ABSTRACT
Introdução: As mastectomias com reconstruções mamárias imediatas podem proteger a paciente de um período de estresse psicossocial, imagem corporal negativa e insatisfação sexual. O advento e utilização de novos materiais como os implantes, expansores e matrizes dérmicas acelulares também contribuíram para o sucesso das reconstruções mamárias. Porém, o uso das matrizes dérmicas acelulares é restrito no Brasil pela legislação e seu alto custo. O objetivo do estudo foi relatar a experiência do autor na reconstrução mamária com implantes e tela sintética como uma alternativa às matrizes dérmicas acelulares. Método: Foi realizada uma análise retrospectiva de 12 pacientes consecutivas (20 mamas reconstruídas) que foram submetidas à reconstrução mamária imediata ou tardia pela técnica descrita com implantes e tela sintética, entre novembro de 2015 e dezembro de 2016. Resultados: Doze pacientes (20 mamas) foram operadas pela técnica apresentada no estudo. O tempo médio de follow-up foi de 14 meses. Nesta série, 15% apresentaram complicações menores como hematoma, deiscência de sutura e rippling. O número de complicações, apesar do número restrito de casos, é compatível com a literatura. O grau de satisfação global com a cirurgia foi, em média, de 75,2 pontos em uma escala de 0-100, sendo a nota mais alta atribuída à aparência das mamas (85 pontos). Conclusão: A reconstrução mamária com implantes e tela sintética se mostrou uma técnica com baixo índice de complicações, alto grau de satisfação das pacientes com o resultado estético e com menores custos em relação ao uso de matrizes dérmicas acelulares.
Introduction: Mastectomy with immediate breast reconstruction may prevent patients from experiencing a period of psychosocial stress, negative body image, and sexual dissatisfaction. The advent and implementation of novel materials such as implants, expanders, and acellular dermal matrices have also contributed to the success of breast reconstruction procedures. However, the use of acellular dermal matrices in Brazil is restricted by law and by their high cost. The objective of the present study was to report the author's experience in breast reconstruction with implants and synthetic mesh as an alternative to acellular dermal matrices. Method: This was a retrospective analysis of 12 consecutive patients (20 reconstructed breasts) who underwent immediate or delayed breast reconstruction using the described technique with implants and synthetic mesh between November 2015 and December 2016. Results: Twelve patients (20 breasts) were operated on using the technique described in this report. The mean time of follow-up was 14 months. In this series, 15% of patients had minor complications, including hematoma, suture dehiscence, and rippling. The rate of complications was similar to the rates reported in the literature, despite the limited number of cases. The average degree of overall satisfaction with the surgery was 75.2 points on a scale of 0-100, and the highest score was given to breast appearance (85 points). Conclusion: Breast reconstruction with implants and synthetic mesh was shown to be a technique with a low rate of complications, high degree of patient satisfaction with the cosmetic result, and decreased cost relative to acellular dermal matrices.
Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Surgical Mesh/adverse effects , Breast/surgery , Breast Neoplasms/surgery , Breast Neoplasms/complications , Breast Neoplasms/drug therapy , Breast Neoplasms/therapy , Mastectomy, Simple/adverse effects , Mastectomy, Simple/methods , Mastectomy, Simple/rehabilitation , Mammaplasty/adverse effects , Mammaplasty/methods , Breast Implants/adverse effects , Plastic Surgery Procedures/methods , Plastic Surgery Procedures/rehabilitation , Surgical Mesh , Breast , Breast Neoplasms , Mastectomy, Simple , Mammaplasty , Breast Implants , Plastic Surgery Procedures , MastectomyABSTRACT
El carcinoma papilar intraquístico es un subtipo de carcinoma ductal no invasivo, puede estar asociado o no acarcinoma in situ y a carcinoma infiltrante, es una patología poco frecuente por lo tanto su aparición en hombres es extremadamente rara. El tratamiento en estos casos es equivalente al carcinoma de mama en mujeres, se debate entre mastectomía simple o mastectomía parcial más radioterapia. Presentamos el caso de un hombre a quien se diagnostica preoperatoriamente con un carcinoma papilar y se realiza mastectomía simple más ganglio centinela.
