhora da função sexual das pacientes mastectomizadas após a reconstrução mamária.

Objectives: The purpose of this study is to evaluate, through the FSFI (Female Function Sexual Index) questionnaire, and to compare the sexuality of women that suffered mastectomy and those who had been submitted to the mammary reconstruction post-treatment of breast cancer. Methods: A transversal descriptive study was carried out. The casuistic was composed by two groups, one with 17 women that suffered mastectomy and another with 19 submitted women to the mammary reconstruction after-mastectomy, with ages between 18 and 60 years old. The exclusion criteria were: illiteracy, use of chemotherapy, radiotherapy, psychiatric treatment, and surgical treatment in less than one year. All the patients are from the ambulatory of plastic surgery or mastology of São Paulo Federal University. The volunteers answered the FSFI questionnaire. The statistical analysis was carried out by applying the Student's t-test and Pearson's correlation coefficient, p ≤ 0.05 was taken as the significance level. Results: The scores obtained from the answers of women that suffered mastectomy were significantly lower than those from women submitted to reconstruction (means: 10.15 ± 2.636 and 22.44 ± 3.055, respectively; p = 0.0057). Correlations were not found between scores and postoperative time (post - p = 0.9382; pre - p = 0.2142) ,as well as for the development of paid activity (post - p = 0.7699; pre - p = 0.5245), stable relation (post - p = 0.2613; pre - p = 0.5245), and age (post - p = 0.3951; pre - p = 0.8427) between both groups. The mean age of the patients did not have a significant difference (p = 0.4740; post mean = 4771 ± 2.012; pre mean = 46.69 ± 1.809). Conclusion: There is an improvement of the sexual function in patients that suffered mastectomy after breast reconstruction.

Quality of life and self-esteem outcomes following augmention mammaplasty / Qualidade de vida e autoestima em pacientes submetidas à mastoplastia de aumento

To evaluate the improvement of quality of life and self-esteem of the patient as a result of Breast Augmentation and retropeitoral subglandular. Method: Forty women with hypomastia aged between 18 and 43 years were selected consecutively from a waiting list and randomly allocated into two groups. For the evaluation of health utilizes the widely used instrument "The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36)", and "Rosenberg SLF-esteem Scale, a tool specifically for the assessment of self-esteem . Evaluations were performed preoperatively and on the second and fourth postoperative months. Results: We observed significant improvements in five of eight aspects of the SF-36 and self-esteem after two and four months of surgery, but no diferança between groups and retropeitoral subglandular. Conclusion: Breast Augmentation promoted a significant increase in quality of life and self-esteem of patients, with no difference in the positioning of the prosthesis.

Avaliar a melhoria da qualidade de vida e autoestima do paciente como resultado da mastoplastia de aumento retropeitoral e subglandular. Método: quarenta mulheres com hipomastia com idade entre 18 e 43 anos foram selecionadas consecutivamente a partir de uma lista de espera e distribuídas aleatoriamente em dois grupos. Para a avaliação de saúde, empregou-se o instrumento amplamente utilizado “The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36)”, e “Rosenberg Slf-esteem Scale”, uma ferramenta específica para a avaliação de autoestima. As avaliações foram realizadas no pré-operatório e no segundo e quarto meses pós-operatórios. Resultados: Foram observadas melhorias significativas em cinco de oito aspectos avaliados pelo SF-36 e na autoestima após dois e quatro meses da cirurgia, mas não houve diferança entre os grupos retropeitoral e subglandular. Conclusão: A mastoplastia de aumento promoveu importante incremento na qualidade de vida e autoestima das pacientes, não havendo diferença em relação ao posicionamento das próteses.

Depression and conservative surgery for breast cancer

BACKGROUND: Depression is prevalent among women and associated with reduced quality of life, and therefore it is important to determine its incidence in adult women, especially in those with breast cancer. OBJECTIVE: To determine the occurrence of depression in women who underwent conservative surgery for breast cancer with or without breast reconstruction. METHODS: Seventy-five women aged between 18 and 65 years were enrolled. Patients had undergone conservative surgery for breast cancer with immediate breast reconstruction (n = 25) or without breast reconstruction (n = 25) at least one year before the study. The control group consisted of 25 women without cancer, but of similar age and educational level distribution as the other two groups. The Beck Depression Inventory was used to measure depression. The collected data were assessed using analysis of variance and the χ2 test. RESULTS: There were no significant differences between groups in age (p = 0.72) or educational level (p = 0.20). A smaller number of patients had undergone the menopause (p = 0.02) in the control group than in other groups. There were no significant differences in occurrence of depression between groups (χ2=9.97; p = 0.126). CONCLUSÍON: Conservative surgery for breast cancer did not affect the occurrence of depression in women, regardless of whether breast reconstruction was performed.