The papillary intra cyst carcinoma is a sub type of ductal no invasive carcinoma, it can be or not associated to in situ carcinoma and to infiltrant carcinoma, is a pathology less frequent, for these reason his apparition in men is extremely rare. The treatment is equivalent to the breast carcinoma in women, debated between simple mastectomy and partial mastectomy with radiation therapy. We present a clinical case of a man with pre operative diagnostic with a papillary carcinoma and realized simple mastectomy with sentinel node.
Subject(s)
Humans , Male , Middle Aged , Carcinoma, Ductal, Breast/diagnosis , Carcinoma, Ductal, Breast/therapy , Carcinoma, Papillary/diagnosis , Carcinoma, Papillary/therapy , Mastectomy, Simple/methods , Breast Neoplasms, Male/diagnosis , Breast Neoplasms, Male/therapy , Medical OncologyABSTRACT
El carcinoma papilar intraquístico es un subtipo de carcinoma ductal no invasivo, puede estar asociado o no a carcinoma in situ y a carcinoma infiltrante, es unapatología poco frecuente por tanto su aparición en hombres es extremadamente rara. El tratamiento en estos casos es equivalente al carcinoma de mama en mujeres, debatiéndose entre mastectomía simple o mastectomía parcial más radioterapia. Presentamos el caso de un hombre a quien se diagnostica preoperatoriamente con un carcinoma papilar y se realiza mastectomía simple más ganglio centinela
The papillary intra cyst carcinoma is a sub type of ductal no invasive carcinoma, it can be associated or no to carcinoma in situ and infiltrate carcinoma, is less frequent, for this reason his apparition in male is rare. The treatment in is equivalent to breast carcinoma in women, with two modalities of treatment: simple mastectomy or simple mastectomy with radiation therapy. We present clinical case of male whom is diagnostic pre surgery with a papillary carcinoma and realized simple mastectomy with sentinel node
Subject(s)
Humans , Male , Sentinel Lymph Node Biopsy/methods , Carcinoma, Ductal/pathology , Carcinoma, Papillary/pathology , Mastectomy, Simple/methods , Breast Neoplasms, Male/surgery , Breast Neoplasms, Male/diagnosis , Breast Neoplasms, Male/pathology , Radiotherapy/methods , Medical OncologyABSTRACT
Presentamos el caso excepcional de paciente con angiosarcoma primario de mama y carcinoma papilar de tiroides sincrónicos. Mujer de 34 años con angiosarcoma primario en la mama derecha sometida a mastectomía simple. En el estudio de extensión se halló un incidentaloma tiroideo derecho compatible con carcinoma papilar que requirió tiroidectomía total y linfadenectomía del compartimento central en segundo tiempo. Los angiosarcomas primarios suponen menos del 0,05% de todos los tumores primarios malignos de la mama. El diagnóstico definitivo de estos tumores viene definido por el estudio anatomopatológico, que define tres grados: alto, bajo, intermedio, los cuales se relacionan de forma directa con la supervivencia. La prevalencia de los incidentalomas malignos tiroideos objetivados por PET varía del 14% - 30,9%. La planificación del tratamiento quirúrgico de las neoplasias incidentales tiroideas en pacientes con otro tumor primario debe analizarse de forma individualizada, según la supervivencia esperada del tumor primario
Present the exceptional case of a female patient with diagnostic of primary angiosarcoma of the breast and synchronous thyroid papillary carcinoma, we review the literature. Patient female 34 year old with diagnostic of primary angiosarcoma in the right breast, it was removed,in the extension study found an incidental thyroid papillary carcinoma that required total thyroidectomy and central lymphadenectomy in a second time. The primary angiosarcomas account for less than 0.05% of all primary malignant tumors of the breast. The definitive diagnosis is determined by the pathology study, which defines three grades: high, low and intermediate, which relate directlyto the survival. The prevalence of malignant thyroid incidentalomas was observed by PET varies from 14% to30,9%, according to different studies. Planning the surgical treatment of incidental thyroid malignancies in patients with other primary tumor should be analyzed individually,according the expected survival of the primary tumor
Subject(s)
Female , Carcinoma, Papillary/pathology , Lymph Nodes/pathology , Hemangiosarcoma/diagnosis , Mastectomy, Simple/methods , Breast Neoplasms/pathology , Thyroid Neoplasms/pathology , Medical OncologyABSTRACT
El miofibroblastoma constituye una entidad benigna de la mama de presentación muy infrecuente, que afecta principalmente la mama masculina. Su principal característica histológica es su estirpe mesenquimal caracterizada por la proliferación de células fusiformes rodeadas de colágeno y que derivan de los fibroblastos. El tratamiento principal es la cirugía, con tendencia a la preservación de la glándula sobre todo en la mujer. Presentamos el caso de una paciente femenina de 64 años de edad, con un tumor solitario, de crecimiento progresivo durante 5 años, hasta que decide solicitar asistencia médica, planteándose el diagnóstico preoperatorio de una lesión de tipo mesenquimal; la cual posterior al tratamiento quirúrgico y mediante estudios inmunohistoquímicos se confirma la presencia de un miofibroblastoma clásico, siendo estos tumores infrecuentes en la práctica clínica diaria, debiendo ser considerados al momento de hacer diagnóstico diferencial.
The miofibroblastoma is a benign tumor of the breast of very infrequent presentation that mainly affects the male breast. The main histological characteristic is the mesenchymal ancestry characterized by the proliferation of plump and spindle cells surrounded by collagen and that derive from fibroblasts. The surgery is the main treatment with preservation of the breast in female patients. We presented a case of a female patient of 64 years old, which presents a solitary tumor with progressive growth by 5 years, until she decides to ask for medical aid, considering the preoperating diagnosis of an tumor of mesenchymal type; which subsequent to the surgical treatment and confirmed by immunohistochemistry the presence of miofibroblastoma of the breast, being this finding very unusual in the clinical practice, and to be considered at the time of making differential diagnosis.
Subject(s)
Humans , Female , Aged , Fibroblasts/ultrastructure , Mastectomy, Simple/methods , Neoplasms, Muscle Tissue/surgery , Neoplasms, Muscle Tissue/pathology , Stromal Cells , Immunohistochemistry/methods , Cell ProliferationABSTRACT
El cáncer de mama en el hombre ha sido considerado durante mucho tiempo como una curiosidad médica, siendo la presentación clínica, la patología y la historia natural similares a la mujer, no siendo así el pronóstico. En el presente trabajo se analiza el comportamiento clínico-histológico de ocho hombres con diagnóstico de cáncer de mama en el Hospital Oncológico "Padre Machado" atendidos entre 1995 y 2006. El 75 por ciento de los pacientes se diagnósticó en estadio II y III. Un paciente en estadio IIIb tenia 23 años y está libre de enfermedad. El 66 por ciento de los pacientes presentaron receptores de estrógenos positivos. Se discuten los resultados y se revisa la literatura.
The cancer of breast in the man has been considered during long time like a medical curiosity, being the clinical presentation, the pathology and natural history similar to the woman, not being therefore the prognosis. In the present work the clinical-histological behavior of eight men with diagnosis of cancer of breast in the Hospital Oncologico Padre Machado is analyzed, taken care of between 1995 and 2006. 75 % of the patients diagnoses were in stage II and III. A patient in IIIb stage with 23 years old and he is free one of disease. 66 % of the patients presented positive estrogens receivers. The results are discussed and literature is reviewed.