Dismorfias mamarias en la población pediátrica y adolescente / Pediatric and adolescent breast dysmorphias

El desarrollo de la mama se presenta entre los 8 y los 13 años de edad y es primer signo de desarrollo sexual secundario. La alteración de las características normales de los senos en una adolescente mujer y el crecimiento mamario en los varones deen ser considerados y en consecuencia estudiados. El cirujano plástico pediátrico debe estar entrenado para diagnosticar y tratar este tipo de dismorfias, así como también contener el impacto psicosocial asociado; para ello debe trabajar interdisciplinariamente con psicólogos y pediatras especialistas en crecimiento y desarrollo.

The development of the breast shows up between 8 and 13 years old in the female patient and is the first sign of sexual development. The distortion of the normal characteristics of the breasts in the adolescent female, as well as the mammary growth in the males must be considered and in consequence studied. The plastic pediatric surgeon must be trained in order to diagnose and manage this type dismorfias holding the associated psicosocial impact working interdisciplinaryly with psychologists, pediatricians and pediatric endocrinologists.

Impacto de fatores clínico-epidemiológicos sobre a opção de reconstrução mamária após mastectomia

Embora a reconstrução mamária não retarde o diagnóstico nem aumente o risco de recidivas do câncer mamário, ela ainda não é uma opção de todas as pacientes submetidas à mastectomia. O objetivo do trabalho foi avaliar a influência de fatores clínico-epidemiológicos no desejo das pacientes de se submeter ou não à reconstrução mamária. Foram selecionadas 78 pacientes mastectomizadas há pelo menos um ano, avaliadas por meio de um questionário de dados clínico-epidemiológicos, incluindo idade, etnia, estado marital, paridade, doenças associadas, tratamento adjuvante, tempo decorrido da mastectomia e desejo ou não de reconstrução. Observou-se diferença com significância estatística (p < 0,005) entre as 49 (62,8%) pacientes que desejavam ser submetidas à reconstrução mamária e as 29 (37,1 %) que não manifestaram desejo de se submeter ao procedimento. Não houve diferença estatística entre os grupos quanto a estado marital, escolaridade e etnia. Houve diferença estatística nos fatores idade, realização de radioterapia e tabagismo (p < 0,001). Os motivos mais freqüentemente relatados para se submeter ou não ao procedimento foram medo de novo procedimento cirúrgico, no caso de resposta negativa, e restabelecimento da imagem corporal, no caso de resposta afirmativa. Conclui-se que a idade das pacientes foi o fator clínico-epidemiológico de maior impacto sobre a opção de submeter-se ou não à reconstrução mamária.

Although the breast reconstruction don't slow down the diagnostic neither increase the recurrence, not yet the option among all postmastectomy patients. The aim of the present study was to assess the influence of clinical and epidemiological aspects on the option for undergoing or not breast reconstruction among postmastectomy patients. Seventy-eight breast cancer patients aged 32 to 75 years-old were enrolled. All the patients had undergone mastectomy at least one year before the enrollment. Clinical and epidemiological aspect, as well as the option for undergoing or not breast reconstruction were assessed. The mean age of participants was 53, 8 years-old. Forty-nine (62%) of the women opted for reconstruction and 29 (48%) did not. The variables with statistical difference were age, radiotherapy and smokers (p < 0,001). The data of this study suggest that age is aspect with more impact on option for undergoing or not breast reconstruction among postmastectomy patients. Informations concerning breast reconstruction must be adapted to the clinical and epidemiological profile of patients, but must be considered as an essential stage of breast cancer treatment.