Subject(s)
Humans , Male , Middle Aged , Sentinel Lymph Node Biopsy/methods , Mastectomy, Simple/methods , Breast Neoplasms, Male/surgery , Breast Neoplasms, Male/diagnosis , Breast Neoplasms, Male/radiotherapy , Tamoxifen/administration & dosage , Carcinoma, Ductal, Breast/pathology , Medical OncologyABSTRACT
Skin-sparing mastectomy [SSM] is an appealing treatment option for patients with early-stage breast carcinoma. This article is a review of the literature concerning this innovative technique. Surgery consists in a total mastectomy with preservation of the cutaneous envelope of the breast. This is done by performing the smallest incision possible, e.g. periareolar incision, with ablation of the nipple-areola complex. Mastectomy is followed by immediate reconstruction with a prosthesis and/or flap. Besides complications of reconstruction, the principal postoperative concern is necrosis of the skin flap. SSM seems oncologically safe as studies didn't find any difference in terms of relapse, metastasis and survival when comparing SSM to non-SSM. Nevertheless, the use of this technique remains controversial in advanced stage breast cancer [2B and 3]. Finally, SSM is associated with improved aesthetics with a high level of surgeons' and patients' satisfaction
Subject(s)
Humans , Female , Skin/surgery , Mastectomy, Simple/methods , Breast Neoplasms , Review Literature as Topic , Postoperative Complications , MammaplastyABSTRACT
Se trata de una paciente femenina de 65 años con diagnóstico de enfermedad de Paget en la mama derecha de un año evolución. Se realizan estudios clínicos y de imagen cuyos resultados fueron sin evidencia de lesión tumoral asociada, de igual forma los estudios de extensión. Es planificada para una mastectomía simple previa biopsia del ganglio centinela; la cual dió negativo para el corte congelado y la pieza definitiva describió enfermedad de Paget asociada a carcinoma ductal in situ con dos ganglios negativos para metástasis. Se plantea el uso del ganglio centinela en la enfermedad de Paget como opción terapéutica para determinar el estatus axilar. Se describe la primera experiencia en el Hospital Oncológico Padre Machado.
The present clinical case is the description of a female patient, 65 years old with diagnosis of Pagets disease of the right breast of one year of evolution. Clinical and the imaginologic studies do not discover tumor disease in the breast. She was planificated for a simple mastectomy surgery plus sentinel lymph node biopsy, this was negative at the frozen section and the final pathologic report described Paget disease plus ductal carcinoma in situ, with two lymph nodes negative for disease. We describe the utility of the sentinel lymph node in the Pagets disease as a therapeutic option to determine the axillaries status. We describe the first experience in our institution Oncological Hospital Father Machado.
Subject(s)
Humans , Female , Aged , Sentinel Lymph Node Biopsy/methods , Paget's Disease, Mammary/surgery , Paget's Disease, Mammary/diagnosis , Mastectomy, Simple/methods , Medical Oncology , Radiotherapy/methodsABSTRACT
Presentamos un informe de una patología quirúrgica infrecuente y descripción de un caso clínico visto en el servicio de patología mamaria del Hospital Oncológico Padre Machado. Paciente femenina de 48 años de edad a la cual se le diagnosticó un tumor Phyllodes benigno de mama derecha, se le realizó mastectomía simple de la mama cuya biopsia definitiva reportó: tumor Phyllodes maligno de alto grado con extensas áreas de necrosis e infiltración a la piel, se observaron áreas de tumor de bajo grado y otros de alto grado, la inmuhistoquímica concluyó: tumor Phyllodes receptores de estrógenos y progesterona con patrón de inmunomarcaje normal, Her-2/neu negativo. El tumor Phyllodes maligno es la neoplasia no epitelial de la mama más frecuente y la cirugía es considerada el pilar fundamental en el tratamiento de esta patología, no existiendo un consenso actualmente sobre el tipo de cirugía debido a la poca incidencia de esta patología.