Mastectomia redutora de risco / Risk reduction mastectomy

A mastectomia redutora de risco (MRR) é uma opção controversa para a prevenção em mulheres de alto risco para câncer de mama. Entre os principais fatores que aumentam a probabilidade de desenvolvimento de câncer de mama estão história familiar importante de câncer de mama e mutações nos genes BRCA-1 e 2. Atualmente, podem ainda ser consideradas outras possibilidades para a prevenção (como história pessoal), concomitantes a alto risco de recorrência, e alguns casos de carcinoma lobular in situ. Existem outras opções de redução de risco além da mastectomia, como monitoramento freqüente (por meio do auto-exame), exame clínico e mamografia, ooforectomia bilateral e quimioprevenção. Nossa revisão na literatura incluiu diversos tópicos, como eficiência da MRR, estimativa de risco, situação psicológica após a cirurgia, múltiplas opções para a redução do risco e aspectos relacionados à cirurgia: técnica, efeitos colaterais, complicações e opções para a reconstrução das mamas. Em comparação com dados publicados anteriormente por outros autores, a previsão do risco de câncer de mama pode ser atualmente mais bem avaliada, e os benefícios da MRR são superiores em virtude do aprimoramento das técnicas cirúrgicas e da abordagem das pacientes.

Risk reduction mastectomy (RRM) is a controversial option for women who are at very high risk of breast cancer. Some of the factors that increase a woman's chance of developing breast cancer include women with a strong family history of breast cancer, BRCA1/2 mutation carriers and others preventive options as women with personal history and high risk for a recurrence and some cases with lobular carcinoma in situ. For these women there are a number of options available besides mastectomy as frequent monitoring by physician, with frequent clinical breast exams and mammograms, breast self examination, bilateral ooforectomy and chemoprevention. We review research in a number of areas, including recent data on the effectiveness of RRM, risk estimation, satisfaction and psychological status after surgery, multiple options for risk reduction and about surgery: surgical technique, side effects, complications and options for breast reconstruction. As compared with many of the published data breast cancer risk predictions seems now be more accurate and the beneficious of RRM are better because mastectomy techniques and the patient approach have improved.

Merleau-Ponty e a compreensão da vivência de mulheres mastectomizadas em uso de prótese / Merleau-Ponty and the understanding of the life experience of mastectomized women in use of prosthesis

Este estudo qualitativo, fundamentado no método fenomenológico, tem como objeto a percepção do corpo pela mulher mastectomizada em uso de prótese após reconstrução mamária. Objetiva a compreensão dessa percepção a partir do conceito de corpo e da fenomenologia de Merleau-Ponty. Foi realizado no ano de 2003, em duas instituições da cidade de Salvador que atendem pacientes oncológicas em tratamento quimioterápico. A coleta de dados, através da entrevista fenomenológica, foi aplicada a cinco mulheres mastectomizadas em uso de prótese. Com base no referencial teórico-filosófico e na interpretação compreensiva dos resultados obtidos nas entrevistas, emergiram três unidades de significação. A vivência da mastectomia e da reconstrução mamária possibilitou-lhes elaborar reflexões e vislumbrar um futuro no qual suas existências são revestidas de um novo sentido.

Custom-made nipple prosthesis: a long-term satisfaction survey.

BACKGROUND: Nipple-areola reconstruction or prosthesis completes the process of breast reconstruction. Although custom made nipple prosthesis (CNP) have been used for almost 10 years, little follow-up data on patient satisfaction is available. We assessed long-term patient satisfaction with CNP. MATERIALS AND METHODS: All patients undergoing CNP from 2000 to 2001 were sent anonymous postal questionnaires. Perceived benefit and satisfaction with size, colour, and projection, were assessed using a modified Likart scale (1 not satisfied, 5 very satisfied). Results are expressed as median and interquartile range (IQR). RESULTS: Of 52 patients who had CNP, 29 responded to the questionnaire (56% response rate), median age (IQR) 56.1 years (52-61). The median time since CNP was 2 years (0.6-3), 67% felt they had benefited from the prosthesis and 39% wore their CNP regularly. Most patients were highly satisfied with CNP size, colour and projection, median score 5 (4-5) for each variable. Patients with CNP Patients with CNP < 3 years were more likely to be satisfied with CNP than those with CNP for = 3 years, 60% vs 18%, p = 0.04. Patients who were satisfied with their CNP (median age 52.9 years, IQR 45.3-59.2 years), were younger than patients not satisfied with their CNP (median age 59 years, IQR 54.7-62 years), p = 0.031, Z = -2.16. Three patients had subsequent nipple reconstruction, a further 7 (24%) wanted nipple reconstruction. All respondents thought CNP should be offered at the time of initial surgery. CONCLUSIONS: Most patients are highly satisfied with CNP, with highest satisfaction in the first 3 years after CNP. CNP should be offered at the time of initial surgery.