We presented a report of infrequent surgical pathology and description of a clinical case seen in service of mammary pathology of Oncological Hospital Father Machado. A feminine patient 48 years old which diagnose benign Phyllodes tumor of the right breast, simple mastectomy was made to her whose definitive biopsy report: Malignant tumor Phyllodes of high degree, with extensive areas of necrosis and infiltration to the skin, deep margin with evidence of neoplasia, were observed areas of tumor low degree and others of high degree, the immunohistochemical conclude: Phyllodes tumor, estrogen receivers and progesterone with pattern of normal immunomarcaje, HER-2/neu negative. The malignant tumor Phyllodes is the most frequent no epithelial neoplasia of the breast, and the surgery is considered the fundamental pillar in the treatment of this pathology, not exist a consensus at the moment on the type of surgery, due to the little incidence of this pathology.
Subject(s)
Humans , Adult , Female , Immunohistochemistry/methods , Mastectomy, Simple/methods , Breast Neoplasms/surgery , Breast Neoplasms/pathology , Medical Oncology , Phyllodes Tumor/pathologyABSTRACT
El cáncer mamario en mujeres ancianas es frecuente, a menudo se diagnostica en estadios avanzados y su tratamiento motiva controversias. Entre 1980 y 1994 estudiamos retrospectivamente 46 mujeres con esta condición. La edad promedio fue de 78 años (rango 70 a 89 años). La detección fue realizada por la paciente en 39 (85 por ciento) casos y en 7 (15 por ciento) por examen médico. la estadificación correspondió en un (2,2 por ciento) caso estadio I, 18 (39,1 por ciento) a II, 23 (50 por ciento) a III, y 4 (8,7 por ciento) a IV. El tamaño promedio clínico del tumor primario fue de 5,5 cm y el histopatológico de 4,95 cm. Se realizó cirugía conservadora en 3 (6,1 por ciento) casos, mastectomía radical modificada en 9 (18,4 por ciento), mastectomía simple extendida en 18 (36,7 por ciento), mastectomía simple en 10 (20,4 por ciento) mastectomía de aseo en 5 (10,2 por ciento), y no se operaron 4 (8.2 por ciento) casos. En 32 pacientes se practicó disección axilar encontrando metástasis nodales en 16 (50 por ciento). El tipo histológico más frecuente fue carcinoma ductal en 35 (71,4 por ciento) casos; de éstos el grado histológico fue II en 21 (61,8 por ciento) y III en 7 (20,6 por ciento) y el grado nuclear fue 2 en 22 (64,7 por ciento) y 3 en 6 (17,6 por ciento). El seguimiento promedio de la serie fue de 58 meses (margen 2 a 204 meses). Al cierre de esta revisión 11 (23,9 por ciento) pacientes están vivas sin enfermedad, 30 (65,2 por ciento) fallecieron (13 (43,3 por ciento) por su cáncer mamario, 10 (33,3 por ciento) por otras causas, 7 (23,3 por ciento) por causa desconocida) y en 5 (10,9 por ciento) se ignora su estado
Subject(s)
Humans , Female , Aged , Breast Neoplasms , Mastectomy, Extended Radical/methods , Mastectomy, Simple/methods , Mastectomy, Radical , Age Distribution , Breast Neoplasms , Carcinoma, Intraductal, Noninfiltrating , Disease-Free Survival , Neoplasm Staging , Retrospective StudiesABSTRACT
Se analiza la experiencia en el manejo de la enfermedad de Paget de la mama, revisando los antecedentes de 15 casos acumulados a lo largo de 1 años. Se encuentra que el diagnóstico es demorado por la mala interpretación del eczema del pezón, el que se presentó como único signo en la mitad de los casos. La citología jugó un papel importante en el diagnóstico. El tratamiento se hizo con cirugía radical y la sobrevida estimada a 67 meses es de 80 por ciento. Se comenta la importancia de las teorías de génesis de la enfermedad en la estructuración de una política terapéutica racional